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Section 7. Medical science
Kadyrov Shavkat Nomonovich, Andijan state medical institute The chair general surgery Science researcher Jalilov Muhammadjan Alijanivich, Andijan region Urgent Medical centre Physician the abdominal department E-mail: [email protected]
Prevention of paralytic ileus in acute diffuse peritonitis
Abstract: Many years of experimental and clinical research staff of the department of surgical diseases of the Andijan State Medical Institute provided the basis for a new way to fill a regional lymph drugs for various diseases. During the period from 2005 to2012. in Andijan State Medical Institute was under the supervision of 89 patients with acute peritonitis. Assessing the prevalence of inflammation in the abdominal cavity is one of the crucial importance in determining the course of treatment. According to the classification V. D. Federova (1974), localized peritonitis was diagnosed in 41 (58.6%) patients, of whom 14 (34.1%) — unlimited, 27 (65.9%) — are limited. Peritonitis was observed in 29 (41.4) patients, ofwhom 9 (31.3%) — diffuse, with 20 (68.7%).We have studied the best way to saturation lymphatic system of the abdomen in acute peritonitis and invented a method lymphotropic administration of antibiotics in the mesentery of the small intestine in the postoperative period. It turned out that this method is more rapidly produce high levels of antibiotics in the mesenteric lymph nodes, as evidenced by observations in experimental studies. Endomesenteria endolymphatic antibiotic therapy, conducted in all 70 patients with peritonitis, was a significant addition to the complex events in the postoperative period.
Keywords: peritonitis, lymphotropic, endomesenteria endolymphatic.
Introduction
Conducting lymphotropic therapy in acute surgical diseases has advantages over traditional methods of drug administration, especially antibiotics [1; 3; 5].
It is proved that in acute intestinal obstruction, peritonitis complicated in animals occurs expressed intoxication, and especially changes in the gastrointestinal tract in the form of paralytic ileus. With the development of peritonitis decreases the formation of lymph edema observed abdominal, lymphovenosus stasis. In this state is more efficient administration of various drugs in the lymphatic system [2; 4].
Another positive features of the lymphatic therapy through the mesentery of the small intestinal is to maintain a high concentration of antibiotics in the lymph nodes of the abdomen. When compared with other methods of administration at 3 and 6 hours of antibiotics in 3-7 times greater in the mesenteric lymph nodes. Long (with a single dose) for 24 hours or more, the finding of antibiotics in the lymphatic channel creates the conditions for a permanent proceeds of the drug into the bloodstream through the mouth of the thoracic duct.
Materials and Methods
During the period from 2005 to2012. in Andijan State Medical Institute was under the supervision of 89 patients with acute peritonitis. Assessing the prevalence of inflammation in the abdominal cavity is one of the crucial importance in determining the course of treatment. According to the classification V. D. Federova (1974), localized peritonitis was diagnosed in 41 (58.6%) patients, of whom 14 (34.1%) — unlimited, 27 (65.9%) — are limited. Peritonitis was observed in 29 (41.4) patients, of whom 9 (31.3%) — diffuse, with 20 (68.7%).
In order to determine the most effective strategy in patients with peritonitis, we studied the microflora in different parts of the abdomen and determined its sensitivity to antibiotics.
In 70 patients with peritonitis used endolymphatic antibiotic therapy in the mesentery of the small intestine. 19 patients in the control group received standard treatment.
Results and Discussion
During the operation, all patients of the main group laparoscopic readjustment abdominal dissection of adhesions and eliminate the source of infection. Between the sheets of serous mesentery microirrigator installed and fixed to the mesentery. Other end of the catheter is removed from the abdominal cavity through a separate incision and immediately injected with 0.5% procaine 20ml for leakage control catheter. Lymphotropic therapy through microirrigator begins on the operating table. Lymphatic therapy involves limphostimulator and lymphotropic injection of antibiotics. As lymphostimulator was used glucose-novocaine mixture in the ratio of 1:1 at a dose of 4 ml/kg body weight of the patient with the additional lidazy (0.5 U/kg), heparin (80 U/kg, with the patient's blood clotting) and mannitol (2.5 ml/kg). in the postoperative period through a catheter inserted in the bowel mesentery, drip immediately after lymphostimulate starting antibiotics in the usual singli dose given the sensitivity of the microflora of the abdominal cavity. Endolymphatic antibiotics depending on the severity of the disease and the patient performed once, sometimes twice a day for 3-5days. The results of treatment were compared with a control group of patients (19) with peritonitis treated in the postoperative period in the traditional way. The criteria for evaluating the effectiveness of the therapy were objective and subjective data of the patient, laboratory and instrumental studies.
During the postoperative period endomesentery lymphotropic antibiotic therapy (70 patients) compared to the conventional methods of treatment (19 patients), peritonitis, complicates dynamic ileus, leucocytosis in the blood was significantly reduced by day 4, and in the control group — 6 days after treatment, the ESR is reduced by day 4 at lymphotropic therapy, whereas in the control group — in 6 days. In addition, we have a great attention was paid to the restoration of the function of the gastrointestinal tract in the postoperative period. A sign of the functioning of the gastrointestinal tract is the amount of aspirated fluid from the stomach into the postoperative period.
Prevention of paralytic ileus in acute diffuse peritonitis
Table 1 shots that during lymphotropic therapy in the mesentery of the small intestine in patients in the postoperative period on the 2nd day auscultated intestinal peristalsis, and the third day is celebrated independent carminative and normalization of stool. In the control group only on the third day of treatment appear peristaltic noises for 4-5 days reduced functional capacity of the gastrointestinal tract. When aspirating gastric contents into the postoperative period of diminishing its scope in the recovery of functional activity of the digestive tract.
With widespread purulent peritonitis were impaired absorption of fluid from the abdominal cavity, which contributes to its accumulation. It is promoted as congestion in the lymphatic and venous system of the abdominal cavity. Conducted endolymphatic antibiotic in the postoperative period, especially with lymphostimulate, improves microcirculation and reduce the accumulation of fluid in the abdominal cavity. Table 1 presents data on the amount of fluid released from the abdominal cavity through the drainage in the postoperative period.
Conclusion
As a result of lymphotropic therapy of released fluid from the abdominal cavity was significantly reduced compared with the control group, starting from the 2nd day of treatment in the postoperative
*) the significance of differences in rates 1 day (P<0,05) Symbols: - lack of intestinal peristalsis +poorly articulated ++ moderate +++ hypercatharsis
It significantly reduces the complications of the underlying disease, promotes early recovery of the gastrointestinal tract, reduce postoperative dynamic obstruction the possibility of intestinal obstruction in late postoperative period.
period, indicating and early recovery of the gastrointestinal tract. With this method of treatment also was a decreases in spending, especially in connection with a reduction in the dose and dose frequency of antibiotics. along with the improved of the patient and normalization of parameters is achieved by reducing the frequency of various complications and reduced mortality in the postoperative period.
In the complex treatment of peritonitis lymphatic therapy through the use of bowel mesentery is pathogenetically substantiated method of therapy and significantly improves the function of the gastrointestinal tract in the postoperative period, reduces the incidence of complications and reduces the average stay of patients in hospital.
We have studied the best way to saturation lymphatic system of the abdomen in acute peritonitis and invented a method lympho-tropic administration of antibiotics in the mesentery of the small intestine in the postoperative period. It turned out that this method is more rapidly produce high levels of antibiotics in the mesenteric lymph nodes, as evidenced by observations in experimental studies.
Endomesenteria endolymphatic antibiotic therapy, conducted in all 70 patients with peritonitis, was a significant addition to the complex events in the postoperative period.
All the patients treated after the operating wound "Dermo-bacter" During smooth joints removed the wound healed with primary intention.
Thus, in the complex prevention and treatment of postoperative ileus dynamic acute peritonitis lymphatic therapy through mesentery is the most effective treatment.
Table 1. - Dynamics of recovery of intestinal peristalsis and volume aspirated gastric contents during treatment
Day treatment Appearance peristalsis Volume stomach contents (ml)
lymphotropic Traditions lymphotropic Traditions
1 - - 1325,7 34,7 1209,2 35,1
2 ++ - 843,6 25,0 1158,9 36,9
3 +++ + 107,9 10,7 793,5 31,0
4 +++ ++ no 250,4 15,8
5 +++ +++ no no
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