THE EXPERIENCE OF EARLY POST-OPERATION SORBTION USING ENTEROSORBENT POLYSORB MP AMONG PATIENTS WITH ACUTE GENERALIZED PERITONITIS
According to different authors the rate of mortality from acute generalized peritonitis is from 24.4% to 55% [4,5]. One of the main reasons for this is impaired motor-evacuation function of the large intestine [1,2] and as a consequence, the development of endogenous intoxication syndrome (EIS), which determines to a large extent the severity of the disease.
Therefore the clinician is faced by the necessity to conduct detoxification actions among the patients with acute generalized peritonitis as soon as possible.
Enterosorbtion conducted in early postoperative period can be one of such actions.
P.K. Zagniboroda (1994) using the models of obturated and strangulated intestinal obstruction of dogs showed high efficiency of intraoperative enterosorbtion using enterosorbent POLYSORB MP.
For evaluation of clinical efficacy of POLYSORB MP in intensive care we used the medicine on 11 patients with acute generalized peritonitis of different ethiology (acute intestinal obstruction - 4 patients, perforation of the hollow organ - 4 patients, penetrating ballistic wounds of abdomen - 3 patients). The condition of patients and wounded was estimated as grave and very grave.
Technology. Through polyfunctional probes set intraoperatively into initial sections of small gut, during first hours after the operation lavage and enterosorbtion were conducted. Electrolytic solution with addition of POLYSORB MP with dose of 300 mg/kg/day was used as lavage medium. Enterosorbtion was done fractionally 4 times per day. Solution made with rated dose of POLYSORB MP was administered with Janet's syringe into the gut through the probe and then the probe was clamped with exposure time 40 minutes, and then at the time of active aspiration the gut contents were removed.
When using the medicine it was noticed that POLYSORB MP is easily suspended in indoor temperature water without flocculation, this gives the possibility to deliver it into sounds of any diameter.
At the ground of conducted enterosorbtion during 3-5 days of postoperation period was noticed the decrease of the level of intoxication markers (LII, leucocytosis, stab shift, the level of middle-molecular peptides). The efficiency of enterosorbtion was proved by decrease of the level of GOT, GPT, creatinine, urea nitrogen and bilirubin in blood serum. This fact proves that usage of the POLYSORB MP at the time of enterosorbtion improves detoxication function not only of digestive tract but also of the detoxication organs (liver, kidneys). It should be noted that detoxication function was improved due to the strengthening of the barrier function of intestinal tract, normalization of indestinal flora and decrease of bacterial translocation. The other remarkable fact is that the level of creatinine in blood serum lowered almost in two times among patients with intact nephatony in comparison with control group (without usage of POLYSORB MP), this fact allows to advertise this medicine among patients with acute and chronic kidney disease in interdialysis period and in some cases even avoid hemodialysis.
Therefore, enterosorbent POLYSORB MP (CJSC Polysorb, the city of Chelyabinsk) is high-efficiency medicine for complex therapy of difficult cases of generalized peritonitis that is accompanied by frank organ disorders.
1.Belyakov N.A. and others. Intraoperative decompression and sorption dialysis of small intestine in case of peritonitis: Manual for medical practitioners. St. Petersburg, 1998.p.3.
2.Burnevich S.Z. and others. The condition of barrier function of digestive tract in case of generalized peritonitis// Endointoxications. Thesis of international symposium. St. Petersburg,1994.p.23.
3.Zagniboroda P.K. The efficiency of intraoperational enterosorbtion with usage of Polysorb in cases of acute intestinal obstruction. ib, p.219.
4. Popova Т. S. and others. Intestinal obstruction syndrome in surgery. Мoscow, 1991.
5. Shorokh G.P. and others. Complex approach to detoxication of organism in case of generalized peritonitis // Endointoxications. Thesis of international symposium. St. Petersburg,1994. P.58.