UDK: 616.34-005.1-099-08

TREATMENT AND PREVENTION OF INTESTINAL INSUFFICIENCY SYNDROME IN SEVERE BLEEDING FROM GASTRODUODENAL ULCERS

I.N. Klimovich, S.S. Maskin, P.V. Abramov, V.A. Golbrah, V.V. Matyukhin

ФГБОУ ВО «Волгоградский государственный медицинский университет» Министерства здравоохранения Российской Федерации

Abstract

Ischemia-reperfusion injuries (IRI) of the intestinal wall in patients with severe bleeding from gastroduodenal ulcers (GDU) lead to the development of intestinal insufficiency syndrome (IIS) in 45–65 % of cases with typical manifestation: lost of the barrier function of the intestinal wall, potentiation of systemic endotoxinemia by intestinal toxins and, as a consequence, the development of multiple organ dysfunction syndrome (MODS). Objective: to determine the directions of prevention and treatment of IIS and evaluate their effectiveness in patients with severe bleeding from GDU. Materials and methods. The treatment-and-prophylactic algorithm for IIS was applied in 81 patients of the main group with severe bleeding from GDU, the comparison group included 78 patients who received standard therapy. In all patients, hemostasis was achieved by the endoscopic injection method. Results and discussion. The pathogenesis and consequences of intestinal IRI determined the range of treatment and prophylactic measures that most significantly influence on the morphofunctional state of the intestine: correction of oxidative stress, inflammatory reaction, metabolic disorders and regeneration processes in the bowel wall; intraluminal detoxification; stimulation of peristaltic activity and normalization of intestinal microflora. This targeted prevention reduced the development of IIS by 11 % in the main group of patients. The treatment of IIS stopped its pathological manifestations 2–3 days earlier than in the comparison group, to reduced the formation of hepatorenal syndrome (HRS) by 18 %, overall mortality by 4 %, and mortality associated with IIS by 12 %. Conclusions. The proposed algorithm of treatment and prophylactic measures for patients with severe bleeding from GDU prevents and/or contributes to the rapid recovery of morphological and functional intestinal disorders, after IRI.

Keywords

severe bleeding, syndrome of intestinal insufficiency, endotoxicosis, prevention, treatment.

Contacts

Климович Игорь Николаевич – д. м. н., профессор кафедры госпитальной хирургии, Волгоградский государственный медицинский университет, e-mail: klimovichigor1122@yandex.ru