Sepsis

A total of 575 patients, 312 of whom had a final diagnosis of diffuse (general), purulent peritonitis, 153 - diffuse (general) fibrinous peritonitis, 110 - diffuse (general) endoperitonitis. In the study group did not include patients with cancer, pancreatic necrosis, surgical complications, infections, bowel infarction, which is due to certain specifics of these diseases as a clinical or a bacteriological and immunological point of view. Most patients had surgical pathology, 80 - obstetric, 6 - Urology. The main nosological units were acute appendicitis, the trauma of abdominal organs and retroperitoneal space, the ulcer perforated ulcer and 12 duodenal ulcer, strangulated hernia, adhesive small bowel obstruction, intestinal obstruction (other forms), gynecological pathology: inflammation of the uterus, abstsedirovanie, endometritis.

General characteristics of patient groups are not well describes the problem areas in the treatment of RP. When separating the patients by type of purulent exudate mortality in RP ranged from 19 to 50%, while in the other groups it was 11.4%.

However, one of the causes of deaths is considered the development of abdominal sepsis and organ function failure.

In the literature of the last decade abdominal sepsis is defined as the systemic inflammatory response of the body in response to the initial development of the destructive process in the abdominal cavity and / or retroperitoneal space, characterized by a set of processes of endotoxemia and multiple organ failure [Gelfand BR, 1998], a syndrome of systemic reactions on inflammation - SSRV (Systemic inflammation response syndrom - SIRS) as a pathological condition caused by a form of surgical alteration of tissue infection or infectious nature (trauma, pancreatitis, burns, ischemia, or autoimmune tissue damage) and is characterized by (but not limited to) the presence of more than one of four clinical signs: body temperature higher than 38 ° C or below 36 ° C, tachycardia above 90 beats per minute, tachypnea over 20 breaths per minute (with IVL-pCO2 less than 32 mm Hg), white blood cell count over 12000 cells ml or less than 4000 cells ml or the number of immature (stab) forms of neutrophils, myelocytes, juvenile exceeds 10% [Members of the American College of Chest Physicians / Society of Critical Care Medicine Consensus Conference Committee, 1992].

The current classification of sepsis can be reduced to the following provisions [Members of the American College of Chest Physicians / Society of Critical Care Medicine Consensus Conference Committee, 1992]:

Sepsis - a syndrome of systemic reaction to inflammation in the presence of proven focus of infection.

Severe sepsis - sepsis combined with organ dysfunction, hypoperfusion, or hypotension (lactic acidosis, oliguria, acute impairment of consciousness). Hypertension is characterized by a decrease in systolic blood pressure below 90 mm Hg or a reduction of more than 40 mm Hg from the level in the absence of other causes of hypotension.

Septic shock - sepsis, coupled with hypotension, persisting despite brand viagra adequate correction of hypovolemia, with hypoperfusion (lactic acidosis, oliguria, acute impairment of consciousness).

Poliorgannooy dysfunction syndrome (PAYG), impaired function of the patient (self-maintaining homeostasis is impossible).

Based on these definitions, we formed groups of patients: the lack of SSRV, with the presence of SSRV, with the presence of SSRV and lack of function of one organ, with the presence of SSRV and lack of function of two or more bodies. Prior to surgery, were studied only the most accessible for rapid detection of symptoms of organ dysfunction: heart rate (> 110 per minute), respiratory rate (> 24 min), mean arterial pressure (<71 mm Hg), hematocrit (<20), Glasgow Coma Scale Score (< 11).

Another set of factors affecting the prognosis of treatment WP and determining the risk of postoperative complications presented in the scales assessing the severity of the state of APACHE II, SOFA, SAPS. More extensive examination of the patient makes widespread adoption of these scales in the work of surgical departments. But, we must recognize that only the development of diagnostic capabilities will develop and implement the work of the surgical clinics of modern schemes monitoring of septic patients. The results of our studies (Table 2) confirm the literature that the most severe cases have preoperative APACHE II score of 20 or more, and for APACHE II score of more than 29 deaths are inevitable.

Attempts to determine the main directions of treatment of advanced peritonitis led to the definition of the basic principles of surgical treatment and postoperative management, including the execution of surgical interventions to the most radical elimination of the source of peritonitis, renovation of the abdominal cavity and its efficient drainage [Niederle B., 1984]. Based on these principles we have identified groups reflecting the basic tactical schemes used in the treatment of RP.

placebo
opposite effect
sympathetic activation
myocardial infarction
tactics