RU1803044C - Method of preventive treatment of stress gastroduodenal ulcer upon completion of traumatic operation on organs of abdominal cavity - Google Patents

Description

department (P8) doubled and amounted to 0.51 mg / min and 0.47 mg / min, respectively. The pH in the body and antrum reached 1.1 (hyperacid state). Start with

on the second postoperative day, 50.0 ml of a 1% solution of novocaine was injected 3 times a day into the microirrigator. Over four days of prolonged novocaine blockade of the vagus nerve trunks, the acidity of the intragastric contents and intragastric proteolysis reached preoperative values: RT - 0.25 mg / min, Ra - 0.24 mg / min, the pH in the body of the stomach is 1.9, the pH in the antrum is 2.4. Subsequently, against the background of the ongoing procaine blockade of the vagus nerves, the pH shifted more and more towards alkaline values and by the eighth day after surgery amounted to 2.2 in the stomach body and 3.0 in the antrum. In the control fibrogastroduodenoscopy performed on the ninth postoperative day, a normal variant was found. The patient was discharged in satisfactory condition on the seventeenth day after surgery.

To prove the proposed technical solution, we studied the acid-forming function of the stomach (methods - intragastric and targeted pH-meter) and intragastric proteolysis according to the method of A.I. Necha et al.), The control group of patients in the postoperative period received the usual / course, for each patient from the study group, a prolonged novocaine blockade of the vagus nerves was performed. For this, at the end of the main stage of the surgical intervention, a peritoneum was cut into the abdominal section of the esophagus by 1.5-2.0 cm, 1 cm indent from the left. A tunnel was created around the esophagus with the index finger of the right hand in the tissue. During this manipulation, the fascia leaf separating the cell spaces in which the anterior and posterior trunks of the X pair of cranial nerves are located was destroyed. In each case, the trunks

vagus nerves were available palpation. A catheter with an inner diameter of 2 mm was inserted into the created tunnel, which at the end had 2 holes, respectively, of the localization of the vagus nerve trunks. The peritoneum over the catheter was tightly sutured. The catheter was removed to the anterior abdominal wall. From the second postoperative day, they began to drip 1%

a solution of novocaine 30.0-50.0 ml 3 times a day. With novocaine intolerance, lidocaine was administered. To assess the condition of the mucous membrane of the stomach and duodenum, all patients with both control and

the studied groups underwent fibrogastroduodenoscopy - an average of 1 time in 3 days. A comparative analysis of the data in both groups showed that the use of prolonged novocaine blockade of the vagus nerves in the early postoperative period significantly reduces the effect of acid-peptic aggression factors on the gastric mucosa; resulting in

In the studied group of patients, acute gastro-duodenal ulcers were not detected in any case, whereas in the control group - in 15%. Thus, the proposed method eliminates the formation of stress ulcers of the stomach and duodenum in patients in the early period after surgical interventions on the abdominal organs due to inhibition of phase 1 gastric secretion. .

Formula la invention

. A method for preventing the formation of stressful gastroduodenal ulcers in the early period after a traumatic operation on the abdominal organs,

including the use of means aimed at reducing acid production, characterized in that, in order to prevent complications due to prolonged blockade of the vagus nerves,

A catheter is placed retroperitoneally in the abdominal esophagus region and local anesthetics are inserted through it.