SU1699433A1 - Method for treating peritonitis - Google Patents

Abstract

This invention relates to surgery and can be used to treat acute peritonitis. The aim of the invention is to prevent complications. The method is carried out by administering reopolyuglyukin, hemodez, and procerin in therapeutic doses under a pressure of 150-200 mm Hg into the superior mesenteric artery. with a speed of 70-75 drops / min 2-3 times in 1 day for 2-4 days.

Description

This invention relates to surgery and can be used to treat acute peritonitis.

The aim of the invention is to prevent complications.

Example. Patient Y.M., 28 years old, was admitted to the general surgical department of a psychiatric hospital with complaints of abdominal pain. According to the accompanying patient, during the week there are abdominal pains, especially severe in the last three days, nausea, repeated vomiting. Contact with the patient is difficult due to mental status. Objectively: the general condition is severe. Does not answer questions, does not focus on the environment. The skin is pale. Muffled heart sounds, pulse 110 beats / min, rhythmic, BP 110/75 mm Hg In the lungs, vesicular breathing, no wheezing, respiratory rate up to 24 in 1 min, shallow breathing, chest type. Tongue dryish, white coated. The abdomen is sharply strained, painful in all departments, is not involved in the act of breathing. Hepatic dullness reduced, liver and spleen not

palpable, intestinal motility is not heard. The symptom of Shchetkin - Blumberg is sharply positive in all departments. X-ray examination revealed the presence of free gas in the dome of the diaphragm. A diagnosis of perforation of the duodenal ulcer, peritonitis was made. After a short-term intensive and infusion therapy, the patient underwent surgery. During the operation, the presence in the abdominal cavity of up to 1 l of purulent-fibrinous effusion with the smell of E. coli was revealed. The source of peritonitis was perforating holes in the terminal ileum at a distance of 35-40 cm from the Bauginov valve, 0, 8 and 0.6x0.6 cm in size. The perforation of the ileum ulcer was sutured, and the small intestine intubation was carried out with a nasi-intestinal probe during 1.5 m from the Treitz link. Drainage of the abdominal cavity for the administration of antibiotics. A thorough intraoperative lavage of the abdominal cavity of 10 l of Ringer's solution with the addition of dioxidine solution,

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metronidazole and kanamycin. Layer wound closure.

The condition of the patient in the early postoperative period is extremely heavy, hemodynamic instability, tachycardia up to 130-140 beats / min, blood pressure 100 / 80-130/90 mm Hg, CVP 0 mm water column. Antibiotics were introduced into the abdominal cavity, taking into account the results of rapid bacterioscopy and bacteriological examination, kanamycin 1 g 3 times a day, metronidazole 500 mg 3 times a day and 1% dioxidine 60 ml. After extubation on March 22, 1989, taking into account the absence of intestinal peristalsis, a catheterization of the superior mesenteric artery was performed with the aim of conducting a regional intraarterial infusion of medicinal substances and the beginning of catheteric therapy with sequential introduction of reopolyglucin 400 ml, then hemodez 800 ml and procerina 1 ml at a speed of 70 drops / min under a pressure of 200 mm Hg continuously. During the first day, two such sessions were carried out. The total amount of intra-arterial infusion 2,4l.

As a result of intraarterial therapy, a positive dynamics was found, expressed in the form of a decrease in signs of intoxication, a pulse rate, a decrease in temperature, the patient had loose stools up to 2 liters per day, the concentration of medium molecules decreased from 361 / ml to 164 at the end of the first days of catheter therapy, the Kalf-Kalif index decreased from 23 to 12.4. From March 24

Claims (1)

1989 enteral tube feeding started. The presence of anemia of HB 84–92 g / l, hypoproteemia up to 43 5 g / l was noted in the patient from analyzes, in connection with which the patient was transfused. protein and plasma transfusions. The patient's condition progressively improved over the fourth day after the operation (on the third day of intra-arterial catheter therapy in the indicated regimen) the concentration of average molecules decreased to 62 / ml, the Kalf-Kalif index was 2.1. From the contents of the abdominal cavity in a patient with a bacteriological examination, a sterile response was obtained under aerobic and anaerobic conditions. On the second day, the patient had active peristalsis, an independent chair without additional stimulation on the fourth day. From the side of blood tests there was an increase in Nb 110 g / l, protein to 56.7 g / l. In this connection, the catheters were removed (day 4) and the patient was transferred to the general surgical department for further treatment in general. For nine days, the patient was discharged from the hospital after removal of sutures. The invention The method of treating peritonitis by administering lyukine reapolyugs, impersonating that, in order to prevent complications, hemodez and procernins are additionally introduced into the superior mesenteric artery in therapeutic doses under a pressure of 150-200 mm Hg. with a speed of 70-75 drops / min 2-3 times in 1 day. within 2-4 days.