The effectiveness of postoperative methods of metabolic homeostasis correction in patients with acute peritonitis

Abstract

Metabolic resuscitation is definitely not an accomplished task for intensive care of patients with acute peritonitis. The efficacy of ethylmethylhydroxypyridine succinate (Elfunate) in the complex of intensive care of patients with acute secondary peritonitis was evaluated to make basis for the early beginning of the organ-protective medications. Patients were divided into two groups: group 1 (control) (n = 20) included patients who received standard intensive care in the postoperative period. The second group (main) (n = 30) included patients who additionally received Elfunate 100 mg 3 times a day in the physiological saline solution (200 ml) from the first day of hospitalization for the first 5 days after surgery, intravenously dripping with speed of 40-60 drops per minute. During the analysis it was revealed that during the first day of hospitalization, the C-reactive protein increased 17 and 18 times higher than normal and was 70.0 ± 13.7 mg/L in group 1, 73.3 ±18.3 mg/L – in the 2nd group, the intergroup differences were not significant (p = 0.888). Significant decrease in mean CRP values to 34.7 ± 5.4 mg /l (p = 0.008) and 19.5 ± 3.7 mg / l (p = 0.018 to the previous stage) was recorded after 5 days of surgery, respectively. At the same time, in patients who received Elfunate in the intensive care unit, the level of CRP at this stage was 1.8 times lower compared to the control group (p = 0.032). Hypoproteinemia was registered in patients with acute peritonitis during the first 24 hours after surgery, when the average protein values in patients of the 1 group significantly decreased to 58.6 ± 1.8 g/L (p = 0.043 to baseline), in the 2nd group – up to 60.2 ± 1.3 g/l (p = 0.010). On the 3rd day after surgery, hypoproteinemia continued to increase to 56.2 ± 1.3 g /L (p = 0.002) in the control group, the average protein value was significantly lower than the baseline level (p = 0.029). In main group where Elfunate was used, the tendency of the total blood protein increase up to 61.4 ± 1.0 g /l (p = 0.021) was registered, the average protein value did not reach the baseline, but did not differ significantly (p = 0.497). Intergroup differences were significant (p = 0.006). In conclusion, the usage of ethylmethylhydroxypyridine succinate (Elfunate) in the intensive care of acute peritonitis is pathogenetically grounded, as it allows to stop the SIRS manifestation, improving the protein synthesis in the liver on the background of endogenous intoxication caused by the underlying disease.