血液生化特征和多器官功能障碍综合征:小肠瘘治疗客观评估的范例

A. Larichev, K. N. Efremov, V. Kuzmin, M. G. Chetverov
{"title":"血液生化特征和多器官功能障碍综合征:小肠瘘治疗客观评估的范例","authors":"A. Larichev, K. N. Efremov, V. Kuzmin, M. G. Chetverov","doi":"10.33920/med-15-2302-03","DOIUrl":null,"url":null,"abstract":"When organizing the treatment process for small bowel fistula, timely diagnosis of significant pathophysiological changes arising from intra-abdominal complications is relevant. We studied the results of the treatment of 41 patients with an unformed small bowel fistula, caused by the failure of the intestinal suture placed in connection with the violation of the integrity of the enteral wall in technically difficult viscerolysis,against the background of diffuse peritonitis, as well as the suture failure after bowel resection in open and closed abdominal trauma and in a strangulated hernia. At three stages of the study (initial — 1–2, intermediate — 5–7, and final — 28 days from the start of treatment), the functional state of vital organs and systems and electrolyte imbalance were assessed by monitoring 10 biochemical blood parameters (total protein and bilirubin, alkaline phosphomonoesterase, alanine and aspartate aminotransferase, urea,creatinine, glucose, amylase and potassium), thereby objectifying the nature of multiple organ dysfunction in its three-stage gradation. It has been found that in the presence of an unformed small bowel fistula at the time of its occurrence, there are multisystem disorders of varying severity. Against the background of the traditional complex of therapeutic measures, including conservative treatment and surgical technologies, there are changes in the evaluated criteria, which become especially clear within the framework of the concept of hemobiochemical profile in its graphical presentation. At the final time interval of follow-up, a third of patients have a critical level of the main clinical and laboratory parameters, including hemobiochemical parameters. Preservation of severe forms of multiple organ dysfunction — sub- and decompensation (from 47 to 69 % of patients), in the process of implementing a three-stage follow-up model, as well as a high level of mortality (41.46 %) indicate the low effectiveness of traditional tactics for the treatment of an unformed small bowel fistula.","PeriodicalId":437500,"journal":{"name":"Hirurg (Surgeon)","volume":"48 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Hemobiochemical profile and multiple organ dysfunction syndrome: a paradigm for objective assessment of small bowel fistula treatment\",\"authors\":\"A. Larichev, K. N. Efremov, V. Kuzmin, M. G. Chetverov\",\"doi\":\"10.33920/med-15-2302-03\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"When organizing the treatment process for small bowel fistula, timely diagnosis of significant pathophysiological changes arising from intra-abdominal complications is relevant. We studied the results of the treatment of 41 patients with an unformed small bowel fistula, caused by the failure of the intestinal suture placed in connection with the violation of the integrity of the enteral wall in technically difficult viscerolysis,against the background of diffuse peritonitis, as well as the suture failure after bowel resection in open and closed abdominal trauma and in a strangulated hernia. At three stages of the study (initial — 1–2, intermediate — 5–7, and final — 28 days from the start of treatment), the functional state of vital organs and systems and electrolyte imbalance were assessed by monitoring 10 biochemical blood parameters (total protein and bilirubin, alkaline phosphomonoesterase, alanine and aspartate aminotransferase, urea,creatinine, glucose, amylase and potassium), thereby objectifying the nature of multiple organ dysfunction in its three-stage gradation. It has been found that in the presence of an unformed small bowel fistula at the time of its occurrence, there are multisystem disorders of varying severity. Against the background of the traditional complex of therapeutic measures, including conservative treatment and surgical technologies, there are changes in the evaluated criteria, which become especially clear within the framework of the concept of hemobiochemical profile in its graphical presentation. At the final time interval of follow-up, a third of patients have a critical level of the main clinical and laboratory parameters, including hemobiochemical parameters. Preservation of severe forms of multiple organ dysfunction — sub- and decompensation (from 47 to 69 % of patients), in the process of implementing a three-stage follow-up model, as well as a high level of mortality (41.46 %) indicate the low effectiveness of traditional tactics for the treatment of an unformed small bowel fistula.\",\"PeriodicalId\":437500,\"journal\":{\"name\":\"Hirurg (Surgeon)\",\"volume\":\"48 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-04-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hirurg (Surgeon)\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.33920/med-15-2302-03\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hirurg (Surgeon)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.33920/med-15-2302-03","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

在组织小肠瘘的治疗过程中,及时诊断腹腔内并发症引起的显著病理生理变化是有意义的。我们对41例未形成的小肠瘘的治疗结果进行了研究,这些未形成的小肠瘘是在弥漫性腹膜炎的背景下,由于脏器溶解技术困难,肠壁完整性被破坏而导致的肠道缝合失败,以及在开放性和闭合性腹部创伤和绞窄性疝气中肠切除术后缝合失败而引起的。在研究的三个阶段(治疗开始后1-2天、中间5-7天和最终28天),通过监测10项血液生化参数(总蛋白和胆红素、碱性磷酸单酯酶、丙氨酸和天冬氨酸转氨酶、尿素、肌酐、葡萄糖、淀粉酶和钾)来评估重要器官和系统的功能状态和电解质失衡,从而客观化多器官功能障碍的三个阶段的性质。已经发现,在发生未形成的小肠瘘时,存在不同严重程度的多系统疾病。在传统复杂的治疗措施的背景下,包括保守治疗和手术技术,评估标准发生了变化,这在血液生化谱的概念框架内变得特别清晰。在随访的最后时间间隔,三分之一的患者的主要临床和实验室参数达到临界水平,包括血液生化参数。在实施三阶段随访模型的过程中,保留严重形式的多器官功能障碍-亚代偿和失代偿(47%至69%的患者),以及高水平的死亡率(41.46%)表明传统策略治疗未形成小肠瘘的有效性较低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Hemobiochemical profile and multiple organ dysfunction syndrome: a paradigm for objective assessment of small bowel fistula treatment
When organizing the treatment process for small bowel fistula, timely diagnosis of significant pathophysiological changes arising from intra-abdominal complications is relevant. We studied the results of the treatment of 41 patients with an unformed small bowel fistula, caused by the failure of the intestinal suture placed in connection with the violation of the integrity of the enteral wall in technically difficult viscerolysis,against the background of diffuse peritonitis, as well as the suture failure after bowel resection in open and closed abdominal trauma and in a strangulated hernia. At three stages of the study (initial — 1–2, intermediate — 5–7, and final — 28 days from the start of treatment), the functional state of vital organs and systems and electrolyte imbalance were assessed by monitoring 10 biochemical blood parameters (total protein and bilirubin, alkaline phosphomonoesterase, alanine and aspartate aminotransferase, urea,creatinine, glucose, amylase and potassium), thereby objectifying the nature of multiple organ dysfunction in its three-stage gradation. It has been found that in the presence of an unformed small bowel fistula at the time of its occurrence, there are multisystem disorders of varying severity. Against the background of the traditional complex of therapeutic measures, including conservative treatment and surgical technologies, there are changes in the evaluated criteria, which become especially clear within the framework of the concept of hemobiochemical profile in its graphical presentation. At the final time interval of follow-up, a third of patients have a critical level of the main clinical and laboratory parameters, including hemobiochemical parameters. Preservation of severe forms of multiple organ dysfunction — sub- and decompensation (from 47 to 69 % of patients), in the process of implementing a three-stage follow-up model, as well as a high level of mortality (41.46 %) indicate the low effectiveness of traditional tactics for the treatment of an unformed small bowel fistula.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信