Rejection

The analysis found that in semi-enclosed method (mean DSS APACHE II 14,0) mortality was 18.6%, with rejection of technique, 59.1%, with semi-open way of reference, provides for 100% use of the method, mortality was 25, 9% (mean DSS APACHE II 15,1). In the group with a complicated course (mean DSS APACHE II 16,1) mortality after application of the method was 59.1%, with rejection of the method - 33,3%. As seen from the results, the expected correlation is absent in the group with a complicated course. Apparently, this is due to the fact that pre-operative patient status at the RSE does not always determine the absence of complications such as failure of the anastomosis of the gastrointestinal tract, occurring usually at 4-6 days after surgery. Of the 13 deceased patients, 7 (54%) developed anastomotic failure or necrosis of the hollow body; of the 15 survivors - only 3 have developed such complications (20%). Determine the total performance indicator method of intestinal intubation and peritoneal-enteral lavage (calculated mortality difference when applying the method and without him in when he was shown). It is at the RSE 29.5%. Thus, in the presence of purulent peritoneal exudate method does not provide a warning most severe complications, but is primarily a component of detoxification.

When semi-enclosed method of total mortality was 10.1%, which defines a group of patients whose treatment may have should be different. The main reasons for the negative results of treatment are underestimating the early signs of organ dysfunction, existing prior to the operation and development of thromboembolic complications. The most informative symptoms correlated with the nature of the exudate were mean arterial pressure, the rate of Glasgow coma scale and frequency of respiratory movements. The bulk of deaths observed in the purulent exudate (19%). With a score of APACHE II> 20 mortality was more than two-thirds (by APACHE II> 30 - 100%), resulting in these cases, the need to clearly justify the refusal of the landmark renovation of the abdominal cavity, or their conduct.

Analysis of the results in the first two groups suggests that the excess value of APACHE II score of 14 is responsible for at least 10%-ing mortality, but at the same time, the lack of classic symptoms of SIRS is not determinative in the choice of tactics. Perhaps there was an element of overdiagnosis, or to determine the half-open tactics of greater importance was given to the characteristics of the exudate, not the symptoms pointing to the generalization of the inflammatory process. Thus, from this group of patients could be treated effectively using semi-method. The presence of preoperative dysfunction of one of the systems at the most seemingly uncompromising - half-open method determines the death of a quarter of patients. On the other hand the presence of symptoms of SIRS can be observed before the operation and fibrinous and serous fluid. Therefore, to better forecast should have a value of resistance in negative symptoms and treatment efficacy in the first day after surgery.

In the group with a complicated course of mortality was 46%. The main factor behind this figure is the late diagnosis (diagnostic time, 150 hours). The main indications for repeated operations were: in 56% of the further development of common inflammation of the peritoneum (the inadequate evaluation of the reorganization of the abdominal cavity, the underestimation of the activity of microorganisms, inadequate drainage, etc.) and in 14% necrosis of the walls of the hollow body, a 21% failure of the anastomosis in 4 % otgranichenny peritonitis. Treatment of patients in this group after repeated operations conducted mostly semi-open way.

Timely and correct prediction of adverse flow is an important task that affects a significant reduction in mortality. Found that when the interval ADD APACHE II [0-10] there was no mortality. Therefore, the use of semi-open technique in cases where a semi-closed totally effective, must be regarded as unjustified, based on hyperdiagnosis RSE, overestimation of symptoms MON, sometimes on a subjective simplification of the indications for a landmark bailouts. In the interval ADD APACHE II [11-15] half-open method has the greatest comparative effectiveness. 2.3 Application of landmark rehabilitation of these patients does not lead to a substantial aggravation of the patient, which determines its relatively high efficiency (reduction of mortality up to 11,5%). When DSS APACHE II> 15 semi efficiency method has no significant advantage before the half-closed manner. When DSS APACHE II> 25 observed 100% mortality regardless of surgical approach (Table 2).

Criteria for the severity of surgical brand viagra infection and quantitative markers of multiple organ failure correlated with preoperative indicators of IIP scales and APACHE II and treatment outcomes. The potential need for semi-open method for the treatment of purulent peritonitis (RSE), which determines mortality in semi-enclosed method is 22%.

The choice of semi method for the treatment of RSE most caused by the absence of mortality in the range of APACHE II ADD ot0 to 10.

Application of semi-open technique is useful when DSS APACHE II ot11do15 and not justified by DOB APACHE II <11.

Definition of indications and complications of high-quality diagnosis still presents considerable difficulties. The presence of dysfunction of two or more organ systems is an opportunity for a semi-open way of managing patients with RP. Dysfunction of the cardiovascular, respiratory system, central nervous system may contribute to the development of complicated postoperative course in the application of a half-closed technique. The undoubted effectiveness of bowel decompression and organo-complex resuscitation measures in purulent peritonitis promotes simplification of the indications for this method and makes giperdiagnosticheskie trends.
Conclusions: 1. The most important tasks in the treatment of RSE are to reduce the diagnostic time in complicated PD and the correct definition of the indications for semi-enclosed and semi-open method of surgical treatment.

2. The preferred method of decompression of the gastrointestinal tract is the total nasogastrointestinal intubation combined with peritoneal-enteral lavage, which, as an independent method, the decrease in mortality to 29% in disseminated purulent peritonitis, and is one of the major components of the complex detoxification of the postoperative period.

3. The greatest difference in mortality in the DSS APACHE II of 11 and 15 causes is preferable to use a semi-open technique for ascertaining DSS in this interval. If you score APACHE II <11 should only be used semi-closed method.

4. The correct diagnosis of complications can be determined by preoperative and follow-up based on the scales assessing the severity of abdominal infection.

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