Клініко-імунологічний підхід до лікування інфекції акушерської хірургічної рани в породілей

Abstract

Purpose - study of the effectiveness of treatment of obstetric surgical wound infection in parturient women with the use of drugs with sorption-detoxification and immunomodulatory properties, which will make it possible to develop and implement a pathogenetically justified method of therapy for this pathology in the postpartum period and obtain a positive economic effect. Materials and methods. To fulfill the purpose of the study, 115 parturient women with purulent wounds of the anterior abdominal wall (after caesarean section) and perineum (episio-, perineotomy) were examined, who, depending on the treatment method, were divided into groups. The Group I - 42 women in labor with purulent wounds, who were treated with organosilicon sorbent gentaxan (application sorption); the Group II - 45 women in labor with purulent wounds, who were treated with organosilicon sorbent Gentaxan (application sorption) and immunomodulator Laferon (intramuscular); the Group III (control) - 28 women in labor with purulent wounds, who were treated with traditional methods. The clinical picture of the healing process was monitored by local symptoms in the wound - hyperemia, edema, tissue infiltration, the number and nature of the compartment. The immune status of women in labour before and after treatment was studied. The material for the study of general immunity was peripheral blood, which was taken from the moment of infection of the obstetric surgical wound. To assess the state of general immunity, the total number of T-lymphocytes (CD3+), their immunoregulatory subpopulations - T-helpers/inducers (CD4+) and T-suppressors/killers (CD8+), the number of B-lymphocytes (CD22+), NK cells (CD16+), the immunoregulatory index (CD4+/CD8+) was calculated. Statistical data processing was carried out using the package of application programs Microsoft Excel 5.0 and using the standard version Statistica 8.0. The difference in indicators was considered statistically significant at Р<0.05. Results and conclusions. The use of drugs with immunomodulatory and sorption properties in the treatment of purulent wounds shows an advantage over traditional methods of therapy, which has increased the effectiveness of treatment of obstetric surgical wound infection in women in labour. In turn, the complex method of treatment with the use of gentaxane and laferon has an advantage over gentaxane monotherapy due to a significant restoration of the indicators of the cellular immune system, which affects faster cleansing of the wound from dead and non-viable tissues, rapid elimination of edema and inflammation in the wound and acceleration of reparative processes. This makes it possible to recommend the above method for widespread clinical use in obstetric practice. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.