Assessment of the intensity of the syndrome of endogenous intoxication in children with common appendicular peritonitis

Abstract

The purpose of the study was to assess the intensity of the syndrome of endogenous intoxication in children with common appendicular peritonitis. Materials and methods. To achieve this goal, 402 children with common appendicular peritonitis were examined. Clinical and laboratory studies included the interpretation of general blood analysis data, including the calculation of leukocyte intoxication index, nuclear neutrophil segmentation index and spontaneous leukocyte agglomeration index on 1-, 2-, 3-, 4- days of illness. The degree of endogenous intoxication was judged by the level of medium plasma molecules. The content of malondialdehyde and the activity of superoxide dismutase and catalase in blood serum were determined. Studies of hemostasis parameters were also conducted. Results. All children with common appendicular peritonit showed a significant increase in the number of total leukocytes (1,7–2,3 times) relative to the control group, a shift of the leukocyte formula to the left, and in a number of patients myelocytes and metamyelocytes were present, which affected the control of the increase in leukocyte intoxication index – LII. The progressive multiple accumulation in the body of children with peritonitis of POL products was manifested by a nearly twofold decrease in the concentration of superoxide dismutase and catalase, as well as an increase in the concentration of malonic dialdehyde and medium plasma molecules by more than 2 times compared with healthy children. In children with common appendicular peritonit before the operation, in the phase of the height of clinical manifestations, a significant increase in spontaneous leukocyte agglomeration index relative to control was observed. With the development of common appendicular peritonit in the hemostasis system, changes occur that are characterized by a significant relative to control decrease in the number of platelets, lengthening of the activated partial thromboplastin time and prothrombin time. Conclusions. It was found that pronounced inflammatory process and endotoxicosis, inevitably accompanying common appendicular peritonit, has a direct effect on the thrombocyte hemostasis, which can be a cause for disorders in the microcirculation system, aggravating both peritoneal lesions and increasing the risk of intra- and postoperative complications.