Abstract
Aim: improving the results of the complex treatment of patients with surgical pathology of abdominal organs by improving prevention and treatment of motor-evacuation disorders of the gastrointestinal tract in the postoperative period. Results: the article presents data on the use of metoclopramide, L- arginine, simethicone for the prevention of postoperative dysmotility development. It is proved that L-arginine use reduces the effects of peripheral vasospasm by improving microcirculation of the intestinal wall and this leads to a more rapid recovery of motor-evacuation function of the gastrointestinal tract.
Highlights
Ⱦɥɹ ɨɰɿɧɤɢ ɦɨɬɨɪɧɨ-ɟɜɚɤɭɚɬɨɪɧɨʀ ɮɭɤɰɿʀ ɒɄɌ ɦɢ ɜɢɤɨɪɢɫɬɨɜɭɜɚɥɢ ɡɧɚɱɟɧɧɹ ɜɧɭɬɪɿɲɧɶɨɱɟɪɟɜɧɨɝɨ ɬɢɫɤɭ, ɜɢɦɿɪɸɜɚɧɧɹ ɹɤɨɝɨ ɩɪɨɜɨɞɢɥɢ ɧɟɩɪɹɦɢɦ ɦɟɬɨɞɨɦ ɲɥɹɯɨɦ ɪɟɽɫɬɪɚɰɿʀ ɬɢɫɤɭ ɜ ɫɟɱɨɜɨɦɭ ɦɿɯɭɪɿ
Ɩɟɪɲɨʀ ɞɨɛɢ ɩɿɫɥɹ ɨɩɟɪɚɰɿʀ ɪɨɡɜɢɜɚɸɬɶɫɹ ɩɿɫɥɹɨɩɟɪɚɰɿɣɧɿ ɩɨɪɭɲɟɧɧɹ ɦɨɬɨɪɢɤɢ ɒɄɌ, ɹɤɿ ɞɨɫɹɝɚɸɬɶ ɫɜɨɝɨ ɦɚɤɫɢɦɭɦɭ ɱɟɪɟɡ 2-3 ɞɨɛɢ ɩɿɫɥɹ ɨɩɟɪɚɰɿʀ ɬɚ ɫɭɩɪɨɜɨɞɠɭɸɬɶɫɹ ɩɿɞɜɢɳɟɧɧɹɦ ȼɑɌ, ɧɚɪɨɫɬɚɸɱɢɦ ɡɛɿɥɶɲɟɧɧɹɦ ɫɭɞɢɧɧɨɝɨ ɨɩɨɪɭ, ɩɿɞɜɢɳɟɧɨɸ ɊɅɒ ɩɪɢ ɡɦɟɧɲɟɧɿɣ ɣɨɝɨ ɩɨɬɭɠɧɨɫɬɿ ɬɚ ɡɚɩɚɥɶɧɨɸ ɜɿɞɩɨɜɿɞɞɸ ɨɪɝɚɧɿɡɦɭ, ɹɤɚ ɡɛɟɪɿɝɚɽɬɶɫɹ ɩɨɧɚɞ 7 ɞɿɛ ɩɿɫɥɹ ɨɩɟɪɚɰɿʀ
Summary
Ɉɿɫɥɹɨɩɟɪɚɰɿɣɧɢɣ ɩɚɪɟɡ ɤɢɲɟɱɧɢɤɚ (postoperative ileus) – ɲɢɪɨɤɨ ɪɨɡɩɨɜɫɸɞɠɟɧɟ ɭɫɤɥɚɞɧɟɧɧɹ, ɹɤɟ ɜɢɧɢɤɚɽ ɧɟ ɬɿɥɶɤɢ ɩɿɫɥɹ ɜɟɥɢɤɢɯ ɨɩɟɪɚɰɿɣ ɧɚ ɱɟɪɟɜɧɿɣ ɩɨɪɨɠɧɢɧɿ, ɡɚɨɱɟɪɟɜɢɧɧɨɦɭ ɩɪɨɫɬɨɪɿ, ɝɿɧɟɤɨɥɨɝɿɱɧɢɯ, ɭɪɨɥɨɝɿɱɧɢɯ ɨɩɟɪɚɰɿɣ, ɚ ɣ ɩɿɫɥɹ ɧɟɜɟɥɢɤɢɯ ɡɚ ɨɛɫɹɝɨɦ ɨɩɟɪɚɬɢɜɧɢɯ ɜɬɪɭɱɚɧɶ, ɭ ɬɨɦɭ ɱɢɫɥɿ ɜɢɤɨɧɚɧɢɯ ɥɚɩɚɪɨɫɤɨɩɿɱɧɨ [3, 8]. ɉɿɫɥɹɨɩɟɪɚɰɿɣɧɿ ɩɨɪɭɲɟɧɧɹ ɦɨɬɨɪɢɤɢ ɤɢɲɟɱɧɢɤɚ ɡɚɡɜɢɱɚɣ ɬɪɢɜɚɸɬɶ ɩɟɪɲɿ 3-5 ɞɿɛ ɩɿɫɥɹ ɨɩɟɪɚɰɿʀ, ɚ ʀɯ ɪɨɡɜɢɬɨɤ ɡɛɿɥɶɲɭɽ ɬɪɢɜɚɥɿɫɬɶ ɩɟɪɟɛɭɜɚɧɧɹ ɜ ɫɬɚɰɿɨɧɚɪɿ, ɥɟɬɚɥɶɧɿɫɬɶ ɬɚ ɜɚɪɬɿɫɬɶ ɥɿɤɭɜɚɧɧɹ [5]. ȼ ɨɫɧɨɜɿ ɩɚɬɨɮɿɡɿɨɥɨɝɿɱɧɢɯ ɪɟɚɤɰɿɣ ɨɪɝɚɧɿɡɦɭ ɧɚ ɩɨɪɭɲɟɧɧɹ ɦɨɬɨɪɢɤɢ ɲɥɭɧɤɨɜɨ-ɤɢɲɤɨɜɨɝɨ ɬɪɚɤɬɭ ɥɟɠɢɬɶ ɩɨɪɭɲɟɧɧɹ ɦɿɤɪɨɰɢɪɤɭɥɹɰɿʀ ɜ ɫɬɿɧɰɿ ɤɢɲɤɢ ɧɚ ɬɥɿ ɪɨɡɜɢɬɤɭ ɫɢɧɞɪɨɦɭ ɟɧɬɟɪɚɥɶɧɨʀ ɧɟɞɨɫɬɚɬɧɨɫɬɿ, ɩɿɞɜɢɳɟɧɨɝɨ ɝɚɡɨɭɬɜɨɪɟɧɧɹ ɜ ɩɪɨɫɜɿɬɿ ɤɢɲɟɱɧɢɤɚ ɬɚ ɩɿɞɜɢɳɟɧɨɝɨ ɜɧɭɬɪɿɲɧɶɨɱɟɪɟɜɧɨɝɨ ɬɢɫɤɭ. ɍ ɩɟɪɲɿ 24 ɝɨɞɢɧɢ ɩɿɫɥɹ ɨɩɟɪɚɰɿʀ ɪɨɡɜɢɜɚɽɬɶɫɹ ɡɚɩɚɥɶɧɚ ɜɿɞɩɨɜɿɞɶ, ɳɨ ɯɚɪɚɤɬɟɪɢɡɭɽɬɶɫɹ ɦɿɝɪɚɰɿɽɸ ɥɟɣɤɨɰɢɬɿɜ (ɫɟɪɟɞ ɹɤɢɯ ɽ ɦɚɤɪɨɮɚɝɢ, ɧɟɣɬɪɨɮɿɥɢ ɬɚ ɬɭɱɧɿ ɤɥɿɬɢɧɢ) ɞɨ ɦ’ɹɡɨɜɨɝɨ ɲɚɪɭ ɤɢɲɟɱɧɢɤɚ ɬɚ ɜɢɞɿɥɟɧɧɹɦ ɧɢɦɢ ɩɪɨɡɚɩɚɥɶɧɢɯ ɰɢɬɨɤɿɧɿɜ, ɪɟɡɭɥɶɬɚɬɨɦ ɱɨɝɨ ɫɬɚɽ ɬɪɢɜɚɥɟ ɩɪɢɝɧɿɱɟɧɧɹ ɤɢɲɤɨɜɨʀ ɦɨɬɨɪɢɤɢ [9]. ɭ ɯɜɨɪɢɯ 2 ɝɪɭɩɢ ȼɑɌ ɛɭɜ ɧɢɠɱɢɦ, ɧɿɠ ɭ 3 ɿ 4 ɝɪɭɩɚɯ ɧɚ 28,6% (ɪ
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