NEW APPROACHES TO POSTOPERATIVE TREATMENT PERITONITIS

Abstract

A significant role in the pathogenesis of peritonitis is attributed to free radical mechanisms of tissue damage. Due to inhibition of a number of membrane-bound enzymes and FRO of lipids of plasma membranes, foci of secondary necrosis appear in the peritoneum. Oxidized lipids have antigenic properties, and therefore stimulate autoimmune processes of tissue damage. In the pathogenesis of peritonitis, an important role is played by inflammatory mediators - cytokines. Their biological activity is manifested by the action on highly specific receptors located on cells. At the same time, interleukins and tumor necrosis factor act on all cells, exhibiting a systemic effect. It was found that the activity of ceruloplasmin in the blood plasma of patients in the control group progressively decreased from the first to the fifth day of the postoperative period, from 77.2 ± 5.61 to 59.32 ± 4.42 o.o. / g of protein, and in the patients of the experimental group it increased highly reliably - from 77.2 ± 5.61 to 97.31 ± 4.42 o.o. / h protein (p <0.001). The same pattern is characteristic of catalase activity. The activity of glutathione peroxidase in patients of both groups significantly decreased up to 3 days after the operation and increased on the fifth day, and it was more pronounced in the patients of the experimental group. When studying the level of cytokines, it was found that the expression of proinflammatory cytokines IL-1b, IL-8, TNFa exceeded the control values, while the expression of anti-inflammatory cytokines IL-1Ra was "delayed" (almost twofold). The highest expression of IL-1b, IL-8 potentiated further chain of pro-inflammatory reactions indicates the adequacy of the anti-inflammatory response and the relative balance between pro-inflammatory and anti-inflammatory cytokines and the adequacy of anticytokine therapy. The total number of septic complications (PBS) in the control group was 82.4%, and in the experimental group it was 66.7%. In dynamics study of pro- and antioxidant systems and serum concentra-tions of cytokine in the patients with acute peritonitis was high prognostic significance of results this study, which allows defining treatment tactic of these patients. To include in complex post-operative treatment of these pa-tients with evaluated antioxidant and anticytokine therapy allowed reducing the development of purulent-septic complications from 82.4 to 66.7%, which increased effectively of treatment in such patients and reduced the term of hospitality.