POSSIBILITIES OF USING THE ANALYSIS OF OXIDANT-ANTIOXIDANT METABOLIC PROCESSES AND ION EXCHANGE IN PREDICTING THE DEVELOPMENT OF POSTOPERATIVE COMPLICATIONS IN SMALL BOWEL SURGERY

Abstract

Summary. Introduction. The work is devoted to the study of the possibilities of using the analysis of oxidant-antioxidant metabolic processes and ion exchange in predicting the development of postoperative complications during operations on the small intestine in conditions of a compromised abdominal cavity.
 The aim of the study. To determine the peculiarities of the flow of oxidant-antioxidant metabolic processes and ion exchange during operations on the small intestine in conditions of intra-abdominal infection and to study the clinical effectiveness of their assessment.
 Materials and methods. Research was conducted at the Institute of General and Emergency Surgery of the State University named after V.T. Zaitsev National Academy of Sciences of Ukraine”. The study properly included 88 patients who were divided into three groups: a control group (20 patients), a study group (50 patients).
 Results and discussion. The most common criteria for assessing the viability of an ischemic intestine are subjective assessments of color, motility, and pulsation of mesenteric vessels both during examination and after physical or pharmacological effects. However, such an assessment is subjective, does not always correspond to the actual condition of the intestinal wall, which leads either to an unjustified expansion of the scope of the intervention, or to an erroneous overestimation of the vital function of the damaged intestine.
 As a result of the research, a decrease in the phagocytic activity of neutrophils was found in patients who underwent resection of intestinal segments. In these patients, the development of endogenous intoxication was characterized by a decrease in the level of platelets and indicators of the blood anticoagulation system, leukopenia and methemoglobinemia, which requires antioxidant, antitoxic, as well as anticoagulant and immunological correction.
 The study of the exchange of metal ions in the blood serum of operated patients revealed dynamic changes in their content, iron ions (Fe2+); zinc (Zn2+); copper (Cu2+). The study of ion exchange of metals in the serum of the studied patients revealed significantly (p<0.05) higher levels of iron and copper, which can have an important diagnostic and prognostic value when justifying the scope of surgical intervention.
 The results of studying the state of oxidant-antioxidant processes in the studied patients revealed an increase in the level of lipid peroxidation products: malondialdehyde (secondary products) and diene conjugates (end products); since the LPO system is a primary predictor of future immunodeficiency.
 The correlation analysis revealed a direct correlation between the initial content of cryoglobulins and the presence of postoperative complications (r=0.56, p=0.07 and r=0.53, p=0.052). Detection of high concentrations of cryoglobulins in the blood serum of operated patients already in the first hours allowed us to assume the presence of maximal autoimmune changes in intra-abdominal infection.
 The study of the spectrum of serum protein fractions, lipid peroxidation, the state of antioxidant protection, the activity of liver enzymes, factors of humoral and cellular immunity, revealed pronounced endotoxicosis, functional damage to hepatocytes, a violation of the immune status of the body, which correlated with the severity of pathological changes against the background of intra-abdominal infection.
 Conclusions. Analysis of oxidant-antioxidant metabolic processes, bioenergetic state testified to the stimulation of free radical processes, activation of lipid peroxidation, inhibition of antiradical protection in the studied patients, which in the complex stimulates the development of membrane pathology against the background of endogenous intoxication and inhibition of bioenergetics; there are processes of primary inhibition of non-specific resistance of the organism, in combination with a violation of the regeneration of individual links of the immune system.