MAIN FACTORS OF DECOMPENSATION SYSTEM I NFLAMMATORY REACTION SYNDROME THE PATIENTS WITH ABDOMINAL SEPSIS
Summary. The goal of the robot is to determine the factors of decompensation of the systemic inflammatory response syndrome (SIRS) in abdominal sepsis (AS). Materials and methods. Based on the results of a comprehensive examination of 295 patients with AS according to the indicators of clinical and laboratory, biochemical, immunological examination and study of intra-abdominal pressure and the severity of enteral insufficiency, the leading factors in the development of DSIRS were determined.
Results and discussion. It was found that against the background of secondary cellular immunodeficiency, the development of severe compartment syndrome with decompensated enteric insufficiency syndrome (EIS) was determined, which in combination deepened pathological changes with the progression of the inflammatory reaction and the development of organ failure. Indicators of the level of C-reactive protein 2.5 times, and procalcitonin 2.4 times were higher during hospitalization of patients with decompensated syndrome (P<0.001). With decompensation, a severe degree of SES was diagnosed 18.5 times more often, and with a compensated one, a mild degree of insufficiency was diagnosed 57 times more often, P <0.001. At the same time, a direct correlation was determined between the severe degree of EIS and symptoms of nausea (r = 0.420), vomiting (r = 0.573) and bloating (r = 0.251), (P <0.005). The immunoregulatory index (IRI) played the role of a marker of decompensation in patients with AS, (r = + 0.74, at p <0.01) with the development of secondary immunodeficiency, according to the T-suppressor type. In 60.8 % (n = 101) of cases with DSIRS, the fourth degree of intra-abdominal pressure was determined, on average it was (46.3 ± 6.3) mm, and I degree was determined only in the case of compensation, (P <0.001). More often in patients with DSIRS, the associations of gram-positive microorganisms and enterococci were determined — in 55.6 % and streptococci — in 38.1 % of cases. At the same time, in 81.3 % of cases, patients with DSIRS were diagnosed with aerobic-anaerobic mixed flora.
Сonclusion. The obtained results of the study require the development of treatment methods that will effectively correct these pathogenetic changes in all directions in patients with AS.
2. Rudnov VA, Kulabuhov VV. Sepsis-3: obnovlennye klyuchevye polozheniya, potencial’nye problemy i dal’nejshie prakticheskie shagi. Vestnik anesteziologii i reanimatologii. 2016;4. 4-11.
3. Savel’eva BC, Gel’fanda BR. Sepsis: klassifikaciya, kliniko-diagnosticheskaya koncepciya, lechenie.M.: OOO «Med. inform. agentstvo»,2010, 352s.
4. Tereshchenko A, Botashev A, Pomeshchik YU, Petrosyan E, Sergienko V. Sindrom endogennoj intoksikacii i sistemnoj vospalitel’noj reakcii pri zhelchnom peritonite, oslozhnennom abdominal’nym sepsisomo. Vestnik eksperimental’noj i klinicheskoj hirurgii. 2013;4.722-26.
5. Kiselevskij M, Sitdikova S, Abdullaev A, SHlyapnikov S, CHikileva I Immunosuppression in sepsis and possibility of its correction. Vestnik khirurgii I. Grekova.2018; 177(5):105-07.
6. Monti G. Landoni G, Taddeo D. Clinical aspects of sepsis: an overview. Methods Mol. Biol.2015;12:(37).17-33.
7. Hecker A, Padberg W, Hecker M. Sepsis: Current Clinical Practices and New Perspectives: Introduction to the Special Issue. J. Clin. Med. 2021 Jan 24;10(3):443.
8. Moraes R, Serafini T, Vidart J, Moretti M, Haas J, Pagnoncelli A, Azeredo M, Friedman G. Time to clearance of abdominal septic focus and mortality in patients with sepsis. Rev. Bras. Ter. Intensiva. 2020 Jun;32(2):245-50.
9. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).JAMA. 2016;315(8).801-10.