Extracorporeal Detoxification Methods in the Treatment of Destructive Pancreatitis
https://doi.org/10.15360/1813-9779-2015-3-65-74
Abstract
The rise in the incidence of acute necrotic pancreatitis in the past decade and high mortality rates of as high as 20—45% all suggest that the disease is of high social, medical, and economic importance.
Objective: to study the efficiency of extracorporeal detoxification methods in the combination treatment of patients with severe destructive pancreatitis.
Subjects and methods. The investigation enrolled 20 patients aged 40 to 53 years with destructive pancreatitis treated in the intensive care unit, Almaty City Clinical Hospital Four.
Results and discussion. Analysis of the findings over time could reveal that early incorporation of extracorporeal detoxification methods in the combination treatment of pancreatic necrosis provides a reduction in the clinical signs of endotoxicosis, which could prevent anuric acute renal failure in 61% of the cases and completely safeguard against multiple organ dysfunction in 22%. The investigation showed the necessity and efficiency the early use of albumin dialysis, hemodiafiltration in the combination treatment of sepsis and septic shock in destructive pancreatitis, leading to a significant reduction in mortality rates. The maximum detoxification potential of albumin dialysis in sepsis complicating the course of destructive pancreatitis is achieved by a combination of different mechanisms for elimination of toxic substances, such as convection, sorption, and diffusion, in the extracorporeal circuit.
Conclusion. Early use of extracorporeal detoxification methods in patients with severe destructive diseases of the pancreas results in a significant reduction in mortality rates.
About the Authors
E. L. Ismailov
S. D. Asfendiyarov Kazakh National Medical University
Russian Federation
Russian Federation
Department of Anesthesiology and Reanimatology with Course of Emergency Care, Institute of Postgraduate Education
88, Tolebi Street, Almaty 050000, Republic of Kazakhstan
S. N. Eralina
S. D. Asfendiyarov Kazakh National Medical University
Russian Federation
Russian Federation
Department of Anesthesiology and Reanimatology with Course of Emergency Care, Institute of Postgraduate Education
88, Tolebi Street, Almaty 050000, Republic of Kazakhstan
B. B. Tekesbaev
S. D. Asfendiyarov Kazakh National Medical University
Russian Federation
Russian Federation
Department of Anesthesiology and Reanimatology with Course of Emergency Care, Institute of Postgraduate Education
88, Tolebi Street, Almaty 050000, Republic of Kazakhstan
R. B. Abdrasulov
S. D. Asfendiyarov Kazakh National Medical University
Russian Federation
Russian Federation
Department of Anesthesiology and Reanimatology with Course of Emergency Care, Institute of Postgraduate Education
88, Tolebi Street, Almaty 050000, Republic of Kazakhstan
References
1. Moroz V.V., Grigoryev E.V., Churlyaev Yu.A. Abdominalnyi sepsis. [Abdominal sepsis]. Мoscow; 2006: 192. [In Russ.]
2. Bagnenko S.F., Tolstoi A.D., Krasnorogov V.B., Kurygin A.A., Sinenchenko G.I., Sukharev V.F., Grinev M.V., Lapshin V.N., Verbitsky V.G., Kiselev V.A., Kabanov M.Yu., Goltsov V.R. Ostryi pankreatit. Protokoly diagnostiki i lecheniya. [Acute pancreatitis. Diagnostic and treatment protocols]. Sankt-Peterburgsky NII skoroi pomoshchi imeni I.I.Dzhanelidze. Sankt-Peterburg; 2004: 12. [In Russ.]
3. Ermolov A.S., Ivanov P.A., Belyaev A.A. Rol maloinvazivnykh vmeshatelstv pri lechenii ostrogo pankreatita. Materialy gorodskogo seminara. [Role of minimally invasive interventions in the treatment of acute pancreatitis. Proceedings of the town seminar]. Moscow: NII skoroi pomoshchi imeni N.V. Sklifosovskogo; 2003: 5—9. [In Russ.]
4. Gostishchev V.K., Glushko V.A. Pankreonekroz i ego oslozhneniya. Osnovnye printsipy khirurgicheskoi taktiki. [Pancreonecrosis and its complications, basic principles of surgical approach]. Khirurgiya. Zhurnal Imeni N.I.Pirogova. 2003; 3: 50—54. PMID: 12698653. [In Russ.]
5. Gorsky V.A., Kovalchuk L.V., Agapov M.A., Khoreva M.V., Ovanesyan E.R., Nikonova A.S., Grechenko V.V. Antimediatornaya terapiya v kompleksnom lechenii ostrogo destruktivnogo pankreatita. [Antimediatory therapy in the complex treatment of acute destructive pancreatitis]. Khirurgiya. Zhurnal Imeni N.I.Pirogova. 2010; 3: 54—61. PMID: 20524238. [In Russ.]
6. Beger H.G., Rau B., Isenmann R. Natural history of necrotizing pancreatitis. Pancreatology. 2003; 3 (2): 93—101. http://dx.doi.org/10.1159/000070076. PMID: 12774801
7. Popova E.Yu., Kuznetsov N.A., Vladimirov V.G., Zarinskaya S.A., Andreitsev A.N., Brontvein A.T., Kuzin A.N. Porazhenie zabryushinnoi kletchatki pri destruktivnom pankreatite. [Lesions of retroperitoneal fatty tissue in destructive pancreatitis]. Khirurgiya. Zhurnal Imeni N.I.Pirogova. 2004; 8: 52—55. PMID: 15340319. [In Russ.]
8. Buter A., Imrie C.W., Carter C.R., Evans S., McKay C.J. Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br. J. Surg. 2002; 89 (3): 298—302. http://dx.doi.org/10.1046/j.0007-1323.2001.02025.x. PMID: 11872053
9. Filimonov M.I., Gelfand B.R., Burnevich S.Z. Destruktivnyi pankreatit: kompleksnaya diagnostika i lechenie. [Destructive pancreatitis: a comprehensive diagnosis and treatment]. Novyi Meditsinsky Zhurnal. 1997; 4 (3): 10—13. [In Russ.]
10. Khoroshilov S.E., Nikulin A.V. Efferentnoe lechenie kriticheskikh sostoyanii. Obshchaya Reanimatologiya. [Efferent treatment for critical conditions. General Reanimatology]. 2012; 8 (4): 30—41. http://dx.doi.org/10.15360/1813-9779-2012-4-30. [In Russ.]
11. Khoroshilov S.E., Nikulin A.V., Marukhov A.V. Preduprezhdenie razvitiya sindroma poliorgannoi nedostatochnosti v fermentativnoi faze tyazhelogo ostrogo pankreatita. [Prevention of multiple organ dysfunction syndrome in the enzymatic phase of severe acute pancreatitis]. Vestnik Natsionalnogo Mediko-Khirurgicheskogo Tsentra Imeni N.I.Pirogova. 2014; 9 (1): 58—62. [In Russ.]
12. Gumenyuk N.I., Kirkilevsky S.I. Infuzionnaya terapiya. Teoriya i praktika. [Infusion therapy. Theory and practice]. Kiev: Kniga plyus; 2004: 119—123. [In Russ.]
13. Kravets V.P., Kravets V.V. Diagnostika i lechenie bolnykh s parezom kishechnika v rannem posleoperatsionnom periode. [Diagnosis and treatment of patients with enteroparesis in the early postoperative period]. Vestnik Sumskogo Gosudarstvennogo Universiteta. Seriya: Meditsina. 2007; 2: 172—175. [In Russ.]
14. Batotsyrenov B.V., Livanov G.A., Andrianov A.Yu., Vasilyev S.A., Kuznetsov O.A. Osobennosti klinicheskogo techeniya i korrektsiya metabolicheskikh rasstroistv u bolnykh s tyazhelymi otravleniyami metadonom. Obshchaya Reanimatologiya. [The clinical course and correction of metabolic disturbances in patients with severe methadone poisoning. General Reanimatology]. 2013; 9 (2): 18—22. http://dx.doi.org/10.15360/1813-9779-2013-2-18. [In Russ.]
15. Eremeyeva L.F., Menshchikov V.V., Berdnikov A.P., Yampolsky A.F. Provedenie lipidnoi «on line» gemodiafiltratsii (eksperimentalnoe issledovanie). Obshchaya Reanimatologiya. [Lipid on-line hemodiafiltration (experimental study). General Reanimatology]. 2013; 9 (1): 37—42. http://dx.doi.org/10.15360/1813-9779-2013-1-37. [In Russ.]
16. Kornilov I.A., Grazhdankin I.O., Redkin D.A., Deryagin M.N., Efremov S.M., Lomivorotov V.V. Ekstrakorporalnoe membrannaya oksigenatsiya pri ostrom infarkte miokarda, oslozhnennom kardiogennym shokom. Obshchaya Reanimatologiya. [Extracorporeal membrane oxygenation in acute myocardial infarction complicated by cardiogenic shock. General Reanimatology]. 2013; 9 (3): 54—57. http://dx.doi.org/10.15360/1813-9779-2013-3-54. [In Russ.]
17. Khoroshilov S.E., Nikulin A.V., Marukhov A.V. Primenenie plazmafereza v fermentativnoi faze tyazhelogo ostrogo pankreatita. Obshchaya Reanimatologiya. [Use of plasmapheresis in the enzymatic phase of severe acute pancreatitis. General Reanimatology]. 2013; 9 (6): 53—60. http://dx.doi.org/10.15360/1813-9779-2013-6-53. [In Russ.]
Review
For citations:
Ismailov E.L., Eralina S.N., Tekesbaev B.B., Abdrasulov R.B. Extracorporeal Detoxification Methods in the Treatment of Destructive Pancreatitis. General Reanimatology. 2015;11(3):65-74. https://doi.org/10.15360/1813-9779-2015-3-65-74
Views:
2172
Email this article 