Subsequent therapy

High mortality in peritonitis (RP) remains one of the toughest problems of abdominal surgery and reaches 65-90%. Formulation of the optimal operating tactics and subsequent therapy is both scientific and specific medical problem (VK Gostishchev, 1992; PG Brousov, 1998). For this purpose we have defined the propagation model of peritonitis. In general, they correspond to the fundamental well-known principled way its surgical treatment - "open", "half-open", "semi-enclosed". Research problem is the mathematical justification for the selection of therapeutic measures in the ER. To do this, use two scales assessing the severity of the state - APACHE II and Mannheim Peritonitis Index (VD Fedorov, 2000; AM Svetuhin, 2002). Patients (575) were examined preoperatively and postoperatively. For a deeper analysis of the studied statistical data reflecting the severity in various forms of multiple organ failure and various parameters of classification syndrome systemic reaction to inflammation (AM Svetuhin, 1999). In the development of tactical algorithms, we assumed that the most favorable course (CFR 10.1%) may be in semi-enclosed method of treatment of RP, ie, after the one carried out correctly and on the testimony of the operation. However, with inadequate therapeutic and diagnostic activities or the development of intra-abdominal complications can not arrest the symptoms of abdominal sepsis and multiple organ failure. In these cases, repeated surgery was undertaken, which significantly reduces the chances of recovery (CFR 46.3%). Repeated interventions undertaken in the event of postoperative peritonitis after routine surgery. In these cases, mortality was 23.8%. Semi-open method of surgical treatment was used as an alternative to semi-enclosed with purulent peritonitis. Its effectiveness, along with a complex organo-resuscitation has been demonstrated, and mortality in this group was 25,9%.

The following results: at a purulent RP treatment was carried out semi-closed manner preoperative score of APACHE II (DOB APACHE II) was 14,0 ± 1,2; Mannheim index - 28,7 ± 1,1. Among patients with purulent peritonitis, treatment was carried out semi-open way, APACHE II score was 15,1 ± 1,7, and MIP - 27,5 ± 2,2. For signs of syndrome, systemic inflammatory response (SIRS) (Bone RC) determines the average brand viagra score of APACHE II - 14,4; absence of SIRS - 10,6. ADD APACHE II and 15] determine the mortality rate 6.2%, the score [16-25] - fatality rate 41.4%; score [26 and over - mortality 88,9%. Mean DSS APACHE II with organ failure constituted 23,4 ± 3,1; for failure of two organ systems - 18,4 ± 1,6; in the absence of dysfunction of organs - 11,3 ± 0,6.

Development of the program provided an opportunity not only to carry out a generalization in the study group, but the scale and calculate the score of APACHE II in its criteria in the dynamics until the sixth day after surgery for each patient. Summarizing the data will give a mathematical justification for the selection of the operating tactics, techniques, decompression of the gastrointestinal tract and other known and emerging methods of treatment WP, as well as identify the most diagnostically useful clinical and laboratory findings during abdominal sepsis.

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