Search

Acute erosive ulcerative hemorrhage (EUH) is one of the most grave complications of burn disease, caused by impaired blood rheology, clotting, and protein status. Twenty-three patients with burns of 12-70% body surface were examined, 17-25% of burns being deep. The most pronounced changes in blood rheology and clotting with formation of erythrocyte aggregations, fibrin precipitation and imbalance of visceral proteins were observed during the shock stage (days 1-3), particularly pronounced in patients with acute EUH. Development of septicotoxemia favored secondary increase in blood clotting and rheological parameters, which led to thrombotic complications. The data helped improve the complex of infusion-transfusion therapy for preventing and treating ulcerative and erosive lesions.

Early diagnosis of retroperitoneal festering is possible if methodologically strictly carrying out of succession of radiation methods (US, computed tomography, roentgenological examination) is applied and used in complex. Extraperitoneal approach to phlegmon of retroperitoneal cellular tissue provides good visualization and is less traumatic. Infusional and enteral therapy in postoperative period promote effective elimination of volemic disturbances, stabilization of hemodynamic indices, and provides stable curative effect.

An analysis of results of 26 patients has been made who had incompetent sutures of anastomoses and stump of the duodenum at the nearest postoperative period after gastric resection. In 14 patients (main group) aspiration-lavage method of drainage was used, in 12 patients (control group) other methods of treatment of incompetent sutures were employed. The advantage of the aspiration-lavage method of treatment over other methods is shown.

A pathogenetically substantiated multicomponent infusion-transfusion therapy for surgical patients with pyoseptic complications is suggested with consideration for the correction of all the links of homeostasis. The authors give a concrete scheme of multicomponent infusion-transfusion therapy as it is applied day by day, with due regard for the set of necessary transfusion media, their volume, the number of times that they are infused, and the order of their use. The favourable experience in the application of infusion-transfusion therapy in 421 patients is discussed.

Rheological properties of blood were studied in dynamics in 33 patients with different localization of purulent processes in the abdominal cavity. It was found that in patients with a limited purulent process the alterations of blood rheology corresponded to the clinical status of the patients and their parameters has a tendency to increase. In patients with generalized purulent processes the alterations of blood rheology did not correspond to the degree of the inflammatory process and pointed to manifestation of signs of coagulopathy of consumption requiring special many-component infusion-transfusion therapy.

Alterations in the system of microcirculation were found in the postoperative period in 30 patients with trauma of the chest and abdomen which depended upon the blood loss volume and are of plastic character. The main cause of these alterations in the early postoperative period is the change of the microvessels tone. In remote terms of the postoperative period changes of blood rheology play the leading role in alterations of microcirculation. The alterations of microcirculation as one of the mechanisms of the development of polyorganic insufficiency in trauma disease need permanent control and therapy, aimed at correction of tonic and vasomotor activity of resistant and capacitance microvessels, rheological components of blood and ratio of globular volume and plasma.

Examinations made in 30 patients with a trauma of the chest and abdomen have shown the alterations in blood rheology resulting from the trauma and blood loss to be persistent and often to make progress in the postoperative period. In purulent complications there appear secondary alterations of blood rheology which acquire a lingering character. The syndrome of decreased viscosity of blood is a dangerous disturbance of microcirculation since it is due to the activation of blood cell structures against the background of elevated utilization of hemostasis factors and requires a purposeful therapy.