IMMUNOLOGICAL REACTIVITY IN PATIENTS WITH ACUTE PERITONITIS

The analysis of clinical and immunological examination of 56 patients with acute peritonitis in which the programmed laparotomy is used. It has been proved that in conditions of depletion of functional activity of immunocompetent cells and secondary immunodeficiency, which is observed in patients with infectious-toxic shock (ITS) and abdominal sepsis (AS) at the time of 3-5 programmed laparotomies, conduction of immunostimulation is inappropriate. In the complex treatment of acute peritonitis against the background of the so-called "immune paralysis", the introduction of plasma of donors-convalescents, who became ill with acute peritonitis, was substantiated. The generalization of the infection is due to the predominance of the activity of the pathogen over the bacteriostatic capabilities of the organism. It should be emphasized that sepsis does not develop because of a violation of immunity in general, but due to a breakdown in one of its links, which causes a violation of the synthesis of antibodies or a decrease in phagocytic activity of neutrophils, or a violation lymphocytes proliferation. The gastrointestinal tract contains normal microflora, which not only engages in digestion, but also in the formation of the immune reactivity of the organism. That is why the lymphoid tissue associated with the intestine is the strongest immune link in the human body, since it serves as an effective barrier against endotoxins and bacteria in the lumen of the intestine. It should also be noted that such an important physiological phenomenon as translocation of endotoxin, which causes increased activity of the reticuloendothelial system (RES), especially of the Kuepfer cells in the liver. In the absence of immune protection, the infection can quickly become generalized. On the other hand, excessive immune response is also capable of harming the body in connection with the massive release of endogenously synthesized pro-inflammatory substances that lead to the development of the syndrome of systemic inflammatory response (SPSS-SIRS). Principal importance in the development of "immune paralysis" has a depletion of proinflammatory mechanisms. This is a peculiar reaction of immunocompetent cells to a massive infection and a variety of extreme influences. Immunoparalysis is manifested by T-cell dysfunction - inferior proliferation of T-lymphocytes under the influence of excessive antigenic or cytokine (IL-2 and IFN-y) stimulation. The purpose of the study is to substantiate the method of correction of violations of the level of specific antibodies against surgical microflora in the complex treatment of patients with signs of ITS in the background of neglected acute peritonitis. In conditions of the most pronounced immune depletion, stimulation of the immune system was not feasible, the only way - is the passive immunotherapy. Indications for re-transfusion of hyperine plasma were the lack of improvement in the clinical picture and the weak dynamics of antibody titer in patients with peritonitis after transfusion of hyperimmune plasma. Conclusions 1. In the conditions of depletion of functional activity of immunocompetent cells and secondary immunodeficiency, which is observed in patients with ITSH and AS at the time of 3-5 programmed laparotomies, conduction of immunostimulation is not feasible. 2. In the complex treatment of acute peritonitis against the background of the so-called "immune paralysis", encouraging results can lead to the use of plasmas of donors-convalescents who became ill with acute peritonitis.