TREATMENT TACTICS OF PATIENTS WITH ACUTE PERITONITIS

Due to the high mortality rate the treatment improvement of patients with acute peritonitis (AP) remains a critical problem. Nevertheless, a well-known set of guidelines contains some contradictions that need to be resolved. The aim of the work is to evaluate the effec-tiveness of the well-established treatment tactics of pa-tients with AP. Materials and methods. 60 patients with local AP were found in 12 (20%) patients, diffuse – in 15 (25) patients, spilled-in 17 (28.33%) patients, and total – in 16 (26.67%) patients. A retrospective analysis of the treat-ment results of 169 patients with various forms of AP. 79 of them have had postoperative complications. 39 pa-tients have died. Treatment of patients has been per-formed using the developed algorithm. Results. The basis of the chosen tactics has been developed predictive scale, which provides the prelimi-nary and main stages of prediction. The indications have been extended for patients of medium and high risk be-fore the surgery. Patients with an average risk have a standard volume of it. We have provided additional measures to correct the state of regulatory mechanisms for patients with high risk. The main evaluation has been performed during the operation, taking into account the content of rod-shaped neutrophil leukocytes and a pro-grammed abdominal debridement. The prevalence of AP has been estimated using the developed objective method. We have used a differentiated set of intraoperative and postoperative measures. The measures indications to prevent wound complications have been expanded for patients with increased risk. The measures to prevent intra-abdominal complications in patients with medium and high risk have been expanded either. The indications for the programmed abdominal debridement have been expanded for patients with high risk. The developed methods of debridement have been used. The standard medicated complex has been supplemented with appropriate means for patients with medium and high risk. The functional condition of the liver, kidneys, mechanisms of fibrinolysis, proteolysis, redox reactions has been taken into account in advance. The means are the following: antioxidant and antiproteolytic drugs, the regulators of the microcirculation, hepatoprotectors, nefroprotector. We treated 24 patients, including 15 patients with spilled and general AP with the help of these tactics, and the rest - with diffuse AP. A programmed lavage has been used to all patients having spilled and general AP. A comparative research has proved that well-known tactics allowed to decrease the residual intra-abdominal infiltrates by 18.18% in patients with spilled and general peritonitis, prevent postoperative wound suppuration, avoid lethality, and reduce the duration of in-patient facility, on average, by 2.5 days. None of the patients with diffuse AP has had any intra-abdominal complications. Conclusions. 1. The developed algorithm, based on a reasonable allocation of risk groups for postopera-tive complications, allows to determine the treatment tactics of patients and improve the medicated complex. 2. The two-stage developed prognostic scale al-lows to identify risk groups for complications before surgery and specify the risk during the operation either. 3. Clinical testing of the algorithm indicates its effectiveness and proper implementation in further wide-spread practice.