Dashchenko Y. Efficiency of different variants of preoperative intensive care of acute hepatic insufficiency in patients with an obturative jaundice.

Dissertation is dedicated to optimization of preoperative intensive care of acute hepatic insufficiency in patients with the obturative jaundice of belignant genesis. The complex clinical,laboratory, instrumental investigation and intensive medical treatment is conducted in 128 patients with acute hepatic insufficiency of the different degree of stage on a background of obturative jaundice were made. We have concluded, that all patients with the syndrome of obturative jaundice have acute hepatic dysfunction which can be transformed into acute hepatic insufficiency at inadequate intensive care and delaying surgical treatment. At surgical restoration of free bilification in patients the phenomena of a syndrome biliary decompression with strengthening of processes of cytolysis syndrome make to progress. Thus glutamatdehydrogenase is the most significant marker of cytolysis syndrome processes. The traditional complex of preoperative intensive care substantially does not affect the biochemical indexes of blood in patients with acute hepatic insufficiency during the first 3 days. Combination of traditional complex of the intensive care with enterosorbtion stabilization the processes of cytolysis within the limits of 1 postoperative day, decrease of endotoxicosis. Combination of traditional medical treatment with enterosorbtion and intraportal infusion of perftoran removes microcirculation and mitohondrial dysfunction and trombocytopathy, decreases of endotoxicosis, blocks development of syndrome of system inflammatory answer. Intraportal infusion of preoxygen perftoran can be examined as a basis of a new direction in medical treatment of acute hepatic insufficiency - hepatocytes protective therapy.