Makoviychuk Y. Optimization of treatment of endotoxicosis in patients with purulent-septic complications

The thesis is presented in 8 chapters. The patients with nosologies accompanied by the development of endointoxication syndrome (EIS) constitute a greater part of all the patients in the intensive care units. Endotoxicosis ,in its turn, complicates the course of the main disease, prevents to realize a complex of therapentic measures, worsens perspectives of recovery. Exo- and endotoxin action on various structures of the functional systems in the primary chain in the formation of endotoxicosis in case of purulent-septic complications. None of the vital body systems can be intact under such conditions. Systemic inflammatory response syndrome (SIRS), transforming into polyorganic failure, is a clinical sign of endotoxicosis. Natural detoxication system of the human body is not always able to cope with this pathology under these conditions, that is why, various methods of detoxication are widely used in clinical practice. Plasmapheresis (PPh) is a preferable detoxication method nowadays. The analysis of scientific literary sources concerning the use of PPh is indicative of its efficacy in different branches of medicine. During the period of research functional state (condition) of the kidneys in patients with SIRS under conditions of endotoxicosis, caused by purulent - septic complications, has been examined. Iono-, volume-, osmoregulatory functions of the kidneys in patients with endotoxicosis under conditions of conducting combined (optimized) discrete PPh with infusion, e.g. glucose-salt solution or sorbilact, have been studied. The influence of optimized plasmopheresis sense upon the level of endotoxicosis including cytokine spectrum in patients with purulent-septic complications has been detected. The state of central and peripheral hemodynamics in patients with SIRS under conditions of endotoxicosis, caused by purulent - septic complications, has been studied as well as the influence of discrete plasmapheresis combined with the infusion of glucose-salt solution or sorbilact upon the circulatory system of patients with purulent-septic complications. Drainage property of plasmopheresis, combined with the infusion of glucose - salt solution and sorbilact, has been examined as well as the character of fluid circulation in the extracellular water-space under conditions of conducting discrete plasmapheresis or other optimizing measures. The analysis of comparative clinical-laboratory characteristics of the detoxication effect of blood plasmapheresis and induced possibilities of renal toxin-excreting function is indicative of efficacy of the elaborated method and substantial prospects (perspectives) to use the combination of extracorporal and intracorporal methods, the combination of diserete plasmapheresis and sorbilact infusion in particular.