Bogun H. Purulent-septic complications prophylactics in patients with acute intestinal obstruction

The thesis is dedicated to the solution of urgent problem of modern clinical surgery - improvement of the results of surgical treatment of the patients with acute intestinal obstruction with the help of worked out method of coordinative antibiotic therapy directed to the decrease of post-operative purulent-septic complications number. During the study of AIO model on 40 white rats hystomorphologic changes in the intestine wall higher the place of obstacle were studied in dynamics in the animals of the control group (without antibiotic therapy) and 4 main groups (8 species in each), receiving antibiotic therapy of ampicillin (group A), hentamicin (group H), oframax (group O) and cifran (group C). Under hystologic study of dynamics of changes, taking place in thin wall of animals with experimental AIO model it was stated that higher the place of obstacle in it features of progressive purulent inflammation are found, starting on the side of mucous membrane. Under coordinative administration of antibiotics to animals with experimental AIO model pathomorphologically in inflammatory intestine wall changes testifying about slowing down of purulent-destructive processes in it are found in animals, receiving cifran and oframax, where even in 48 hours after AIO formation no focus necrosis of intestine wall appeared; both in animals receiving ampicilin or hentamicinу and in animals of control group focuses of perforation of intestine wall with peritonitis development appeared in the same terms. Microbiologic picture of intestine microbiocenosis violations as long as AIO develops was manifested in the way of progressive decrease of bifido- and lactobacteria titer and the growth of pathogenic strains of staphylococcus and intestine bacillus of appeared peptococcus and clostridiae. In 48 hours from the moment of AIO modeling in intestine wall on the background of ampicillin and hentamicin application the number of toxonomic groups decreased from 5 to 3, under application of cifran and oframax - to 2, when 5 toxonomic groups of microorganisms were defined from bioptates of intestine wall in animals of control group. Proved experimentally according to clinical, morphologic and bacteriologic criteria benefits of cifran and oframax in treatment of AIO are mostly (besides spectrum of antimicrobe activity) defined by their ability to accumulation in inflammatory intestine and "retention" in it in TEQ in compzrison with ampicillin and hentamicin. The results of the conducted experiment allowed scientific validation of the program of purulent-septic complications prophylaxis in patients operated on AIO for clinical use, which includes diagnostics of AIO by the way of US method and foresees execution of antibiotic therapy to the patients with the use of preparations of fluoridequinoline and cefalosporine line in treatment dozes immediately after diagnosis validation. The application of the worked out complex of means in 85 patients of the main group operated on AIO (control group - 81 patient) provided decrease of purulent-septic complications number from 33,3% to 19,1% and post-operative lethality - from 9,8% to 4,7%.