Sobko V. Endoscopic hemostasis in ulcerous bleeding in patients with hemorrhagic shock

In order to improve the treatment of patients with hemorrhagic shock because of ulcerative gastro-duodenal bleeding, the method of endoscopic reparative-hemostatic injection therapy with the use of platelet-riched plasma is proposed. To evaluate the effectiveness of this methodology, an experimental model of gastrointestinal bleeding with the following endoscopic reparative-hemostatic injection therapy (Patent of Ukraine for Utility Model No. 114893) was developed on the background of hemorrhagic shock. Metabolic violations of periulcetal tissues were studied under the conditions of development of hemorrhagic shock in the experiment, as well as methods of correction of these changes. The proposed method of endoscopic reparative-hemostatic injection therapy allows achieving a reliable hemostasis, as well as adjusting metabolic changes in periulcetal tissues, which leads to more rapid healing of ulcer defects. In practice, this can reduce the mortality of patients with hemorrhagic shock because of ulcerative bleeding, as well as reduce the length of their inpatient treatment. It has been established that stimulating therapy in the form of local periulcetric introduction of plasma enriched with platelets allows to slow down the processes of VOL, activate protective functions of the mucous membrane and accelerate the processes of reparation in the periulcele zone. Morphologically, this is accompanied by a decrease in cellular elements of inflammatory reaction and activation of elements of the fibroblastic series, which, in turn, is manifested by a progressive decrease in the area of ulcer defects. In the clinical part of the work, the reparative and hemostatic properties of PRP have been studied for periulcelar injection in patients with hemorrhagic shock because of ulcerative gastro-duodenal bleeding. The efficiency of the proposed method is shown in practical use. The clinical part of the dissertation was a prospective study of patients treated for ulcerative gastro-duodenal bleeding in the clinic of endoscopic and cardiovascular surgery at Vinnitsa National Medical University M. I. Pirogov on the basis of the department of abdominal surgery of the Vinnytsia Regional Clinical Hospital M. I. Pirogov from 2013 to 2017 years. Thus, the results of the morphological study convincingly suggest that the use of plasma enriched platelets in the treatment of stomach ulcers in conditions of hemorrhagic shock, leads to more rapid inhibition of inflammation and accelerates the healing of ulcer defects.