The thesis describes the actual tasks of modern medicine such as improvement of the results of treatment of patients with diabetic ketoacidosis and prevention of its complications, early diagnosis of hepato-intestinal dysfunction, optimization of intensive care by introducing the method of enteral oxygenation.
The purpose of the research is to improve the results of treatment of patients with diabetic ketoacidosis and to prevent its complications by early diagnosis of hepato-intestinal dysfunction and optimization of intensive care by introducing the method of enteral oxygenation and pharmaco-metabolic correction based on the comparison of dynamics of clinical and functional disorders.
The clinical-laboratory and instrumental examination was performed to 85 patients with diabetic ketoacidosis. The diagnosis of diabetic ketoacidosis is set according to the data of clinical-laboratory and functional methods of examination (hyperglycemia, ketonuria, typical dysfunctions of the vital organs, reohepatography, ultrasonography). The disorders of the digestive system were clinically evaluated as paresis of the intestine, hepatomegaly. During the detection of gastrointestinal disorders the dynamic clinical and instrumental examination was carried out in all cases.
Patients were divided into two groups depending on the features of the conducted intensive care. The 1st group consisted of 42 patients who were undergone traditional IT. The 2nd group included 43 patients. The patients of the 2nd group were performed both ІТ and enteral oxygenation. Patients were determined the level of glycemia, lactate, ketoneuria, were taken intra-abdominal pressure, were checked reo-hepatology, venous blood saturation, general clinical and biochemical blood tests, ultrasound examination of the abdominal cavity.
It has been established that faster and more reliable normalization of the intra-abdominal pressure and oxygen consumption occurs during the use of enteral oxygenation in the complex of intensive care in patients with diabetic ketoacidosis already on the 3rd day in comparison with traditional treatment. The most patients of both groups in the initial state had signs of intra-abdominal hypertension of the II-III degree (Me = 18 mm Hg), during the process of IT the incidence of intra-abdominal pressure in patients of the 1st group was 12.5 [7; 16] mm Hg, on the 3rd day – 6.5 [2; 12] mm Hg, in the 2nd group – 6 [1; 12] mmHg. and 2 [0; 3] mm Hg (p<0.05). The normalization of the indicators of the reohepatography is revealed in parallel with the elimination of intra-abdominal hypertension, which reflects the improvement of blood supply to the liver. The decrease in the manifestations of systemic hypoxia was confirmed by the normalization of venous saturation and oxygen extraction, a reduction in the concentration of blood lactate. The indicator SvO2 in patients of the 1st group was 60 [58.62] % on the 3rd day, 64 [61.66] % on the 5th day; in the 2nd group – 65 [63.68]% and 72 [69.74] %, the concentration of lactate in patients the 1st group was 2.4 [2.1, 2.8] mmol/l on the 3rd day, on the 5th day – 1.9 [1.7; 2.2] mmol/l; in patients of the 2nd group – 1.9 [1.6; 2.2] mmol/l and 1,5 [1.3; 1.6] mmol/l (p<0.05). The use of enteral oxygenation in these patients affects the rapid improvement of the hematological indicators of intoxication, biochemical indicators that characterizing the renal function and carbohydrate metabolism. Reduction and elimination of hepato-intestinal dysfunction, hypoxia, intoxication and metabolic disorders have caused a more rapid compensation multiple organ disorders in patients with diabetic ketoacidosis, especially from the central nervous, respiratory and cardiovascular systems. The analysis of the complication of treatment has showed a tendency to reduce the number of serious complications of the vital organs, a smaller percentage of incidents of hypokalemia and acetonuria, a significantly lower number of cases of hyperglycemia using IT in patients of the 2nd group.
The mathematical model for predicting the risk of these complications in real time with the introduction of clinical and functional signs has been designed to identify the opportunities to deepen the severity of hepatotoxic and intestinal dysfunction in these patients and its prevention. The 5 most important indicators have been determined by the method of step-by-step logistic regression to define the threatening condition in the first days of hospital stay. They are the intra-abdominal pressure, the time of pulse wave propagation from the heart, the rheographic index, the venous blood saturation, ultrasound results of the abdominal cavity.
The scientific and reasonable corrections have made for the optimization of diagnostics of hepato-intestinal dysfunction in patients with diabetic ketoacidosis and their treatment by using the enteral oxygenation as the IT complex.
