Datsyuk A. The Optimization of infusion support and modulation of systemic inflammatory response in complex intensive care patients with acute pancreatitis in the early phase (experimental and clinical research)

The scientific work is devoted to optimization of methods of diagnosis, monitoring of progress and intensive therapy of acute pancreatitis in order to improve the quality and results of treatment and to reduce mortality. In experimental acute pancreatitis the efficacy and safety of regional intraarterial infusion therapy with catheter tr.celiacus was investigated. The optimizing possibility of the intraarterial infusion therapy, and the use kvertsitin, L-arginine, HES 130 / 0.4 on the severity of necrobiotic and necrotic changes due to the restoration of blood supply in the tissue of the pancreas, the course of reparative processes in acute experimental pancreatitis and positive effect of these drugs on the compensatory-adaptive reactions has been shown. A comprehensive assessment of the condition and severity of systemic inflammatory response in 223 patients with acute pancreatitis has been perfomed. The effect of liquid resustsitation on central and peripheral hemodynamics and course of the first phase (pancreatic toxemia) acute pancreatitis has been studied. We proved that application kvertsitin and L-arginine can reduce the manifestations of systemic inflammatory response syndrome and endothelial dysfunction in patients with severe acute pancreatitis. We justified new approaches to fluid therapy in patients with severe acute pancreatitis in early phase under conditions of cardio-respiratory dysfunction. A new algorithm of infusion therapy in these patients using intraarterial (in celiac trunk) infusion therapy was suggested. All these measures have reduced mortality from 19.3% to 10.3%, changed the survival function with increasing the patients lifetime (log-rank test, p = 0.021) and reduced pancreatic infection frequency from 45.7% to 26.4% in patients with severe acute pancreatitis.