Vlasov A P, Salakhov E K, Markin O V, Vlasova T I, Muratova T A, Vilkov A V, Sitdikov I I, Levkin K I
N.P. Ogareva National Research Mordovian State University, Saransk, Russia.
Mendeleev Central District Hospital, Mendeleevsk, Russia.
Khirurgiia (Mosk). 2022(2):50-56. doi: 10.17116/hirurgia202202150.
To determine the effectiveness of a new treatment regimen for patients with widespread peritonitis with an accent on enteroprotection based on the use of a drug of the metabolic type of action of remaxol and physiotherapy.
Clinical and laboratory studies of 82 patients with widespread peritonitis, mainly with grade 2 severity according to the Mannheim peritonitis Index, severe form - according to the ARASNE II scale. In the 1st group (28) patients underwent intraoperative intestinal intubation in the traditional way; in the 2nd (22) - intestinal intubation according to the original method; in the 3rd (32) - intestinal intubation according to the original method and combined use of remaxol (parenterally, enterally and intraperitoneally). An intestinal tube of an original design was used, which allows electrical stimulation of the duodenum in the postoperative period. The study evaluates clinical data, the results of instrumental and laboratory studies: ultrasound examination of the abdominal cavity, assessment of the functional state of the small intestine, a number of indicators of homeostasis.
It was shown that in patients with acute widespread peritonitis who underwent intestinal intubation according to the original method (group 2), as well as in combination with remaxol (group 3), the postoperative period was relatively more favorable. One of the factors optimizing the course of the disease was the relatively rapid restoration of the structural and functional state of the small intestine due to its electrical stimulation. The clinical and laboratory positive effect was especially significant in the 3rd group of patients, in which the use of remaxol, which has a membrane-stabilizing effect, played a special role in the enteroprotective effect. Timely correction of enteral distress syndrome resulted in a significant decrease in the severity of the syndrome of endogenous intoxication and oxidative stress, which was important in significantly improving the results of treatment of patients.
The use of technical innovations in the form of an original nasointestinal tube, which allows to quickly restore intestinal motility due to electrical stimulation, as well as the use of remaxol (parenterally, enterally and intraperitoneally) significantly optimize the course of the early postoperative period of patients with acute widespread peritonitis.
确定一种新的治疗方案对广泛性腹膜炎患者的有效性，该方案重点在于基于使用具有瑞马克索代谢作用类型药物和物理治疗的肠保护作用。
对82例广泛性腹膜炎患者进行临床和实验室研究，根据曼海姆腹膜炎指数，主要为2级严重程度，根据ARASNE II量表为严重形式。第1组（28例）患者采用传统方式进行术中肠插管；第2组（22例）——采用原始方法进行肠插管；第3组（32例）——采用原始方法进行肠插管并联合使用瑞马克索（经胃肠外、肠内和腹腔内给药）。使用了一种原始设计的肠管，其允许在术后对十二指肠进行电刺激。该研究评估临床数据、仪器和实验室研究结果：腹腔超声检查、小肠功能状态评估、多项内环境稳定指标。
结果表明，采用原始方法进行肠插管的急性广泛性腹膜炎患者（第2组）以及联合使用瑞马克索的患者（第3组）术后恢复相对更顺利。优化疾病进程的因素之一是由于电刺激小肠结构和功能状态相对较快恢复。临床和实验室阳性效应在第3组患者中尤为显著，其中具有膜稳定作用的瑞马克索在肠保护作用中发挥了特殊作用。及时纠正肠窘迫综合征导致内源性中毒和氧化应激综合征严重程度显著降低，这对显著改善患者治疗效果具有重要意义。
采用原始鼻肠管形式的技术创新，其可通过电刺激快速恢复肠道蠕动，以及使用瑞马克索（经胃肠外、肠内和腹腔内给药）可显著优化急性广泛性腹膜炎患者术后早期的病程。
