Vlasov A P, Trofimov V A, Vlasova T I, Ryazantsev V E, Sinyavina K M
National Research Mordovian State University named after N.P. Ogarev, Saransk, Russia.
Penza State University, Penza, Russia.
Khirurgiia (Mosk). 2024(1):34-41. doi: 10.17116/hirurgia202401134.
Based on objective criteria of the structural and functional state of the kidneys in various urgent surgical and uronephrological pathologies (peritonitis, pancreonecrosis, intestinal obstruction, urinary peritonitis, acute purulent secondary pyelonephritis) to identify and prove the general pattern of development of renal changes, their influence on the pathogenesis of homeostasis disorders at the organizational level and to form the evidence base of a new symptom complex - renal distress syndrome in surgery and uronephrology; to establish the effectiveness of Remaxol in its correction.
Experimentally on 60 mongrel dogs with acute peritonitis, pancreatitis, intestinal obstruction of varying severity, the state of renal function, including detoxification, was assessed based on the assessment of the inflow-outflow difference in the level of toxins and in the parenchyma of organs - the composition of lipids, the activity of peroxidation of membrane lipids and phospholipases. Clinical and laboratory studies included patients with acute peritonitis (48), acute pancreatitis (18), intestinal obstruction (21), acute purulent secondary pyelonephritis (19). Patients with peritonitis (20) underwent standardized therapy (the first subgroup) or with the inclusion of Remaxol (28) (the second subgroup).
In the experiment and in the clinic, in acute surgical and some urological diseases with a different nature of the inflammatory process, there is a significant decrease in renal function. The recorded acute renal injury is combined with a pronounced membrane-stabilizing process in the tissue structures of the kidneys, the degree of which is associated with the severity of the disease. In order to correct and stabilize the indicated changes, Remaxol was used. The drug increased kidney tolerance to trigger pathogenetic agents, which improved the functional status of the kidneys. These data confirm the significance of the studied molecular mechanisms in kidney damage in urgent pathology.
Experimental and clinical evidence has been obtained for the formation of a new concept - a symptom complex in acute surgical and uronephrological diseases of the abdominal cavity and retroperitoneal space called renal distress syndrome. Renal distress syndrome in surgery and uronephrology is a set of pathological processes of the body, the most important manifestation of which is the progression of endogenous intoxication due to a violation of the functional status of the kidneys as a result of membrane-stabilizing phenomena of organ cells due to oxidative stress and phospholipase activity.
基于各种急腹症手术及泌尿肾科疾病（腹膜炎、胰腺坏死、肠梗阻、尿性腹膜炎、急性化脓性继发性肾盂肾炎）中肾脏结构和功能状态的客观标准，识别并论证肾脏变化发展的一般规律，及其在组织水平对体内稳态紊乱发病机制的影响，并形成外科学和泌尿肾科学中一种新症状复合体——肾窘迫综合征的证据基础；确定瑞马唑仑在纠正该综合征方面的有效性。
对60只患有不同严重程度急性腹膜炎、胰腺炎、肠梗阻的杂种犬进行实验，根据毒素水平及器官实质（脂质组成、膜脂质过氧化活性和磷脂酶）的流入 - 流出差异评估肾功能，包括解毒功能。临床和实验室研究纳入了急性腹膜炎患者（48例）、急性胰腺炎患者（18例）、肠梗阻患者（21例）、急性化脓性继发性肾盂肾炎患者（19例）。腹膜炎患者（20例）接受标准化治疗（第一亚组）或联合使用瑞马唑仑（28例）（第二亚组）。
在实验和临床中，在具有不同炎症过程性质的急性外科和一些泌尿系统疾病中，肾功能显著下降。所记录的急性肾损伤与肾脏组织结构中明显的膜稳定过程相关，其程度与疾病严重程度相关。为纠正和稳定上述变化，使用了瑞马唑仑。该药物提高了肾脏对引发致病因子的耐受性，改善了肾脏的功能状态。这些数据证实了所研究的分子机制在急性病理中肾脏损伤的重要性。
已获得实验和临床证据，以形成一个新概念——腹腔和腹膜后间隙急性外科和泌尿肾科疾病中的一种症状复合体，称为肾窘迫综合征。外科学和泌尿肾科学中的肾窘迫综合征是机体的一组病理过程，其最重要的表现是由于氧化应激和磷脂酶活性导致器官细胞的膜稳定现象，进而引起肾脏功能状态受损，导致内源性中毒进展。
