Therapeutic and diagnostic complex in intestinal failure syndrome in patients with closed abdominal trauma

• Published in: Hirurgija (Moskva) no. 9; p. 57
• Main Authors: Rogal, M L, Yartsev, P A, Zhigalova, M S, Kiselev, V V, Shavrina, N V, Staleva, K V, Teterin, Yu S, Petrikov, S S
• Format: Journal Article
• Language: English; Russian
• Published: Russia (Federation) 2024
• Subjects: Abdominal Injuries - complications; Abdominal Injuries - diagnosis; Abdominal Injuries - therapy; Adult; Enteral Nutrition - methods; Enteral Nutrition - statistics & numerical data; Female; Humans; Intestinal Diseases - diagnosis; Intestinal Diseases - therapy; Male; Middle Aged; Multiple Trauma - complications; Multiple Trauma - diagnosis; Multiple Trauma - mortality; Multiple Trauma - therapy; Russia - epidemiology; Syndrome; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - physiopathology; Wounds, Nonpenetrating - therapy; Russia; mesenteric hypoperfusion; intestinal failure syndrome; intestinal barrier; enteral therapy
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia202409157

Currently, severe combined abdominal trauma ranks third among all causes of mortality In Russia, second only to cardiovascular and oncologic diseases. In the period from 2019 to 2020 in our country, a slight decrease in traumatism is noted due to a decrease in the number of traffic accidents as the main cause of combined and multiple trauma. The number of abdominal injuries from the total number of injuries In Russian regions ranges from 1.5 to 36.5% and is accompanied by a high level of disability (25-80% in combined trauma and 5-8% in isolated trauma). Despite modern medical advances, lethality in combined trauma of abdominal organs varies from 10.7 to 69.7%, with closed abdominal trauma accounting for up to 6% of fatal outcomes. Improving treatment outcomes in patients with closed abdominal trauma through comprehensive diagnosis of SCN and optimization of enteral therapy in patients with closed abdominal trauma. The study included 40 patients (29 (72.5%) men and 11 (27.5%) women), who underwent examination and treatment at the State Budgetary Institution "Research Institute of SP. Im. N.V. Sklifosovsky Research Institute of St. Petersburg State Medical Center with the diagnosis: Closed abdominal trauma. The age of the patients varied from 25 to 81 years (Mean age was 49.6±13.1). To evaluate the effectiveness of intensive therapy, the patients were divided into 2 groups: the comparison group ( =26) included patients who were treated with complex conservative therapy. Patients of the main group ( =14) conservative therapy was supplemented with the use of ER to restore the functional activity of the intestine under the control of ultrasound and assessment of the degree of intra-abdominal hypertension, as well as with Intestamine to stimulate the intestinal trauma. In the course of the study it was found that, as a result of complex enteral therapy in the patients of the main group, starting from the 7th day of stay in the ORIT, positive dynamics was observed, consisting in a statistically significant decrease in the levels of lactate, ALT, AST, LDH, and CRP. By the 14th day there was also a statistically significant decrease in leukocyte and PCT levels. The lethality in the main group amounted to 7.2%, =1. At the same time, in patients of the comparison group only by the 7th day there was a decrease in concentration of CRP ( =0.065), by the 10th day - ALT (<0.001) and by the 14th day there was a decrease in leukocytes level ( =0.038). Lethality in this group amounted to 23.1%, =6. Timely initiation of pathogenetic enteral therapy contributes to faster normalization of clinical and laboratory parameters, protection of intestinal barrier function, prevention of complications associated with bacterial translocation and bacterial overgrowth syndrome, increase in immunoresistance of the organism.