Summary. Aim. The determination of the impact of the developed complex treatment of patients with peritonitis on the functional state of effector cells of antimicrobial resistance during the course of the disease. Materials and methods. The study included patients with toxic and terminal stages of peritonitis (124 patients), who were treated in 2022. They were divided into 3 groups. Group I (main) included 39 (31.4 %) patients whose complex treatment included cytochrome C. Group II (main) included 41 (33.1 %) patients whose complex treatment included cytochrome C and Tivorel. The comparison group consisted of 44 (35.5 %) patients in whom the indicated drugs were not used. Results. In patients of group I, the 7th day of the study was characterized by a significant decrease in the spontaneous activity of neutrophil granulocytes (NG) in the NBT-test relative to the initial values by 2.21 times (p<0.001). However, a 2.91 (p<0.001) times increase in the activity of induced NG was determined. An increase in the functional spontaneous activity of monocytes relative to the initial values was determined by 3.12 times (p<0.001). Indicators of functional activity in the induced reaction exceeded initial values by 4.96 times (p<0.001). In patients of the II group, on the 7th day of the study, a decrease in the functional activity of NG in the spontaneous NBT-test was found relative to the initial values by 2.94 times (p<0.001). A 4.52-fold increase in NG activity in the induced test relative to baseline values was determined (p<0.001). An increase in the functional activity of monocytes was established in the spontaneous and induced NBT-test. These indicators were 2.93 (p<0.001) times and 5.25 (p<0.001) times relative to the initial values, respectively. Conclusions. The activity of neutrophil granulocytes and monocytes in the spontaneous and induced nitroblue tetrazolium recovery test (NBT-test) are objective indicators of the activity of nonspecific inflammatory factors in patients with peritonitis.

Objective. To improve surgical tactics in peritonitis, caused by complicated course of colorectal cancer. Materials and methods. Through the 2017 - 2020 yrs period in Department of Surgery in Brovary Multidisciplinary Clinical Hospital 18 patients with colorectal cancer, complicated by peritonitis, were operated. Among them there were 14 (77.8%) men and 4 (22.2%) women, ageing in spectrum 42 – 83 yrs old. In 12 (66.7%) patients the cancer of Stage III was diagnosed, while in 6 (33.3%) – Stage ІV. Results. The right-sided hemicolectomy was performed in 22.2% of the patients, resection of transverse colon – in 3 (16.7%), a left-sided hemicolectomy – 1 (5.6%), Hartmann operation – 9 (50.0%), subtotal colectomy – 1 (5.6%). All the operations were performed without formation of primary anastomoses, and with stoma construction in proximal part of intestine. Reoperation were performed in 4 (22.2%) patients. There were 3 (16.7%) postoperative deaths – in patients with the cancer Stage IV, peritonitis in a terminal stage – due to development of the polyorgan insufficiency syndrome. Conclusion. Formation of primary interintestinal anastomoses while doing surgical intervention for colorectal cancer, complicated by peritonitis, is contraindicated because of high risk of the sutures insufficiency presence.

БІЛЯЄВА Ольга Олександрівна д-р. мед. наук, професор, Національний університет охорони здоров'я України ім. П. Л. Шупика ORCID ID: 0000-0003-2862-0423 КАРОЛЬ Іван Вікторович канд. мед. наук, Національний університет охорони здоров'я України ім. П. Л. Шупика, зав. хірургічного відділення КНП «Броварська багатопрофільна клінічна лікарня» ORCID ID: 0000-0003-3684-0127 Україна ЕТІОЛОГІЯ ТА РАЦІОНАЛЬНА ЕТІОЛОГІЯ ТА РАЦІОНАЛЬНА АНТИБІОТИКОТЕРАПІЯ ПЕРИТОНІТУ АНТИБІОТИКОТЕРАПІЯ ПЕРИТОНІТУОднією з найскладніших проблем абдомінальної хірургії є лікування гострого перитоніту 1 . При його прогресуванні часто розвивається абдомінальний сепсис -тяжке захворювання, яке зумовлене ушкодженням тканин та органів черевної порожнини і супроводжується вираженою запальною реакцією системного характеру, що призводить до розвитку синдрому поліорганної дисфункції 2 . Летальність при розвитку цих патологічних станів різко зростає до 70-90 %, і, незважаючи на впровадження сучасних методик лікування, не має тенденції до зниження 3 . Адекватна інтенсивна, антибактеріальна та навіть імунна терапія, дотримання принципів «source» та «damage control» не завжди дозволяють стабілізувати стан пацієнта з тяжким перитонітом та досягнути його одужання 4 .В патогенезі перитоніту, ускладненого абдомінальним сепсисом основна роль належить розладам мікроциркуляції та системного кровото-

Objective. To investigate pathogens in peritonitis. Materials and methods. In 2021 yr in Department of Surgery of Brovary Multidisciplinary Clinical Hospital were treated 360 patients with an acute peritonitis of various genesis: 186 (51.7%) women and 174 (48.3%) men. Results. In the patients 391 strains of microorganisms, which are optionally-anaerobic and aerobic of Gram-negative and Gram-positive pathogens were isolated: Escherichia coli – in 144 (36.8%), Streptococcus spp. – 52 (13.3%), Enterococcus faecalis – 47 (12.0%), Staphylococcus aureus – 37 (9.5%), Klebsiella pneumoniae – 31 (7.9%), Citrobacter – 25 (6.4%), Staphylococcus haemolyticus – 23 (5.9%), Pseudomonas aeruginosa – 14 (3.6%), Acinetobacter baumannii – 13 (3.3%), and Proteus mirabilis – 5 (1.3%) strains. Conclusion. Majority of microorganisms, isolated in patients, suffering peritonitis, was characterized by significant antibiotic resistance. Most frequently Escherichia coli was sowed – 36.8%. All strains of Escherichia coli isolated were resistant to vancomycine, clindamycine and linezolide.

Objective. To study a functional state of cardio-vascular system in patients, suffering peritonitis. Materials and methods. Analysis of dynamics in the electrocardiogram changes in 166 patients, including 84 women and 82 men, was conducted for studying of functional state of cardio-vascular system in extended peritonitis. Results. Changes on electrocardiograms were non monotonous and depended on the peritonitis stage. In 28.3% patients diffuse changes in myocardium were observed, while in 43.9% - moderate. In 42.6% patients the disorders in metabolic processes in myocardium were revealed. Changes in conductivity and excitability were noted merely in half of the patients. Hypoxia was observed in 17.7% patients in reactive stage of peritonitis, in 32.0% - in a toxic, in 75.8% - in terminal. Tachycardia in a reactive stage of peritonitis was noted in 77.4% patients, in toxic one - in 89.3%, and in terminal - in 86.2% patients. In terminal stage of peritonitis in 13.8% patients bradycardia was noted. The blood supply disorders of various compartments of myocardium was revealed in 34.4% patients. Conclusion. Functional changes of cardio-vascular system in patients depends on stage of peritonitis. In all the patients, suffering peritonitis, medicinal correction of the cardio-vascular system work must be conducted, while its intensity depends on stage of peritonitis.