Цель исследования. Изучить особенности диагностики и лечения эндотоксикоза как проявления постреанимаци онной болезни при острых экзогенных отравлениях. Материалы и методы. Использование клинико лаборатор ных и статистических методов диагностики эндотоксикоза, осложнившего течение острых отравлений наркотика ми, психофармакологическими средствами и прижигающими жидкостями, и применение комплексной физико химической детоксикации для его лечения у 554 больных. Результаты. Установлено, что при изучаемой патологии наблюдается 3 стадии развития эндотоксикоза -от функциональных (начальных) до развитых и тер минальных клинико лабораторных проявлений в виде полиорганной недостаточности. Наилучшие лечебные ре зультаты достигаются на фоне использования эффективных лечебных мероприятий уже в начальной стадии эндо токсикоза, что позволяет существенно снизить летальность и частоту пневмоний, уменьшить сроки разрешения пневмоний. Основной вклад в сокращение частоты летальных исходов при острых отравлениях связан с физико химической детоксикацией, значительно уменьшающей влияние интоксикационного фактора постреанимацион ной болезни. Заключение. При диагностике эндотоксикоза у больных с острыми экзогенными отравлениями необ ходимо учитывать весь комплекс типичных изменений маркеров эндотоксикоза и показателей гомеостаза: гематологических, иммунологических, гемореологических, показателей ПОЛ/АОС, которые необходимо свое временно корригировать с помощью основных эфферентных методов искусственной детоксикации (гемосорбция, гемодиафильтрация, гемофильтрация) с обязательным использованием физио и химиогемотерапии (лазерно ультрафиолетовая гемотерапия, инфузии гипохлорита натрия). Ключевые слова: острые отравления; эндотокси коз; физико химическая детоксикация.Objective: to study the specific features of the diagnosis and treatment of endothoxicosis as a manifestation of postresus citative disease in acute exogenous poisoning. Subjects and methods. Clinical, laboratory, and statistical methods of the diagnosis of endotoxicosis complicating the course of acute poisoning by narcotics, psychopharmacological agents, and cauterants, as well as complex physicochemical detoxification were applied to 554 patients. Results. The study pathology has been ascertained to have 3 developmental stages -from functional (primary) to developed and terminal clinical and laboratory manifestations as multiple organ dysfunctions. The best therapeutic results are achieved by effective thera peutic measures just in early stage endotoxicosis, by substantially reducing the rates of death and pneumonia and the time of the latter's resolution. The major contribution to the reduction in the rate of death due acute poisoning is associated with physicochemical detoxification that considerably lessens the influence of the intoxication factors of postresuscita tive disease. Conclusion. When diagnosing endotoxicosis in patients with acute endogenous intoxication, it is necessary to keep in mind a whole spectrum of typical changes in endotoxicosis markers and homeostat...

N.V. Sklifosovsky Research Institute for Emergency Medicine, Healthcare Department of Moscow|, 129090, Moscow, Russian Federation Research and Applied Toxicology Center of Federal Medical and Biological Agency|, 129090, Moscow, Russian Federation Russian Medical Academy of Continuous Professional Education, RF Ministry of Health|, 125993, Moscow, Russian Federation The problem of correction of disturbed homeostasis parameters in critical conditions, including acute poisoning, has revealed its increasing importance in recent years. In this respect, extracorporeal methods of detoxification (hemosorption, hemodialysis, etc.) and physio- and chemohemotherapy are quite effective. With the help of these methods positive changes in hemorheological, immune and other parameters are achieved, that increase significantly the overall results of treatment of patients. At the same time, targeted correction of disturbed homeostasis outside detoxification activities is still carried out mainly through infusion therapy. Along with this in recent years a growing number of scientific papers devoted to the correction of homeostatic disorders by enteral administration of special solutions in emergency conditions has appeared. However, this approach, although physiological and technically simple, has not yet been studied in clinical toxicology, and this fact encourages further research in this direction.

The analysis of the literature data allowed us to establish that today enteral nutrition (EN) is unanimously recognized by specialists as the preferred method of nutritional therapy, which significantly affects the course of critical conditions (CC). The use of EN now affects almost the entire nosology that forms the cohort of such patients. To the least extent, the scientific analysis of the possibilities of EN touched acute poisoning, where, given the special danger to life of their severe forms, there are great prospects for further research of this kind. It is especially emphasized that EN mainly in the first 24-48 hours from the onset of the disease mostly affects the achievement of positive results of treatment of CC, accompanied by an improvement in metabolic processes in organs and tissues. There is great interest in studying the pathogenesis of CC by assessing changes in homeostasis indicators using modern laboratory and instrumental control, which strengthens the scien-tific basis of EN. At the same time, it also contributes to the disclosure of his sanogenesis. Considering that, along with immunological shifts, the formation of oxidative stress and hemorheological disorders is of particular  importance in the pathogenesis of CC, being to a large extent involved in the development of endogenous intoxication and their irrevers-ibility, studies on EN in this field are promising, which, in our opinion, are still are very limited,  and in relation to hemorheology, according to the data available to us, are not represented at all. There are also no generalized up-to-date data on the economic component of EN. Further improvement of EN, as well as the  corresponding organizational measures, it seems, can bring this method to a  higher level of efficiency and, accordingly, safety, which, combined with the economic advantages of EN, will expand the possibilities of its  implementation in clinical practice.AIM OF STUDY Standardization of staged treatment of patients with severe concomitant closed abdominal trauma.

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