A feature of the severe condition of acute pancreatitis is the high risk of complications occurring in 50% of patients. The most dangerous are thrombohemorrhagic complications and arrosive bleeding, with late diagnosis of which mortality can reach more than 85%. The aim of the study was to determine early diagnostic criteria for the onset and development of bleeding in acute pancreatitis. The results of treatment of 82 patients with severe acute pancreatitis were analyzed. The patients were divided into the main group (with bleeding) (30 people) and the comparison group (without bleeding) (52 people). The parameters of hemocoagulation, α-amylase activity in peritoneal exudate and intra-abdominal pressure were assessed. The tPA activity and the level of TAT in the main group were of normative value and are vital for the group of individuals who are in the range of norms, as well as candidates for early markers for the diagnosis of bleeding. From the ROC analysis, the analysis determined the informativeness of the proposed indicators in the predicted bleeding. For tPA activity, the area under the ROC-curve (AUROC) became 0.942 (95% CI 0.889-0.995), the point of change is 4,5 IU/ml, for the TAT area under the ROC-curve (AUROC) it became 0.945 (95% DI 0.871-0.998), the change point is 11.5 ng/ml. We conclude that in patients with severe acute pancreatitis, a tPA activity level ≥4.5 IU/ml (sensitivity 90.2%, specificity 83.3%) and/or a TAT level ≥ 11.5 ng/ml (sensitivity 92.2%, specificity 83.3%) can be considered as a possible predictor of bleeding.

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The aim: Improving the results of treatment of patients with acute surgical pathology of the abdominal cavity by correcting intra-abdominal hypertension (IAH). Materials and methods: The results of examination and treatment of 187 patients with acute surgical pathology, which was accompanied by elevation of IAP. To compare the results, depending on the chosen diagnostic and treatment tactics, patients were divided into two groups: comparison and main. The comparison group (85 people (45,5%) included patients who have been treated with traditional approaches in diagnosis and treatment according to existing treatment protocols. The main group (102 people (54,5%) included patients in whose treatment we additionally used our proposed step-by-step approach in the treatment of IAH. Results: Systemic complications occurred in 12 patients of the main group (11,8%) and in 46 patients of the comparison group (54,1%), while in the second group the frequency of systemic complications was significantly higher (χ2 = 38,6, CI 29,3-53,6, p <0,0001). 20 patients (10,7%) died (2 patients of the main group (1,96%) and 18 patients of the comparison group (21,2%) (χ2 = 17,85, CI 10,4-29,18, p <0,0001). Conclusions: Use in the complex treatment of patients with acute surgical pathology of the abdominal cavity, accompanied by IAH, the proposed step-by-step approach has improved treatment outcomes by reducing the incidence of systemic complications from 54,1% to 11,8%, total mortality from 21,2% to 1,96% and postoperative mortality - from 22,4% to 2,4%.

На умовах ліцензії CC BY 4.0 С СП ПИ ИС СО ОК К Л ЛИ ИТ ТЕ ЕР РА АТ ТУ УР РЫ Ы 1. Campylobacter jejuni, an uncommon cause of splenic abscess diagnosed by 16S rRNA gene sequencing / P. Seng et al.

Relevance. Early onset of enteral nutrition (up to 48 hours after hospitalization) in patients with severe acute pancreatitis is associated with a 24% reduction in infectious complications and a 32% reduction in mortality. Data on the possibility of nasogastric tube feeding remain contradictory. Objective: comparison of the effectiveness and safety of nasogastric administration of food mixtures in patients with severe acute pancreatitis. Methods. The study included 103 patients with severe acute pancreatitis, which were divided depending on the characteristics of the chosen treatment tactics into three groups: based group (nasogastric nutrition was performed) - 34 patients, comparison group #1 (standard enteral nutrition) - 33 patients and comparison group #2 (parenteral nutrition) - 36 patients. To analyze the effectiveness of nutritional support in the study groups after 7 and 14 days from the beginning of treatment, the level of laboratory parameters was assessed, the incidence of local complications, mortality, duration of multiorgan failure and hospital stay were analyzed. Results. After 7 and 14 days of nutritional support, a significant difference was found between total protein, albumin, creatinine, urea, cholesterol, glucose and serum Na + (p<0.05) between patients in the main group and comparison group #2, with the level of cholesterol, K + and Na + corresponded to the norm in both groups. There was also a significant difference in the incidence of infected local complications of severe acute pancreatitis in the main group and comparison group #2 - 35.3% and 61.1%, respectively (χ2=4.59, 95% CI 2.43-45.53, p=0.03), duration of multiorgan failure - 12.2±1.7 [8-16] days and 15.3±1.1 [13-18] days, respectively (p<0.001), duration of hospital stay - 55.5±30.5 [27-124] days and 71.5±35.9 [35-148] days, respectively (p=0.04) and fatalities - 14.7% and 36.1%, respectively (χ2=4.13, 95 % CI 0.81-39.68, p=0.04). When comparing these indicators between the main group and the comparison group #1 no significant difference was obtained (p>0.05). Conclusions. Nasogastric nutrition is an effective and safe method of administration of mixtures in patients with severe acute pancreatitis and can be considered as an alternative to enteral nutrition.