Endotoxicosis as the Contents of Posresuscitative Disease in Acute Poisoning

Abstract

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...

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