Intestine antegrade

PREVENTION AND TREATMENT OF SYNDROME OF INTESTINAL FAILURE

The syndrome of intestinal insufficiency in the AU is not only an important component, but the main factor of the pathogenesis of MODS. Moreover, the violation of the barrier function of the gastrointestinal tract syndrome of intestinal insufficiency creates conditions for the uncontrolled translocation of conditionally pathogenic microorganisms and their processes and maintain septic process even at a sufficiently effective remediation of other foci of infection. Intestinal failure, in fact, becomes the "motor" tanatogenesis AU, because damage to anatomical and physiological integrity of the gastrointestinal tract is included in a vicious cycle of metabolic distress syndrome and deep depression intestinal mechanisms of anti-infectious protection.

That is why prevention and correction of intestinal insufficiency syndrome is the most important area of therapy AU.

The Clinic of Surgery Medical University developed strategic directions for the treatment of this syndrome (Table 4).

Table 4

Ways of treating intestinal insufficiency syndrome

Maintaining normal microecology tract:

* Selective decontamination of the digestive tract;
* Optimal systemic antibiotic therapy.

Correction of disorders of the gastrointestinal tract:

* Drainage of the gastrointestinal tract;
* Enterosorption;
* Early enteral nutrition (and possibly natural);
* Restoration of intestinal motility;
* Application enteroprotektorov (somatostatin).

Correction of metabolic distress syndrome

Optimization of oxygen transport and microcirculation

Of particular importance is the elimination of increased intraintestinal pressure associated with abnormal sequestration in the lumen of the intestinal tube of the critical volumes of liquids and gases. In this situation, an active drainage GIT aims to actively remove the intestinal contents, thereby ensuring the effect of intestinal decompression [6]. Reducing intraintestinal pressure ensures the recovery process of blood circulation in the intestinal wall and the normalization of its motor, the barrier and metabolic functions [3].

Given the data on the pathogenesis of GI syndrome, functional impairment in AS with the maximum severity of violations in the small intestine, completely shown is the predominant drainage of the entire small intestine or proximal of its divisions.

It should be noted that currently there is no consensus on the selection method of draining the small intestine. Thus, most surgeons prefer a private method, when the probe is conducted into the intestine antegrade. In this case, the shortcomings of the method are: low efficiency of drainage due to the need for continued active aspiration of the probe against the pressure gradient, the development of respiratory disorders, mainly in patients of senile and elderly, the dislocation of the probe with the development of aspiration into the airways [3,6].

Public methods of drainage (via the gastro-, entero-, appendix-, tsekostomy) have not lost their practical value in our days, but have limited brand viagra application due to the large number of complications (detachment of the stoma, the formation of intestinal fistulas with the development of water-electrolyte and metabolic disorders) [6]. Keep in mind that prolonged use of nazointestinalnogo or nasogastric drainage leads to infection in the overlying gastrointestinal and tracheobronchial tree, which, in combination with a long forced horizontal position of the patient and continued mechanical ventilation is the cause of the progressive increase in the number of nosocomial pyo-septic complications in the AU.

Of particular importance in the prevention and treatment of intestinal insufficiency syndrome in the AU is the timely appointment of a synthetic somatostatin (stilamin / Ares-Serono / or sandostatin / Sandoz Pharma /). Studies conducted in various centers, as well as in our clinic (VS Savel'ev et al., 1996) [5], suggest this drug is not only effective in the treatment of pancreatitis, gastrointestinal bleeding, and fistula, and systemic and enteroprotektorom adaptogen digestive system.

sensitivity to sodium
multivitamin
Review CNS
long time
choice for correction