Perioperaciina Medicina en-US <p><a href="" rel="license"><img src="" alt="Creative Commons License"></a><br>This work is licensed under a <a href="" rel="license">Creative Commons Attribution 4.0 International License</a></p> (Oleksandr Marchuk) (Viktor Vitkovskyi) Wed, 01 Jun 2022 00:00:00 +0300 OJS 60 Use of dexmedetomidine in complex treatment of patients in intensive care units <p>Sedation is an important aspect of adequate treatment of patients in the intensive care unit. Recent drug developments and new ventilation strategies provide improved sedation management that allows for better adaptation to the clinical condition and individual needs of the patient. This article provides an overview of the general principles of sedation of patients in intensive care units and focuses on a relatively new drug in the pharmaceutical market of Ukraine — dexmedetomidine. Given the pandemic of coronavirus disease COVID-19, there was carried out a review of the international and domestic literature describing the use of dexmedetomidine as a sedative and analgesic in patients with acute respiratory distress syndrome caused by SARS-COV-2 virus. Its anti-inflammatory and antioxidant properties are also described, which will allow the use of the drug in complex therapy in the treatment of COVID-19 in severe patients.</p> Dmytro Dmytriiev, Oleksandr Nazarchuk, Yuliana Babina Copyright (c) 2022 Mon, 30 May 2022 00:00:00 +0300 Piperacillin/tazobactam in modern clinical practice <p>Piperacillin/tazobactam represents a combination of the ureidopenicillin and the lactamase inhibitor. The antibiotic is the drug of choice for the treatment of severe infections, primarily in surgical and intensive care units. The area of clinical use of piperacillin/tazobactam includes intra-abdominal infections, skin and soft tissues infections, late nosocomial pneumonias, including ones in the context of the covid -19 pandemic, and infections of other localizations. The effectiveness of the intervention increases with intravenous administration of the drug by the method of prolonged infusions. A high susceptibility of most causative pathogens of wound infection to piperacillin/ tazobactam has been established in Ukraine (with the exception of Klebsiella spp. and non-fermenting bacteria). The drug can be used in patients with a history of allergic reactions to lactams; preliminary allergological testing is indicated only in cases of allergy to aminopenicillins and aminocephalosporins. The first domestic piperacillin/tazobactam under the name Refex is registered on the Ukrainian market.</p> Igor Bereznyakov Copyright (c) 2022 Mon, 30 May 2022 00:00:00 +0300 The choice of drug treatment in patients with acute purulent paraproctitis <p>Treatment of acute paraproctitis remains an urgent surgical problem which is associated with both the choice of surgical tactics and the peculiarities of postoperative management of patients. The article presents a comparative analysis of postoperative treatment of 59 patients with acute paraproctitis without concomitant pathology and vascular lesions according to the generally accepted and improved methods using Rheosorbilact, Arginine hydrochloride, Pentoxifylline, Decametoxin. Schemes of treatment are described. The rate of postoperative wound healing was assessed by the time of granulation in the wound and the decrease in wound volume. It is established that the proposed scheme of drug treatment in the postoperative period reduces the duration of the first phase of the wound process by 25–30 %, and the average weekly rate of postoperative wound healing is higher compared to the control group by 12–15 %.</p> R Paliienko, M Stetsenko Copyright (c) 2022 Mon, 30 May 2022 00:00:00 +0300 Treatment of infected wounds of the abdominal wall after mesh hernia repair <p><strong>Background</strong>. An infected wound of the abdominal wall after mesh hernia repair is related to mesh infection, because mesh is situated at the bottom of the wound and granulation tissue doesn’t cover it. Infected mesh wounds have traditionally been treated by surgically removing the mesh which causes prolonged hospitalizations and hernia recurrence. Objective of the study is to increase the efficiency of treatment of wounds infection after mesh heria repair.</p> <p><strong>Маterials and methods.</strong> We analyzed the results of wound infection treatment in 72 patients. 37 patients (group I) were treated according to the developed algorithm (ultrasound cavitation, VAC-therapy and decamethoxine solution), 35 (group II) were treated according to the traditional one (ultrasound cavitation, VAC-therapy and chlorhexidine digluconate solution).</p> <p><strong>Results.</strong> The number of microbial colonies (CFU) in the wound decreased to lg (2.33 ± 0.51) CFU/ml and lg (1.35 ± 0.49) CFU/ml in group I against lg (4.01 ± 0) CFU/ml and lg (2.93 ± 0.56) CFU/ml in group II. (p &lt; 0.01) The results of morphological examination of the wound edges confirmed more efficient growth of connective tissue in patients of group I (mesh was completely covered with granulation tissue) which improved wound healing. While in group II, mesh explantation was performed in 5 (14.3 %) patients (granulation tissue hasn’t covered mesh completely). The duration of wound healing in patients of group I was 16 ± 1.05 days, compared with 21 ± 1.2 days in group II (p &lt; 0.01). We achieved better results through the use of the developed algorithm in group I, in particular the combination of ultrasound cavitation, VAC therapy and decametoxine solution, which has not only antimicrobial action, but also promotes connective tissue repair in the wound.</p> <p><strong>Conclusion.</strong> Developed algorithm for wounds infection treatment after alloplasty, which includes ultrasound cavitation, VAC-therapy and decamethoxine solution, improves treatment outcomes, reduced wound healing time to 16 ± 1.05 days in patients of the main group against 21 ± 1.2 in comparison group, and excludes the possibility of mesh explantation in the main group against 14.3 % in the comparison group.</p> Yaroslav Feleshtynskyi, K D Derkach, V V Smishchuk, O O Dyadyk, Yu I Beketova Copyright (c) 2022 Mon, 30 May 2022 00:00:00 +0300 The first data on international multicenter clinical study RheoSTAT-CP0691 on the efficacy and safety of Rheosorbilact® infusion in therapy of purulent peritonitis <p>Generalized forms of peritonitis are a major factor leading to non-traumatic mortality in all cases of emergency care and the second leading cause of sepsis in critically ill patients. Objective of this study was to evaluate the efficacy and safety of multicomponent infusion solution Reosorbilact in the treatment of patients diagnosed with purulent peritonitis. An international multicenter randomized study included 181 patients aged from 18 to 60 years with a diagnosis of purulent peritonitis. Patients received therapy with Reosorbilact according to the prescribing information for use. The primary endpoint of the effectiveness was change in SOFA scale on day 3 of therapy. Changes in APACHE II, SAPS II, MODS, and MPI scores as well as changes in endogenous intoxication markers on day 3 of therapy were considered as secondary endpoints. Safety was assessed by analysis of adverse events (AE) and vital signs after 3 days of therapy. On day 3 of treatment with Reosorbilact statistically significant changes were observed in SOFA (1.80 ± 0.91 points), MODS (1.45 ± 0.76 points) and MPI (1.84 ± 5.03 points) scales. There was a statistically significant improvement in markers of endogenous intoxication (creatinine, bilirubin, white blood cell count, C-reactive protein, neutrophil to lymphocyte ratio) on day 3 of treatment. The majority of AE (98.99 %) were mild. No AE were associated with the study preparation and did not result in the patient’s withdrawal from the study. According to the results of RheoSTAT-CP0691, Rheosorbilact is an effective and safe drug for the treatment of patients with purulent peritonitis. It is advisable to include Rheosorbilact in routine treatment algorithms for patients with purulent peritonitis.</p> S Agop, V Sharipova, K Kashibadze, D Vashadze, V Tevdoradze, I Kolosovich, S Peev, A Ligonenko, V Cojocaru, A Bely Copyright (c) 2022 Mon, 30 May 2022 00:00:00 +0300 Study of endothelin-1 dynamics in the pathogenesis of experimental peritonitis and under the influence of different methods of correction <p><strong>Background.</strong> Currently, one of the most serious complications of acute inflammatory diseases of the abdominal cavity is peritonitis. Objective: to study the development of endothelial dysfunction in experimental peritonitis and compare its correction with a solution of decamethoxine, aminoguadine and L-arginine.</p> <p><strong>Materials and methods of research.</strong> The study was conducted on 260 white rats of reproductive age (3 months), animal weight — 180–220 g. Animals were divided into 4 groups. Fecal peritonitis was simulated by introducing a 10 % fecal suspension at a dose of 0.5 ml per 100 g of animal weight to the abdominal cavity of laboratory animals by puncture method.</p> <p><strong>Research results.</strong> Pathological increase in vasoconstriction caused by experimental peritonitis was revealed. It was found that the use of solution, consisting of decamethoxine (10 mg/50 ml of solution) and sodium hyaluronate, is an effective method of rehabilitation and the basis for further correction of complications of experimental fecal peritonitis.The use of aminoguadine in combination with the rehabilitation of the abdominal cavity with a solution of decamethoxine had a positive effect on reducing the level of endothelin-1 in the simulated peritonitis. Combination of nitric oxide donor with decamethoxine solution and sodium hyaluronate nitric oxide donor effect on reducing the level of endothelin-1 in the simulated peritonitis.</p> <p><strong>Conclusions:</strong> Given the influence of endogenous intoxication on the increase of the marker of vasoconstriction, rehabilitation of the abdominal cavity, the choice of decamethoxine solution (10 mg/50 ml of solution) in the conditions of our study is justified.</p> I V Savitsky, S V Tsypovyaz, R G Zashchuk, R G Lenik, S G Znamerovsky Copyright (c) 2022 Mon, 30 May 2022 00:00:00 +0300