Manifiststions of abdominal sepsis in patients with diffuse peritonitis
Aim. The study of the dynamics of the syndrome of intraperitoneal hypertension and ischemic reperfusion syndrome, which cause abdominal sepsis in patients with diffuse peritonitis. Materials and methods. The course of the disease was studied in 136 patients suffering from diffuse purulent peritonitis. Four groups of patients were identified according to the level of intra-abdominal hypertension (WSACS). A retrospective assessment of the severity of the infection was carried out in accordance with the basic positions of “Sepsis-3”. The intraabdominal pressure was monitored by the Uno Meter Abdo Pressure® Kit. The level of lactate in peripheral blood was evaluated by chromatographic method. Results. In groups 3 and 4 (n=74), abdominal sepsis was in 47 patients, in 27 patients there was a septic shock. Intra-abdominal hypertension was reduced in 29 patients by naso-intestinal intubation, in 45 patients - by decompression laparostomy. Ischemic reperfusion syndrome developed in 58.6% and in 48.9% of cases, respectively. The dynamics of blood lactate and organ failure was more productive in patients with laparostomy. Mortality rate was 17.2% and 15.6%, respectively. Conclusions. The severity of reperfusion disorders in peritonitis depends on the severity of intra-peritoneal hypertension and intra-intestinal hypertension, the timing of their existence, the way and speed of decompression of the abdominal cavity and intestines. Progression of abdominal sepsis and negative dynamics of the reperfusional disorders syndrome in the postoperative period in patients with diffuse peritonitis increases lethality.