A. I. Evdokimov Moscow State University of medicine and dentistry, Ministry of Health of Russia
Study objective: to improve treatment results of patients with AP complicated by DT by early concomitant use of artificial lung ventilation (ALV) and detoxification by plasmapheresis.Methods of study and treatment. 146 patients with chronic alcoholic intoxication (CAI) and AP development complicated by DT were enrolled to the study. Patients of Group I (reference group, n=45) received «standard» therapy. Group II included patients who received extracorporeal detoxification by plasmapheresis in addition to «standard» therapy (n=51). Group III included patients who underwent oxygenation correction by ALV in addition to «standard» therapy and extracorporeal detoxification by plasmapheresis (n=50).Results. During the evaluation of plasmapheresis efficacy, more rapid normalization of blood biochemistry in patients from Group II was noticed. The following parameters were decreased: blood α#amylase by 73.2%, bilirubin level by 33.3%, AST by 34.1%, ALT by 17.7%; arterial blood lactate level was normalized by 47.6% on Day 3 vs. Group I (p<0.05). 17.7% patients (n=8) in Group I and 17.6% patients (n=9) in Group II received respiratory support by ALV at different time points due to severe hypoxia. Concomitant use of exogenous detoxification by plasmapheresis and early ALV in patients with AP complicated by DT decreased delirium duration from 5.4±0.2days (Group I) and 4.1±0.2 days (Group II) to 1.1±0.1 days in Group III patients. In patients of the Group III no cases of self-aggression were reported. No significant differences were observed between Group I and Group II.Conclusion. Concomitant use of exogenous detoxification by plasmapheresis and early extended ALV during complex therapy of patients with AP complicated by DT improves blood biochemical parameters and decreases delirium duration and in-patient duration of treatment. Medication sedative therapy with extended ALV levels abrogates the development of a self-aggression.