TREATMENT ASPECTS OF PATIENTS WITH SEVERE COURSE OF ACUTE PANCREATITIS AND OBESITY
DOI:
https://doi.org/10.11603/2414-4533.2024.1.14648Keywords:
acute pancreatitis, obesity, treatment, resuscitationAbstract
The aim of the work: to study and determine the tactics of treatment in patients with a severe course of acute pancreatitis and obesity.
Materials and Methods. Two groups were randomly assigned to study the aim among patients with severe acute pancreatitis and obesity (average BMI was 37.48±2.19kg/m2). In the first group (n=18), in the first 5 days, resuscitation with Ringer’s lactate was used, and on the 10th day, a diagnostic fine-needle puncture was performed under ultrasound control in order to control the flora. The primary stage of surgical intervention was drainage under ultrasound control. The secondary stage of surgical intervention, if necessary, is laparoscopic retroperitoneal necrectomy (retroperitoneal video-assisted debridement – VARD). Open surgical intervention was performed in case of development of abdominal compartment syndrome. In the second group (n=18 – control), as in the study group, the primary stage was drainage under ultrasound control. The secondary stage was surgical intervention in the scope of a traditional median laparotomy with the formation of a laparostomy.
Results and Discussion. The presence of two independent samples makes it possible to assess the effectiveness of treatment results. A statistically significant level of procalcitonin was found in the compared groups on the 10th day (1.83 compared to 3.32 ng/mg; p=0.001; α=0.05), on the 15th day (1.15 compared to 1 .83 ng/mg; p=0.001; α=0.05) and on the 45th day (0.35 compared to 0.55 ng/mg; p=0.001; α=0.05). These indicators confirm the effect of the escalation method of treatment by reducing the risk of infection. The length of stay in the hospital correlates with the presence of postoperative complications. In the experimental group, the length of stay in the hospital was (49.7±4.2) bed-days, while in the comparison group it was (56.67±5.84) bed-days (p=0.01; α=0.05). An increase in the length of hospital stay is associated with postoperative complications of the Clavien-Dindo class III b and IV a. A class IV complication requires patients to stay in the intensive care unit and intensive care unit. Among the patients of the study group, the length of bed-day stay in the ICU was (8.3±2.6) days, in contrast to the comparison group, where the indicator was (11.3±3.2) bed-days (p=0.01; α=0 ,05).
The effectiveness of the early use of Ringer’s lactate in patients with severe acute pancreatitis and obesity is evidenced by a statistically significant difference in the level of CRP in the compared groups on the 10th day (р=0.035; α=0.05). Application in the research group of VARD, as a secondary operative stage, is a less traumatic, but at the same time effective method (p=0.001; α=0.05), which reduces the total number of complications (χ²=4.012; p=0.046). The “before” - “after” assessment revealed the effectiveness of the treatment using the research group’s method (χ²=5.4; p=0.021).
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