Optimization of the diagnostic program in patients with acute small intestinal obstruction
DOI:
https://doi.org/10.11603/2414-4533.2017.4.8249Keywords:
гостра непрохідність тонкої кишки, діагностична програма, оптимізація.Abstract
The aim of the work: developing an effective and accessible diagnostic program for patients with acute small intestinal obstruction to improve the results of their surgical treatment.
Materials and Methods. In 221 patients, a comprehensive survey was conducted with the definition of the comorbidity index, the functional status of patients and the degree of surgical-anesthetic risk. Retrospective analysis was performed in 30 patients with adverse effects.
Results and Discussion. X-ray examination was performed in 96.67 % of dead patients and in all patients with a favorable course of the disease. Ultrasonography of the abdominal cavity was performed in 33.33 % and 49.77 % of cases, respectively. Attention is drawn to the significance of each of these methods during the examination of patients. In the exploration of the motor-evacuation function of the digestive tract, it was found that satisfactory peristalsis of the small intestine was only in 8 (3.62 %) cases, its amplification was observed in 78 (35.29 %) patients, oppression – in 103 (46.61 %) of patients and its absence – in 32 (14.48 %) of the hospitalized patients. In patients with an unfavorable course of the disease in one case, the nature of peristaltic sounds was rhythmic, not reinforced, in 36.67% – there was an increasing of them, oppression and its absence – in 60 % of patients. In the study of leukocyte index of intoxication and rod nuclear lymphocytic index, it was found that in the unfavorable course of acute small intestinal obstruction, leukocyte index of intoxication was (3.99 ± 0.84) units, rod nuclear lymphocytic index – (1.21 ± 0.33) units, in patients with favorable course of the disease – (4.06 ± 0.24) units and (0.82 ± 0.07) units respectively. In 146 (66.06 %) cases, the functional condition of the patients was compensated and in 75 (33.94 %) cases – decompensated. The comorbidity index in these patients was as follows: to 59 years – 1.03, at the age of 60–74 years – 4.82 and in the age group 75–89 years – 6.0. In patients with unfavorable course of disease, the comorbidity index was significantly higher, indicating the importance of concomitant diseases in the course of acute small intestinal obstruction. A diagnostic algorithm is proposed for patients with acute small intestinal obstruction, which allows to monitor the course of the disease and provides optimization of surgical care to such patients.
References
Benedykt, V.V., Hnatiuk, M.S., & Holda, Yu.M. (2002). Osoblyvosti zmin pokaznykiv nespetsyfichnoi rezystentnosti orhanizmu u khvorykh na perytonit [Features of changes in the indices of non-specific resistance of the body in patients with peritonitis]. Zdobutky klinichnoi ta esperymentalnoi medytsyny. Zbirnyk naukovykh prats XLY pidsumkovoi naukovo-praktychnoi konferentsii. Vypusk 7 – Achievements of clinical and experimental medicine. Collection of scientific papers of the XLY final scientific-practical conference. Issue 7. Ternopil: Ukrmedknyha [in Ukrainian].
Kalf-Kalif, Ya.Ya. (1947). O gematologiacheskoy differentsyatsyy razlichnykh form i faz ostrogo apenditsyta [About hematological differentiation of various forms and phases of acute appendicitis]. Khirurgiya – Surgery, 7, 40-43 [in Russian].
Tamm, T.I., Bardiuk, O.Ya., Bohun, O.A., & Kkhalive, V. (2003). Suchasni mozhlyvosti diahnostyky mekhanichnoi kyshkovoi neprokhidnosti na pochatkovykh etapakh yii formuvannia [Modern possibilities of diagnostics of mechanical intestinal obstruction at the initial stages of its formation]. Naukovyi visnyk Uzhhorodskoho universytetu, seriia “Medytsyna” – Scientific Journal of Uzhhorod University, series “Medicine”, 20, 125-128 [in Ukrainian].
Charlson, M.E., Pompei, P., Ales, K.L., & McKenzie, C.R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chron. Dis., 40 (5), 373-383.
Little, J.P. (1995). Consistency of ASA grading. Anaesthesia, 50 (7), 658-659.
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