Alexandr B. Fursov, Nicolai V. Mironuk, Sergey K. Vervein,

Bakyt A. Ismagambetova, Sergey G. Astapkevich

Astana medical University, Republic of Kazakhstan, Astana

Forecasting, prophylaxes and treatment of erosion and ulcer lesions mucous of the upper part of gastric and intestinal tract

in postoperative period

Experimental and clinical research was carried out in this work. Research objects were animals during the first stage. Patients with acute surgical pathologies were examined and they have been diagnosed by erosion and ulcer of the upper part of gastric and intestinal tract on the second stage.

Research aim: To increase efficiency of and treatment of erosion and ulcer lesions of gastroduodenal mucous and also of their complications in patients in postoperative periods.

Research structure: retrospective and prospective, randomized and controlled research. Periods are analytical, screening and main. Randomization for groups: method of randomized choice. Statistic processing of data with the help of the program “Statistica 6.0”.

Application ability of substrate antyhypoxant (SA), inductor of endogene interferone (IEI) and prostaglandine E (PGE) for prophylaxes of erosion and ulcer lesions of gastric mucous membrane and duodenal intestines was studied. Data characterizing hypoxia and oxidation and reduction processes in the organism had been researched. It was revealed that complex of preparations SA, IEI, PGE influences positively on restoring processes in the mucous membrane of the upper part of gastric and intestinal tract as in the experiment as in clinical picture. For the determination of hazard degree of erosion and ulcer formation in patients in postoperative periods, the statistic calculations were done. The main criteria of mucous lesions had been revealed. Complex estimation scale of the surgical patient severity, possibility of erosion and ulcer lesions of the mucous membrane were elaborated, complications were in the form of bleeding. The character of microcirculatory disturbances in gastroduodenal mucous membrane had been investigated in and after operative intervention. Factors which increase risk of ulcer formation in patients were revealed.

Classification of microcirculatory disturbances in the area of ulcer and erosion was done. The application of SA, IEI, PGE before the operation, and during operation they caused prophylaxes effect on hypoxic processes and microcirculation in the gastric mucous membrane. Endoscopic introduction of the inductor of endogene interferone (as well intraoperative pricking all around sutures after catching up of perforated gastric or duodenal intestines ulcer) accelerates healing processes, decreases risk of postoperative erosion and ulcerative bleedings in patients, diminishes healing periods of treatment in in-patient department.

Recommendations to the work introduction:

It is necessary to apply the improved experimental model, using additional decreasing of regional blood flow by means of alloying of gastric vessels with single-stage registration of blood flow level in their walls for the research on processes study of ulcer formation.

It is necessary to take a computer examination to estimate patients’ condition severity according to the elaborating complex scale, to do all investigations of all parameters filed into electronic data beforehand during the urgent patient’s admission into in-patient department for the operative treatment.

It is necessary to begin preventive treatment by substrate antihypoxant, inductor of endogene interferone with prostaglandine of the group E1-2 in the revealing of threshold score amount (103 and higher) of hospitalized urgent patients including that complex of medications into the scheme of preoperative preparations.

Intraoperative inductor of endogene interferone should be introduced in the following cases: a) endoscopically- in the presence of remarkable erosion mucous membrane lesions in patients; b) intragastrically and periulceratively-in catching up of perforative ulcer, anostomosis application after gastric resection.

To conduct endoscopic investigation of the condition of microcirculation, changes of blood flow level, endothelial growth factor, general mucous membrane condition and so on for the modern diagnostics of its lesions in postoperative period beginning with the first 24 hours day in patients with the high risk of erosion and ulcer disturbances of gastroduodenal mucous membrane and possible complications.

To use elaborated classification in that research for reliable determination of microvascular reaction type, as well characteristics of microcirculatory disturbances of mucous membrane of gastroduodenal zone depending on pathological processes and its localization. Classification was presented by the following points: microcirculation of atrophy zone, hyperplasia zone, in erosion, in acute ulcer, in chronic ulcer, scarring areas after the treatment, in perforation-marginal and periulcerative zone, microcirculation in the zone of suturing, scarring areas after operation, anastomosis areas after operation.

To take endoscopic monitoring beginning with 1-3 days of postoperative period in revealing in surgical patients with acute abdominal pathologies of significant deviations of reological and coagulative blood constant; in endoscopic features of mucous ichemization; disorders of lipid metabolism and antioxidant protection; data decreasing of blood flow in gastric wall and mucous membrane, duodenal intestine. To take into account the severity of general condition and complication risks according to the elaborated risk scale.

To use life quality results of patients according to criteria of OBDQ ( abdominal pain) in the early postoperative period for efficiency estimation of the treatment more rationally, and then nonspecialized questionnaire SF-36 with a glance diseases dynamics.

The field of research work application - medical universities and scientific laboratories investigating the problem of ulcer bleeding, surgical clinical pictures of general and specialized profile.

The results of investigation can be introduced into practical medicine on the level of the Republic, and to decrease the amount of postoperative complications without any significant financial expenses.