Influence of drug correction options of postoperative motility disorders of the gastrointestinal tract on inflammatory and anti-inflammatory markers
DOI:
https://doi.org/10.15587/2313-8416.2015.41607Keywords:
postoperative ileus, L-argininum, simeticonum, neostigminum, inflammationAbstract
Introduction. Postoperative dysmotility of the gastrointestinal tract is a common complication after operations on the abdominal cavity. Intestinal inflammatory response plays an important role in the development of postoperative motility disorders.
Materials and methods. After Local Ethics Committee approval and obtaining informed consent, 103 patients were prospectively divided into 4 groups depending on the characteristics of post-operative intensive care. In the 1 (control) group (n=27), patients after operation received stimulation of the gastrointestinal tract with metoclopramidum and neostigminum. In group 2 (n=24), patients received L-arginine and metoclopramidum. In the group 3 (n=25) patients received metoclopramidum and simeticonum. In group 4 (n=27), patients received L-arginine, metoclopramidum and simeticonum. Markers of inflammation (leukocyte levels, fibrinogen, IL-1α, TNFα, IL-10, the calculation of leukocyte index of intoxication) were studied preoperatively, after 1,3 and 7 days.
Results and Conclusion. Pathological process in the abdomen accompanied by the development of postoperative gastrointestinal dysmotility, increase in the number of white blood cells to 58.8% (p <0.001) and fibrinogen to 55.5% (p<0.001), imbalance of the inflammatory response of the body in the form of increased pro-inflammatory IL-1α by 25.1% (p = 0.047) with a simultaneous decrease the level of TNF more than 400% (p <0,001), before surgery. Group 1 patients inflammatory response persisted for more than 7 days after the operation and leads to depletion of proinflammatory cytokine system, as indicated by the levels of pro-inflammatory IL-1α and TNFα, whose values were below normal at 503% (p <0.001) and 57.9% (p <0.001). When using metoclopramide and L-arginine manifestations of inflammatory response persisted throughout the observation period, but progressively, and at 7 days after operation were smaller than in the other groups. So, in group 2 at 7 days after operation the level of IL-1α was the highest, exceeding the value of 1 to 367% (p <0.001), 3 - by 314% (p <0.001), 4 - 400% (p <0.001). At the same, TNFα levels in group 2 did not differ statistically significantly from preoperative. In group 1 at 7 days after surgery there was increase of anti-inflammatory IL-10 level is above normal and figures 3 and 4 groups at 78.2% (p <0.001) and 124% (p <0.001) and 60, 2% (p = 0.001).
The most rapid restoration of peristalsis was using metoclopramide and L-arginine. So, in group 2 independent carminative observed after 2.22 days after operation that 21.8% (p = 0.001) was lower than in group 1, 29.7% (p <0.001) - 3 groups, 26 6% (p = 0.003) - 4 group. This reduces the length of stay in ICU. 100% of patients 3 and 4 and the absolute majority of the patients 1 and 2 groups at 28 days after surgery VIII reached the level of quality of life scale RLAS
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