A comparative analysis of the results in the first two groups can be assumed that the excess value of APACHE II score of 14 is responsible for at least 10%-ing mortality, but at the same time, the lack of classic symptoms of SIRS is not determinative in the choice of tactics. Perhaps there was an element of overdiagnosis, or to determine the half-open tactics of increasing importance given to the visual characteristics of the fluid, rather than the symptoms pointing to the generalization of the inflammatory process. Thus, from this group of patients could be treated effectively using semi-method. The presence of preoperative dysfunction of one of the systems at the most seemingly uncompromising - half-open method determines the death of a quarter of patients. On the other hand the presence of symptoms of SIRS can be observed before the operation and fibrinous and serous fluid. Therefore, to better forecast should have a value of resistance in negative symptoms and treatment efficacy in the first (how?) Days after the operation. Application landmark rehabilitation can be considered progressive method with purulent peritonitis due to many reasons, but that does not mean that the determination of indications for repeated operations do not need to fight.
Postoperative peritonitis leads to 47% mortality. The most important factor contributing to this figure is the late diagnosis. In the event of Poland after the planned operations average time to re-intervention was 28 hours, and after the operations brand viagra undertaken at the ER re-intervention was performed after an average of 150 hours. Preoperative patient's condition was not significantly different from patients whose treatment was half-closed manner. The main indications for repeated operations were: in 56% of the further development of common inflammation of the peritoneum (the inadequate evaluation of the reorganization of the abdominal cavity, the underestimation of the activity of microorganisms, inadequate drainage, etc.) and in 14% necrosis of the walls of the hollow body, a 21% failure of the anastomosis in 4 % otgranichenny peritonitis. The greatest diagnostic difficulties encountered by 3-4 days after the first operation, when uncomplicated RP is to be expected the effect of all previous therapeutic interventions. Treatment of patients in this group after repeated operations conducted mostly semi-open way. Significant importance in determining the indications for repeated operations is deontological factor.
Thus, these data suggest that the definition of indications and complications of diagnostic quality still presents considerable difficulties. To this end, one of the main problems in the treatment of peritonitis is a qualitative monitoring of the patient based on the well-established criteria for the severity of his condition, as well as development of algorithms for selection of tactical schemes. The presence of dysfunction of two or more organ systems is an opportunity for a semi-open way of managing patients with RP. Monoorgannaya dysfunction, pronounced by indicators such as respiratory rate, Glasgow Coma Scale, and mean arterial pressure in the presence of high activity of the microflora can define complicated postoperative course in the application of a half-closed technique. The undoubted effectiveness of bowel decompression and peritoneal-enteral lavage in purulent peritonitis promotes simplification of the indications for this method and makes giperdiagnosticheskie trends. Diagnosis of prolonged inflammation of the peritoneum, even on the basis of informative clinical data still presents considerable difficulties. In these cases, greater informational value to buy the tests for the maintenance of pro-inflammatory cytokines of peripheral blood, tumor markers, procalcitonin.
microadenomas
wrong interpretation
stable remission
placebo
metabolism
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