[Prospects for stimulation in early rehabilitation of patients and restoration of bowel function after proctological operations]. / Vozmozhnosti rannei reabilitatsii patsientov i vosstanovleniia funktsii kishechnika posle obshcheproktologicheskikh operatsii.

RELEVANCE: The leveling of postoperative pain, early activation of patients are the leading components of the fast-track program, providing fast recovery with good quality of life, minimizing postoperative problems. In colorectal surgery, the most important factor determining the early recovery of patients is the normalization of bowel function, the restoration of defecation rhythm. AIM: To assess the possibility of using dietary fiber (arabinogalactan) in combination with lactoferrin (the drug Fibraxin, Alfa Sigma) in the complex postoperative therapy of proctologic patients, as well as to determine the effectiveness of their influence on the dynamics of rehabilitation. MATERIAL AND METHODS: A non-randomized cohort comparative prospective study was conducted in two clinical groups of 100 patients operated on for proctological pathology. In the first (control) group, after the operation, venotonics were prescribed for 2-3 weeks, as well as topical preparations - for 2.5 weeks. In the second (main) group, this treatment is supplemented with the use of Fibraxin, at a dosage of 6g 1 time per day, the observation period is 4 weeks. A comparative analysis of the rates of relief of postoperative defecation disorders, as well as the effect of the drug on the dynamics of the relief of leading postoperative complaints, has been carried out. RESULTS: In the main group, the best results were obtained for the main parameters analyzed, early normalization of the frequency and rhythm of bowel movements was achieved, with adequate relief of complaints of pain during bowel movements and after it. Intolerance to the drug and pathological reactions associated with its use was not. The positive effect of Fibraxin in patients with concomitant diseases of the colon, including colitis, irritable bowel syndrome, diverticular disease and chronic colonic stasis, was noted. CONCLUSION: The use of the drug Fibraxin at a dose of 6g per day allows a significant influence on the course of the postoperative period in proctological patients. The inclusion of Fibraxin in the scheme of rehabilitation treatment allows to stabilize the immediate results of treatment and reliably improve long-term, due to the correction of rectal dysfunction, elimination of dysbiosis, normalization of motility, as well as potentiation of reparative and restorative processes.

[Assessment of oxygen status in critical patients with systemic inflammatory reaction].

Diagnostic ability of alveolar-arterial oxygen gradient (A-aDO2 and respiratory index (RI) for acute respiratory distress syndrome was underestimated before recent time. 68 patients with severe inhomogeneous lung injure (severe concomitant trauma, pneumonia, and pancreonecrosis) were involved in the study. Patients were divided into two groups (basic group--34 patients and control group--34 patients). There were no differences in data of severity-of-disease by APACHE II and SOFA scales and J.F. Murrey lung injury score in both groups. Conventional volume controlled and pressure control respiratory techniques were used in patients of control group. Multi-level ventilation with three levels was used in patients of basic group. Blood gas containing, A-aDO2 and RI were studied. Gas status data improved both to gas exchange efficacy in patients of basic group. The data were significant different in the control group. Thus multilevel ventilation improves alveolar ventilation and arterial oxygenation, decreases pulmonary shunt and lung injury and improves respiratory lung functions.