RESUMEN
Treatment results of 63 patients with surgical sepsis (aged 17-92 years) were analyzed. The necessity of intravenous immunoglobulin infusion in the complex treatment of sepsis was proved by the comparative morphological study of immunocompetent tissues of 30 patients, died of sepsis and nonseptic reasons. The rational use of intravenous immunoglobulin should be based on the condition of the patient and defined by the APACHE II and SOFA scores.
Asunto(s)
Antibacterianos/uso terapéutico , Sistema Inmunológico/patología , Inmunoglobulinas Intravenosas/uso terapéutico , Reoperación/métodos , Infección de la Herida Quirúrgica , Síndrome de Respuesta Inflamatoria Sistémica , APACHE , Adulto , Anciano , Técnicas Bacteriológicas , Terapia Combinada , Femenino , Humanos , Sistema Inmunológico/fisiopatología , Inmunidad/efectos de los fármacos , Factores Inmunológicos/uso terapéutico , Masculino , Persona de Mediana Edad , Factores de Riesgo , Infección de la Herida Quirúrgica/inmunología , Infección de la Herida Quirúrgica/mortalidad , Infección de la Herida Quirúrgica/patología , Infección de la Herida Quirúrgica/terapia , Síndrome de Respuesta Inflamatoria Sistémica/inmunología , Síndrome de Respuesta Inflamatoria Sistémica/mortalidad , Síndrome de Respuesta Inflamatoria Sistémica/patología , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Resultado del TratamientoRESUMEN
The results of treatment of 73 patients with confirmed diagnosis of sepsis are analyzed. The most frequent immune disorders in septic patients are: decrease in lymphocyte count, both T (60%) and B (45.7%) populations, decrease of T-helpers and T-suppressors (52.6%) count, increase of C3-complement activator titre (50%) and phagocytic coefficient (52.4%). The more expressed immune depression observed in patients with gram-negative sepsis in comparison with the gram-positive. Standard immunoglobulins were used in the treatment of 38 patients: "Endobulin" (ImmunoAG, Austria)--in 9 cases; "Intraglobin" (Biotest, Germany)--in 14 and "Pentaglobin" (Biotest, Germany)--in 15 cases. Analyze of the control immunogramms showed the reliable improvement of immune indices and normalization of T-cell counts. Lethality among septic patients treated with immunoglobulins was 14.5%.
Asunto(s)
Inmunoglobulinas/uso terapéutico , Inmunoterapia/métodos , Complicaciones Posoperatorias/terapia , Sepsis/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Complemento C3/análisis , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/inmunología , Infecciones por Bacterias Gramnegativas/terapia , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/inmunología , Infecciones por Bacterias Grampositivas/terapia , Humanos , Inmunoglobulinas/administración & dosificación , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inmunología , Complicaciones Posoperatorias/mortalidad , Sepsis/inmunología , Sepsis/microbiología , Sepsis/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
The methods of extracorporeal detoxication acquire special importance in combined treatment of sepsis. The sessions of plasmapheresis, hemodialysis and isolated ultrafiltration were performed in 61 of 83 patients with sepsis. Indications to these methods are determined, their efficacy is evaluated. It is established that administration of antibiotics and immunoglobulins after sessions of plasmapheresis and hemodialysis to achieves therapeutic drug concentration in blood. It is difficult to select the dose of antibiotics and immunodrugs in permanent round-the-clock ultrafiltration since the part of them are eliminated through the filters. Overall lethality was 20.4% (17 of 83 patients died), in the group of patients with severe polyorganic insufficiency and septic shock who needed extracorporeal detoxication--27%.
Asunto(s)
Plasmaféresis , Diálisis Renal , Sepsis/terapia , Infección de la Herida Quirúrgica/terapia , Ultrafiltración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos , Quimioterapia Combinada/farmacocinética , Quimioterapia Combinada/uso terapéutico , Femenino , Humanos , Inmunoglobulinas/uso terapéutico , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Sepsis/sangre , Sepsis/mortalidad , Infección de la Herida Quirúrgica/sangre , Infección de la Herida Quirúrgica/mortalidad , Tasa de SupervivenciaRESUMEN
On the basis of critical analysis of the results of combined treatment of 73 patients, the authors suggested that sepsis could be diagnosed only in the presence of systemic inflammatory response, multiorganic insufficiency and obligatory isolation of hemoculture. The microorganisms' specimen from the infected area and the blood are not identical both in primary and repeated inoculation. Impossibility to verify the pathogenic microorganism in the blood prevents from carrying out adequate and purposeful treatment. The absence of correlation between the severity of clinical course of sepsis, microflora species and laboratory immunography data, confirms the opinion that the organism responds to the inflammatory process by complex general physiologic reaction of defence, which includes, besides immunologic system, fermentative, endocrine, vegetative and other systems of homeostasis.