«Актуальные проблемы современной фармакотерапии»
Республиканская научно
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практическая конференция
63
EFFICIENCY OF PHARMACOTHERAPY IN COMBINED TREATMENT
OF EXTENDED PURULENT PERITONITIS
Sabirmatov A.A.
Tashkent Pediatric Medical Institute
Mamatova N.M.
Tashkent Pediatric Medical Institute
Agzamova N.V.
Tashkent Pediatric Medical Institute
THE RELEVANCE OF THE PROBLEM
Despite the progression and improvement of methods of surgical
interventions, the number of peritonitis spread among emergency operations
performed is 20-35%, of which 19-60% of cases end in mortality. The main key
factor in the etiopathogenesis of peritonitis remains the bacterial link. At the same
time, the appearance of highly virulent microflora contributes to the antibiotic
resistance of drugs associated with the presence of beta-lactamases [1; 2; 6; 7].
It is known that the prognosis of recovery of patients with peritonitis at
58% practically does not depend on treatment with antibacterial drugs. The key
moment in the complex treatment of this disease belongs to the rehabilitation of
the abdominal cavity (SBP). A widely used method of sanitation of the abdominal
cavity (SBP) is currently washing with various medicinal solutions (because
solutions of hydrogen peroxide 3%, furacilin solution, dimexide, sodium
hypochlorite, ozonated solutions, etc.) [2; 4; 5; 9].
According to a number of scientists, the development of the method of
antibacterial photodynamic therapy (AFDT) may be used to solve the above
problems. It has been established that inflamed tissues tend to delay dyes
–
photosensitizers (FS) and therefore biological materials, such as inflamed tissue, and
pathogenic bacteria, can become objects for exposure to photodynamics [3; 8].
Photodynamic therapy (PDT) requires a photosensitizer, i.e. a drug with a
certain range of radiation absorption, a source of laser or LED radiation
corresponding to the absorption spectrum of the photosensitizer, an endogenous
factor
–
singlet
–
oxygen, it is generated during a photochemical reaction.
Photosensitizers are dyes that are sensitive to light of the appropriate wavelength
and are activated (excited) from it.
The purpose of the research is to develop and evaluate the effectiveness of
the antimicrobial PDT method in the complex treatment of diffuse peritonitis (RP)
under experimental conditions.
The material
of the research was laboratory animals 161 white mongrel
rats. The experimental research was performed on 161 animals of mongrel rats,
with weights of 140-180 gr. All animals were in standard vivarium mode.
«Актуальные проблемы современной фармакотерапии»
Республиканская научно
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практическая конференция
64
The work was carried out in the Central Scientific Research Laboratory (TSNIL)
of the Tashkent Pharmaceutical Institute. Animals were taken out of the
experiment according to the rule of humanism in relation to laboratory animals
by an overdose of anesthesia. At the initial stage, we conducted experimentally in
vitro studies to study the bactericidal properties of methylene blue and LED
radiation in the red color
range with a wavelength of 630 ± 20nm separately, then
in their combination (methylene blue and LED radiation) at different
concentrations and exposure time of LED radiation. At the same time, the
bactericidal properties of 0.02% chlorhexidine solution were studied.
Experimental studies in vivo included 4 series. In the first series, we studied
the effects of methylene blue (MS), LED radiation in the range of 640±20nm, as
well as their combinations (PDT) and 0.02% chlorhexidine solution on the
morphological structure of the parietal and visceral peritoneum in intact animals
(n=75).
In the second series, we developed an experimental model of widespread
peritonitis in 18 rats.
The third series consisted of 28 rats (control group), and abdominal
sanitation (SPBP) in acute experimental peritonitis (OEP) was carried out with
solutions of chlorhexidine in a dilution of 0.02%.
The last series included 40 mongrel rats and lavage was carried out by PDT
using a solution of methylene blue in a concentration of 0.05%.
RESULTS AND DISCUSSION
The purpose of the first stage of research was to study the damaging effect
of chemicals (methylene blue and chlorhexidine), and LED emitters on a healthy
peritoneum. All studies were performed under identical conditions,
simultaneously, under general anesthesia of animals. During and after the
experiment, the condition of the animals was assessed by the established criteria.
The second stage of the study is the development of a model of widespread
peritonitis according to Blinkov Yu.Yu. et al. [A/c: RU 2338265 from 10.11.2008].
By overdosing on anesthesia, the animals were removed from the experiment. To
simulate peritonitis a fecal mixture was made, which was obtained from the colon
of several rats. After the stool was mixed with saline solution, the resulting
mixture was carried out through gauze napkins, and for 20 minutes the mixture
was injected into the abdominal cavity of experimental animals at a dose of 0.5 ml
per 100 g. The animals were in a head-down position at the same time. During
puncture, the tip of the needle was occasionally changed to achieve infection of
the entire abdominal cavity.
The aim of the third stage of the study was to simulate peritonitis,
laparotomy, and sanitation of the abdominal cavity (SBP) with 0.02%
chlorhexidine solution 24 hours after the simulation. Under inhalation ether
anesthesia, mid-laparotomy was performed on experienced animals. Then the
abdominal cavity was inspected, the morphological picture of the peritoneal
«Актуальные проблемы современной фармакотерапии»
Республиканская научно
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практическая конференция
65
cavity was judged, as well as the state of the parietal and visceral leaf of the
peritoneum; the amount of exudate and composition were measured,
characterization was given, bacteriological seeding of exudate was obtained from
the abdominal cavity, observing the rules of asepsis; a part of the parietal leaflet
of the peritoneum was taken for biopsy. With the help of a syringe, the entire
exudate was sucked out of the abdomen, followed by 3-4 times washing to the
purity of the abdominal cavity with solutions of chlorhexidine in a dilution of
0.02%. The methods listed above did not differ from the main group of animals.
The amount of chlorhexidine for abdominal lavage in the control group was 3 ml,
and the exposure time was 5 minutes.
At the conclusion of the experiment, the wound of the anterior abdominal
wall was sutured through all layers, animals were labeled and sent to a standard
vivarium, where identical conditions were provided. All experimental animals
who underwent surgery with fecal peritonitis, despite the methods of sanitation
of the abdominal cavity for 3 days in the postoperative period (POP), were given
antibiotic therapy with gentamicin at a dosage of 2 mg/kg per div weight,
intramuscularly).
The purpose of the fourth stage of the study was to study the effect of
photodynamic therapy (PDT) in the treatment of diffuse peritonitis RP and
compare the results with the traditional method of abdominal sanitation SBP.
During the operation, the macroscopic picture of the peritoneum in rats
corresponded to the picture of acute diffuse purulent peritonitis
In the main IV series of animals, after determining the status of the
abdominal cavity and the spread of the inflammatory process, the abdominal
cavity was drained and a 0.05% aqueous solution of methylene blue (MS) was
injected in a volume of 2-3 ml, then fluorescence diagnostics were performed to
determine the degree of accumulation of photosensitizer (FS) in the peritoneum.
After that, the abdominal cavity was washed with 0.9% isotonic solutions to pure
waters, fibrin deposits were removed from the abdominal cavity by active
aspiration with a syringe. The abdominal cavity was irradiated for 5 minutes with
an LED device. As a photodynamic therapy (PDT) emitter, the VOSTOK 010203
device was used with an output power of up to 200 MW, a wavelength of
640 ± 20nm., operating in continuous mode.
For photodynamic therapy (PDT), the energy density is equal to 25 to
35 J/cm2 [4].
Experimental animals were derived from an experiment with an overdose
of ether anesthesia. For comparison, we studied: hematology and blood
biochemistry, intoxication indicators, histological materials, and mortality of rats
with acute experimental peritonitis (OEP). In the control group, the abdominal
cavity was washed with a solution of chlorhexidine in a dilution of 0.02%, which
is widely used in surgical practice due to the active bactericidal action of the drug,
many people know that chlorhexidine is sensitive to both gram-positive and
gram-negative pathogenic bacteria.
«Актуальные проблемы современной фармакотерапии»
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Following the events, the antibacterial effect of photodynamic therapy
(PDT) was revealed, after photodynamic therapy (PDT), regenerative functions of
tissues were enhanced, early appearance of granulation in necrotic foci,
acceleration of transplant time for auto dermoplasty of patients with burns [5].
The use of photodynamic therapy (PDT) for purulent wounds has great potential
before traditional methods of treatment, which include treatment with
antiseptics, the use of antibiotics, and antibacterial ointments. And the potential
of photodynamic therapy (PDT) is: for the bactericidal action of PDT, the
spectrum of sensitivity of microorganisms to antibiotics does not matter; with
repeated use of photodynamic therapy (PDT), resistance to the method does not
appear in microorganisms; The method has a direct bacteriostatic and
bactericidal effect, with repeated use it does not affect the microorganism
sideways, due to selective accumulation photosensitizer (FS) in pathogenic cells.
Based on the above, we can say photodynamic therapy (PDT) is actively
developing in medicine, especially in surgery.
RESUME
Despite the development of medicine, especially surgery (diagnostics,
methods of surgery, postoperative measures, development of new technologies),
many questions still remain unresolved and are awaiting their answers. Spilled
purulent peritonitis has been and remains a formidable pathology in abdominal
surgery which still requires research, development of new treatment methods,
and innovative ways of cleansing from pathogenic cells of the abdominal cavity,
which help to improve the results of treatment of spilled purulent peritonitis.
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