Мать и дитя в Кузбассе (May 2023)
INFLAMMATORY DISEASES OF THE UTERINE APPENDAGES FROM THE STANDPOINT OF THE SYSTEMIC INFLAMMATORY RESPONSE SYNDROME AND INSTRUMENTAL ASSESSMENT OF THE HEMOSTASIS SYSTEM
Abstract
The number of inflammatory diseases of the uterine appendages tends to increase. At the same time, purulent diseases of the uterine appendages occupy a leading place in the structure of the causes of infertility, miscarriage and disability in women of reproductive age. In a prospective, continuous, cross-sectional study, 449 women with inflammatory diseases of the uterine appendages were examined. Aims – to determine the clinical patterns, markers of endogenous intoxication and mechanisms of coagulation shifts in inflammatory diseases of the uterine appendages from the standpoint of the systemic inflammatory response syndrome (SIRS). Materials and methods. Patients with inflammatory diseases of the uterine appendages were divided into 2 groups: 107 women with uncomplicated inflammatory diseases of the uterine appendages and 342 patients with inflammatory diseases of the uterine appendages. Separately, 253 women with non-destructive purulent diseases of the uterine appendages and 89 cases with purulent tubo-ovarian masses were considered. Patients were evaluated for endotoxicosis indices and the state of the hemostasis system. The severity of the process and the degree of intoxication of the body were assessed using the SIRS, SAPS, SOFA scales. The evaluation of thrombohemorrhagic complications was assessed using thromboelastography (TEG). Results. Bilateral process of uterine appendages predominates in purulent diseases of the uterine appendages (80.2 %). In 70.4 % of cases, the destructive process was preceded by a chronic course of inflammatory diseases of the uterine appendages. A feature of the course of purulent diseases of the uterine appendages was the recurrent nature of the disease (63.4 %). In the case of a destructive process, the presence of three signs of SIRS (SIRS-3) in combination with the SAPS scale index (>10 points) and data on leukocyte indices is necessary as criteria for the risk of infection generalization. Thrombotic complications were observed in 6.4 % of patients with purulent diseases of the uterine appendages: 4.4 % – thrombophlebitis of the veins of the lower extremities, 1.2 % – thrombosis of the veins of the pelvic organs, 0.6 % – pulmonary embolism, 0.3 % – cerebral ischemia. Conclusion. The use of indicators of intoxication indices as markers of purulent-necrotic destruction and instrumental assessment of violations of the coagulation potential of the blood make it possible to personalize the diagnosis and choice of tactics for managing patients with inflammatory diseases of the uterine appendages.
