POSTOPERATIVE PNEUMONIA: PREVENTION AND TREATMENT IN URGENT ABDOMINAL SURGERY

Abstract

Objective: Preventive maintenance and treatment of postoperative pneumonia in patients with urgent abdominal pathology. Methods: The results of examination and treatment of 86 patients with postoperative pneumonia (PP) for the period from 2005 to 2017 analyzed. There were 51 men (59.3%), women – 35 (40.7%). All patients were operated for the diffuse peritonitis caused by acute destructive appendicitis (n=21), perforated gastroduodenal ulcer (n=10), strangulated ventral hernia (n=4), acute intestinal obstruction (n=19), destructive forms of acute calculous cholecystitis (n=18) and acute destructive pancreatitis (n=14). In addition, the work presents the results of the application of the preventive measures developed by authors in 70 patients with urgent diseases of the abdominal cavity without PP. Results: To reduce the frequency of PP in patients with urgent surgical diseases of the abdominal cavity, complicated by intraperitoneal hypertension syndrome and enteral insufficiency, a method of antegrade intubation of the small intestine has been developed. In cases when after approaching of the edges of laparotomic wounds, the intra-abdominal pressure was above 15 mm Hg, the operation completed by hemming to the edges of the aponeurosis using a polypropylene mesh. The use of preventive endoprosthetics allowed to increase the volume of the abdominal cavity and, thereby, to level out the high standing of the diaphragm and the lung compressions, which was a surgical preventive maintenance of PP. After completion of the operation, in 22 cases, a catheterization of the small intestine mesentery was performed with subsequent introduction of 10 mg of serotonin adipate twice daily with a microdose jet pump SN-50. The patients observed the resolution of paresis on the second day after the surgery. Conclusion: Proposed measures for the prevention of PP allow to significantly improve the immediate results of surgical treatment of urgent diseases of the abdominal cavity by reducing the incidence of nonspecific complications. The use of serotonin adipate promotes the normalization of automatism and contractile activity of the smooth muscles of the intestine and allows reducing the frequency of complications and lethality among this complex category of patients.

Keywords

• postoperative pneumonia
• abdominal cavity
• serotonin adipate