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CNAA / Theses / 2008 / June /

Adjuvant therapy in the complex treatment of acute severe pancreatitis


Author: Ruslan Baltaga
Degree:doctor of medicine
Speciality: 14.00.37 - Anaesthesiology and Reanimathology
Year:2008
Scientific adviser: Valeriu Ghereg
doctor habilitat, professor
Scientific consultant: Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution: State University of Medicine and Pharmacy "Nicolae Testemitanu"

Status

The thesis was presented on the 18 June, 2008
Approved by NCAA on the 18 September, 2008

Abstract

Adobe PDF document0.30 Mb / in romanian

Keywords

acute pancreatitis, systemic inflammatory response syndrome, veno-venous hemofiltration, epidural analgesia, conservative treatment.

Summary

The present paper shows results of a research performed on 82 patients, who were admitted to the anaesthesia intensive care and reanimation clinic with diagnosis of acute severe pancreatitis. Severity of disease were stratified according to multiple scoring systems SIRS, RANSON, SAPS and was compared predicted mortality with rate of mortality registered in this group of patients. Were established the character of process in acute severe pancreatitis which was confirmed as Systemic Inflammatory Response Syndrome, starting with early phase of disease.

It was applied a protocol of management and conservative treatment of patients with acute pancreatitis in initial phases. Protocol establishes criteria of severity according to severity scores SIRS, RANSON, SAPS. In case of severe acute pancreatitis, patients are treated in intensive care unit. Complex treatment includes respiratory support, volemic and hydroelectrolitic resuscitation, hemodynamic support, effective diuresis, clinical nutrition, prophylactic antibiotics. In this study adjuvant therapies using venovenous hemofiltration, intravenous perfusion with Reosorbilact, epidural analgesia where indicated from the initial phases in the complex of conservative treatment. It was studied: parameters of central hemodynamics using non-invasive method of tissular bioimpendance: parameters of tissular perfusion (DO2, VO2, and VO2/DO2), intragastric PCO2; parameters of renal blood flow. It was established a favourable hemodynamic profile, and improvement of tissular perfusion using above mentioned therapies.

Complications of pancreatitis were registered in 56% of patients. Mortality in studied group was 21%.