Clinical efficacy of remaxol in the volume infusion therapy of acute pancreatitis
Background. In Ukraine, as elsewhere in the world, there is a tendency to increase in the incidence of acute pancreatitis (AP), which causes the primary disability of patients or, if the course is unfavorable, leads to multiple organ failure (multiple organ dysfunction syndrome — MODS) and a possible fatal outcome of the disease. The AP causes pathological sequestration of the fluid in the retroperitoneal space and splanchnic vascular system, causing deep fluid disorders, reduction of porto-hepatic circulation with a violation of the trophic reserve of blood circulation and cellular homeostasis, especially in parenchymal organs. The basis for the application of a balanced polyionic solution containing amber acid is the ability of the succinate to support synthesis and maintain cellular energy under acute metabolic disturbance and exhausted energy resources. The purpose of the study is to improve the treatment of patients with various forms of acute pancreatitis by optimizing infusion therapy by restoring energy deficiency in the tissues of the body and enhancing natural detoxification systems. Materials and methods. The early period of intensive care was studied prospectively in 120 AP patients, 81 (67.5 %) men and 39 (32.5 %) women aged 46.6 ± 12.7 years. The primary distribution in groups was carried out according to the type of acute volemic disorders caused by AP. Group 1 — primary dehydration degree II, APACHE II — 13 [10, 14] points, organ failure according to the modified MODS — 2 [1, 2]: 1a subgroup (controls) — 24 (20 %) patients who underwent standard volemic resuscitation without succinate; 1b subgroup — 71 (59.2 %) patients, a balanced solution containing remaxol pro infusionibus succinate was added to the basic resuscitation. Group 2 — 25 patients (20.8 %) with acute surgical dehydration degree III and predicted severe course of AP; APACHE II — 19 [16, 24] points, MODS — 3. Results. In all patients with AP, the primary acute surgical dehydration degree II and III was detected, it was associated with the systemic inflammatory response syndrome (SIRS), mild (heart rate — 118 ± 5 bpm, leukocytosis — 14.6 ± 1.3 · 109/l, neutrophil left shift — 13.8 ± 1.5 %) or moderate (body temperature was 38 °C) degree. After 72 hours of treatment, the severity of leukocytosis and shift were 11 % lower (p < 0.02) in those patients who received remaxol three times. At day 5 of treatment in patients receiving remaxol (1b subgroup), the levels of α-amylase, bilirubin, transaminases were within the reference range. When using remaxol, persistent organ failure was observed in 7 % of cases (5 patients), in contrast to the patients in the 1a subgroup who did not receive remaxol — 12.5 % (3 patients), and a regression of persistent manifestations occurred during the fourth day of observation, whereas in 1a subgroup after 72 hours, 2 (8.3 %) patients had a repeated deterioration of the clinical condition due to necrotic damage to the pancreas. Against the background of remaxol, all organ disorders developed 9.1 % less frequently than in 1a subgroup, and the severe course of AP was detected 6.8 % less frequently. Conclusions. The use of remaxol in the early period of the AP reduces the manifestations of intrahepatic cholestasis, cytolysis, nonspecific mesenchymal inflammation, exhibits hepatoprotective effect, preserves metabolic, homeostatic and detoxification functions of the liver; slows down the progression of SIRS and organ disorders, creates the conditions necessary for optimizing reparative processes in the pancreas, regardless of the severity of the AP; provides effective clinically significant (in 16 % of cases) redistribution of patients towards the moderate (mild) AP, promotes mostly uncomplicated, mostly moderate AP and regression of transient and persistent organ failure, slows down the development of MODS and the progression of pancreatic necrosis in the severe course of AP.
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