DOI: https://doi.org/10.22141/2224-0586.2.97.2019.161654

To help the practitioner: enteral correction of intestinal insufficiency syndrome in patients after surgical interventions

A.V. Tkhorevsky, A.O. Prisyazhnyuk, R.M. Slobodyanyuk

Abstract


To help the practicing doctor, the article discusses the important problem of modern surgery such as intestinal insufficiency and possible ways to solve it. The purpose of the work was to study the features, need and possibility of early enteral nutrition in comprehensive treatment of surgical patients with syndrome of intestinal insufficiency in order to reduce complications, to optimize treatment. The enteral nutrition was started when shock was treated, after performing urgent surge-ries and stabilizing haemodynamic indicators. For the analysis of opportunity and comparative efficiency of various ways and terms of nutrition support, all patients depending on the time when nutrition was started were divided into three groups: group I (n = 15) included patients with oral nutrition whose enteral nutrition was initiated within 1–2 days, group II (n = 15) consisted of patients whose nutrition was started within 4–5 days, and group ІІI (n = 15) included patients who have been fed after 5 days, with comprehensive intensive care aimed at stabilization of vital functions. The features, need and possibility of early enteral nutrition in comprehensive treatment of surgical patients with syndrome of intestinal insufficiency were studied in order to reduce complications, to optimize treatment. Importance was noted of intestines preparation, against the background of comprehensive intensive care aimed at the improvement of splanchnic circulation, to the enteral nutrition by drop introduction of the warm balanced crystalloid solutions, administration of sorbents, pre- and probiotics. The importance of drip introduction of warm semi-element mixtures, the osmolarity of which is close to that of chymus, is noted. Influence of early enteral nutrition on a decrease in infectious complications and duration of hospital stay is shown. Inclusion of early enteral nutrition in the therapy allowed reducing the time for achieving target values of abdominal perfusion pressure, i.e. to optimize blood circulation at the systemic and tissue levels. The method of early (in 6–12 hours) introduction of the balanced solution sterofundin in a gut, with further evaluation of the intestinal absorptive function and initiation of early introduction of a warm enteral nutrition (this method was developed in our clinic), has advantages in decreasing complications in patients.

Keywords


intestinal insufficiency; early enteral nutrition; infectious complications; splanchnic circulation

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