Issue №4-86, 2018

New approaches to complex treatment of the syndrome of intestinal insufficiency as an important component of post-aggressive rehabilitation of surgical patients in critical condition

View article (Download PDF file)



Download XML file

1 Ivanova G.Ye., 2 Popova T.S., 3 Shestopalov A.E., 2 Tropskaya N.S., 2 Matkevich V.A., 2 Vladimirova E.S., 2 Ryk А.А., 2 Kislyakova Е.А., 2 Botin А.S., 2 Kislitsyna O.S., 2 Vilkova I.G.

1 Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia
2 N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department, Moscow, Russia
3 Russian Medical Academy of Postgraduate Education of Ministry of Health and Social Development of Russian Federation, Moscow, Russia


ABSTRACT

The review presents the main modern achievements in the field of complex treatment of the syndrome of intestinalinsufficiency as a rather frequent complication of acute surgical diseases and traumatic abdominal injuries, which largelydetermines the outcome of therapeutic care. The review analyzed a pathogenetic modern concepts concerning combinedand consistent use innovative technologies in the intensive care medicine of the syndrome of intestinal insufficiency in patientsin a critical state. The proposed methodology, tested in the experiment and clinic, found high efficiency and confirmedthe necessity of using in the early postoperative period naso-intestinal intubation and decompression of the gastrointestinaltract, intestinal lavage with a chyme-like glucose-salt enteral solution, enterosorption, a modern prokinetic drugs withstimulating and regulating mechanisms of action, pharmaco-nutrients and enteral nutrition, as well as prebiotics, probioticsand metabiotics.


KEYWORDS: syndrome of intestinal insufficiency, gastric and intestinal lavage, enterosorption, prokinetic drugs, pharmaco-nutrients, prebiotics, probiotics, metabiotics.



References:

  1. Ermolov A. S. i dr. Sindrom kishechnoj nedostatochnosti v neotlozhnoj abdominal'noj hirurgii (ot teorii k praktike) //M.: MedEHkspertPress. - 2005. - T. 460. - S. 112.
  2. Popova T.S. Ostraya kishechnaya nedostatochnost' kak proyavlenie postagressivnoj reakcii organizma // Rukovodstvo po klinicheskomu pitaniyu / pod red. V. M. Lufta. SPb.: Art-EHkspress. 2016; s. 175-189.
  3. SHestopalov A.E., Popova T.S. Patofiziologiya sindroma kishechnoj nedostatochnosti // Intensivnaya terapiya: Nacional'noe rukovodstvo / pod red. Gel'fand B.R., Saltanov A.I. M.: GEHOTAR-Media. - 2009. - T. 1. - S. 735-743.
  4. Savel'ev V. S. i dr. Sindrom kishechnoj nedostatochnosti v urgentnoj abdominal'noj hirurgii: novye metodicheskie podhody k lecheniyu //Trudnyj pacient. - 2005. - T. 3. - №. 4. - S. 30-37.
  5. Savel'ev V. S. Sindrom kishechnoj nedostatochnosti v ehkstrennoj hirurgii organov bryushnoj polosti //M.: MAKS Press. - 2006. - 28 S.
  6. Rukovodstvo po klinicheskomu pitaniyu / pod red. V. M. Lufta. SPb.: Art-EHkspress. 2016; 484 s.
  7. Baklykova N. M. Sostav i prigotovlenie sred dlya vnutrikishechnogo vvedeniya pri peritonite // Metodicheskie rekomendacii. - M., 1986.
  8. Matkevich, V.A Kishechnyj lavazh pri ostryh peroral'nyh otravleniyah: avtoref. diss.: kand. med. nauk. - M., 1988. 23 s.
  9. Matkevich V. A. i dr. Rol' kishechnoj translokacii v geneze ehndotoksemii pri ostryh otravleniyah i detoksikacionnyj ehffekt kishechnogo lavazha // ZHurnal im. NV Sklifosovskogo «Neotlozhnaya medicinskaya pomoshch'». - 2016. - №. 4. - S. 16-21.
  10. Tropskaya N.S. Mekhanizmy posleoperacionnyh narushenij motorno-ehvakuatornoj funkcii zheludka i tonkoj kishki i ih farmakologicheskaya kor-rekciya //Dis. d-ra biol. nauk. M. - 2009. - 320s.
  11. Tropskaya N.S., Popova T.S. Postoperative ileus: Pathophysiology and Treatment // Current concepts in colonic disorders Edited by Godfrey Lule - Published by in Tech, Croatia, 2011 - Ch.12.-P.203-220.
  12. ropskaya N.S. Prokinetiki // Parenteral'noe i ehnteral'noe pitanie: nacional'noe rukovodstvo / pod red. M.SH. Hubutiya, T.S. Popovoj, A.I. Saltanova.- M.: GEHOTAR - Media, 2014.- S. 236-247.
  13. Alekseeva E. V., Popova T. S., Tropskaya N. S. Nekotorye aspekty ispol'zovaniya prokineticheskih svojstv ehritromicina //Kremlevskaya medicina. Klin-icheskij vestnik. - 2009. - №. 4. - S. 80-86.
  14. Alekseeva E. V. i dr. Primenenie prokinetika domperidona u bol'nyh v rannem posleoperacionnom periode //Hirurgiya. - 2010. - №. 3. - S. 62-69.
  15. Sturm A. et al. Prokinetics in patients with gastroparesis: a systematic analysis //Digestion. - 1999. - T. 60. - №. 5. - S. 422-427.
  16. Li Z. S. et al. Physiological modulation of intestinal motility by enteric dopaminergic neurons and the D2 receptor: analysis of dopamine receptor expression, location, development, and function in wild-type and knock-out mice //Journal of Neuroscience. - 2006. - T. 26. - №. 10. - S. 2798-2807.
  17. Alekseeva E. V. Prokinetiki v lechenii sindroma kishechnoj nedostatochnosti u hirurgicheskih bol'nyh v kriticheskom sostoyanii //Dis. kand. med. nauk. M. - 2010.
  18. Tack J. Georges Brohee Prize 1994. Motilin and the enteric nervous system in the control of interdigestive and postprandial gastric motility //Acta gastro-enterologica Belgica. - 1995. - T. 58. - №. 1. - S. 21-30.
  19. Tropskaya N.S., Popova T.S. Mekhanizmy dejstviya trimebutina v korrekcii funkcional'nyh rasstrojstv zheludochno-kishechnogo trakta // Clinical Gastroenterology and Hepatology = Klin.gastroehnterol. i gepatol.: russ. izd.-2008.-№4.- S.294-297.
  20. Kizhaeva E. S., Zaks I. O. Poliorgannaya nedostatochnost' v intensivnoj terapii //Vestnik intensivnoj terapii. - 2004. - T. 1. - S. 12-24.
  21. Tropskaya N. S., Popova T. S., Solov'eva G. I. Vliyanie blokatora sinteza NO na ehlektricheskuyu aktivnost' zheludka i tonkoj kishki krys v rannem po-sleoperacionnom periode //Byulleten' ehksperimental'noj biologii i mediciny. - 2005. - T. 139. - №. 3. - S. 270-273.
  22. Moncada S., Palmer R. M. L., Higgs E. A. Nitric oxide: physiology, pathophysiology, and pharmacology //Pharmacological reviews. - 1991. - T. 43. -№. 2. - S. 109-142.
  23. Kiseleva A. V., CHurlyaev YU. A., Grigor'ev E. V. Rol' oksida azota v povrezhdenii nejronov pri kriticheskih sostoyaniyah //Obshchaya reanimatologiya. -2009. - T. 5. - №. 5. - S. 80-83.
  24. Esplugues J. V. NO as a signalling molecule in the nervous system //British journal of pharmacology. - 2002. - T. 135. - №. 5. - S. 1079-1095.
  25. Griffiths R. D. Glutamine in the critically ill patient: can it affect mortality? //Clinical nutrition supplements. - 2004. - T. 1. - №. 1. - S. 25-32.
  26. Wischmeyer P. E. Clinical applications of L-glutamine: past, present, and future //Nutrition in clinical Practice. - 2003. - T. 18. - №. 5. - S. 377-385.
  27. Griffiths R. D. Glutamine: The struggle for proof? //Critical care medicine. - 2011. - T. 39. - №. 6. - S. 1546-1547.
  28. Heyland D. et al. A randomized trial of glutamine and antioxidants in critically ill patients //New England Journal of Medicine. - 2013. - T. 368. - №. 16. - S. 1489-1497.
  29. Bollhalder L. et al. A systematic literature review and meta-analysis of randomized clinical trials of parenteral glutamine supplementation //Clinical nutrition. - 2013. - T. 32. - №. 2. - S. 213-223.
  30. Morris Jr S. M. Arginine: beyond protein //The American journal of clinical nutrition. - 2006. - T. 83. - №. 2. - S. 508S-512S.
  31. Popovic P. J., Zeh H. J., Ochoa J. B. Arginine and immunity //The Journal of nutrition. - 2007. - T. 137. - №. 6. - S. 1681S-1686S.
  32. Ochoa J. B. et al. Nitrogen oxide levels in patients after trauma and during sepsis //Annals of surgery. - 1991. - T. 214. - №. 5. - S. 621.
  33. Heyland D. K. et al. Should immunonutrition become routine in critically ill patients?: A systematic review of the evidence //Jama. - 2001. - T. 286. - №. 8. - S. 944-953.
  34. Ariel A., Serhan C. N. Resolvins and protectins in the termination program of acute inflammation //Trends in immunology. - 2007. - T. 28. - №. 4. - S. 176-183.
  35. Calder P. C. Rationale for using new lipid emulsions in parenteral nutrition and a review of the trials performed in adults: Conference on ‘Malnutrition matters’ Symposium 4: Hot topics in parenteral nutrition //Proceedings of the Nutrition Society. - 2009. - T. 68. - №. 3. - S. 252-260.
  36. Mayer K. et al. Parenteral nutrition with fish oil modulates cytokine response in patients with sepsis //American journal of respiratory and critical care medicine. - 2003. - T. 167. - №. 10. - S. 1321-1328.
  37. Heller A. R. et al. Omega-3 fatty acids improve the diagnosis-related clinical outcome //Critical care medicine. - 2006. - T. 34. - №. 4. - S. 972-979.
  38. SHenderov B. A. Misheni i ehffekty korotkocepochechnyh zhirnyh kislot //Sovremennaya medicinskaya nauka. - 2013. - №. 1-2. - S. 21-50.
  39. Miyoshi M. et al. Oral administration of tributyrin increases concentration of butyrate in the portal vein and prevents lipopolysaccharide-induced liver injury in rats //Clinical nutrition. - 2011. - T. 30. - №. 2. - S. 252-258.
  40. Kislyakova E.A. Tributirin v korrekcii posleoperacionnyh narushenij ehlektricheskoj aktivnosti tonkoj kishki (ehksperimental'noe issledovanie) //Dis. kand. biol. nauk. M. - 2016.
  41. Tropskaya N. S., Kislyakova E. A., Popova T. S. Mekhanizmy motornyh narushenij tonkoj kishki pri ehndotoksemii i patofiziologicheskoe obosnovanie dlya ispol'zovaniya tributirina kak protivovospalitel'nogo i prokineticheskogo farmakonutrienta //Anesteziologiya i reanimatologiya. - 2016. -T. 61. - №. 1.
  42. Hubutiya M. SH. i dr. Pervaya uspeshnaya transplantaciya tonkoj kishki v Institute skoroj pomoshchi im. NV Sklifosovskogo //Transplantologiya. -2013. - №. 3. - S. 16-27.
  43. Gibson G. R. et al. Selective stimulation of bifidobacteria in the human colon by oligofructose and inulin //Gastroenterology. - 1995. - T. 108. - №. 4. -S. 975-982.
  44. Zaharenko S. M., Suvorov A. N. Antibiotiki, probiotiki, prebiotiki: druz'ya ili vragi? //Consilium medicum. - 2009. - T. 11. - №. 8. - S. 47-51.
  45. Kiselev S. A., CHicherin D. S., Haritonov D. V. Prebiotiki: novaya strategiya lecheniya disbakterioza //Kachestvo zhizni. Medicina. Bolezni pishchevar-eniya. - 2004. - T. 2. - №. 5. - S. 70-71.
  46. Ardatskaya M. D. Klinicheskoe primenenie pishchevyh volokon. - 2011.
  47. Vinolo M. A. R. et al. Regulation of inflammation by short chain fatty acids //Nutrients. - 2011. - T. 3. - №. 10. - S. 858-876.
  48. Erofeev N. P., Radchenko V. G., Seliverstov P. V. Klinicheskaya fiziologiya tolstoj kishki //Mekhanizmy dejstviya korotkocepochechnyh zhirnyh kislot v norme i pri patologii. SPb. - 2012.
  49. Ardatskaya M. D. Klinicheskoe znachenie korotkocepochechnyh zhirnyh kislot pri patologii zheludochno-kishechnogo trakta //Dis.... d-ra med. nauk. M. - 2003.
  50. Hamer H. M. et al. The role of butyrate on colonic function //Alimentary pharmacology & therapeutics. - 2008. - T. 27. - №. 2. - S. 104-119.
  51. Canani R. B. et al. Potential beneficial effects of butyrate in intestinal and extraintestinal diseases //World journal of gastroenterology: WJG. - 2011. -T. 17. - №. 12. - S. 1519-1528.
  52. Wang Y., Ruby E. G. The roles of NO in microbial symbioses //Cellular microbiology. - 2011. - T. 13. - №. 4. - S. 518-526.
  53. Shenderov B. A. Probiotic (symbiotic) bacterial languages //Anaerobe. - 2011. - T. 17. - №. 6. - S. 490-495.
  54. Tazoe H. et al. Roles of short-chain fatty acids receptors, GPR41 and GPR43 on colonic functions //J Physiol Pharmacol. - 2008. - T. 59. - №. Suppl 2. -S. 251-262.
  55. Gibson G. R., Roberfroid M. B. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics //The Journal of nutrition. -1995. - T. 125. - №. 6. - S. 1401-1412.
  56. Minushkin O. N. i dr. Opyt primeneniya probiotika «Baktistatin» v terapii hronicheskogo pankreatita //Farmaciya. - 2006. - №. 3. - S. 39-43.
  57. SHenderov B. A. Metabiotiki-novaya tekhnologiya profilaktiki zabolevanij, svyazannyh s mikroehkologicheskim disbalansom cheloveka //Vestnik vosstanovitel'noj mediciny. - 2017. - №. 4. - S. 40-49.
  58. SHenderov B. A. «OMIK»-tekhnologii i ih znachenie v sovremennoj profilakticheskoj i vosstanovitel'noj medicine //Vestnik vosstanovitel'noj mediciny. - 2012. - №. 3. - S. 70-78.
  59. Oleskin A. V., EHl'-Registan G. I., SHenderov B. A. Mezhmikrobnye himicheskie vzaimodejstviya i dialog mikrobiota-hozyain: rol' nejromediatorov // Mikrobiologiya. - 2016. - T. 85. - №. 1. - S. 3-25.
  60. Delcenserie V. et al. Immunomodulatory effects of probiotics in the intestinal tract //Current issues in molecular biology. - 2008. - T. 10. - №. 1/2. - S. 37.
  61. Opyt primeneniya preparata Zakofal'k® v razlichnyh oblastyah ga-stroehnterologii : sb. nauch.-prakt. rabot / pod red. M. D. Ardatskoj. - M. : 4TE Art, 2013. - 64 s. : il.
  62. Vorobejchikov E. V. i dr. Immunotropnye ehffekty probioticheskogo kompleksa Baktistatin na fone primeneniya antibiotikov //Antibiotiki i himiotera-piya. - 2008. - №. 1. - S. 3-9.
  63. Rolik O.I. Mikrobnyj faktor v ehndokrinologicheskoj reabilitacii i bioregulyatory iz kishechnoj flory // Revitalizaciya. - 2015. - № 10. - S. 20-28.
  64. Popova T.S. i dr. Doklinicheskaya ocenka ehffektivnosti produkta dlya funkcional'nogo pitaniya «EHkstrakt brozheniya kislomolochnyh bakterij, fer-mentirovannyh v soevom moloke» «Dajgo» - M. - 2016. - 44 s.
  65. Popova T. S. i dr. Vliyanie ehkstrakta brozheniya kislomolochnyh bakterij Dajgo na sostav mikroflory i motornuyu funkciyu kishechnika pri ehksperimental'nom disbioze //Transplantologiya. - 2016. - №. 4. - S. 39-47.



Creative Commons License
The content is available under the Creative Commons Attribution 4.0 License.

©

Эта статья открытого доступа по лицензии CC BY 4.0. Издательство: ФГБУ «НМИЦ РК» Минздрава России.
This is an open article under the CC BY 4.0 license. Published by the National Medical Research Center for Rehabilitation and Balneology.