RU2523137C1 - Method for determining clinical effectiveness in patients with diffuse peritonitis with developing multiple organ failure - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used to determine the clinical effectiveness in developing multiple organ failure syndrome (MOFS) in patients suffering from diffuse peritonitis. For the first three postoperative days, the SOFA scale rating and its absolute increment on the second and third day are determined in a patient suffering from diffuse peritonitis and manifestations of multiple organ failure. If deriving 7 and more points on the first postoperative day in a combination with the SOFA rating increment on the third day as compared to the increment on the second day by less than 100%, therapeutic actions are considered to be effective.

EFFECT: method enables early detection of the clinical effectiveness of diffuse peritonitis with a negative trend of MOFS, improving a prognostic ability of the SOFA rating scale in the patients with diffuse peritonitis, assessing faster or slower development of MOFS.

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Description

The invention relates to medicine, namely to surgery, and can be used to determine the effectiveness of therapy with the progression of multiple organ failure syndrome (SPON) in patients with advanced peritonitis.

A method for determining the effectiveness of ongoing therapy for advanced peritonitis is currently comparing the SOFA score (Sepsis-related Organ Failure Assessments Score / Sequential Organ Failure Assessment).

The scale was adopted in 1996 by the European Society of Intensive Care - Europeean Society of Intensiv Care Medicine / ESICM (V. S. Savelyev, B. R. Gelfand, M. I. Filimonov. “Peritonitis”, 2006. P. - 66).

The disadvantages of determining the effectiveness of therapy on the SOFA scale: the inability to assess the effectiveness of treatment in the early stages with the progression of multiple organ failure.

EFFECT: determination of the effectiveness of treatment of widespread peritonitis with negative dynamics of SPON in the first three days of the postoperative period, increased prognostic ability of the SOFA scale in patients with advanced peritonitis, the ability to assess the acceleration or deceleration of progression of SPON.

The essence of the method is to determine the absolute increase in points on the SOFA scale on the second and third day of the postoperative period, as well as the presence of 7 or more points on the first day after the operation. For this, it is necessary to evaluate the SOFA score on the first, second and third days after surgery. As a result, the increase (decrease) in the absolute increase in the growth of the previous period in percent (%) is determined.

The method is as follows.

In a patient with common peritonitis with a clinical course of SPON progression, the SOFA score is determined on the first, second and third days after surgery. Next, determine the absolute increase in points of the second and third days. If you get 7 or more points on the SOFA scale on the first day after the operation, in combination with an increase in the scores of the SOFA scale of the third day compared with the increase in the second day by less than 100%, therapeutic measures are evaluated as effective (the rate of progression of SPON decreases).

The advantage of the proposed method for determining the effectiveness of therapy in patients with advanced peritonitis with the progression of multiple organ failure is the ability to assess the acceleration or deceleration of the progression of SPON, to objectify the evaluation of the effectiveness of treatment in the early stages (the first three days after surgery), and to increase the prognostic ability of the SOFA scale.

Case Studies

Example 1. History code 26807. Patient, 77 years old. Diagnosis: cholelithiasis. Acute gangrenous calculous cholecystitis. Subhepatic infiltrate. Common biliary fibrinous peritonitis. Retroperitoneal phlegmon. Dynamic intestinal obstruction. SPON.

On the first day, 7 points were determined by SOFA, on the second day - 9 points, on the third day - 9 points. That is, the absolute growth of the second day amounted to +2 points, and of the third day - 0 points. Therefore, the increase in the absolute increase in the points of the SOFA scale of the third day in relation to the absolute increase in the points of the second day was 0% (no increase). The number of points on the SOFA scale on the first day was more than 7 (9 points).

Thus, the rate of progression of SPON to the third day decreased. The treatment was effective, the patient recovered.

Example 2. History code 20829. Patient, 60 years old. Diagnosis: Acute thrombosis of the inferior mesenteric artery. Common serous fibrinous peritonitis. Gangrene of the sigmoid colon. SPON.

On the first day, SOFA revealed 9 points. On the second day, the patient was determined 12 points by SOFA. On the third day - 11 points.

The absolute increase in the second day amounted to +3 points, and the third day -1 point. Consequently, the increase in the absolute increase in the points of the SOFA scale of the third day relative to the absolute increase in the points of the second day amounted to -33.3% (absolute decrease). The number of points on the SOFA scale on the first day was more than 7 (9 points).

The rate of progression of the ELEPHANT to the third day became negative, that is, the beginning of positive dynamics is determined. However, compared with the first days, the dynamics of SPON is still negative (11 points of the third day versus 9 points of the first day). The treatment was effective, the patient recovered.

Example 3. History code 25951. Patient, 60 years old. Diagnosis: Perforated duodenal ulcer. Common purulent-fibrinous peritonitis. SPON.

On the first day, SOFA revealed 9 points. On the second day, the patient had 10 points. On the third day - 13 points according to SOFA.

The absolute increase in the second day amounted to +1 point, and the third day +3 points. Consequently, the increase in the absolute increase in the points of the SOFA scale of the third day in relation to the absolute increase in the points of the second day was 300% (more than 100%). The number of points on the SOFA scale on the first day was 9 (more than 7). Positive dynamics against the background of the treatment was not received. The rate of progression of SPON on the 3rd day increased (the absolute increase in points is more than 100%). The treatment was ineffective, the patient died.

Thus, the use in the postoperative period of the proposed method allows to determine the change in the rate of progression of SPON with common peritonitis and to evaluate the effectiveness of the therapy in the early stages of the disease. An increase in the discriminatory ability of the SOFA scale in terms of individual prognosis is also noted.

Claims (1)

A method for determining the effectiveness of therapy in patients with advanced peritonitis with progressive multiple organ failure during the first three days after surgery by evaluating the SOFA score, characterized in that the absolute increase in scores on the second and third days, and in the presence of 7 or more points on the first day in combination with an increase in the scores of the SOFA scale of the third day compared with the increase in the second day by less than 100%, therapeutic measures are evaluated as effective.