GROUNDING FOR INDICATIONS TO RELAPAROTOMY AND PROGNOSTICATION OF DISSEMINATED PERITONITIS OUTCOMES

Aim. To study the methods for improving estimation of treatment efficiency in patients with disseminated peritonitis (DP), in particular, to detect the necessity of relaparotomy for abdominal sanation. Material and methods. 132 patients with disseminated peritonitis were examined: prospectively – 92 cases, retrospectively – 40. To analyze the degree and dynamics of polyorgan insufficiency, “Dynamic Organ Dysfunction Assessment Scale” (DODAS) was used. Determination of 7 and more scores by this scale reliably proves the presence of polyorgan insufficiency syndrome (POIS). The scale permits to estimate patients’ status by 6 systems and organs with a maximum sum of 24 scores. The number of scores of the 1 st, 2 nd and 3 rd days after the operation was subjected to trend analysis using the program Microsoft Office Excel. The trend score analysis of polyorgan insufficiency allows to determine its stage and efficiency of treatment. As a result, we managed to determine the indications to relaparotomy at the earlier terms than when using prognostic relaparotomy index. Results. The predicted lethality in the main group was established to coincide with the real one (27,3%). In the group of comparison, the real number of lethal outcomes (85,7%) occurred to be higher than the prognosticated ones (72,0%). Sensitivity and specificity of the suggested method of relaparotomy indications determination was 0,9 and 0,8, respectively. Thus, determination of polyorgan insufficiency stage makes it possible to correct treatment and determine relaparotomy indications in time. Conclusion. The course of polyorgan insufficiency in disseminated peritonitis during the adjacent three days is subjected to the laws of polynomial function and is different by development rate and regression. Prognosis for life in disseminated peritonitis depends on the stage of polyorgan insufficiency. Efficiency of DP treatment in the postoperative period is to be estimated by means of trend analysis of polyorgan insufficiency assessment scale scores.

Peritonitis, polyorgan insufficiency, trend analysis