DIAGNOSTIC AND PROGNOSTIC VALUE OF VEGETATIVE HOMEOSTASIS IN ACUTE SMALL INTESTINE OBSTRUCTION

Abstract

Acute obstruction of a small intestine (AOSB) remains one of the serious acute diseases of the abdominal cavity, during which a specific reaction of the body to the manifestation of the general adaptation syndrome in conditions of surgical stress is observed. To determine the functional state of the patient’s body in the pre- and postoperative period, it is not the absolute values of individual homeostasis indicators of a specific patient that are important, but their mutual correlation, which reflects the mobilization of various systems to a stressful situation. The article presents the results of research of the state autonomic nervous regulation in patients who have acute small bowel obstruction in the pre and postoperative periods, as a prognostic criterion of the course of the disease and a tool of therapeutic tactics. Thus, the tone of the sympathetic and parasympathetic nervous system was studied using Kerdo’s index in 213 patients with ASBO at different time after surgery and a retrospective analysis of 30 medical cards of deceased surgical patients with AOSB was done. In the preoperative, the ratio of the tone of the sympathetic and parasympathetic departments of the autonomic nervous system was significantly disturbed in patients with HTCC, with a significant overload of number of patients with sympathetic tone (in 3.52 times). The value of the Kerdo index with an increased tone of the sympathetic nervous system was greater than the value of parasympathetic nervous system (in 1.18 times). When patients were discharged from hospital, the ratio of these two departments of the autonomic nervous system changed radically. When conducting a retrospective analysis of 30 medical records of patients with fatal outcome, the following Kerdo index data were obtained: before the start of the treatment, the studied value was +19.5±1.21, and at the end of observation it was +47.93±1.64. It was defined that a long term increase in an average digital values of the sympathetic division of the autonomic nervous system at the same time as a decrease in an average digital values of the parasympathetic department indicates a decrease in the mortality of the digestive tract and undesirable course of disease. At the same time an increase in the number of cases with vegetative balance on the third or fifth day after surgery is positive.