PROGNOSTIC VALUE OF COMPREHENSIVE ASSESSMENT INDICATORS OF THE PATIENT WITH ABDOMINAL SEPSIS SEVERITY

Анотація

Abstract. The prognosis of the course of abdominal sepsis is possible with an adequate assessment of the severity of the patient's condition. Pathological syndromes of the patient characterize the prognosis of the disease. The goal of assessing the severity of the patient's condition is to ensure the best treatment results. Therefore, scoring systems for assessing the severity of the condition of patients are constantly used in the practice of the doctor. This allows you to adequately assess the patient's condition, correct treatment tactics and care, predict the course and consequences of the disease.

The aim was to determine and analyze the dynamics and consequences of the course of the postoperative period in patients with abdominal sepsis, depending on the score indicators for assessing the severity of the patient.

Materials and methods All patients in the preoperative period were retrospectively calculated operative and anesthetic risk. Also, in order to assess the severity of the patients' condition in the dynamics of the postoperative period and to reveal the dependence of the disease outcome and the severity of the patients' condition, all patients were scored for the severity of the condition according to the APACHE II scale in the modification of A.P. Radzyhovsky.

Research results Among 85 studied patients, 12 (14.11%) patients died during the postoperative period. All 12 patients died after 7 days of the postoperative period. The cause of death in all patients was multiple organ failure, endogenous intoxication, septic shock. Among the deceased patients, 7 patients (25.92%) belonged to group 3, who had 13 or more points on the APACHE II scale at admission; they had the IV degree of operative and anesthetic risk with the sum of points from 5.5 to 8. Another 5 (17.85%) of the deceased patients belonged to group 2, who had scores from 7 to 12 on the APACHE II scale at admission and had the III degree of operative and anesthetic risk with a sum of points from 3.5 to 5. A clear increase in in-hospital mortality was noted with an increase in the number of operative and anesthetic risk scores, as well as scores on the APACHE II scale in patients with abdominal sepsis. In patients who recovered according to the point assessment of the severity of the condition according to the APACHE II scale, the indicators of endotoxicosis decreased significantly up to 10 days.

Conclusions:

1. Point assessment of parameters of the degree of operative and anesthetic risk and indicators for assessing the severity of the patient's condition according to the APACHE II scale allow adequate assessment of the patient's condition, have high prognostic significance. With an increase in operative and anesthetic risk scores and scores on the APACHE II scale, the mortality rate of patients in the postoperative period increases significantly.
2. In the postoperative period, it is necessary to take into account the degree of operative and anesthetic risk and each day to carry out a point assessment of the severity of the patient's condition. This will allow time to identify the objective deterioration of the patient and adequately adjust care and treatment tactics, prevent the development of postoperative complications, reduce mortality.