Efficiency of endolymphatic drug administration

Relevance. It is known that the lymphatic system plays a leading role in the pathogenesis of purulent-inflammatory diseases, since the spread of bacteria and toxins occurs mainly through lymphatic vessels and lymph nodes, where their delay occurs and a so-called «toxic depot» is created. Therefore, the endolymphatic administration of antibiotics, immunomodulators, antioxidants, and anticoagulants is pathogenetically justified. Drug saturation of the lymphatic system allows to create high therapeutic concentrations of antibiotics and other drugs on the pathways of bacterial factors, improve lymphatic rejuvenation, which allows to unlock inflamed lymph nodes, reduce the likelihood of limiting and abscessing inflammatory infiltrates in the lymphatic system (1,2,3).

Some authors (1,5) point to the existence in the body of a single integral cellular-humoral defense system, including immunity, homeostasis and nonspecific resistance of the organism. The change in one of the functional links of this system entails a shift in the others. Immunodeficiencies that develop in patients after serious injuries and surgeries are accompanied by a decrease in the number and functional activity of lymphocyte populations and an imbalance in the level of the main classes of immunoglobulins (4,6). Consequently, the course of the postoperative period and the outcome of the disease depend not only on the quality of the performed operation, the nature of antibiotic therapy and detoxification measures, but also on the state of immune and adaptive reactions of the organism (3,6).

The aim of the study was to determine the effectiveness of endolymphatic drug administration (EDA) in the complex therapy of surgical patients with pathology of the abdominal cavity.

Materials and methods. The endolymphatic administration of the drugs was used in the complex treatment of 147 surgical patients who formed the main group. The control group consisted of 100 patients receiving standard treatment without endolymphatic therapy. In the main group, all patients were catheterized with a lymphatic vessel of the foot, through which the medicinal substances were administered once a day before and after the operation: roksipim 1.0 g, heparin (1:10) 1.0 ml, rheosorbylact 10 ml, contrikal (with destructive pancreatitis) 10 000 units in 10 ml of saline.

Dynamics of laboratory parameters of cellular and humoral immunity, anti-inflammatory cytokines, dynamics of indices of endogenous intoxation, the presence and nature of side effects were evaluated.

Results and discussion. It was noted that in the main group positive changes — improvement in the general condition of patients occurred on 1–2 days, and laboratory blood tests — on the 3–4 days of the postoperative period. The dynamics in the control group for the same period was insignificant — positive changes in the subjective state of the patients were noted by the 7–8 day of the disease. There were signs of a violation of the immune status. In the control group, complications of purulent-inflammatory nature developed in 3.5 % of patients, whereas similar complications in the main group developed in 44 patients, which was 0.3 %.

In the main group, there were positive changes in the assessment of endotoxemia, an earlier normalization of the temperature response, an early appearance of intestinal peristalsis (gas leakage).

A significant decrease in leukocytosis was observed already by 4–5 days after the operation, which was regarded as a result of the anti-inflammatory effect of lymphocorrection.

Table

On the part of the phagocytic link of immunity, a clear tendency to an increase in the phagocytic activity of neutrophils and a phagocytic number in patients of the main group was 87 %, and in the control group significantly less — 42 %.

In the main group there was a significant decrease in the concentration of the investigated anti-inflammatory cytokinins (IL-1a, TNF-a, IL-1b) by 2.5 times, which is a favorable factor indicative of attenuation of the inflammatory process. In the control group, the level of anti-inflammatory cytokinins remained for a long time in high numbers.

When the peripheral lymphatic system was catheterized, there were complications in the form of a cut and the intersection of the vessel-0.01 %, a catheter puncture-0.03 %, lymphorrhea-0.001 %, lymphonitis-0.02 %, catheter failure-0.01 %.

The conclusion. Thus, EDA is an effective method of treatment of purulent-inflammatory diseases:

1) EDA contributed to early relief of inflammation;

2) EDA allowed to achieve clinical effect and contributed to the reduction of complications and improvement of the immune status of patients;

3) EDA reduces the mortality of patients by 10 times;

4) Complications of EDA are minimal and do not affect the status of patients.

References:

1. Yu.Ye. Vyrenkov, V. V. Kharitonov, A. V. Gavrilov. Limfologiya, № 1. 2013.
2. O. A. Kozlov / avtoreferat «Antegradnaya endolimfaticheskaya antibiotikoterapiya v kompleksnom lechenii bol'nykh razlichnym peritonitom yazvennoy etiologii», Khirurgiya, 2009.
3. I. A. Yeryukhin, S. A. Shlyapnikov «Khirurgicheskiy sepsis» (diskussionnyye aspekty problemy) Khirurgiya, 2000, № 3.
4. Yu.M. Gain, S. I. Leonovich, N. V. Zavada «Immunnyy status pri peritonite i puti yego patogeneticheskoy korrektsii». Minsk: Yunipress, 2001.
5. V. D. Fedorov V. D., V. K. Gostishchev, A. S. Bognitskaya «Sovremennyye predstavleniya o klassifikatsii peritonita i sistemakh otsenki tyazhesti bol'nykh». Khirurgiya. 2000.
6. Van der Poll, T/ «Bacterial sepsis and septic shock. Cytokines and anticytokines in the pathogenesis of sepsis»/ T/ van der Poll, S. J. H. van Deventer// Infect. Dis. Clin. 1999.