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HOUR PRACTICE EXPERIENCE IN APPLYING “FAST-TRACK” PROGRAM FOR THE PATIENTS’ TREATMENT WITH PERFORATED GASTRODUODENAL ULCERS

Mykhaylichenko V. Yu., Basnaev U. I., Karakursakov N. E., Sulima A. N., Babich T. Yu., Mykhaylichenko K. A.

Abstract: Aim. To study the «Fast-track» program effectiveness of accelerated recovery for the treatment of the patients with perforated gastroduodenal ulcer complicated by the extended peritonitis. Materials and methods. During our research work, we performed prospective analysis of surgical treatment of 24 patients (index group) with perforation of gastroduodenal ulcer, and also comparative retrospective analysis of surgical treatment of 35 patients (experimental group) with the same diagnosis. All patients had been treated in the inpatient surgical department of the State budgetary institution of health care in Crimea Republic State clinical hospital №7 in Simferopol during the period from 2016 to 2017, and from 2015 to 2016 respectively. Treatment of all patients from both groups was performed in line with generally accepted peritonitis management plan. Treatment of index group patients was made in accordance with “Fast-track” program. Clinical, laboratory and instrumental data received by us in post-operative period demonstrate quick restoration of the intestinal peristalsis, of the protein indicators; less complication frequency in the main group as to an experimental one. Results. Pain syndrome level in the post-operative period at index group patients didn’t exceed 4 points; in the experimental one pain level according to VAS (Visual Analog scale) didn’t exceed 4 points at 24 patients, it was more than 4 at 9 patients and 5 of them had it more than 5 (р˂0,05). By the 3-rd day Leukocyte index of intoxication (LII) was 3,2±0,1 in the index group patients and 3,6±0,2 - in the experimental group patients. Total protein level in the index group patients has grown up till 48,9±1,2 grams per liter and up till 46,8 ±1,65 grams per liter (р˂0,05) - in the experimental group patients. By the 5-th day LII was 2,7±0,3 in the index group patients; 3,9±0,1- in the experimental one. Total protein level in the experimental group patients has increased up to 53,52±1,60 grams per liter; in the index one- up to 61,70 ±1,77 grams per liter (р˂0,05). Restoration of motor-evacuation function of the intestine was noted on average in 18±2,5 hours. In the experimental group of the patients it was observed in 38,5±6,5 hours (р˂0,05). The average duration of inpatient treatment of the experimental group patients was 14,1±2,2 days, in the index group patients - 7,9±1,1 days (р˂0,05). Conclusions. “Fast-track” program applying increases the treatment effectiveness contributing to reduction of pain syndrome in the post-operative period, to the earlier restoration of motor-evacuative intestinal function, accelerated endotoxicosis reduction, decreases risk of the post-operative complications development. This point significantly reduces time spent in the hospital and accelerates the patients’ rehabilitation process. Key words: extended peritonitis, perforated ulcer, «Fast-track».

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