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Khirurgii

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Year 2015 Vol. 23 No 3

GENERAL & SPECIAL SURGERY

Y.P. ORLOV, V.N. LUKACH, V.T. DOLGIKH, N.V. GOVOROVA, A.V. GLUSCHENKO

DEFEROXAMINE AS PATHOGENETICALLY VALID PREPARATION FOR COMPLEX THERAPY OF PATIENTS WITH ACUTE PANCREATITIS

SBEE HPE "Omsk State Medical University",
The Russian Federation

Objectives. To study the correlation between the severity of systemic inflammatory reaction, polyorganic failure and iron metabolism parameters in a course of severe acute pancreatitis, to determine the efficacy of iron metabolism disorders correction with deferoxamine to prevent organ failure and septic process.
Methods. 63 patients with complicated acute pancreatitis have been examined in the resuscitation and intensive care unit. 31 patients received standard intensive therapy, whereas deferoxamine therapy was applied for other 32 patients (6-12 mg/kg/day). Ranson’s criteria (RC) were used to determine the severity of the attack of AP thrice (on admission to the hospital, after the 1st and the 3rd days) which values for these components (activity of erythrocyte superoxide dismutase, catalase, total serum bilirubin concentration and its fractions, transferrin, iron, ferritin and free hemoglobin) were calculated. The severity of endotoxemia was defermined by concentration of low and medium molecular-weight substances (LMMWS) in plasma and erythrocytes.
Results. The close correlation was revealed between the changes of free hemoglobin level and total bilirubin concentration. A similar relationship has been determined between the concentration of ferritin, manifesting the iron storage in the body, and a concentration of LMMWS in the blood plasma. In addition, the similar high direct relationship has been established between ferritin concentration and the severity of the general condition of patients measured by APACHE II scale and firmed the ability of intensive therapy with deferoxamine for patients with severe forms of acute pancreatitis to reduce the incidence of systemic hemodynamic and respiratory failure, damage of the liver and kidneys, to decrease the incidence of pancreatogenic sepsis and retroperitoneal phlegmons by 3 folds so as to diminish mortality rate by 19,6%.
Conclusion. Using of deferoxamine in the intensive therapy program is pathogenetically justified due to its ability to bind the iron ions excess in blood plasma, thereby the drug prevents the development of severe, sometimes fatal, complications of acute pancreatitis.

Keywords: acute pancreatitis, iron metabolism, deferoxamine, systemic inflammatory response syndrome, polyorganic failure, retroperitoneal phlegmon, mortality rate
p. 286-295 of the original issue
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Address for correspondence:
Address for correspondence:
644119, Rossiyskaya Federatsiya,
g. Omsk, ul. Pereleta, d. 9.
MUZ GK BSMP¹ 1,
kafedra anesteziologii i reanimatologii,
tel. mob.: 8-960-981-82-52,
e-mail: orlov-up@mail.ru,
Orlov Yuriy Petrovich
Information about the authors:
Orlov Y.P. MD, professor of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Lukach V.N. An Honored Worker of Higher School, MD, professor of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Dolgikh V.T. An Honored Worker of Science of the Russian Federation, MD, professor, a head of the pathological physiology chair with the course of clinical pathological physiology of SBEE HPE "Omsk State Medical University".
Govorova N.V. MD, professor, a head of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
Gluschenko A.V. PhD, an assistant of the anesthesiology and resuscitation chair of SBEE HPE "Omsk State Medical University".
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