EUROMEDICA  Hanover 29-30  Mai 2006	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Different conditions including peritonitis during acute surgical pathology are the most frequent cases of death in the surgical clinic. In spite of achieved successes in the spread peritonitis treatment due to development of the antibacterial therapy methods and use of modern medical technologies lethality in the postoperation period is from 28 % to 83.7 %. Counting on the point of view of some authors such high lethality due to this pathology is conditioned by sever infringements of metabolism and development of protein-energy insufficiency (I.N. Liederman, M.A. Everesh 2004). The significant role of protein-energy insufficiency is considered in the polyorganic pathology development (Schlichtig R., Agres S.M. 1988). Due to literary data 40 % of the patients with spread peritonitis in Russian clinics are in the condition of alcohol drunks or have chronic alcohol intoxication in anamnesis and therefore disadvantageous somatic background.

Modern detoxication therapy with early adecvate nutritional support is the one of the perspective programs of critical conditions correction in urgent surgery.

We had 28 patients with acute surgical pathology, with alcohol intoxication and 2 stage endagenic intoxication development. We carried out nutritional support in the postoperation period with the nasointerstitial intubation of intestine in the case of estimate of enteral nutrition efficiency.

All patients were men, average age 44,7 ± 8,4 years. Nosological characteristic of peritonitis is presented by destructive appendicitis, destructive cholecystitis, ulcer perforation of the stomac and duodenum, perforation of intensive and colon. 80 % of the observed patients at the moment of the beginning of nutritional insufficiency. Enteral nutrition was carried out in 8 -12 hours after operation through nasoduodenal bougie established during the operation. Definition of energy requirements was carried out using Harries-Benedict formula. Nutrition was carried out using standard lactose free isokalories blends: Nutrison Standard, Nutricomp standard. Nutrition was carried out with not interrupting method during 18-20 hours (Burtov A.V., Evdokimov E.A., Kostuchenko A.L., Liederman I.N., etc 2003).

Criteria of efficiency of early use of enteral nutrition in the patients rehabilitation are clinic-laboratory indices, including antropometric data, albumin, transferrin, nitrogen balance, lymphocytes, length of artificial ventilation of the lung, level of endotoxicoses, duration of being on reanimation bed.

Results of research testify to decrease of endotoxicoses in patients decrease of use of use of blood specimen, protein parenteral specimen, decrease of organic infringements and complications in postoperation period.

Therefore early nutritional support using nasointerstitial intibation of intestine is perspective and pathogenic proved and effective method for rehabilitation of people with chronic alcohol intoxication in postoperation period during protein energy insufficiency.