Examinations of 406 patients aged from 60 to 93 years with acute poisoning with psychopharmacological medicines of varying severity were performed. The nomenclature of preparations that caused poisonings and combinations were analyzed. The concentrations of psychopharmacological preparations in blood and urine were monitored until they were absent in biological fluids. It was revealed that in patients of gerontological age more than half of poisonings occur as a result of combined intake of drugs of two or more pharmacological groups. It has been found that in patients older than 60 years with therapeutic concentrations of drugs in blood, symptoms of mild poisoning can be recorded in the case of use of one drug, and when combined intoxication is more severe. This category of persons is characterized by long-term excretion of psychopharmacological medicines from body during treatment, that influences the course of poisoning – can contribute to the fatal outcome as a result of prolonged intoxication and the development of life-threatening complications.

Проведена оценка эффективности препарата ремаксол в комплексном лечении больных гепатопатией, обусловленной острым экзотоксикозом. Исследование включало 2 этапа: на первом проанализированы результаты терапии 73 пациентов с признаками поражения печени на фоне отравлений различной этиологии (парацетамол, наркотические средства, этанол и др.). Пациентов разделили на 2 группы в зависимости от схем терапии: у больных основной группы в схему терапии был включен препарат ремаксол (400 мл 2 раза в сутки с интервалом 12 ч внутривенно капельно со скоростью 40 – 60 капель в минуту, курс 5 дней), в контрольной группе дезинтоксикационная терапия проводилась по стандартной схеме. Выявлена большая эффективность схемы лечения, включающей ремаксол: более выраженная положительная динамика общеклинических показателей крови (снижение лейкоцитоза, уменьшение выраженности лейкопении и повышение уровня тромбоцитов) и ферментативная активность печени (нормализация показателей общего белка и выраженная положительная динамика ферментов печени – достоверное снижение уровней АЛТ в 2,8 раза, а АСТ – в 4 раза, p ≤ 0,05). Второй этап исследования включал сравнительный анализ гепатопротективного эффекта схемы лечения, включающей ремаксол, у 34 пациентов в зависимости от этиологического агента острого отравления. Выявлено, что наибольшая эффективность достигнута при лечении острого экзотоксикоза, обусловленного парацетамолом, что проявлялось выраженной положительной динамикой ферментов печени: снижением уровня АЛТ в 7,3 раза, АСТ – в 8,8 раза и ГГТП в 2,1 раза соответственно (p ≤ 0,05). Таким образом, полученные результаты позволяют предложить включение препарата ремаксол для повышения эффективности лечения в схемы терапии гепатопатий при острых отравлениях, особенно медикаментозной этиологии.

BACKGROUND. Acute poisonings with cauterant agents are accompanied by an increase in acid­forming function of the stomach in more than half of the cases. It slows reparative processes in the gastric wall and increases the risk of complications. MATERIALS AND METHODS. The study involved 40 patients with chemical burns of the stomach grade III­IV who had underwent standard therapy. The complex therapy for 20 patients included 5 days of intravenous Rabeloc, 20 mg daily. RESULTS. Rabeloc included into the complex of therapeutic measures in patients with chemical burns of the stomach grade III–IV helped reduce the length of stay in the ICU by 1.5 times and inpatient treatment by 1.8 times, reduce the frequency of early secondary hemorrhage and decompensated cicatricial narrowing of the stomach. CONCLUSION. Early parenteral use of Rabeloc increases the effectiveness of complex therapy for acute poisoning with cauterant substances.

Colon dysbacteriosis was revealed in 40 patients with acute poisoning caused by psychopharmacological agents at the stage of rehabilitation which waы confirmed by clinical symptoms and bacteriological tests in 21 cases (10 — control group, and 11 — study group) as well. We demonstrated an adequacy of Pectovit prebiotic for management of colon microbiocenosis violations.

The stress-realizing reaction provides a metabolic basis of compensatory and adaptive changes occurring in the human body under the impact of aggressive factors including chemical agents. The main role in neuroendocrine regulation of a stress is played by the brain layer of adrenal glands. The thyroid gland, as well as adrenal glands also belongs to «classical» endocrine glands and plays an important role in maintenance of homeostasis. Researches were conducted in 144 patients aged from 20 to 45, in 40 children at the age of 11 to 15 and in 45 patients from 1 to 5 year old admitted to hospital before a special care was performed. The conducted researches showed that during the first hours after acute poisonings with psychopharmacological preparations, irrespective of age, cortisol concentration increased in patients blood proportionally to the severity of intoxication which was more expressed in children at early age. Concentration changes in the thyroid gland hormones in all patients happened within reference values.

The prevalence of acute poisoning with caustic substances in Russia is higher than in other countries and is reported by different authors as accounting for 10-32% cases among the patients admitted to acute poisoning treatment centres. Especially unfavorable prognosis is considered for necrotizing burns to the stomach that increase the risk of severe complications leading to disability of patients. The study aimed at improving the treatment of necrotizing chemical burn to the stomach by the infusion of a 5% Mexidole solution into the edges of a burn lesion at different stages of the treatment course. The paper presents the outcomes of patients who sustained chemical burns to the stomach with mucosa ulceration and necrosis, and provides an assessment of early endoscopic treatment effect.

The prevalence of acute poisoning with caustic substances in Russia is higher than in other countries and is reported by different authors as accounting for 10 32% cases among the patients admitted to acute poisoning treatment centres. Especially unfavorable prognosis is considered for necrotizing burns to the stomach that increase the risk of severe complications leading to disability of patients. The study aimed at improving the treatment of necrotizing chemical burn to the stomach by the infusion of a 5% Mexidole solution into the edges of a burn lesion at different stages of the treatment course. The paper presents the outcomes of patients who sustained chemical burns to the stomach with mucosa ulceration and necrosis, and provides an assessment of early endoscopic treatment effect.

Intragatric pH-metry made in 80 patients with chemical gastric burn (CGB) in the acute and early postburn periods revealed that in 17% of the victims, gastric acid secretion remains normal, 51.2% of cases showed its increase (hyperacidity) whose maximum rates (100%) are detected in patients with extensive CGB of the third degree and whose minimum rates (20%) were found in those with fourth-grade CGB. Hypoacidicity was diagnosed in 31.2% of the patients. A significant (1.7-6-fold) enhancement of acid secretion was observed during stimulation, which suggests the compensated hyperfunction of intact gastric mucosal portions and supports the fact that the values of basal acidicity are leveled by bile reflux duodenogastritis. The latter was diagnosed by pH-metry data in 63.8% and by esophagogastroduodenoscopy (EGDS) in 87.5% of cases. The detection rate of reflux gastroesophagitis (RGE) was also higher by EGDS than that by pH-metry: 42.5 and 26.3% of cases, respectively. The lowest detection rate of RGE was noted in patients with fourth-degree CGB whereas the endoscopic signs of reflex esophagitis (RE) were most pronounced: erosive and ulcerative RE was diagnosed in 28% of cases.

The study of these intoxications has demonstrated that the blood level of methemoglobin (MH) is in conformity with the severity of intoxication. The pathospecific therapeutic effect of sodium hypochlorite (SHC) in acute intoxications of varying severity has been found to appear as a significant intensification of demethemoglobinization and as a three-fold reduction in the half-life of MH. The nonspecific effect of SHC manifests itself in correcting metabolic acidosis and in improving blood oxygenation. The use of SHC accelerates the regression of clinical manifestations of disease and reduces the length of inpatient treatment.

Objective: to study the specific features of the diagnosis and treatment of endothoxicosis as a manifestation of postresus-citative disease in acute exogenous poisoning. Subjects and methods. Clinical, laboratory, and statistical methods of the diagnosis of endotoxicosis complicating the course of acute poisoning by narcotics, psychopharmacological agents, and cauterants, as well as complex physicochemical detoxification were applied to 554 patients. Results. The study pathology has been ascertained to have 3 developmental stages — from functional (primary) to developed and terminal clinical and laboratory manifestations as multiple organ dysfunctions. The best therapeutic results are achieved by effective therapeutic measures just in early-stage endotoxicosis, by substantially reducing the rates of death and pneumonia and the time of the latter’s resolution. The major contribution to the reduction in the rate of death due acute poisoning is associated with physicochemical detoxification that considerably lessens the influence of the intoxication factors of postresuscitative disease. Conclusion . When diagnosing endotoxicosis in patients with acute endogenous intoxication, it is necessary to keep in mind a whole spectrum of typical changes in endotoxicosis markers and homeostatic parameters: hematologi-cal, blood rheological, lipid peroxidation/antioxidative systems, which should be timely corrected by the basic efferent artificial detoxification techniques (hemosorption, hemodiafiltration, hemofiltration), by compulsorily employing physio-and chemohemotherapy (laser-ultraviolet hemotherapy, sodium hypochlorite infusion).