Влияние модифицированной управляемой реперфузии на системный воспалительный ответ при острой ишемии конечности

Objective. To study up a possibility of reduction of unfavorable effects of reperfusion on distant organs and systems in an acute ischemia of the extremity. Materials and methods. In the investigation, conducted in the Zaytsev Institute of General and Urgent Surgery 37 patients were included, operated in 2016 - 2019 yrs for severe acute ischemia due to an acute proximal occlusion of the lower extremity artery. In the Group I (comparative) 23 patients the standard treatment was conducted. In 14 patients of the Group II (the main) during the blood flow restoration, the proposed procedure of modified governed reperfusion in combination with a low-flow hemodialysis was applied in the first 12 h of reperfusion period. Dynamics of concentration of interleukins (IL-1β, IL-6, IL-8, IL-10) and the tumor necrosis factor alpha (TNF-α) during 48 h after the operation in peripheral venous blood was registered. As well in early postoperative period the levels of myoglobin, general creatinphosphokinase, creatinine and potassium were estimated as well. Results. Raising of concentration of anti-inflammatory cytokines in the blood serum, peculiarly of IL-6 and IL-8, was registered. Application of the method proposed for the governed reperfusion have permitted during first two days to lower concentration of IL-6 by 51 - 67%, and concentration of IL-8 - by the third part. While application of the method proposed the essential lowering of maximal and the average indices of levels of myoglobin and general creatinphosphokinase in the peripheral blood serum was noted as well. Reduction of the renal dysfunction severity and quantity of unfavorable cardio-pulmonary events was noted clinically. Conclusion. Application of the elaborated method of the governed reperfusion leads to reduction of inflammatory answer and systemic impact of products of ischemic metabolism and rhabdomyolysis in early postoperative period in patients, suffering severe ischemia of lower extremities.