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Features of development of sepsis in operated cancer patients
Last reviewed: 23.04.2024
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Causes of development of sepsis in operated oncological patients
At the heart of the development of sepsis in oncosurgical patients is a pronounced secondary immunodeficiency. A decrease in IgM, IgG and IgA levels in 1,2-2,5 times, lymphopenia (less than 1,0х10 9 / l), a decrease in the phagocytic capacity of neutrophils (FI 5 min <0), low concentrations of pro-inflammatory cytokines (TNF, IL- 1, IL-6) in the blood serum, as well as a decrease in the expression of HLA-DR on monocytes. The level of lymphocytes decreases intraoperatively, due to lymphadenectomy, since oncological operations are extended, with a high traumatism and a large volume of surgical tissue trauma, a clinical picture.
The clinical picture of sepsis is characterized by a low level of total blood protein (35-45 g / l), including albumin (15-25 g / l), which is accompanied by a shortage of preload, increased vascular permeability (impaired lymphatic drainage function), low CODE (14 -17 mmHg), hypercoagulation and thrombus formation in the deep veins of the lower extremities and small pelvis, stress ulcers in the digestive tract also often develop.
- Early onset of sepsis (2-4 days after surgery) due to severe immunodeficiency.
- Difficulties in diagnosis arise due to the development of SSRS and an increase in the level of procalcitonin (> 5 ng / ml) 1-3 days after surgery, in response to surgical tissue trauma.
- Prevalence as a causative agent of gram-negative resistant flora.
- The development of the syndrome often occurs both during the development of the septic process, and through surgical intervention involving the relevant organs and systems.
- Most often, sepsis develops due to peritonitis (abdominal sepsis in general) and pneumonia.
Diagnostics
- Control of the focus of the infection and the isolation of the pathogen from it.
- Control hemodynamics, including central (invasive and non-invasive methods).
- Biochemical and clinical analysis of blood definition of leukocyte formula, coagulogram, CBS, RCD and level of procalcitonin.
- Analysis of urine.
- X-ray diagnosis and CT.
- Dynamics of the state (scales APACHE, MODS, SOFA).
[10]
Treatment of sepsis in operated oncological patients
Intensive therapy for sepsis is aimed at sanation of the foci of infection, correction of manifestations of SSRM and PON.
- Assign solutions of hydroxyethyl starch (30-40 ml / kg) and 20% albumin solution 5 ml / kg iv, they allow to bring the COD up to 23-26 mm. Gt; Art. And thus maintain an adequate preload level and avoid hyperhydration of the lungs. Use a combination of colloidal solutions, vasopressors and hydrocortisone (with septic shock).
- Combination of antibacterial drugs (protected cephalosporins III, cephalosporins IV, carbapenems) and immunoglobulin solution are administered intravenously. Due to such a combination, elimination of the pathogen is sought and development of resistance to antibiotics is avoided.
- Application of LMWH and proton pump inhibitors.
- Substitution of functions of organs with PON. Use the so-called protective strategy of ventilation (with the development of ARDS), HD or hemodiafiltration (with the development of arresters).