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Intestinal lavage - intestinal lavage
Last reviewed: 17.10.2021
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The most reliable way to cleanse the intestines from toxic substances is to wash it with the help of sensing and introducing special solutions - intestinal lavage, or washing the intestines.
The therapeutic effect of this method is concluded in the possibility of a direct cleansing of the small intestine, where in the late gastric lavage (2-3 hours after poisoning) a significant amount of the toxicant continues to enter the blood.
[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]
Method of carrying out intestinal lavage
To perform intestinal lavage, a two-channel silicone probe (about 2 m long) with a metal mandrel inserted into the stomach is injected into the stomach through the nose. Then, under the control of a gastroscopy probe, this probe is distanced 30-60 cm distally from the Treitz's ligament, after which the mandrene is removed. Through the opening of the perfusion channel located at the distal end of the probe, a special saline solution identical in ionic composition to chyme (substitute) is introduced.
In cases of hyperhydration of the body (renal failure, extensive perifocal edema in inflammation, other cases of local or systemic hyperhydration), a solution is used whose osmolality exceeds the value of osmolality of the plasma. In cases of increased permeability of the capillary wall (shock, acidosis, allergy, etc.), the osmolality of the solution must correspond to the osmolality of the plasma. In such cases, the plasma COD of the patient is first determined, then a solution is prepared for it, the osmolarity of which is higher or equal to the osmolality of the plasma. Description of the intestinal lavage technique.
The procedures of intestinal lavage technically and methodically differ from each other depending on the indication and condition of the patient.
Method number 1 (continuous intestinal lavage)
In acute oral poisoning and endotoxicosis, patients without consciousness enter intestinal lavage in the following way.
The patient is placed in a two-channel naso-jejunal probe under endoscopic control. The salt electrolyte solution heated to 38-40 ° C is injected by means of a pump into one of the probe channels at a rate of 60-200 ml / min. After a while, the patient develops diarrhea, part of the solution pours out through the second channel of the probe. Together with the intestinal contents, the toxic substance that caused the poisoning is removed. To enhance the detoxification of the body, intestinal lavage is combined with enterosorption by injecting a suspension of powdered enterosorbent in an amount of 70-150 g with a syringe through the aspirating (broad) channel of the probe. The bowel is washed before the appearance of enterosorbent in washings obtained from the rectum, or to light washings , no longer containing poison. The total volume of the solution used is 30-60 liters and more (up to 120 liters). As a result of intestinal lavage, the symptoms of intoxication undergo reverse development.
Possible complications of intestinal lavage in the form of traumatic lesions of the gastrointestinal mucosa due to intestinal sensation (5.3%), vomiting and aspiration (1.8%), hyperhydration (29.2%), with strict adherence to the procedure can be minimized. Hyperhydration can be easily eliminated with an ultraviolet "artificial kidney".
Method number 2 (fractional intestinal lavage)
Patients in serious condition, excluding the possibility of independent intake of the solution, intestinal lavage is carried out through a single-channel nasogastric or nasoduodenal probe. Use a salt electrolyte solution with osmolarity equal to the osmolarity of the patient's blood.
The temperature of the solution is 37-38 ° C. For the prevention of regurgitation and aspiration of gastric contents, the selection of an adequate rate of administration of a solution excluding gastric overflow, an elevated position of the upper half of the patient's body, and intubation of the trachea in case of impaired consciousness are necessary. The solution is administered in portions of 150-200 ml every 5 min. After the introduction of 1.5-2.5 liters of solution appears liquid stool, and then - watery discharge without inclusions (intestinate). In the absence of stool, after administration of 2.5 liters of solution, a single dose of the solution is halved, an enema is made with the same solution in a volume of approximately 1.5 liters (25-30 ml per 1 kg of body weight) and / or an injection of spasmolytic (single dose of papaverine , drotaverina, platifillin and other drugs, excluding atropine). The last portion of the solution is added with probiotics and pectin in a daily dose. The total volume of the solution is 70-80 ml per 1 kg of the body weight of the patient. Control over the body's water balance is carried out by measuring the body weight of the patient with the help of outdoor bed weights before, during and after intestinal lavage, and also on the basis of the amount of liquid administered and allocated to the patient and the state of the laboratory indices of homeostasis.
Intestinal lavage is considered to be the most effective method of cleansing the intestine in acute oral poisoning and its use in combination with blood purification methods gives the fastest and lasting effect of detoxification.