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"Emergency medicine" 2 (65) 2015

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Effect of metoclopramide and L-arginine on the performance of motor-evacuation function of the gastrointestinal tract and hemodynamic safter emergency abdominal surgery

Authors: L. V. Novitskaya-Usenko - Stateinstitution «Dnipropetrovskmedicalacademy» ofMinistryOfHealsofUkraine, Dnipropetrovsk, Ukraine; S. G. Domin - Municipal institution «Dnipropetrovsksixthcityclinicalhospital» ofDnipropetrovskRegionalCouncil, Dnopropetrovsk,Ukraine

Categories: Medicine of emergency

Sections: Clinical researches

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Introduction. Motor-evacuation dysfunction of the gastrointestinal tract is widespread in the postoperative period and occurs not only after major abdominal operations, gynecological, urological surgeries, and after small-scale surgery, including laparoscopic. The effects of postoperative motility disorders of the gastrointestinal tract (GIT) significantly increased length of hospital stay, have an adverse effect on the consequences of the disease and increase the cost of treatment. Applicationstandard therapy using metoclopramide and neostigmineleads to many side effects. We assumed, that the positive impact of L-argininumto restore endothelial function in ischemic reperfusion-bowel lesionscould lead to more rapid recovery of intestinal peristalsis.

Materials and methods. After Local Ethics Committee approval and obtaining informed consent, 51 patients were prospectively divided into two groups depending on the characteristics of post-operative intensive care. In the 1 (control) group (n=27), patients after operation received stimulation of the gastrointestinal tract with metoclopramidum and neostigminum. In group 2 (n=24), patients received L-arginine (4,2 g i.v. once a day) and metoclopramidum from the 1 until the 3 postoperative day. All patients were comparable according to age, sex, concomitant pathology, ASA class (IIE-IIIE) and type of surgery (laparotomy following peritonitis).We investigatedintraadbominal pressure (IAP), indicators of central and peripheral hemodynamics, timing of the reversal of peristalsis,subjective complaints survey ;endpoint of our study was 28 days after surgery, when we evaluated the mortality and quality of life on a scale of Rancho Los Amigos.

Results. Analysis showed thatbefore surgery 63,1%surveyedwas increased IAP, and its value is 58,5% (р<0,001) higher than normal. This was accompanied by changes in hemodynamics: increase in total peripheral vascular resistance (TPVR) - by 45.1% (p <0.001)higher than normal and decrease the cardiac output on 34,2% (р<0,001). The maximum increase in ICP in all groups, we observed 2 days after surgery.Mean ICP exceeded the normal in patients of group 1 48.5% (p <0.001), 2 - by 45.7% (p = 0.002).In group 1 during the whole period of intensified examination of the phenomenon of peripheral vasospasmindicating an increase inTPVR.So, on day 3 after surgeryTPVR in 1 group exceeded the norm on 34% (р<0,001)vs24% (р<0,001) in group 2. In patients of group 1 TPVR increase caused additional stress on the heart muscle and lowers cardiac output. This indicated reduction cardiac output whose value when using Neostigmine was less than the normal of 16.2% (p = 0.012).Whereas in group 2 decrease TPVR led to preservation of cardiac output on normal values, increase of capacity of the left ventricleat 38.7% (p <0.001) vs  group1on day 7 after surgery. Analysis of final treatment results showed that the most rapid recovery peristalsis after bowel surgery in patients  group 2. Thus, the application of metoclopramide and L-arginine self discharge gases observed over 2,22 ± 0,3 days after surgery. This is on 21.8% (p = 0.001) was lower than in group 1. Fasterrecovery peristalsis to cut the length of stay in ICU. Thus, in 2 groups of patients length of stay ICU was 2,25 ± 0,3 days vs 2,81 ± 0,3 days in group 1. Deaths in both groups at 28 days after surgery was not recorded. 100% of patients in both groups at 28 days after surgery VIII reached the level of quality of life scale RLAS, indicating their return to normal life.


Bibliography

1. The majority of patients in the early postoperative period after emergency abdominal operations developed postoperative gastrointestinal dysmotility.

2.    The use of L-arginine and metoclopramide was accompanied by a decrease in peripheral vasospasm phenomena on a constant work of the left ventricle , increase its capacity and leads to a quicker recovery motility than using neostigminum.

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