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25THE EFFECT OF OZONE ON THE COURSE AND DEVELOPMENT OF COMPLICATIONS OF PERITONITIS IN CHILDREN Abduvoyitov B.B.1, Djalolov D.A.2, Khasanov A.B.3, Abbasov K.K.4
1Abduvoyitov Bobur Bahodirovich - Student;
2Djalolov Davlatshokh Abduvokhidovich - Student;
3Khasanov Aziz Batirovich - Student;
4Abbasov Khojimuhammad Khabibullayevich - Student, DEPARTMENT OF PEDIATRIC SURGERY, MEDICAL SCHOOL
SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: currently, ozone therapy has found wide application in clinical practice. The analysis of the scientific literature in this area has shown that there are a number of issues that require further study. An important effect achieved when using ozone is its bactericidal effect even on resistant microorganisms, which causes its widespread use in management in surgical patients and in the prevention of postoperative complications. Keywords: ozone therapy, peritonitis, multiple organ failure syndrome, immunomodulation, phagocytosis activation.
The basis of the therapeutic effect of ozone therapy is oxidative "stress" and adequate mobilization of antioxidant protection (AOP), which determine the metabolic and neuroendocrine rearrangement in the body, aimed at restoring the homeostatic balance of redox processes [1, 25].
A feature of ozone therapy is that ozone, actively participating in the regulation of oxygen metabolism, effectively uses energy substrates and stimulates the restoration of adaptive-compensatory subcellular structures [2; 4].
The use of ozone in clinical medicine is based on its oxidative, antioxidant, disinfectant, bactericidal detoxification, energy-stimulating, immunocorrective, antihypoxic, trophic, microcirculation and rheological properties [5; 6; 7]. In recent years, reports on the successful use of ozone in clinical practice in various groups of patients with a surgical and general therapeutic profile with endo- and exotoxicoses of varying severity [8; 9,]. Given the metabolic, bactericidal, virucidal, fungicidal action of ozone, the latter was applied by intravenous administration of ozonized solutions, applications, irrigation, compresses, small and large autohemotherapy, intracavitary administration. High concentrations of ozone have a toxic effect and are used to combat microflora. An increase in the antibacterial activity of many antibiotics and anticeptics during ozonation was found [10].
Low antibacterial activity of chlorhexidine, dioxidine and furacilin has been observed for staphylococci, proteus, pseudomonas and Escherichia coli [11; 12; 13; 14]. So, with a 10-minute exposure, 15% - 20% of the colonies of the proteus died, while there was no bactericidal effect on the blue pus bacillus. At the same time, the action of ozonized antiseptics and distilled water turned out to be detrimental to 100% of the strains of these microbes within the first minute [15; 17].
According to the literature, ozone in a concentration of from 1 to 5 mg / l leads to the death of 99.9% of E. coli, Streptococcus faecalis, Mycobacterum tuberculosum, Cryptosporidium parvum, Varavium, etc. within 4-20 minutes. At a concentration of 0.1 mg / l, even for the destruction of highly persistent spores of Pennicilinumnotatum took 15-20 minutes. An increased sensitivity of microorganisms to the bactericidal action of complement when exposed to ozone has been demonstrated. Ozone solutions are very effective against Methicillin-resistant Staphylococcus aureus [18].
In addition to the bactericidal action, most authors found a noticeable acceleration in the dynamics of the healing of purulent wounds and the elimination of the general and local symptoms of inflammation. According to Miroshin S. I. et al. with local ozone therapy,
wounds were cleaned 4-5 days earlier from purulent-necrotic discharge and began to be filled with granulations in comparison with conventional treatment methods, with simultaneous disappearance of signs of inflammation and purulent intoxication [19].
A number of authors have applied systemic ozone therapy in the course of acute respiratory therapy in the background of polyorganic insufficiency [20; 21; 22; 23]. Noted improvement of the peripheral and microcirculatory blood flow of the peritoneum, improvement and normalization of intestinal motility, reduction and elimination of accumulation of exudates in the abdominal cavity, as well as a decrease in fibrin on the peritoneum and intestinal loops [24].
Laberko, L. A. et al., Proposed correction of manifestations of enteral insufficiency syndrome in case of widespread peritonitis using enteral ozone lavage. They presented an analysis of the effectiveness of enteral ozone lavage in the complex treatment of patients with advanced peritonitis, and it was shown that lavage of the small intestine with ozonized saline through a nasointestinal probe in the postoperative period can effectively eliminate the pathological intraluminal bacterial contamination, reduces the toxicity of the enteral content and leads to a significant improvement in functional luminescence indices of the small intestine and the results of treatment in general [25].
Ozone in therapeutic concentrations, both with local and systemic use, stimulates the phagocytic activity of polynuclears. Intravascular infusion of solutions containing ozone in a concentration of 4-6 mg/l led to the mobilization of the humoral anti-infective protection unit - an increase in neutrophil phagocytic activity, an increase in the absorptive capacity of test microbes by phagocytes, and an increase in the phagocytosis completeness index [26; 27; 28]. It has been suggested that parenteral use of ozone at the level of intracellular mechanisms stimulates the activity of the antibacterial protection enzymes of neutrophilic leukocytes [29].
According to some authors when ozonating blood, the number of neutrophils involved in phagocytosis, within 10 minutes increases from 14% to 24% and by 15 min. reaches 26%, remaining at this level for 3 days. Absorption capacity increases, respectively, from 0.3 to 0.7 and further to 2.7 to 15 minutes [25]. The index of completion of phagocytosis is increased from 0.72 to 1.20. The pronounced immunocorrective and antibacterial properties of ozone made it possible to achieve significant success in the treatment of RAH, reduce the number of postoperative complications by 1.8 times and reduce postoperative mortality from 32.6% to 18.9% [30].
A.M. Shamsiev et al., Using ozone therapy in the prevention and treatment of postoperative abdominal abscesses in children with CAP, came to the conclusion that ozone has a bactericidal, antihypoxic, detoxification action, and also has an immunomodulatory effect [29].
Thus, local and systemic ozone therapy opens up new prospects for the treatment of CAP, in particular, in patients with multiple organ dysfunction syndrome. Most researchers do not note any adverse, toxic, mutagenic and teratogenic effects of ozone therapy, while respecting the recommended dosages. Analyzing the literature data on ozone therapy of widespread purulent peritonitis, clinical and experimental data indicate that in addition to the bactericidal effect, ozone has: - antihypoxic action; - immunomodulating effect; -detoxification action.
Despite the data obtained on the high efficacy of ozone therapy in the treatment of patients with CAP, the tactics of managing these patients remain unclear. Which is better - a single sanitization with ozonized solutions or repeated washing of the abdominal cavity? What criteria can be guided in the management of patients with CAP. When can the abdominal cavity be considered sterile after rehabilitation? Unfortunately, we did not find this in the literature we studied. We also did not receive a response in the literature.
In conclusion, the following can be said: many aspects of the treatment method under consideration leave behind a wide field for further study. Such as: dosage and concentration
of ozone in the solutions used for their local and systemic use, depending on the phases of
peritonitis and the degree of intoxication, bacterial contamination of the peritoneum;
parameters of negative effects and side effects on the patient and many others.
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FEATURES OF MICROFLORA IN THE ETIOLOGICAL STRUCTURE OF DIFFUSE APPENDICULAR PERITONITIS Djalolov D.A.1, Abduvoyitov B.B.2, Khasanov A.B.3, Shavazi R.N.4
1Djalolov Davlatshokh Abduvokhidovich - Student; 2Abduvoyitov Bobur Bahodirovich- Student; 3Khasanov Aziz Batirovich - Student; 4Shavazi Ramiz Nuralievich - Student, DEPARTMENT OF PEDIATRIC SURGERY,
MEDICAL SCHOOL, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the main role in the pathogenesis of peritonitis belongs to the bacterial factor -microbial seeding of the abdominal cavity and the state of immunoreactivity of the organism, which determines the rate of generalization of the process caused by the action of bacterial endo-and exotoxins. The character and severity of the changes depend on the severity of the microbial aggression, the prevalence and duration of the pathological process.
Keywords: diffuse appendicular peritonitis, microflora, exudate, antibacterial therapy, sensitivity to antibiotics.
According to the World Health Organization, "operations for acute appendicitis occupy a leading position in the structure of emergency abdominal operations performed on children, and account for more than 70% of all surgical interventions" [2, 5, 10, 11, 15]. According to world statistics, the total incidence of appendicitis ranges from 3 to 6 per 1000 children with
