Клинико-морфологическая характеристика канальцевого аппарата почек при различных формах сепсиса
IVAN I. LI CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF RENAL TUBULAR APPARATUS AT VARIOUS FORMS OF SEPSIS
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| IVAN I. LI
CLINICAL AND MORPHOLOGICAL CHARACTERISTICS OF RENAL TUBULAR APPARATUS AT VARIOUS FORMS OF SEPSIS 14.00.15- Pathologic anatomy Dissertation on competition to the degree of candidate of medical sciences Sepsis mortality in many countries and regions of the world remains very high, reaching 52,4 % of cases. The purpose of this research is the examination of the morphological changes in tubular apparatus kidney at various forms of sepsis in comparison with its clinical manifestations and functional kidneys disorders. In this work we studied the analysis of 240 case patients histories died from sepsis, among them 122 medical histories were with histological analysis of 244 kidneys. As the result of this research we have revealed that concerning the sepsis severity the sepsis frequency was 2.5%. Thus severe sepsis (98 patients) was defined at 80,3% cases, septic shock (21patients) was determined at 17,2% ,polyorgan insufficiency was detected at 46% (56 patients). The most wide-spread sepsis sources were bacterial endocarditis (34,4%), urosepsis (20,5%) and pneumonia (17.2%). The wound sepsis was 11.5%. Gastrointestinal and hepatobiliary system diseases were resulted in the sepsis development at 6,6% of cases, purulent meningitis was at 40% , otogenic infection - at 0,9 %. Gram-negative flora was dominated among the causative sepsis agents in the observable material with multi-resistant forms. Multi-resistant forms of the Gram - negative pathogens has been more often than twice (64,6%) in a severe sepsis, comparison with Gram-positive (30,6%). The sepsis basis diagnosis is a universal diagnostic criterion of ACCP \ SCCM. Three criteria SIRS have been detected at 54% patients (66% patients had severe sepsis, 34%- septic shock ), four criteria SIRS - 46% (36%- severe sepsis , 64%- septic shock ). Septic shock is accompanied by a complete picture of SIRS more often than twice. Using APACHE II scale has been demonstrated that a severity sepsis is 18-20 points and it did not differences at severe sepsis and septic shock. The probability of fatal result at patients with the state severity more than 20 points (after 48 hours from the sepsis beginning) is 75%, nobody was death with severity less than 15 points. With the increasing in the number of organs and systems in the SPD (according R. Bone and A. Baue) mortality is grown up: – Death-rate was composed 8% at two organs and systems injuries ; – At three organs and systems injuries - 52,5% (in patients with septic shock was significantly higher -68.75% than by the severe sepsis - 41,7%); – At four organs injuries - 90% (in septic shock was significantly higher - 100% than in the severe sepsis - 85, 7%); – At five or more organs and systems injuries - 100%. For improving the morphological diagnosis of pathological states should be requirement of histological examination rules, which is based on the multivariate semi-quantitative analysis of histological features and the synthesis of the most informative diagnostic criteria (Khmelnitsky O.K.1994). According to classical sepsis classification author’s own sectional material was divided into 3 groups: 1. Septicemia was detected in 10% (12 patients) from the total number of sepsis deaths. 2. Bacterial endocarditis was 30% (36 patients). 3. Pyosepticemia was observed in 60% (74 patients). In conclusion, our histological analysis of various septicemia subgroups by morphological signs of the tubules injuries were cortical and medullary tubule epithelial necrosis , its shape and size changes also its internal hydronephrosis. Morphological changes in the kidneys under bakendocarditishave been characterized by the hydropic degeneration of epithelial tubules, and foci of coagulatory and colliquative necrosis. Glomerular and tubular kidney apparatus changes and circulation disorders as the fibrin thrombi in the glomeruli were determined at the pyosepticemia. Подписано в печать 11.05.2010 г. Формат 60х84 1/16. Объем 1,0 п.л. Бумага офсетная Печать Xerox. Заказ № 977. Тираж 100 экз. г. Алматы, ул. Толе би, 65 Тел.: +7 (727)272-47-02, 272-48-61 e-mail print3 @ copytech. Kz Отпечатано в ТОО «КОПИТЕК» жүктеу/скачать 1,47 Mb. Достарыңызбен бөлісу:
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