Impact of enteral administration of sodium hypochlorite on the mechanisms of inflammation and hemostasis in cancer patients with enteral insufficiency syndrome after multi-organ surgeries

Abstract

Background. Enteral insufficiency syndrome is a complicated and multifactorial symptom complex that is accompanied with impaired functions of the gastrointestinal tract and is also one of the main causes of the development of endotoxicosis, systemic inflammatory response syndrome, abdominal sepsis, septic shock, and multi-organ failure. Thrombosis, which is associated with oncological diseases, is another common cause of death among patients with cancer after the progression of the disease. Development and implementation of new methods of detoxification in cancer patients in clinical practice after multi-organ surgeries is a major problem in intensive care. Purpose – to study the effectiveness of the enteral administration of sodium hypochlorite in cancer patients after multi-organ surgeries with systemic inflammatory response syndrome and to monitor the dynamics of certain markers of inflammation. Materials and methods. 53 patients with cancer were observed after having undergone multi-organ surgeries on the abdominal organs. The patients were divided into two groups: the main group (n=27), in which indirect electrochemical detoxification with sodium hypochlorite at a concentration of 0,06% was carried out by the drip infusion method through a gastrointestinal tube, and the comparison group (n=26), in which the treatment was performed according to standard treatment regimens. The examination was carried out at 3 stages – before NaClO infusion, on the 1st and the 7th day after the indirect electrochemical detoxification. Groups were compared according to age and anatomical and functional zones of the surgery (the surgery was performed on the abdominal organs). Results. Patients with stage 2/3 enteral insufficiency syndrome were treated with the method of electrochemical detoxification with sodium hypochlorite, which led to the inflammation reduction and normalization of the hemostatic system parameters. In patients, who were receiving sodium hypochlorite (the main group), the reduction in inflammatory mediators was observed: C-reactive protein (CRP) – from 22.1 to 5.6 mg/l, interleukin-6 (IL-6) – from 14,36 to 1.55 pg/ml, and also hemostatic parameters were improved. A decrease in the international normalized ratio (INR), fibrin, activated partial thromboplastin time (APTT), D-dimer level, blood clotting time, and an increase in prothrombin index were observed. Analyzing the effectiveness, it should be noted that the correction of the hemostatic system and the development of inflammation are significantly faster (on the 1st day after the NaClO infusion) compared with standard treatment methods while also ensuring plasma preservation. Conclusions. The use of the method of electrochemical detoxification with 0,06% NaClO in postoperative intensive therapy in enteral insufficiency syndrome prevents the development of systemic inflammation and hypocoagulation. The inclusion of sodium hypochlorite in the complex postoperative therapy during the day allowed the development of inflammation (a decrease in the expression of IL-6 and CRP) to be halted and procoagulative changes (a decrease in INR, fibrin, APTT, D-dimer level, blood clotting time, and an increase in prothrombin index) to be achieved.