[Systemic coagulopathic distress syndrome in surgery: concept, pathogenesis, prophylaxis]

Area of Science:

• Surgical pathology
• Hemostasis and thrombosis
• Lipid metabolism

Background:

• Urgent surgical diseases significantly impact hemostasis and lipid metabolism.
• Understanding these interactions is crucial for managing thrombohemorrhagic complications.

Purpose of the Study:

• To correlate changes in hemostasis (humoral and tissue) with lipid metabolism in urgent surgical diseases.
• To establish a scientific basis for defining a new syndrome: systemic coagulopathic distress syndrome.

Main Methods:

• Experimental studies in dogs with induced pancreatitis, peritonitis, and intestinal obstruction.
• Clinical analysis of 55 patients with various acute abdominal conditions.
• Evaluation of hemostasis components and lipid metabolism indicators.
• Assessment of Remaxol's therapeutic effect in a subgroup.

Main Results:

• Early, pronounced changes in humoral and tissue hemostasis were observed in all studied conditions.
• Coagulation system modifications occurred in both affected and target organs.
• Membrane destabilization, driven by phospholipid changes and lipid peroxidation, triggers the hemostatic cascade.
• A new syndrome, systemic coagulopathic distress syndrome, was defined based on these findings.

Conclusions:

• Systemic coagulopathic distress syndrome involves phospholipid bilayer disruption due to oxidative and phospholipase activity, leading to coagulopathy.
• This understanding shifts prevention strategies for thrombohemorrhagic complications.
• Complex therapy, including membrane-stabilizing agents like Remaxol, is effective.