[Pathogenetic rationale and basic principles in the comprehensive detoxifying therapy of purulent peritonitis]

The multimodality therapy for patients with purulent peritonitis and Degrees II-III endotoxicoses involves efferent methods of detoxification and hemocorrection alone and in combinations with hemosorption (HS), plasmapheresis (P), ultraviolet autoblood radiation (UVAR), immunocorrection through extracorporeal donor xenosplenic inclusion (EDXSI) or xenoperfusate infusion (XPI), indirect electrochemical detoxification (IECD) of blood and exfused plasma by the use of sodium hypochlorite (NaClO) obtained on an EDO-1 electrochemical unit. The analysis of therapeutical results has indicated that the efferent methods should be included into the multimodality therapy only in Degrees II-III endotoxicoses when a considerable number of toxic components leading to the development of organ- and system-specific insufficiency accumulate in the patients' circulatory systems. With this, the obligatory conditions are an adequate sanitation of the abdomen with the topical application of NaClO as an antiseptic and a fibrinolytic, rational antibacterial and homeostatic corrective therapy. The combined use of the efferent methods (HS+UVAR; HS+XPI; P+IECD of plasma) in the programmed mode is pathogenetically grounded, which produces a potentiating detoxifying effect, and levels the negative aspects of each method alone. P is preferable when it is used alone (in case of adequate plasma replacement. A comprehensive therapy policy has been developed in accordance with the stage of peritonitis and the degree of endotoxicosis.