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Among complications from an urinary system the ischuria is most often noted that has a talk disturbance of the difficult neuroreflex mechanism of an urination with a temporary atony of a detrussor or a spasmolytic condition of a sphincter of a bubble. Most of patients can urinate in the first 12 — 18 hours. G. Ya. Iosset (1959) notes that the ischuria can be considered as complication if it lasts more than a day. According to our data, it is noted at 206 patients (4%). At patients with phlegmonous and gangrenous forms complication was more often, especially at development of peritonitis. It is explained by the combined development of an atony of a bladder and dynamic intestinal impassability. It is not necessary to hurry with catheterization. It is necessary to consider that some patients cannot urinate in a prone position, in the presence of strangers, in connection with a pain syndrome. After elimination of all these reasons at the majority there comes the independent urination.
In cases when these actions are inefficient, resort to catheterization. For fight against the proceeding ischuria appoint the spasmolysants, means toning muscles of a bubble. At most of patients these phenomena pass after elimination of the phenomena of paresis of intestines, at the therapy which is effectively carried out in this regard (prozerin, hypertonic salt solution intravenously, aceclidine, hypertensive enemas). In certain cases rational is a use of urotropin on 0,5 3 times a day, Sol. Kalii acetici of 2% on 1 tablespoon in 1 — 2 hour.
At the catheterization of a bubble which is carried out 2 times a day, the special attention is paid to prevention of infectious complications.
Inflammatory complications from an urinary system meet rather seldom. G. Ya. Iosset (1959) on 15 000 appendectomies registered development of cystitis in 1 patient, a pyelitis — at 1 and a piyelouretrotsistita — at 1 patient. Development of acute nephrite after appendectomies is very seldom observed (V. R. Braytsev, 1946; M. S. Astrov, 1953).
We observed development of cystitis at 2 (0,04%) patients after appendectomy concerning phlegmonous and gangrenous appendicitis, the pyelocystitis is diagnosed for 1 patient. The therapy applied in such cases (antibiotics, antiseptic agents, plentiful drink and so forth) quickly led to stopping of the dysuric phenomena and recovery.
Terrible complication of appendectomy is development of an acute renal failure which we observed at 7 patients (0,14%). In its genesis after appendectomy seldom there are such reasons as shock to sharp disturbance of a hemodynamics, hemotransfusion, more often peritonitis is the reason.
Diagnosis of an acute renal failure presents considerable difficulties. At the same time early identification of complication before an anury considerably improves results of treatment.
Initial symptoms of a renal failure are hidden by that complication of appendectomy which is a proximate cause of its development. The special attention should be paid to the frustration of a hemodynamics (collapse) which are important in a pathogeny of this complication. Coming after this the oliguria especially amplifies in the following oligoanurichesky stage (S. D. Goligorsky, N. T. Terekhov, 1969). At research of urine note decrease in specific weight to 1008 — 1010, it muddy with existence of erythrocytes, leukocytes and epithelial cells in draft. The azotemia, acidosis accrues, weakness, an adynamia, intestines paresis amplifies, and often arising vomiting aggravates disturbances of electrolytic balance. As S. D. Goligorsky, N. T note. Terekhov (1969), sharp decrease in concentration ability of kidneys is characteristic of a postoperative renal failure is not dependent on the size of a daily urine against characteristic clinical and biochemical signs of a renal failure.
For diagnosis of this complication the special attention should be paid to the size of a daily urine, changes in urine, if necessary — to studying of residual nitrogen or urea of blood, indicators of an electrolytic exchange. Follows at each patient, especially at the complicated current of the postoperative period to investigate a daily urine, to watch closely a condition of urine. These simple researches, possible in any surgical hospital, with big degree of reliability can reveal symptoms of the developing renal failure.
In its initial stage the main attention is paid to correction of circulator frustration. For this purpose enter cardiacs, vitamins, a hydrocortisone, blood loss taking into account the volume of the circulating blood, transfusion of Polyglucinum, proteinaceous drugs (a protein, albumine) etc. is filled.
In an oligoanurichesky stage of an acute renal failure the main attention has to be paid to fight against the appendectomy complications which were the reason of its development (peritonitis, acute postoperative pancreatitis, intestinal impassability, pneumonia) and also normalization of a water salt metabolism. It is necessary to consider strictly amount of the liquid lost by an organism (urine, emetic masses, kcal, a discharge of intestinal fistulas, perspiration taking into account body temperature) and to make completion of liquid taking into account these losses. Both hypo - and overhydratation worsen a condition of patients. Patients have to receive good nutrition as starvation increases a catabolism of proteins and an azotemia (K. Blazha, S. Krivda, 1962). Due to the limited administration of proteinaceous drugs along with carbohydrates (400 — 500 ml of 20 — 30% of solution of glucose with insulin and vitamins) introduction of fatty emulsions is especially valuable (intralipid).
At acidosis recommend administration of soda taking into account acid-base equilibrium indicators. The special attention is required by the developing hyperpotassemia and a hypocalcemia. The hyperpotassemia korrigirutsya by massive introductions of strong solutions of glucose, 10% of solution of a gluconate of calcium (to 100 ml), an exception of a diet of the products containing a large amount of potassium (milk, vegetables, fruit).
At development of an oliguria the great value is got by the substances stimulating diuresis. For this purpose in clinic widely use intravenous administration of the Diaphyllinum strengthening a renal blood stream and mobilizing salts and water from fabrics. At a number of patients we gained the expressed therapeutic effect, appointing Acidum etacrynicum drug — Uregitum. To fight against an oliguria and prevention of an acute renal failure recently widely apply a mannitol. At timely introduction its initial acute changes in kidneys can be reversible (N. T. Terekhov, 1966; Fine, 1962; Powers, 1964; Elahou, 1965).
Treatment of this group of patients should be carried out with the nephrologist. It allows to develop joint treatment planning of the patient, and if necessary to define indications to carrying out a hemodialysis.