Патологоанатомическая характеристика септического шока в условиях современной терапии

The aim of this study was to identify the morphological features of organ damage due to shock in deceased with different types of sepsis under modern complex therapy. Material and methods. We studied archival material of 93 autopsies of the deceased with a clinical diagnosis of sepsis. Microscopic examination assessed the frequency among the observed groups and the prevalence of signs of damage to the microvasculature vessels, as well as organ parenchyma: myocardium, liver, kidneys, and brain. Statistical processing of the obtained data was carried out with the determination of significant differences between the observed groups. Results. 4 observation groups were distinguished: the first group with leukocyte mini-foci and shock (n=10), the second group with mini-foci without shock (n=11), the third group without purulent metastases with shock (n=15), the fourth group without purulent metastases without shock (n=43). It was revealed that the main etiological factor of septic shock is gram-negative microflora. It was found that in septic shock, the activation of the coagulation system is more pronounced, which is confirmed by the greater frequency of detection of blood clots in the lumen of microvasculature blood vessels. In the deceased groups with shock and leukocyte mini-foci leukostasis in the kidney vessels and desquamation of the endothelium were detected reliably (p = 0.01 and p = 0.01) more often than in the group with shock without purulent metastases. Conclusion. Septic shock is detected in every fourth (26%) deceased with this pathology. Septic shock development is based on the hyperergic response of the body to a generalized gram-negative infection, in 64% of cases presented by Klebsiella pneumonia. Septic shock is characterized by decrease in arteriole tone, absence or minimal manifestations of purulent metastasis , more severe damage to the vessels of the microcirculatory bed, manifested through the widespread exfoliation of endotheliocytes in the lumen of the vessels, frequent development of a sludge phenomenon and blood clots in the vessels of the myocardium, as well as hyaline membranes in the lungs. The detection of at least minimal manifestations of purulent metastasis in the tissues of those who died from septic shock is associated with increased expression of adhesive molecules in the myocardial vascular endothelium, its desquamation, and the appearance of leukostasis in the kidneys. These few morphological differences are associated with the nature of the patient's body reaction to a generalized infection and, accordingly, the rate of its development.