# Method for predicting cardiopulmonary complications before surgical operation

FIELD: medicine.

SUBSTANCE: method involves recording heart beat rate and systolic arterial blood pressure before and after two-stage exercise stress. The first stage is of 50 W within 3 min and the second one is of 75 W during 2 min. Patient rest pause is available between loading stages to recover initial heart beat rate. Prognostic estimation of cardiopulmonary complications is carried out with mathematical formula applied.

EFFECT: reduced risk of complications in performing tests.

The invention relates to anesthesiology-reanimatology and can be used for surgical patients, preparing for a long and traumatic interventions on the organs of the chest and abdomen.

The main problem of anesthetic management is to optimize the response of the life support systems on the anesthetic and operational distress. There are three formulas predict complications (Richter Larsen, U.G.Svendsen, N.Milman, J.Brenoe, B.N.Petersen. Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma // Eur. Respir. J. 1997. 10: 1559-1565). Formulas were obtained by statistical processing parameters homeostasis during exercise testing with the execution of the load to failure.

1. The first formula is used to predict therapeutic and surgical complications: 7,911-0,052*VO_{2,max}% pred-1,365*FEV_{1}. But it is known that surgical complications depend on surgical technique and anatomical features.

2. The second formula is proposed to predict deaths - 3,917-0,099*VO_{2,max}. This formula is only analyzed the consumption of oxygen is not taken into account the behavior of the life-support systems and energy metabolism, with supervision only 5 patients.

3. The third formula is proposed to predict cardiopulmonary complications - 0,794-0,016*Wr_{max}. (prototype). Under taccom of this method is the use of great physical exercise to failure,
because of the risk of disorders of homeostasis during testing.

The objective of the invention is to eliminate this disadvantage. The technical result is to reduce the risk of destabilizing systems during physical activity during the observation of the cardiovascular system.

The technical result is achieved in that in the method pre-operative prediction of cardiopulmonary complications with the use of multi-metered load (DFN) increasing power, which consists in registration of the hemodynamic performance of the patient to DFN and during DFN followed prognostic assessment by the formula, initially measure the heart rate and blood pressure of the patient, and DFN takes place in two stages, the first stage is 50 W for 3 minutes, the second 75 watts for 2 minutes, between which there is a period of rest of the patient to restore the original heart rate, using the index systolic blood pressure (SBP), and prognostic assessment is carried out according to the formula:

Y=+0,0446*(BP_{sist}50 W 3 - AD_{sist}50 W 1)-0,0296*(BP_{sist}50 W 3 - AD_{sist}before the test)+0,0219*(BP_{sist}75 watt 2 - AD_{sist}50 W 3)-0,1019, where Y is a prognostic assessment.

HELL_{sist}to test a GARDEN to DPN,

HELL_{sist
50 W 1 - GARDEN at the end of the 1 minute load capacity 50 W,}

HELL_{sist}50 W 3 - the GARDEN at the end of 3 minutes, load capacity 50 W,

HELL_{sist}75 watt 2 - the GARDEN at the end of 2 minutes the load capacity of 75 watts.

If Y≥0 - positive result, when Y<0 - negative result (cardiopulmonary complications).

Similar signs (our formula prediction) is not found in the known methods of forecasting of cardiopulmonary complications in patients before surgery. Therefore, the proposed method has the essential features of novelty and practical significance.

The way the preoperative prediction of cardiopulmonary complications is as follows: DFN performed the day before surgery, doctors and patients were not informed of its purpose and outcomes. To DPN patients refrained from hard work, Smoking, coffee or tea. Indications, contra-indications, identification of the threshold of tolerance (Fri) to DRR was defined by who criteria [2] and the fall of the stroke volume of the heart, by an increase in total peripheral vascular resistance compared with the initial level. DFN was a two-stage submaximal, growing power, intermittent with periods of rest to restore the original heart rate) Bicycle test (walkergate the p company "Tunturi",
Finland). The first stage load was 50 W for 3 minutes, the second stage is 75 watts for two minutes. Complications DFN was not. Conducted continuous ECG monitoring on channel cardiograph "Elkar". Arterial pressure was measured, the number of heartbeats per minute, percussion (formula Starr), cardiac output, cardiac index, total peripheral resistance vessels. Estimated vital capacity (VC) and forced expiratory volume in the first second (FEV_{1}) (spirograph), the hemostatic system (electrocoagulator H-333). Measured chronometric performance T_{1}(clotting time), T_{RF}(the timing of retraction and fibrinolysis), amplitude readings And_{max}(number of elements), And_{about}(the density of the bunch), And_{RF}(power retraction and fibrinolysis), the level of platelets in the blood plasma.

Compared the original data to test data during DFN (cardiovascular data) and after (respiratory and hemostatic parameters), preoperative indicator with indicators during the ANM and in post-traumatic period. The obtained data were analyzed prospective, sequential, double-blind, using the statistical software package Statistica for Windows company "Stat Soft", version 5 (1995), NRA (1995). The patients were divided into the ve groups: a - without complications (group comparison) and B - complications and death (main group). The group without complications included 26 patients with 13 diseases of the breast: cancer (3), tuberculosis (3), cancer of the esophagus (3), diseases of the esophagus (2), diseases of the diaphragm (2); 10 diseases of the chest and abdomen: cancers of the gastrointestinal tract (5), gastric ulcer and duodenal ulcer (5); other (3). The group with cardiopulmonary complications included 47 patients with 32 diseases of the breast: cancer (11), tuberculosis (9), purulent diseases of the lungs (3), cancer of the esophagus (5), diseases of the esophagus (4); 14 diseases of the chest and abdomen: cancers of the gastrointestinal tract (9), gastric ulcer and duodenal ulcer (5); other (1). In the group without complications completed 26 of operations, 23 radical operations on the organs of the chest - 10, abdomen - 8, chest-abdomen - 5 and 3 diagnostic laparotomy (from the analysis of these data excluded). In the group with complications completed 47 of operations, 42 radical operations on the organs of the chest - 27, belly - 12, chest-abdomen - one, chest-neck - and two 5 diagnostic laparotomy (from the analysis of these indicators were excluded). As a reference method used there is the group behind the development of complications within 30 days after surgery. Estimated amplitude of oscillations and the average values of the studied parameters of the systems. The significance of differences of the same name indicators within a group and between groups were determined using student test (p<0.05). Conducted a stepwise discriminant procedure. Analyzed the relation between the parameters DFN with the outcome of the operations. To do this in stages compared to 11 parameters using student's criterion (p). Identified information weight single characteristic, and combinations thereof. Statistical analysis included the most informative variables and their combinations. At the final stage got the formula prediction. Reviewed evolved anesthetic, surgical, mixed complications (a combination of anesthetic and surgical complications).

The development of cardiopulmonary complications during surgical treatment is determined by the reaction rate for the HELL_{sist}to DFN, at the end of 1, 3 minutes to load 50 W and at the end of 2 minutes 75 watts and is calculated by the formula: Y=+0,0446*(BP_{sist}50 W 3 - AD_{sist}50 W 1)-0,0296*(BP_{sist}50 W 3 - AD_{sist}before the test)+0,0219*(BP_{sist}75 watt 2 - AD_{sist}50 W 3)-0,1019, where the HELL is_{sist}to test for systolic blood pressure to DFN, AD_{sist}50 W 1 - systolic blood pressure at the end of the 1 minute load capacity 50 W, AD_{sist}50 W 3 - systolic is some blood pressure at the end of 3 minutes, load capacity 50 W,
HELL_{sist}75 watt 2 - systolic blood pressure at the end of 2 minutes the load capacity of 75 watts. If Y≥0 - positive result, when Y<0 - negative result (cardiopulmonary complications).

The sensitivity of the proposed prediction method was 68.75%, specificity 90%, positive predictive value of the - 91.6%, predictive value of a negative result is 64.3%.

7 operations on the organs of the chest forecast absence of complications of surgical treatment faithful in 43%. The prediction of outcome 3 operations on abdominal coincided in one case (33%), with two simultaneous operations combined access turned out to be accurate 100%. Just forecast the absence of complications faithful in 6 cases out of 12 (50%). 42 radically operated patients had 4 anesthetic complications (2 DFN, accurate prediction 2-100%), 23 surgical complications (15 DFN, accurate prediction 11-73%), 15 mixed complications (DFN 9, an accurate prediction 7-78%). Thus, recorded 19 of cardiopulmonary complications. In the analysis of complications for anatomical zones obtained the following data. At 20 operations on the organs of the chest prediction is correct in 75%. When two operations on the organs of the chest-abdomen, chest, neck complications correctly predicted 100%. Forecast of development of complications in 5 operations on the organs of the abdomen coincided 80%.

Clinically the example. Patient BMM, 61-year history No. X. Diagnosis: Peripheral cancer of the right lung. Operation performed: Extended pulmonate right, drainage of pleural cavity. Dosed physical load 75 watts for 2 minutes. Predicted the development of cardiopulmonary complications. Conducted cardiotropic support solution Domina during surgery, expanse every 20 minutes-lung ventilation. Cardiopulmonary complications during and after surgery has not developed.

When the prediction of cardiopulmonary complications in our formula reduces the risk of complications testing, account for the behavior of the cardiovascular system during the test, appropriate measures for prevention of cardiopulmonary complications.

The way the preoperative prediction of cardiopulmonary complications with the use of physical activity, including registration of heart rate (HR) before and during subsequent prognostic assessment by the formula, wherein the pre-and during physical activity measured systolic blood pressure and use a two-stage dosed physical load (DFN), the first stage is 50 W for 3 min, the second 75 W for 2 min, with a rest period to restore the original is the real heart rate, prognostic assessment carried out by the formula

Y=+0,0446·(AL_{sist}50 W 3 - AD_{sist}50 W 1)-0,0296·(AL_{sist}50 W 3 - AD_{sist}before the test)+0,0219·(AL_{sist}75 watt 2 - AD_{sist}50 W 3) - 0,1019,

where the HELL is_{sist}to test for systolic blood pressure to DPN,

HELL_{sist}50 W 1 - systolic blood pressure at the end of 1 min load capacity 50 W,

HELL_{sist}50 W 3 - systolic blood pressure at the end of 3 min load capacity 50 W,

HELL_{sist}75 watt 2 - systolic blood pressure at the end of 2 min load 75 watt,

and when positive or equal to 0 the value of Y predicted the absence of cardiopulmonary complications, negative Y value forecast cardiopulmonary complications.

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