Method for the treatment of patients with pulmonary hypertension
(57) Abstract:The method can be used in medicine, namely in pulmonology for the treatment of patients with pulmonary hypertension. Assessment of the functional state of the renin angiotensin aldosteronoma system (RAAS) on the basis of the measurement of angiotensin 11, is the prediction of treatment with discriminant equation based on the measured values of angiotensin 11 (AP). Using the radioimmunoassay method is determined by the initial level of angiotensin 11 ng/l, the treatment efficiency is predicted by solving the discriminant of the equation D = + 0,362 AP, where D is the discriminant function, a limit value which is + 12,30. The presence of positive treatment outcome is predicted at more 12,30, and when D is equal to or lower boundary values, predicted the absence of a positive treatment outcome. Increases the effectiveness of treatment of pulmonary hypertension inhibitors, such as captopril, in patients with chronic non-specific lung diseases. The invention relates to medicine, namely, pulmonology, and can be used for the treatment of pulmonary hypertension in patients grooby treatment of pulmonary hypertension with the use of nitrates, B-blockers, calcium antagonists, diuretics, inhibitors of angiotensin - converting enzyme (ACE) inhibitors and other drugs (Savelovskaya L., Orlov, C. A. Pulmonology, 1995, No. 4, S. 62 - 67).The prototype was elected as a method of treatment of patients with pulmonary hypertension with the use of inhibitors of angiotensin - converting enzyme (ACE) inhibitors such as captopril (Belousov Y. B. et al. Clinical pharmacology and pharmacotherapy), 1993, S. 133 - 135). The method consists in the use of captopril in a daily dose of 25 to 50 mg.The known method has the following disadvantages.1. Does not allow a differentiated selection of individuals for treatment with inhibitors (ACE) inhibitors in pulmonary hypertension.2. Contains no clear quantitative and qualitative criteria for assessing the functional status of the renin-angiotensin-aldosterone system selection for treatment with inhibitors (ACE) with pulmonary hypertension.3. The method does not allow to predict the effectiveness of treatment with inhibitors (ACE) inhibitors in pulmonary hypertension in patients with chronic nonspecific lung diseases.The purpose of the invention is to improve the effectiveness of treatment of pulmonary hypertension inhib is noshirvani positive therapeutic effect of captopril depending on the functional state of the renin-angiotensin-aldosterone system (RAAS).The objective is achieved by the fact that the assessment of the status of the RAAS is performed based on the measurement of angiotensin II, and prediction is performed using the discriminant equation based on the measured values of angiotensin II (AP).The proposed method includes the following methods:
using the radioimmunoassay method is determined by the initial level of angiotensin II in ng/l;
the effectiveness of the treatment is predicted by solving the discriminant of the equation:
D = +0,362 UP,
where D is the discriminant function, a limit value which is 12,30.The presence of positive treatment outcome is predicted at more 12,30, and when D is equal to or less than the boundary value, it is predicted that the lack of positive treatment outcome.Captopril is used in a daily dose of 25 mg for 4 weeks.Below are two examples of using the proposed method.Example 1. P., 35 years old, was admitted with a diagnosis of Exogenous allergic asthma. Moderate severity. The acute phase. Chronic pulmonary heart. Pulmonary hypertension. ABO.The values of systolic pressure in the pulmonary artery was 38.5 mm resolved discriminant equation
+ 0,362 48,1 = +17,412,
discriminant function more boundary values +12,30, predicted a positive outcome. After four weeks of treatment with captopril at a daily dose of 25 mg systolic pressure in the pulmonary artery decreased to 26.3 mm RT.art., testified to normalize the pressure in the pulmonary artery.Example 2. Century , 40 years, was admitted with a diagnosis. Exogenous allergic asthma. Moderate severity. The acute phase. Chronic pulmonary heart. Pulmonary hypertension. HPA-B.The values of systolic pressure in the pulmonary artery was 37,4 mm RT. senior Level of angiotensin II in the serum of 23.5 ng/l For prediction of treatment outcome resolved discriminant equation
+0,362 23,5 = +8,507,
the discriminant function is less than the boundary values +12,30, predicted the absence of a positive treatment outcome. After four weeks of treatment with captopril at a daily dose of 25 mg systolic pressure in the pulmonary artery accounted for 35.9 mm RT.article It pointed to the preservation of pulmonary hypertension.The proposed method was tested at the clinic of the Institute fisiologia pulmonary hypertension in 33 cases.The results of the validation of the proposed method has shown its effectiveness. Correct prediction was determined in 88% of cases. Method for the treatment of patients with pulmonary hypertension through the use of captopril, wherein explore the initial level of angiotensin II (AP) in ng/l and solve discriminant equation D = 0,362 up and when the value of D > 12,30 predict a positive therapeutic effect of captopril, and when D 12,30 predict the absence of a positive therapeutic effect.
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SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.
EFFECT: excluded recurrences of surgically removed neovascular membrane and development of proliferative retinopathy and retina detachment; retained vision function.
3 cl, 5 dwg