The way to prevent thrombogenic complications after prolonged abdominal operations
(57) Abstract:The invention relates to medicine, namely to surgery. A method for prevention of thrombogenic complications in post-operative patients, including the introduction of anticoagulant, wherein the patient from the first day after surgery lasting more than 3 hours to enter therapy under the control of electrocochleography when the amplitude of the retraction and fibrinolysis less than 0.9.E., lifetime dense clot more than 2.1 min and the blood clotting time less than 6 minutes Method eliminates the risk of thrombogenic complications and reduce mortality in the early postoperative period. 1 C.p. f-crystals, 2 ill., table 1. The invention relates to medicine and can be used in the rehabilitation of post-operative patients
The problem of postoperative phlebothrombosis in elderly patients with often neoplastic lesions of the gastrointestinal tract and pancreatobiliary system, with a number of concomitant diseases, propensity active hemostasis to hypercoagulability, undoubtedly relevant.The phlebothrombosis and pulmonary embolism complicating the early postoperative period is 2-3 times more often than is commonly believed. Pulmonary embolism (PE) are defined in General the th involve the use of indirect anticoagulant.All indirect anticoagulants are derivatives of coumarin (dikumarina, neodikumarin, acenocoumarol or singular).Anticoagulants of indirect action are antagonists of vitamin K, necessary for the formation in the liver of prothrombin. The mechanism of action is inhibition of VII, IX, X clotting factors.Unlike heparin, these drugs do not give effect immediately, are slowly and continuously, have cumulative properties.Anticoagulants of indirect action are not widely used in patients in the early postoperative period.These drugs have been successfully used as supportive therapy in cases of heparin in acute myocardial infarction, rheumatic heart disease, pulmonary embolism. (C. I. Metelitsa. Reference cardiologist for clinical pharmacology./ Ed. by E. I. Chazov, 2nd ed., reprocessing. and extra - M.: Medicine, 1987., 368 C.)
There are also known ways to prevent thrombogenic complications with medications aimed rheological actions, that is acetylsalicylic acid. (Diagnosis, prognosis, and prevention of postoperative venous, thromboembolization has a weak anticoagulant activity and has a marked inhibitory effect on spontaneous and induced platelet aggregation. Aspirin is administered to the patient within 1 hour before surgery the rate of 7 mg/kg of body weight. After surgery the patient is in the same dose gets this drug every 8 hours.The disadvantages of the method include the fact that such a dose aspirin may be used in patients with low and moderate risk thrombogenic complications in the early postoperative period, and after a short, low-volume operations.For the prototype we have adopted a method of preventing thrombogenic complications by patient heparin (Diagnosis, prognosis, and prevention of postoperative venous thromboembolic complications. Moscow, 1993, guidelines. Author D. M. N. Nozdrachev Y. N.).In patients with high risk of thrombogenic complications in the immediate postoperative period prescribed heparin, 50 units/kg 2 hours before surgery, followed by the introduction of the drug every 8 hours in the same dose within 1 day, with 2 on the 9th day of the postoperative period, the dose is increased up to 70 units/kg with the same interval, then gradually reduce and cancel.In nefrackzionirovannam drugs, called "heparin", dominated by high molecular weight fraction chap who priori calculations, because hypocoagulation effect it individually varies within very wide limits. It depends on four main factors:
- the plasma of the patient of anti-thrombin III, without which heparin has no anticoagulant actions, and this resistance cannot be overcome by increasing the dose of the medication;
- blood levels of acute phase proteins that bind and inactivate heparin;
the degree of fixation of complex antithrombin III - heparin on vascular endothelium;
- the heterogeneity of heparin because of the different content of high - and low-molecular components;
When intermittent injections of heparin, every four hours, there are major differences in the gemokoagulyatsii from full neverthemore blood to its normal performance, or even hypercoagulable before each new introduction (pologize heparin in circulation is 70 - 100 minutes, so by the end of 3-4 hours in the blood is almost there).Hemorrhagic thrombotic complications such intermittent introduction 7 times more often than with long-term infusion of the drug. (Liceu Century, Diagnosis and treatment of disseminated intravascular coagulation. M, Medicine, 1993, is LNA fibrotic transformation of the hemostatic clot ends within 24 hours after injury of the vascular wall. (Hemodynamics surgical bleeding Francoise Clinquart, Nicola d' Attellis, Jean-Francois Baron, France, 1999)
The degree of risk of thrombogenic complications increases with long-term (over 3 hours) operations, when the source of hypercoagulation, especially in the elderly on the background of the tumor process.All this requires complex interventions to individualize the ability to prevent thrombogenic complications after surgery.The goal is to ensure reliable prevention of thrombogenic complications in postoperative patients.Tasks.1. Ensuring the manageability of the process of formation of fibrin clot under the control of electrocochleography.2. The elimination of the blocking effect of anticoagulant on fibrinolysis.3. The lengthening of the period of validity of the drug
4. Reducing the risk of developing thrombocytopenia.The invention consists in that the patient with the first day after surgery, lasting more than 3 hours, under the control of electrocochleography - (rapid diagnosis, prevention and treatment of acute and chronic coagulopathy, Methodological recommendations for physicians, clinicians and laboratory doctors. Auto is S="ptx2">For the record electrocochleography specically, only the peripheral venous blood.The reproducibility of the method is not in doubt, since you used certain equipment and is available for the medical staff process.The method is as follows.Based on the existing classification of the degree of risk of thrombogenic complications in the early postoperative period (Diagnosis, prognosis, and prevention of postoperative venous thromboembolic complications. Moscow, 1993 , guidelines. Author D. M. N. Nozdrachev Y. N.) the studied patients were administered 4 hours after surgery therapy (20 to 40 mg) and then every 12 hours after the first injection.The basis for assigning Clexan immediately after surgery is a specific type of graphic recording electrocochleography at which the amplitude of the retraction and fibrinolysis less than 0.9 conventional units, the existence of a dense clot more than 2.1 min and the blood clotting time less than 6 minutes (Appendix I,II).The formation of friable clot, according to electrocochleography, is a criterion of adequacy of the selected dose of Clexan (see table).Predelay, Krasnodar.The entire group of patients was provided reliable prevention of thrombogenic complications in the early postoperative period.Example: History N 115. Patient L., 42 years old, was admitted to the hospital with a diagnosis of stomach Cancer. T4N2M1. The main complication: Subphrenic abscess on the left.Under General anesthesia the patient had an operation combined gastrectomy, splenectomy, resection of the body and tail of pancreas, left nephrectomy, resection of the small and large intestine. Total lymphadenectomy, drainage of the abdominal cavity. The operation is performed under General anesthesia, lasted about 19 hours.The nature of the underlying disease, the extent of surgical intervention, duration of surgery, patient age, initial hypercoagulation, significantly increased the risk of thrombogenic complications.Prevention thrombogenic complications in the early postoperative period the patient received 20 mg of Clexan, subcutaneously, the region of the navel, over 12 hours after the first injection, any violations in the hemostatic system during this period have been identified.Given the continuing threat of thrombosis TCB=5,7 min, IC=87,5%, KA=15,3 srvc. eating informative. A day after the surgery, the dose of Clexan increased to 40 mg twice a day.After increasing the dose of Clexan up to 80 mg per day increased clotting time (TCB= 7,3 min), almost 20% decrease in coagulation (IC= 66,6%), a decrease of 1.5 times the coagulating activity of the blood (KA=9,13 srvc. units ), increasing the hemostatic potential of 3.6 times (SE= 6,14 srvc. units ), reducing the extent of fibrinolysis (SF) to 3,13% and fibrinolytic potential of AF to 0.3 s.ed.After a month of observation TCB= 10 min and 20 sec, IC=84,3%, KA= 8,03 srvc.ed., SF= 4,65%, SE=3.63 services.ed., FP= 0.44 services.ed.The results of monitoring the condition of hemostasis method electrocochleography allowed to make a conclusion about the formation of a loose clot in a patient during the whole time of observation.When used, the method allows for reliable prevention of thrombogenic complications in the early postoperative period in patients with high risk of thrombosis (age over 40 years, the original hypercoagulation, long and extended surgery) and completely eliminate the mortality in these patients in the early postoperative period from thrombogenic complications.Spooky thrombogenic complications in postoperative patients including the introduction of anticoagulant, wherein the patient from the first day after surgery lasting more than 3 hours to enter therapy under the control of electrocochleography when the amplitude of the retraction and fibrinolysis less than 0.9. that is , the lifetime of a dense clot more than 2.1 min and the blood clotting time less than 6 minutes2. The method according to p. 1, characterized in that therapy is administered subcutaneously.
FIELD: medicine, thoracic surgery, anesthesiology.
SUBSTANCE: as non-narcotic medicinal preparation one should apply heparin to be introduced intratracheally at the dosage of 300-500 IU/kg, moreover, heparin should be introduced during the first 30 min after the operation is over. The present innovation enables to create prolonged anesthetizing effect in combination with prophylaxis of postoperational thrombohemorrhagic complications due to heparin capacity to be kept in the body due to its accumulation by mast cells at blockade of their fermentative activity followed by its gradual release into the blood.
EFFECT: higher efficiency.
1 cl, 1 ex, 3 tbl
FIELD: chemistry of natural compounds, polymers.
SUBSTANCE: invention proposes a method for preparing low-molecular heparins from high-molecular heparins by the enzymatic fermentative depolymerization using the enzyme complex from Streptomyces kurssanovii immobilized on silochrome in the weight ratio heparin : immobilized enzyme = 1:1. Then suspension is stirred, the immobilized preparation is separated by centrifugation, washed out and washing liquid is combined with supernatant followed by desalting on column with Sephadex 6-10 and the obtained product is lyophilized.
EFFECT: improved preparing method, reduced cost of method.
FIELD: analytical methods in medicine.
SUBSTANCE: invention concerns hematological procedures and, in particular, can be used in heparin treatment practice. Method of invention is based on measuring rate of thrombin-mediated hydrolysis of a chromogenic substrate, thrombin having activity 0.5-0.6 unit/ml and chromogenic substrate being z-Ala0Ala-Arg-pNA·HBr.
EFFECT: extended assortment of home reagents, simplified preparation procedure, and increased sensitivity of method.
1 dwg, 3 tbl, 2 ex
FIELD: medicine, endocrinology, physiotherapy.
SUBSTANCE: the present innovation deals with introducing preparations of antioxidant, antiaggregate, antithrombotic and hypolipoedemic action as detralex and sulodexide along with the impact of low-intensity laser radiation (LILR) (at wave length of 0.97 mcm and power of 5-7 W). Moreover, LILR impact should be performed by contact since the 1st d of conservative therapy on projection of the main vessels of lower limbs in, at least, 2 o\points at every of them per 1-2 min/every point, and high-intensity laser radiation (HILR) impact should be carried out by contact-free technique from the distance of 1-3 cm for visually altered part of affected limb's skin in area of trophic disorders up to the border with intact tissue, beginning from toes towards talocrural joint and longitudinally towards knee joint, proximally up to the lower third of femur.
EFFECT: higher efficiency of therapy and decreased traumatism.
1 cl, 2 ex
FIELD: medicine, first aid, anesthesiology, resuscitation, surgery.
SUBSTANCE: along with conventional medicinal preparations applied to treat shock one should introduce crystalloids into central vein in certain sequence: 7.5% and 0.9%-sodium chloride solution, 5%-glucose solution, and, also, infucol and similar-group plasma; after stabilizing arterial pressure one should introduce, additionally, either mildronate, or dalargin at certain dosages. The present innovation enables to restore the volume of extracellular liquid in the shortest period of time at decreased volume of infusion that, in its turn, favors to remove shock and prevent other possible further complications.
EFFECT: higher efficiency.
FIELD: medicine, resuscitation.
SUBSTANCE: one should obtain the values on head's vertical position, pulmonary ventilation, efforts coming to organs of controlling and parameters of cabin's hermetic nature. A transport driver should get the information on irregular extreme situation, one should supply 100% oxygen. In case of acute respiratory insufficiency at the background of spontaneous respiration, in case of acute pain, high heart beating or gunshot wound it is necessary to perform additional electrostimulation of the muscles that actively participate in respiration act, with amplitude-frequency-modulated triangular series of impulses at impact duration being 1.5-2.0 sec at pause being about 3-4 sec. Moreover, electrostimulation should be combined with anesthesia performed due to automatic injection of medicinal preparation into biologically active point Tan'-Chzhun along with the intake of therapeutic dosage of an antiaggregant, a thrombolytic, a nitropreparation, beta-adrenoblocking agent and low-molecular heparin. Automatic pharmacoinjection should be conducted manually as a transport driver desired, and in critical situation - due to distance-controlled operation; moreover, injection should be fulfilled perpendicularly for the depth not exceeding 0.5-0.6 cm. The innovation increases the number of preparations applied in extreme situations to rescue a transport driver.
EFFECT: higher efficiency of rescue activity.
3 cl, 1 dwg
FIELD: medicine, surgery.
SUBSTANCE: one should perform Novocain blockade presacrally before operation and not less than one time after operation. Solution for blockade is being a 200 ml 0.25%-novocaine solution supplemented with 1.0 g antibiotic and 40 mg low-molecular heparin. The method enables to improve motor-evacuatory intestinal function, conduct microbiocenosis correction of small intestine, decrease the risk of the development of enterogenic purulent-septic complications, improve microcirculation and hemostasiological profile in mesenteric vessels of small intestine and its wall.
EFFECT: higher efficiency of therapy.
1 ex, 3 tbl
FIELD: medicine, phthisiology.
SUBSTANCE: for the purpose to treating tuberculosis it is necessary to carry out pathogenetic heparinotherapy at the background of antibacterial therapy, moreover, heparin should be introduced into tracheobronchial tree by inhalations or due to endobronchial spreading. Heparin dosage corresponds to 500-700 IU/kg. Introductions should be performed 3-6 times at 3-5-d-long intervals. The innovation enables to accelerate healing process, provide rapid regress of respiratory deficiency due to improving microcirculation in pulmonary tissue and bronchial drainage function in tuberculosis patients, in those with fibrous-cavernous tuberculosis, among them.
EFFECT: higher efficiency of therapy.
1 cl, 4 dwg, 1 ex, 2 tbl
SUBSTANCE: method involves making milled hole in Dandy point. Ventricular catheter is introduced into lateral cerebral ventricle, its distal end being connected to input opening of valve system. Venous mastoid outlet is exposed and externally threaded nipple is screwed to one half of its canal and filled with anticoagulation solution. Bone groove is manufactured in the vicinity of ventricular catheter bending, the catheter is laid into it and attached to dura mater. The valve system is connected to ventricular catheter distal end and to nipple outlet opening.
EFFECT: enhanced effectiveness of treatment; reduced risk of complications.
3 cl, 2 dwg
FIELD: medicine, pharmacology, pharmacy.
SUBSTANCE: invention relates to formulations comprising heparin as an active component and a base consisting of lipid and polymeric components for oral using. The lipid component is able preferably to enhance effect of the main component while the polymeric component possesses ability to dissolving or swelling, and at least part of the lipid component is incorporated into the polymeric matrix being in the molecular-dispersed state. Invention provides the sufficient complete absorption of active substance in digestive tract after its oral intake.
EFFECT: valuable properties of formulation.
9 cl, 2 dwg, 8 ex