The way of forecasting the development of multiple organ failure (monday) on the basis of informative indicators of homeostasis was investigated in the first trimester of pregnancy

 

(57) Abstract:

The invention relates to medicine, namely to obstetric practice. The proposed method consists in the following: in the first trimester of pregnancy in women explore a number of free of endothelial cells, the level of D-dimers, fibrinogen, platelet count, lymphocyte count III type, the level of interleukin-6, an index of leukocyte activity, total peripheral vascular resistance (SVR), on the basis of these figures in the formula to calculate the value of F, when F>0 make a conclusion about the likely toiletries pregnant women at risk for the development PONT, when F<0 is likely toiletries pregnant women to the group, where is PONT will not develop during pregnancy. Effect: method allows to identify the patients belonging to the group of risk PONT, and prescribe appropriate therapy.

The invention relates to medicine, namely to medicine critical conditions, in particular to obstetric practice, and can be used by doctors of the following specialties - anesthesiology-intensive care doctors, obstetricians and gynecologists, physicians of clinical laboratory diagnostics, trance is astice this disease.

In the basis of the method based on the individual peculiarities of the organism and the state of the main life-support systems, determining a set of symptoms that characterize multiple organ failure (PON). The problem of the reference point (state standards) that require specific clinical decisions is extremely important because it is the resultant with respect to all issues of the diagnostic process, because of its correct decision depends on the usefulness of the contribution of the developed forecasts, providing diagnostic standards, pre-clinical signs of multiple organ failure, as well as its manifested forms.

Currently, multiple organ failure arising as a rule, against the background of late gestosis and obstetric hemorrhage is the leading cause of maternal mortality and perinatal morbidity, mortality and disability in newborns. The experience of the authors suggests that the majority of women delivered in a maternity facility in a serious condition, which indicates an underestimation of this pathology in female consultations and the lack of adequate methods to forecast its development in CLASS="ptx2">

The analysis of the literature suggests that there is almost no systematization informative criteria to predict the development of multiple organ failure. Diagnosis of multiple organ failure, used in health care practice, implies recognition of already developed patologii and does not allow to predict its development from pre-clinical stages, and does not take into account the presence of transitional forms.

Known methods of diagnosis and awareness of the already developed multiple organ failure, described in [1, 2, 3].

Closest to the claimed is a method for the diagnosis of multiple organ failure [4, 5], the essence of which according to J. Meakins and j. Marshall is that bowel dysfunction, implemented in the form of changes in the permeability of the mucosa, is a determining factor in the development of multiple organ failure.

The disadvantage of this method is the impossibility of its use for long-term forecast of the development of this pathology and the orientation of this method on the state of one system of the body.

Thus, there are currently no methods long-term forecast is the function of an organ or system, that is not possible to talk about a possible forecast of development of the given pathology. There is also no clear picture is quite simple, acceptable to the majority of intensive treatment of early clinical signs that would indicate a high probability of the development of multiple organ failure in a particular patient.

The purpose of the invention is to develop a method long-term forecast of the development of multiple organ failure in patients obstetric profile in the second half of pregnancy on the basis of the study of informative indicators of homeostasis responsible for the pathogenesis of multiple organ failure in the first trimester of pregnancy.

This goal is achieved by the fact that explore the systems of the body: endothelial, hemostasis, Hematology, immune and hemodynamic, analyze the received data based on theory of functional systems based on the system approach, identify inter - and lotrisonebuy integration intercellular interactions responsible for the formation of multi-organ failure. Using a method of pattern recognition to detect informative indicators of homeostasis: the number of SV is Yan interleukin-6, index of leukocyte activity, total peripheral vascular resistance and output decision rule:

F=K1A-K2IN+K3WITH-K4D+K5E+K6G+K7F+K8J+0,01 (1)

where a is the number of cells type III (%);

- Number of vacant endothelial cells (104/l);

With the level of interleukin-6 in serum (PCG/ml);

D - index of leukocyte activity (srvc.ed.);

E - fibrinogen concentration (g/l);

G - level of D-dimers (ng/ml);

F - SVR (Dyne.sec.cm-5);

J - the number of platelets (109/l);

TO1TO2TO3TO4TO5, K6TO7, K8- coefficients, which are equal to: K1= 0,002, K2=0,21, K3=0,67, K4=0,007, K5=0,02, K6VALUE =0.01, K7=0,14, K8=0,092.

When F>0 make a conclusion about the likely toiletries pregnant women at risk for the development of MON.

When F<0 make a conclusion about the likely toiletries pregnant women to the group, where PON will not develop during pregnancy.

The proposed method gives the probability of correct detection at risk for the development of MON in 71% of cases at a significance level of p<0.001 and gives the probability of correct you the

Endothelial system are examined by determining the amount of circulating blood endothelial cells by the method of isolation of endothelial cells together with platelets with subsequent deposition of platelets in the form of aggregates using ADP. The number of endothelial cells counted in two grids camera Goryaeva by phase-contrast microscopy [6].

The hemostatic system - study of gemokoagulyatsii hold on an empty stomach in the morning using coagulometer CL4 and automatic analyzer Thromsoluzer Chrom!" firms Behnk Elektronik (Germany). In the study of hemostasis include the study of vascular-platelet, coagulation, anticoagulant and fibrinolytic units. To perform gemostaziogramma take from 3 to 5 ml of venous blood by puncturing a vein in the upper extremity. The blood is placed in two special vacuum tubes to study the gemokoagulyatsii. In the first test tube is the stabilizer of 3.8% th acid (AACC). A solution of sodium citrate in the mixture with EACH prepared in advance at the rate of 100 mg EACH 1 ml of citrate. The ratio of blood and stabilizer set depending on the indicator hematocrite values of the investigated blood. The amount of blood withdrawn in the first test tube is 2 ml, the second 3 ml at a ratio of blood and stabilizer 9: 1. Platelet-rich plasma obtained by centrifugation with a speed of 1500 rpm for 5 min; poor - 10 000 rpm for 15 minutes drive Time from blood collection prior to conducting the research is 5-15 minutes

Hematological system are examined on an empty stomach in the morning on the analyzer peripheral blood Cell-dyn 3500R" company "Abbott (USA) with the index of activity of leukocytes [7].

The immune system is investigated under standard conditions based on the evaluation of morphological and functional activity of lymphocytes according to lymphocytopenia with identifying the most active forms (lymphocytes III and IV types) [8] and immune homeostasis by ELISA analysis, which is the concentration of IL-6 and TNFa in serum (test kits Elisa, Finland).

System hemodynamics investigated by the method of tetrapolar rheography, precisely p is therealchromey peoplesmart RPG-02. Recording is performed in the horizontal position of the patient during the expiratory phase. The measuring electrodes are superimposed at the level of the 7th cervical vertebra and the xiphoid process of the sternum. The analysis is based on a recording of 6-8 cycles with calculation of hemodynamic parameters by standard formulas [9, 10].

For the mathematical processing of the results using the pattern recognition method ("quasar-Plus"). The stable stahosticheskie the relationship between the number of endothelial cells (endothelial system), the level of D-dimers, fibrinogen, platelet count (indicators of hemostasis), the number of lymphocytes type III and level of interleukin 6 (the immune system), an index of leukocyte activity (figure hematological system), total peripheral vascular resistance (SVR), a measure of system hemodynamics) and the emergence of multiple organ failure in the second half of pregnancy. Derived decision rule (1) forecast of development of multiple organ failure on informative indicators of homeostasis in the first trimester of pregnancy. Our proposed method gives the probability of correct detection gruppioni L. P., 24. This first pregnancy, obstetric and medical background is not burdened. In pregnancy 12 weeks was conducted laboratory examinations in the amount indicated above. Received F Or=0.6. Based on the research revealed the likelihood of developing multiple organ failure in the second half of pregnancy, i.e., this pregnant woman is referred to the risk. From the proposed course of preventive therapy at the time of the survey and required further monitoring during pregnancy, the patient refused. In the period of 32 weeks pregnant woman was admitted in the obstetric clinic with symptoms of severe preeclampsia, preeclampsia and development of multiple organ dysfunction two systems (subcompensated form DIC-syndrome, respiratory disorders).

Example 2. Ivanchuk K. A., 26 years. This third pregnancy, obstetric history is not burdened.

Laboratory examination held in pregnancy 11 weeks. Obtained F=-1,6. This patient, therefore, does not fall into the risk group. A pregnant woman was on the observation, during which they conducted monitoring control in the above described amount of laboratory research. The second was pooves and ended urgent delivery.

Thus, our proposed method for forecasting development PON with early pregnancy allows to identify the risk of developing this syndrome and to monitor the patient's condition during pregnancy, as well as to decide on the need for preventive etiopathogenetic therapy. Given all this, it seems to us possible to offer it for widespread use in clinical practice.

Literature

1. Serov C. N., Markin, S. A. Features of infusion therapy in obstetric practice // Russian journal of anesthesiology and intensive care, 2, 1999, S. 65-67.

2. Silber, A. P., E. Shifman M. Obstetrics eyes anesthesiologist. - Petrozavodsk, 1997

3. Zolotokrylin E. C. Diagnosis of hypoxic conditions in the Department of resuscitation and intensive therapy // Clinical laboratory diagnostics, 6, 1998, p. 3-6.

4. Leiderman I. N. The syndrome of multiple organ failure. Metabolic framework // journal of intensive care, 2, 1999, S. 8-13.

5. Leiderman I. N. The syndrome of multiple organ failure. Metabolic framework // journal of intensive care, 3, 1999, S. 13-18.

6. Momot A. P., Barkagan H. C. B. N. Onoprienko The shift index of blood leukocytes as a marker of reactivity in acute inflammation // lab.case 1, 1983, S. 60-61.

8. Novoderezhkin Y. K. peripheral blood Lymphocytes during pregnancy (morphological features) //Clinical laboratory diagnostics, 6, 1993, S. 64-65.

9. Pushkar Y. T., Podgorny C. F., Hamar, I. Tsvetkov, A. A. Opportunities and prospects eographically methods for the study of the circulatory system // therapist. The archive, 11, 1986, S. 132-135.

10. Kubicek, W. G. Clinical applications of impedance cardiography // Thoracic impedance measurements in clinical cardiography. Ed. Winter U. et al. New York, 1994, pp.26-33.

A method for predicting the development of multiple organ failure (PON) in pregnant women on the basis of informative indicators of homeostasis was investigated in the first trimester of pregnancy, characterized in that examine the number of free endothelial cells, the level of D-dimers, fibrinogen, platelet count, lymphocyte count III type, the level of interleukin-6, an index of leukocyte activity, total peripheral vascular resistance (SVR) and on the basis of the decision rule

F= K1A-K2B+K3C-K4D+K5E+K6G+K7SVR+K8J+0,01, where a is the number of cells type III, %;

In the number of free is vnesti leukocytes, srvc. units ;

E - the concentration of fibrinogen, g/l;

G - level of D-dimer, ng/ml;

SVR - total peripheral vascular resistance, dissm-5;

J - the number of platelets, 109/l;

K1TO2TO3TO4TO5TO6TO7, K8the coefficients equal to K1= 0,002, K2= 0,21, K3= 0,67, K4= 0,007, K5= 0,02, K6VALUE = 0.01, K7= 0,14, K8= 0,092,

when F>0 make a conclusion about the likely toiletries pregnant women at risk for the development PONT, when F<0 make a conclusion about the likely toiletries pregnant women to the group, where PON will not develop during pregnancy.

 

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