A method for predicting the occurrence of postoperative complications nitropropene
The invention relates to the field of medicine, particularly surgery. The method provides high information content and availability in the practical application of the method for predicting the occurrence of postoperative limited liquid formations and hematomas. On the first day after surgery the patient produce biochemical and electrocochleography, thus determine the activated thromboplastin time (APTT), prothrombin index (PTI), number of platelets, the density of the clot (A0), time out (T1), the lifetime of the clot (TSS) and fibrinolytic activity (AF) and in the presence of improve And0in combination with one of the following conditions: either APTT more than 43, PETIT less than 85% and T1over 3.5 min; or T1over 3.5 min, platelet count less than 150 thousand/ál; or TSS less than 1.0 min, OP more than 1.1.E. predict a high risk in the first 6 days of the postoperative period limited liquid formations and hematomas. 4 Il., table 1. The invention relates to medicine, namely to surgery, and can be used for postoperative examination of patients. is the mandates and bruising is an important task in surgery, as it allows to carry out their prevention. The occurrence of such complications is fraught with certain conditions, the development of intraoral abscesses, and will require additional treatment and diagnostic procedures (puncture and drainage of exudate, ultrasound monitoring the effectiveness of drainage, increased antibiotic prophylaxis), and also contributes to the prolonged stay of the patient in the hospital in 2-3 days (Gilly F. N., Francois Y., Sayag-Beaujard A. C., Glehen O., A. Brachet , Vignal J. Prevention of lymphorrhea by means of fibrin glue after axillary lymphadenectomy in breast cancer: prospective randomized trial// Eur. Surg. Res. -1998. - V. 30, N 6. - p. 439-443).Despite the continuing relevance of the problems in the world practice rather poorly developed methods for predicting the occurrence of postoperative limited liquid formations and bruises.The chance of any of the above nitropropene complications in violation of the functional state of hemostasis noted for a long time. Thus, according to S. Idell et. al. (Abnormalities of pathways of fibrin turnover in the human pleural space// Am. Rev. Respir. Dis. - 1991. - V. 144, N 1. - p. 187-194) cause exudative pleurisy - violation of local balance between procoagulant and fibrinolytic active vascular permeability. But as time increased vascular permeability underlies the pathogenesis nitropropene complications.Similar to the proposed method is a method for predicting the possibility of a destructive complications of pneumonia with pleurisy with electrocochleography (Podolsky, L. C., Andreenko, C., Fedorov, A. M. Laboratory diagnosis of complications of pneumonia with exudative pleurisy in children using electrocochleography// Laboratory work. - 1988. - 4. - S. 39-42). The method consists in the evaluation of fibrinolytic activity of blood on the basis of indicators AndRF(the amplitude of the retraction and fibrinolysis) and Yf(the rate of fibrinolysis) electrocochleography. Activation of fibrinolysis is prognostic indicator of an exudative pleural effusion and lung destruction.The disadvantage is the lack of consideration of all pathogenic mechanisms of occurrence nitropropene complications, which reduces the reliability of the result.A prototype of the proposed method is adopted a method for predicting postoperative nitropropene complications based on the evaluation of the functional state of hemostasis (Pacinian D. M., mitasova I. C. Method of forecasting 10).Determination of the functional state of hemostasis is carried out in this case by implementing functional cuff samples, allowing to evaluate the Pro - and anticoagulant activity of the vascular wall. About the formation of a fibrin clot is judged by the results of determining the quantity of fibrinogen by the method of Clauss, thrombin time and activity fibrinstabilizirueshchego factor. Then, it calculates sootnosheniya data indicators (symmetry in double proportion, called "wurf"). The mathematical formula for determining "wurf" looks like this:where, and is the number of fibrinogen; b - thrombin time; - activity fibrinstabilizirueshchego factor.Value "wurf" relatively constant and is 1,309. The deviation of 3-5% from the norm reflects the stress state of the system functioning, and 5% - pathological.Thus, calculate indicators "wurf" before and after local ischemia and compare them. If the numeric value "wurf" after conducting cuff samples differ by more than 5% of its original value, predict the development of local hemorrhagic complications (hematoma) after operirovana the possibility of predicting the occurrence of postoperative along with bruising limited liquid clusters (exudates). In the pathogenesis of these two complications are common mechanisms from the side of the functional state of the hemostatic system.2. Underestimation of all the possible changes in the functional state of the hemostatic system, which may contribute to the emergence of nitropropene complications in the postoperative period.Objectives: 1. Development of informative and accessible in the practical application of the method for predicting nitropropene complications postoperative period (limited liquid of education and hematoma).2. Identifying in the immediate postoperative period of prognostic criteria for the possible development nitropropene complications.3. Improving the accuracy of forecasting nitropropene complications.The essence of the proposed method is that if the comprehensive assessment of the functional state of hemostasis using biochemical coagulation and electrocochleography registered increased JSC electrocochleography of more than 0.6 at.E. ("loose clot in combination with one or more of the following conditions: - activated partial thromboplastin time more than 43 C, prothrombin index is less than e (index T1electrocochleography) over 3.5 min, platelet count less than 150 thousand/ál; - the existence of the clot (figure TCC electrocochleography) less than 1.0 min, fibrinolytic activity (indicator AF electrocochleography) more than 1.1.E. predict a high risk in the immediate postoperative period local haematomas and liquid formations.The method is as follows. On admission the patient from the operating theatre he produced a study of the functional state of the hemostatic system based on the electrical and biochemical coagulation. Biochemical coagulation profile should include a set of the most informative and fast-realized of tests to judge all phases of the process of gemokoagulyatsii. Method electrocochleography (Wetmaker U. A., Tolstojeva I. A. New device for the study of the blood coagulation system - coagulogram //Laboratory work. - 1967, 7) is a functional test of the study of hemostasis, defining "quality" in contrast to biochemical coagulation, based on the determination of the quantitative characteristics of the hemostatic system. Simultaneous electrical and biochemical coagulation allows oticheskih parameters electrocoagulating the computation of the integral indicators coagulation activity (KA), fibrinolytic (AF) and hemostatic potential (GP) (velicka N. A. , Professor of borochov S. A., Professor Tursunov B. S., Petrova, M. D., Yakovenko p. P. , Bergen, Etc., rapid diagnosis, prevention and treatment of acute and chronic coagulopathy // Methodical recommendations for physicians, clinicians and laboratory doctors. Tashkent, 1989).Was conducted a retrospective analysis of the functional state of the hemostatic system on the basis of biochemical and electrocochleography 1 day after surgery in 46 patients who subsequently in the immediate postoperative period (first 6 days) were identified localized hematoma and liquid concentrations (table. 1).Pathognomonic criterion for all these patients was the formation of loose clot (increase JSC electrocochleography). The presence of friable clot in this case testified to increased vascular permeability. Along with this criteria identified other changes biochemical and electrocochleography that were not characteristic for all investigated patients. In this respect, there were 3 groups of patients depending on changes in the functional state of the hemostatic system.1 GRU is OBLASTNOGO time) reduction PETIT (prothrombin index, elongation index T1electrocochleography (the start time of the collapse). This combination testified to the presence of hypothrombinemia and the associated failure fibrinstabilizirueshchego factor that caused the formation of loose clot (zabolotskikh I. B. , Sinkov S. C., Levko Century A. Bolotnikov D. C. the Methodology of evaluation of efficacy and safety of thromboprophylaxis// Kuban scientific medical journal. - 2001. - 2, a - C. 4-18). Hypothrombinemia in turn was a consequence of consumption coagulopathy or overdose of anticoagulants.In group II along with the formation of friable clot was lengthening index T1electrocochleography (the start time of the collapse), combined in most cases with thrombocytopenia. The rest of the studied parameters were within normal limits. Therefore, the cause of the formation of loose bunch in this group was gipoallergennosti platelets caused or consumption (thrombocytopenia) or overdose antiplatelet (zabolotskikh I. B., Sinkov S. C., Levko Century A. Bolotnikov D. C. the Methodology of evaluation of efficacy and safety of thromboprophylaxis//Kuban scientific is the shortening of the lifetime of the clot (figure TCC electrocochleography) and increased fibrinolytic potential (FP). The rest of the studied parameters were within normal limits. This combination testified about hyperactively fibrinolysis, and that was the reason for the formation of loose clot (zabolotskikh I. b . Sinkov S. C., Levko Century A. Bolotnikov D. C. the Methodology of evaluation of efficacy and safety of thromboprophylaxis// Kuban scientific medical journal. - 2001. - 2. - C. 4-18).Thus, the total property of hemostasis characteristic of patients with postoperative local bruising and fluid accumulations, was the formation in 1 day after surgery, friable, gemostaticski defective clot. But the reasons for his education. In one case it is hypothrombinemia and associated failure XIIIa (fibrinstabilizirueshchego) factor in the second - functional deficiency of platelets, and in the third - hyperactivation of fibrinolysis.Thus, the presence of the patient received from the operating, friable clot (figure JSC electrocochleography more of 0.6.E.) in combination with any of the following conditions: - activated partial thromboplastin time more than 43 C, prothrombin index is less than 85%, the start time of coagulation (figure T1electrocoin, platelet count less than 150 thousand/ál;
- the lifetime of the clot (figure TCC electrocochleography) less than 1.0 min, fibrinolytic activity (indicator AF electrocochleography) more than 1.1.E.predict a high risk in the immediate postoperative period local haematomas and liquid formations.In Fig. 1 shows a scheme for predicting the occurrence in the near p/period local haematomas and liquid formations based on the evaluation of the functional state of the hemostatic system.Clinical example 1.Patient N. , 54, (ist. 963) entered the ICU 06.07.1999, after pilosocereus pancreatoduodenal resection for cancer of the pancreas. Surgery duration was 18 hours State upon receipt regarded as very difficult, due to the unstable hemodynamics due to hemorrhagic shock III senior Patient required inotropic and respiratory support. After 3 hours after admission, performed biochemical and electrocoagulogram (Fig. 2). On electrocoagulation registered friable clot (figure JSC 2.4 for.E.). It was also found the combination of the following the new index (PTI) - 83,5%, lengthening the time of coagulation (figure T1electrocochleography to 4.2 min). The data obtained indicated hypothrombinemia (consumption coagulopathy) and the formation as a result of loose gemostaticski defective clot. In accordance with the proposed algorithm, the patient was predicted high risk of developing nitropropene complications. The prediction was confirmed on the 5th day after surgery using ultrasound revealed a limited liquid accumulation in the right flank and in the subhepatic space. When puncture under ultrasound control received about 170 ml of serous content.Clinical example 2.Patient B., 54, (ist. 1613) was admitted in the intensive care unit on 25.11.1999, after removal of the duodenum from under the root of the mesentery and create montepeloso of choledochoduodenostomy about Stanovoy disease. Surgery duration was 7 hours State upon receipt regarded as serious, but stable. After 5 hours after admission, performed biochemical and electrocoagulogram (Fig. 3). On electrocoagulation registered friable clot (figure AO - 0,8 in.E.). It was also found the combination of the following data: shortening the lifetime of the clot (pokazali - 1,6.E.). The obtained data suggested excessive activation of fibrinolysis and formation as a result of loose gemostaticski defective clot. In accordance with the proposed algorithm, the patient was predicted high risk of developing nitropropene complications. The prediction was confirmed 3 days after surgery diagnosed local hematoma in the right subphrenic space, which was punctured under ultrasound control.Clinical example 3.Patient W. , 65 HP (East. 543) entered the ICU 22.03.2000, after elimination of adhesive intestinal obstruction (previously performed gastrectomy for gastric cancer). Surgery duration was 5.5 hours the State of admission regarded as serious, but stable. After 4 hours after admission, performed biochemical and electrocoagulogram (Fig. 4). On electrocoagulation registered friable clot (figure AO - 0.7-in.E.). It was also found the combination of the following data: lengthening the time of coagulation (figure T1electrocochleography to 5.8 min), thrombocytopenia ñ 102.1 thousand/ál. The obtained data suggested a functional deficiency of platelets in the background of Tr and with the proposed algorithm, the patient was predicted high risk of developing nitropropene complications. The prediction was confirmed by 6 days after surgery found limited liquid formation in the left subphrenic space. When puncture under ultrasound control was obtained about 300 ml of serous content.Medico-social impact - the proposed method can improve the accuracy of forecasting in the postoperative period limited liquid accumulations and hematomas.
A method for predicting the occurrence of postoperative limited liquid formations and bruising, including the assessment of hemostasis using biochemical coagulation, characterized in that in the first day after surgery the patient produce biochemical and electrocochleography, thus determine the activated thromboplastin time (APTT), prothrombin index (PTI), number of platelets, the density of the clot (A0), time out (T1), the lifetime of the clot (TSS) and fibrinolytic activity (AF) and in the presence of improve And0in combination with one or more of the following conditions: either APTT more than 43, PETIT less than 85% and T1over 3.5 min, or T1Bali risk in the first 6 days of the postoperative period limited liquid formations and hematomas.
FIELD: medicine, laboratory diagnostics.
SUBSTANCE: the suggested studying should be carried out on the glass simultaneously with several inductors by applying minimal inter-taking antilogarithms concentrations of aggregation inductors which correspond at double combination of inductors: ADP 5.0 x 10-8 M, adrenaline 3.0 x 10-9, collagen - dissolving the main suspension 1:8, thrombin 0.075 U/ml; at triple combination of inductors: ADP 10-9 M, adrenaline 10-9, collagen - dissolving the main suspension 1:9, thrombin 0.060 U/ml. The development of aggregation means thrombocytic activation in patients with arterial hypertension at metabolic syndrome. The method enables to evaluate the changes of thrombocytic functional state with combination of inductors more probably present in area of vascular lesion by applying minimal necessary concentrations that develops real conditions at hemostatic initiation in human vessels.
EFFECT: higher efficiency of studying.
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SUBSTANCE: method involves checking consciousness, blood coagulation state, peripheral blood leukocytes number, K+ ions, bilirubin, fibrinogen, hemolysis and hemoglobinuria availability, prothrombin index and exotoxic shock development. Each value is calculated in points as follows. Lucidity is evaluated as -2 points; depression - +3 points; coma - +6 points; lack of changes in blood coagulation system - -2 points; coagulation availability without clinical injuries - +2 points; coagulopathy with clinical manifestation signs - +19 points; K+ ions concentration being less than 3.0 mmole/l - +3 points, from 3.1 to 3.5 mmole/l - -5 points, from 3.6 to 5.0 mmole/l - 0 points, greater than 5.0 points - +7 points, failure in determining K+ ions concentration - 0 points; hemolysis availability - +6 points, its lack - -3 points; hemoglobinuria availability - +8 points, its lack - -1 points; leukocytes number being less than 12.0x109/l - -2 points, from 12,1 to 18.0x109/l - 0 points, higher than 18.0x109/l - +8 points; hourly urine output being less than 30 ml/h - +6 points, greater than 30 ml/h - -2 points; bilirubin content being less than 31 mcmole/l - -2 points, from 30.1 to 50.0 mcmole/l - 0 points, greater than 50.0 mcmole/l - +2 points, failure in determining bilirubin content due to hemolysis being available -+6 points; prothrombin index being equal to or less than 60% - +3 points, greater than 60% - 0 points, failure in determining prothrombin index due to hemolysis being available - +12 points; fibrinogen concentration in blood plasma being less than 2.1 g/l - +4 points, from 2.1 to 4.0 g/l - -1 point, from 4.1 to 6.0 g/l - +1 point, failure in determining fibrinogen concentration due to erythrocyte hemolysis being available - +13 points; exotoxic shock development - +9 points, its lack - -1 point. The points are summed up. The value being greater than +13, admission for treatment in resuscitation department is indicated. The value being less than -13, admission for treatment in therapeutics department is indicated. The value being from -13 to +13, resuscitation expert consultation is advised.
EFFECT: high evaluation accuracy.
FIELD: medicine, laboratory diagnostics.
SUBSTANCE: one should evaluate the time for clotting of plasma under testing in phospholipid-dependent test, moreover, one should apply high- and low-sensitive thromboplastin reagents to lupus anticoagulant to calculate the ratio of indices of prothrombin time prolongation and at its value being either equal to or above 1.1 one should diagnose APS.
EFFECT: shortened terms of research.
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SUBSTANCE: method involves analyzing symptoms manifesting initial disseminated intravascular blood coagulation syndrome danger like burn area, availability of upper air passages burn, shock with its severity degree taken into consideration, sepsis development; clinical manifestations of disseminated intravascular blood coagulation syndrome like lung, kidney, liver function insufficiency, cerebral dysfunction, local and multiple hemorrhages, thrombosis, infarction; homeostasis system laboratory analysis data, hyper- and hypocoagulation based on chronometry test data, number of blood platelets, fibrin-monomer complexes, D-dimers, activity of antithrombin III, C and S proteins, XIIa-dependent fibrinolysis plasminogen content, availability of injured erythrocytes, combinations of laboratory tests for recognizing disseminated intravascular blood coagulation syndrome. Each sign under consideration receives a number of points corresponding to its diagnostic significance and integral value is calculated DIBCSIV=(X1+X2+…+Xn)/n, where n is the number of signs taken into consideration. DIBCSIV value equal to 1.0-1.5 units shows physiological norm. The value being between 1.6 and 2.5 units, light disseminated intravascular blood coagulation syndrome is diagnosed. The value being between 2.6 and 3.5 units, disseminated intravascular blood coagulation syndrome of medium severity is diagnosed; 3.6-4.5 points to one heavy severity degree; 4.6 and greater indicates highly severe case of disseminated intravascular blood coagulation syndrome.
EFFECT: high accuracy and objectiveness in differentiating syndrome severity degrees.
FIELD: medicine, diagnostics.
SUBSTANCE: one should study blood components to detect anticoagulant-fibrinolytic activity. Moreover, patient's blood should be sampled: in whole blood one should detect the presence of affected erythrocytes and evaluate the quantity of thrombocytes, in plasma it is necessary to study the activity of antithrombin III, XIIa-dependent fibrinolysis, the content of soluble fibrin-monomeric complexes, in blood serum of the sample taken one should detect the concentration of urea, creatinine, sodium, albumin, total cholesterol and the activity of aspartate aminotransferase, moreover, one should calculate integral value of renal-hepatic deficiency, to put corresponding point for the degree of parameters under testing, then one should calculate integral value of disseminated intravascular clotting (IVDIC) and at its value being 6.3 U and more DIC-syndrome should be diagnosed, moreover, at IVDIC value ranged 6.3-10.1 U it is possible to diagnose latent DIC-syndrome, at 10.2-14.6 - subacute DIC-syndrome and at 14.7 and higher - acute DIC-syndrome should be concluded.
EFFECT: higher accuracy and efficiency of diagnostics.
4 ex, 2 tbl
FIELD: medicine, obstetrics.
SUBSTANCE: the present innovation deals with predicting disadaptive processes in women in dynamics of menstrual cycle. During menstrual cycle beginning since the 1st d to the 21st d one should detect the dynamics for alteration in coefficient of activity of syntoxic adaptation programs (CASAP), calculated by the following formula:
where CST - concentration of blood serotonin, AAT-III - activity of antithrombin III, Aaoa - total antioxidizing activity of plasma, CCD8 + - concentration of T-suppressors, Cad - concentration of blood adrenalin, Cα2MG - concentration of α2-macroglobulin, CMDA - concentration of malonic dialdehyde, CCD4 + - concentration of T-helpers. Moreover, normally CASAP value alters two-fold against the first day of the cycle - since 0.70 up to 1.40 on the 21st d of the cycle, at no alterations in CASAP value one should diagnose female disadaptive alterations leading to failed pregnancy. The innovation enables to perform diagnostics of disadaptive processes in women in dynamics of menstrual cycle followed by prognostic conclusion upon future pregnancy.
EFFECT: higher accuracy of diagnostics.
SUBSTANCE: method involves determining spontaneous blood platelets aggregation and one induced by adrenalin and collagen, thrombocytospecific peptides activity of β-thromboglobulin and thrombocytic factor 4 in blood plasma.
EFFECT: high accuracy of diagnosis.
SUBSTANCE: method involves determining coagulating blood viscosity values like reaction period r, thrombin constant K, maximum amplitude MA, time T for forming fibrin-thrombocytic blood clot, spontaneous blood platelets aggregation intensity Ar, retraction and spontaneous clot lysis total FA. The r being within 5-7 min, Ar from -2 to -6 relative units, K being within 4-6 min, MA within 500-700 relative units, T within 40-60 min and FA equal to 10-20%, low inflammatory process activity is considered to be the case. The r being less than 5 min, Ar equal to -8 to -12 relative units, T less than 40 min and FA less than 10% with no changes in K and MA being observed, inflammatory process activity in chronic glomerulonephritis case is considered to be of high severity degree.
EFFECT: high accuracy of diagnosis; enhanced effectiveness of treatment method selection.
FIELD: medicine, clinical neurology, neurosurgery.
SUBSTANCE: one should study both activation and aggregation of thrombocytes in blood of carotid artery, at the quantity of thrombocytic active forms being above 70% and the number of aggregated thrombocytes being above 9.0% one should predict the development of cerebral ischemic lesion along with stable focal neurological symptomatology, and at the quantity of thrombocytic active forms being below 30% and the number of aggregated thrombocytes being below 8.0% it is possible to predict positive dynamics in the course of the disease mentioned without developing cerebral ischemic lesion.
EFFECT: higher accuracy of prediction.
FIELD: medicine, clinical neurology, neurosurgery.
SUBSTANCE: one should study the level of von Willebrand's factor in patient's carotid artery blood. At its content being below 105% one should predict the development of repeated AICH. The innovation improved information value of testing due to possibility to obtain reliable prediction in latent period, as well.
EFFECT: higher accuracy of prediction.
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