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.


Claims

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.

 

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3 dwg, 3 ex, 2 tbl

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3 tbl

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1 ex, 4 tbl

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1 tbl

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4 ex, 2 tbl

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