A method for the diagnosis of endotoxemia

 

(57) Abstract:

The invention relates to medicine and can be used for the diagnosis of endotoxemia. The method improves the accuracy of diagnosis of endotoxemia by increasing vascular permeability and exit of the liquid portion of blood from the vascular bed. Duringthere radionuclides method determines the average transit time spread (Tdin second and nedifferentsiruemogo (Tnin second indicators, the minute volume cardiac output (MO), calculate the extravascular lung fluid (URL) in ml/m according to the formula: according to the data obtained, calculate the value of D using the discriminant equation D=0,115 URL and when it is 12,55 and more diagnosed endotoxicosis.

The invention relates to medicine and can be used for the diagnosis of endotoxemia.

A known method for the diagnosis of endotoxemia by definition toxic substances, such as middle molecules (CM), blood or other biological liquids of an organism (Nagoev B. S., Gabrilovich M. I. significance of the definition of middle molecules in the blood plasma in infectious diseases of viral and bacterial etiology // Clinical laboratory diagnostirebuli the blood or other biological fluid of the patient.

2. To assess local endotoxemia, such as lung abscess, surgery is required - transthoracic puncture of the abscess cavity with the evacuation of its contents for analysis, for example medium-sized molecules, if the cavity of the abscess drained through the bronchi, the evacuation of its contents produce bronchoscopic method.

3. The method does not accurately assess the severity of local endotoxemia in the hearth of bacterial lesions on stage infiltrative inflammation, such as lung tissue, and the existing method of determining CM in bronchoalveolar lavage inaccurate due to unaccounted losses installed liquid due to diffusion and unknown extent of its cultivation bronchial content.

The purpose of the invention is to reduce the morbidity method and the expansion of its diagnostic capabilities.

This objective is achieved in that the severity of endotoxemia, such as in bacterial inflammatory diseases of the lung, is determined using a quantitative assessment of extravascular fluid, for example, in the lungs.

The content of extravascular fluid lungs (URL) was determined known duringthere radionuclides method, KAZ.

Studies conducted on dual radiological installation type “Gamma” (Hungary), in the supine position install the sensor on the right and left lungs in the mid-clavicle line at the level of the fourth intercostal space. The first intravenous131I-albumin, human serum, the activity of 1.5 MBq in a volume of 0.2 ml, and record on the tape recording device behavior introduced substances and simultaneously record radionational, which define the parameters of Central hemodynamics, necessary to calculate VIL. After 10 min intravenous substance that can easily diffuse from the vascular bed,169Ib-DTPA activity of 1.4 MBq in a volume of 0.2 ml, and also write on the tape recorder.

Definition URL was chosen because in response to endotoxicosis in inflammation increases the permeability of capillaries, which inevitably leads to the exit of the liquid portion of blood from the vasculature into the interstitial space, and thus there is an increase VGL. Indicator, namely169Ib-DTPA that can easily diffuse from the vascular bed, allows to judge about the number URL.

For definition wide-angle is/SUB> and Tn- the average transit time for diffusing and nedifferentsiruemogo indicators (C);

K - flow in the lungs (ml/s);

The OCP is the amount of pulmonary blood (ml/m2);

URL - the extravascular lung fluid (ml/m2).

Using these values solve the discriminant equation:

D=0,115 URL,

where D is the discriminant function, a limit value which is 12,55.

Endotoxicosis diagnosed when D is equal to or more 12,55, and when D is less than the boundary values diagnose the absence of endotoxemia.

Example 1. Patient D., 51 years old, was admitted with a diagnosis of prolonged right abstemiously pneumonia. Complaints of cough with purulent malodorous sputum to 500 ml per day, hyperthermia (up to 38C, weakness, headache, lack of appetite. In the right lung at the level of the upper lobe heard wet and dry rales. Pulse - 90 tank/min, number of breaths - 22 beats./min In the blood: leukocytosis - 16 000, ESR - 26 mm/h, the average molecules 480,9 unit opt.sq. Radiographically in the upper lobe of the right lung on the background infiltrative shadows visible destructive cavity with a diameter of 6 cm from the liquid level. Extravascular fluid in lung AOR/P>0,115290,3=33,38.

Because discriminant function more boundary values 12,55, was diagnosed with endotoxicosis.

Example 2. The patient Was, 31 years old, was admitted with a diagnosis of a deviated septum of the nose. Clinically and radiographically in pulmonary pathology. Clinical and biochemical blood tests with normal (leukocytosis - 6000, ESR - 4 mm/h, the average molecules 270,9 unit opt.sq.).

Was determined the extravascular lung fluid over the area of the upper lobe of the right lung, which was to 62.1 ml/m2.

For the diagnosis of endotoxemia resolved discriminant equation:

0,11562,1=7,14.

Since the discriminant function is less than the boundary values 12,55 diagnosed the absence of endotoxemia.

The proposed method has been clinically tested at the clinic of the far Eastern scientific center of physiology and pathology of respiration SB RAMS.

We examined 20 patients with acute destructive pneumonia and lung abscesses. The control group consisted of 20 patients with a deviated nasal septum, in which the clinical examination were excluded pathology of the lungs.

Using the proposed method seslenisime and laboratory signs of endotoxemia.

A method for the diagnosis of endotoxemia, characterized in that duringthere radionuclides method determines the average transit time spread (Tdin C and nedifferentsiruemogo (Tnwith indicators, minute volume cardiac output (MO), calculate the extravascular lung fluid (URL) in ml/m2according to the formula

according to the data obtained, calculate the value of D using the discriminant equation D=0,115 hurl and when it is 12,55 and more diagnosed endotoxicosis.

 

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