Way assessment system gemokoagulyatsii disseminated intravascular blood coagulation

 

(57) Abstract:

The invention relates to medicine, namely to methods assessment system gemokoagulyatsii, and can be used to determine changes in orientation of the coagulation potential of blood (Hyper - or hypocoagulation) in patients with DIC-syndrome. Conduct research prothrombin and thrombin time, activated partial thromboplastin time in plasma. The values of these timing tests are expressed in relative units. Calculate the integral indicator system state gemokoagulyatsii (IPSG) by the formula IPSG=K1+C2+C3where K1- identified patient's prothrombin time to average the same indicator healthy people; TO2- identified patient thrombin time to average the same indicator healthy people; TO3- identified patient's activated partial thromboplastin time average of the similar indicator in healthy people. When is IPSG 2,72% and below diagnosed with hypercoagulation. When is IPSG 3,39% and above - hypohalous Method allows you to more accurately assess the state of the system gemokoagulyatsii.

The invention relates to medicine, more specifically, to methods assessment system gemokoagulyatsii when the disseminated intravascular coagulation (DIC) and can be used by medical clinicians and medical technicians to determine changes in orientation of the coagulation potential of blood (Hyper - or hypocoagulation) in patients with DIC-syndrome for assignment of patients to appropriate treatment and monitor the effectiveness of therapeutic interventions.

In the evaluation of gemokoagulyatsii in terms of DIC may use the results of timing tests - prothrombin and thrombin time, activated partial thromboplastin time (encyclopedia of clinical laboratory tests. /Ed. by N..The TIC. TRANS. from English. edited by centuries Menshikov. M: Labelform, 1997. - 960 C.). However, in this case, each of the tests is evaluated out of touch with each other, i.e. the results are not analyzed in aggregate (not defined integral index, calculated on the basis of various timing tests). This is a significant disadvantage of the known methods of determining the state of the system gemokoagulyatsii syndrome of ice.

However, asssitance using the results of the various timing tests, is obvious, since it allows to quantify the depth of the changes in the system gemokoagulyatsii and on the basis of the severity of her disorder to assign adequate therapy, to monitor the effectiveness of treatment of patients in the dynamics of the pathological process, to conduct a comparative analysis of the action of new drugs for the correction of hemostasis that coins can be used not only in practice but in experimental medicine at the clinical trial of drugs.

The present invention is the elimination of the existing drawback is the creation of an integrated indicator based on the results of several timing tests for objectification assessment system gemokoagulyatsii with DIC.

The problem is solved due to the fact that in patients with DIC-syndrome take blood, separates the plasma and using well-known methods of conducting research prothrombin and thrombin time, activated partial thromboplastin time values measured timing tests are expressed in relative units, UB>+C3,

where K1- identified patient's prothrombin time to average the same indicator of healthy individuals;

TO2- identified patient thrombin time to average the same indicator of healthy individuals;

TO3- identified patient's activated partial thromboplastin time average of the similar indicator in healthy people,

and when is IPSG 2,72% and below diagnosed hypercoagulation, 3,39% and above - a hypocoagulation, and in the range 2,73-3,38% - state system gemokoagulyatsii when DIC is assessed as uncertain.

The method is as follows. Blood for the study are taken from the cubital vein. Using known methods from blood prepared plasma sample for analysis and determine prothrombin, thrombin, and activated partial thromboplastin time.

Pre-set the control values of the analyzed parameters in the group of healthy people (30-40 people). Calculate the arithmetic mean value for each timing indicator and the data of ito the th healthy people (control group) compute the integral indicator system state gemokoagulyatsii by the formula

IPSG=K1+C2+C3,

where K1- the ratio of the values of prothrombin time every healthy person in the control group by the average of the similar index of all surveyed healthy individuals;

TO2- ratio values found thrombin time every healthy person in the control group by the average of the similar index of all surveyed healthy individuals;

TO3- the ratio of the values of the activated partial thromboplastin time every healthy person in the control group by the average of the similar index of all surveyed healthy individuals;

Based on the results of the determination of IPSG in a healthy person, calculate the arithmetic average variation of the number (M), standard deviation (Sigma) and calculate the normal range indicator (IPSG) within M±2, which in our research was 2,73-3,38% (conventional units). Therefore, in healthy people, IPSG is in this range. The value of the parameter in the control group were examined 2,73-3,38% due to natural physiological fluctuations result of the calculations cascade in the process of implementing their specific homeostatic functions of blood and is not associated with disseminated intravascular coagulation syndrome (in contrast to patients diagnosed with syndrome of ice on the totality of other laboratory tests of hemostasis and clinical manifestations complications - drop activity of anti-thrombin III, the increase in the blood content of degradation products of fibrin and fibrinogen and soluble fibrin-monomer complexes, the reduction in the number of platelets and the violation of their duties, tested positive for the damaged red blood cells, depression Ja-dependent fibrinolysis).

Patients expect the coefficients K1, K2and K3where K1- identified patient's prothrombin time to average the same indicator of healthy SCADA;

TO2- identified patient thrombin time to average the same indicator of healthy individuals;

TO3- identified patient's activated partial thromboplastin time average of the similar indicator in healthy people.

Calculate the integral indicator system state gemokoagulyatsii (IPSG) by the formula IPSG=K1+C2+C3. When is IPSG 2,72% and below diagnosed hypercoagulation, 3,39% as uncertain, what is usually observed in a transitional phase syndrome DIC between phases of Hyper - and gipokoagulyatsii and due to opposite shifts chronometric performance. Pronounced divergence data timing tests with severe DIC occurs quite often and is one of the typical signs (markers) changes to the system of hemocoagulation with this complication. When significant changes or other chronometric indicator may be masked no less significant deviations of the other timing parameter in the opposite direction. In this regard, patients with Tzelem-DIC IPSG can be located within 2,73-3,38% although homeostatic mechanism gemokoagulyatsii such patients violated.

The proposed method for the determination of IPSG order judgments about the state of the system gemokoagulyatsii when DIC tested in the examination of patients who received thermal injury and were treated in the Russian burn center on the basis of the Nizhny Novgorod research Institute of traumatology and orthopedics.

The hemostasis is defined in 112 patients with burns on the square from 21% to 90% of the body surface in the dynamics of the pathological picture diagnosed with DIC varying severity (latent or mild, subacute or moderate, acute or severe syndrome DIC). Definition IPSG allows to characterize the phase violations of hemocoagulation in one or another period of flow of burn disease (phase Hyper - or gipokoagulyatsii, transition phase), which together with the data about the severity of DIC is most fully reflects the depth of coagulation disorders and protivosvertawatei blood systems and provides an opportunity to formulate a detailed diagnosis of DIC syndrome. In turn, the objective assessment of hemostasis in patients with the syndrome of DIC is a necessary basis for decision-making on the appointment of adequate therapy and monitor the effectiveness of therapeutic interventions that have a positive value for a favorable outcome of the pathological process.

The foregoing is illustrated by examples.

Example 1.

Patient E-VA S. N. 67 (East. b-nor N 194684) received NIETO about burn the flame of the face, neck, upper extremities, back and front surface of the chest on the area of 32% of the skin depth AB - IV degree. Burns of the upper respiratory tract. A day after thermal injury, the patient developed DIC subacute form (conclusion according to maximized. the subsequent observation days for DIC acute and irreversible. The diagnosis of DIC acute form. Hypocoagulation. IPSG 3,43, 3,48 4,13 on the 5th, 7th and 8th day, respectively. The patient died 10 days after thermal injury.

Example 2.

The patient With s Acting 41 years (East. b-nor N 194557) entered the Russian burn center on the basis of the Nizhny Novgorod research Institute of traumatology and orthopedics with flame burn of face, neck, trunk, upper extremities I-II-AB degree in the area of 40% of the body surface. The eyes burn first degree. A day after the burn based on aggregate results hemostatic tests (total triglycerides) diagnosed with DIC subacute form. The hemostasis - hypercoagulation (IPSG - 2,64%). In subsequent observation days up to 10 days, the patient continued to be identified DIC subacute forms of raznonapravlennymi shifts indicators timing tests. This IPSG on the 2nd day after burn was 3,05 on the day 3 is 3.08, the 7th day of 3.33, the 8th day of 3.15 and on the 10th day 3,10% After cupping DIC and a full treatment of burn disease the patient was discharged in satisfactory condition after 47 days from m the bookmark thermal injury NIETO due to burn with flame I-II-AB-IV degree neck, torso, upper and lower extremities on the area of 45% of the body surface. A day after the burn by the aggregate hemostatic tests (total triglycerides) in a patient diagnosed with DIC with signs gipokoagulyatsii (IPSG 3,55%). In subsequent follow-up period DIC worsened. Diagnosed with acute DIC with wavy nature of the change of gemokoagulyatsii: IPSG on the 2nd day after injury - 3,03, 3-day - 3,0% (multidirectional shifts timing tests), on the 5th day - 2,49% (hypercoagulation), the 7th day of 3.07% After adequate treatment measures DIC was arrested. Upon completion of the course of rehabilitation treatment, including complex plastic surgery, the patient was discharged in satisfactory condition at 80 days after admission to the Institute.

Thus, predlozhennym way to evaluate a system of gemokoagulyatsii with integral indicator timing tests in patients with DIC-syndrome allows to quantitatively characterize the degree of imbalance of the basic units of coagulation and protivosvertawatei blood systems with this complication, which ultimately allows the doctor clinical largely determined by the phase of hemocoagulation disorders of the cascade.

Way assessment system gemokoagulyatsii with disseminated intravascular coagulation of blood, including blood sampling, separation of plasma and research prothrombin and thrombin time, activated partial thromboplastin time, characterized in that the values of the timing tests are expressed in relative units, calculate the integral indicator system state gemokoagulyatsii (IPSG) according to the formula

IPSG=K1+C2+C3,

where K1- identified patient's prothrombin time to average the same indicator of healthy individuals;

TO2- identified patient thrombin time to average the same indicator of healthy individuals;

TO3- identified patient's activated partial thromboplastin time average of the similar indicator in healthy people,

and when is IPSG 2,72% and below diagnosed hypercoagulation, 3,39% and above - a hypocoagulation, and in the range 2,73-3,38% - state system gemokoagulyatsii when DIC is assessed as uncertain.

 

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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.

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3 dwg, 3 ex, 2 tbl

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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.

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3 tbl

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1 ex, 4 tbl

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EFFECT: high accuracy and objectiveness in differentiating syndrome severity degrees.

1 tbl

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4 ex, 2 tbl

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