Method for determination of threat of recurrence of gastroduodenal ulcer bleeding

 

(57) Abstract:

The invention relates to the field of medicine. The detection method is characterized by the fact that the register redox potential tissue ulcers, through fibrogastroduodenoscopy into the lumen of the organ to be investigated is injected active platinum needle electrode perpendicular to the plane of the mucosa to a depth of 2 mm, and when the value of the redox potential equal to or greater than 70 mV, the state of the tissue ulcers appreciate how progressive ischemic necrosis and the risk of recurrent bleeding, and when the value of the redox potential of less than 70 mV assess the state of the tissue as ischemic damage and no threat of recurrent bleeding. The invention provides precision definition.

The invention relates to medicine, namely to methods for predicting recurrence of ulcer bleeding.

Known forecasting methods:

A) Statistical methods based on the selection in multivariate regression analysis, the most probable stigma threat of recurrent bleeding (G. P. Rustling and other “gastroduodenal Ulcer bleeding”. - Minsk, 1998).

The disadvantage of this method is that it does not take account ocalenie indicators of pathologic process and therefore in the method of statistical forecasting is already incorporated the probability of an incorrect prediction in 10-15% of cases.

B) endoscopic Ultrasound Doppler ulcers based on the study of blood flow velocity in the ulcer crater in the dynamics; increased speed of blood flow through relatively large arteries may indicate the risk of recurrent bleeding (Bernd Kohler, Maier Mattias "Acute ulcer bleeding (a prospective randomized trial to compare Doppler and Forrest classification in endoscopic diagnosis and therapy", Digestive Diseases and Sciences, 42(7) p.1370-74, July, 1997, D. Beckly, M. Casebow "Prediction of rebleeding from peptic ulcer experience with an endoscopic Doppler device", Gut, 1986, 27, p.96-99).

This method allows to determine the velocity of blood flow in large arteries, whereas the recurrence of bleeding may occur from smaller vessels; increased blood flow suggests the normalization of microcirculation after blood loss and not always indicative about the threat of recurrence of bleeding; this method is expensive, requires special equipment and skills of the personnel.

C) Sighting endoscopic thermometry ulcers based on the introduction through the biopsy channel of the fiberscope thermometer and measure the temperature of tissue in the ulcer crater. The increase of tissue temperature indicates an increase of blood flow in the plague and the threat of recurrence of bleeding (Lagoda, A. E. “the Justification of the principles of individualization of surgical treatment Bolin normalization of microcirculation after blood loss and not always indicative about the threat of recurrence of bleeding; temperature change is a very indirect measure of the intensity of local blood flow; local temperature indicator variable and may depend on a number of factors (e.g. temperature insufferable at endoscopy in the stomach of air).

The present invention is the elimination of the previously mentioned drawbacks.

This object is achieved in that a method for determining the threat of recurrence of gastroduodenal ulcer bleeding, namely, that register redox potential tissue ulcers, through fibrogastroduodenoscopy into the lumen of the organ to be investigated is injected active platinum needle electrode perpendicular to the plane of the mucosa to a depth of 2 mm, and when the value of the redox potential equal to or greater than 70 mV, the state of the tissue ulcers appreciate how progressive ischemic necrosis and the risk of recurrent bleeding, and when the value of the redox potential of less than 70 mV assess the state of the tissue as ischemic damage and no threat of recurrent bleeding.

The method is illustrated by the following example.

In the lumen of the stomach (duodenum) be fibrogastroduodenoscopy. Visually ilgausakas bleeding be performed endoscopic hemostasis one of the methods of engagements.

Next registration oxidation and restitution of action potential (redox potential, Eh) that occur between the measuring electrode implanted in Muco-submucosal layer of the wall of the stomach (duodenum), and the reference electrode.

The measuring electrode is a platinum electrode needle with a diameter of 0.6 mm and a length of 3 mm, the Measuring electrode is connected to a recording device through a conductor length of 2000 mm and a diameter of 1 mm. Conductor, the connection of the active electrode with the conductor and the nearest to the conductor 1 mm active electrode is covered with a layer of insulator (PVC skin). The total diameter of the conductor and insulator should not exceed 2 mm.

The reference electrode is silver chloride, standard, factory-made. The reference electrode is placed in the left axilla of the patient, the contact of the reference electrode and the skin through gauze napkins soaked with 0.9% sodium chloride solution.

The recording device is a voltmeter with a range of value not less than -300...+300 mV, resolution 1.

Validation of the potential of the measuring electrode Rel is ASS="ptx2">Fibrogastroduodenoscopy is introduced into the lumen of the stomach (the duodenum), the end face of fibrogastroduodenoscopy is placed in front of the investigated area of the wall of the body at a distance of 5 mm from the last.

Through the working channel of fibrogastroduodenoscopy in the lumen of the stomach (duodenum) is entered active electrode with the conductor.

The active electrode is implanted in the surveyed area of the wall of the stomach (duodenum) perpendicular to the plane of the mucosa to a depth of 2 mm to full contact insulator with a mucous membrane.

The recording device will be switched to the definition of potential. The true value of oxidation-healing capacity is the value to be registered not less than 1 min after the start of measurement.

If the value of the redox potential greater than or equal to 70 mm, the state of the tissue of the ulcer is regarded as progressive ischemic necrosis, indicating that the risk of recurrent bleeding and requires urgent surgical intervention.

If the value of the redox potential is less than 70 mV, the state of the tissue of the ulcer is regarded ka is of conservative treatment.

The method was tested on the basis of the Moscow hospitals.

The volunteers in the absence of pathology Eh stomach and duodenum was +15 mV.

In the measurement of Eh patients with an established bleeding from ulcers and subsequently not receiveremail Eh was +50-69 mV.

Patients subsequently developed recurrent bleeding (refused surgery) Eh before relapse was +70-mW.

This method for determining the yield statistically reliable results about the threat of recurrence of gastroduodenal ulcer bleeding on the value of the redox potential tissue ulcers. The method does not require expensive equipment.

Method for determination of threat of recurrence of gastroduodenal ulcer bleeding, characterized in that register redox potential tissue ulcers, through fibrogastroduodenoscopy into the lumen of the organ to be investigated is injected active platinum needle electrode perpendicular to the plane of the mucosa to a depth of 2 mm, and when the value of the redox potential equal to or greater than 70 mV, the state of the tissue ulcers appreciate how progressive ischemic necrosis and the risk of recurrent bleeding, and when the value reeva bleeding.



 

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