The method of individual selection of pharmacotherapy in patients with acute purulent obstructive pyelonephritis with metabolic x-syndrome

 

(57) Abstract:

The invention relates to medicine, namely to urology. The way is to study the clinical and biochemical indicators of blood, which transform according to the formula (1): where ai- the value of one of the studied parameters; Aminand Amax- limits of changes in laboratory parameters in healthy individuals and patients with acute purulent obstructive pyelonephritis, with the subsequent calculation of the coefficient of gravity (CT) by the formula (2): where Ilthe number of leukocytes; ICH- the number of segmented neutrophils; Imothe number of band neutrophils; Im- urea; Ikr- creatinine; ICH- glucose; IAC- AST. The value of CT= 2-6.E. - considered the norm. CT<9.E. the condition of patients assessed as satisfactory and conduct conventional therapy. CT>10.E. - heavy state. In addition, the treatment with the immunomodulator “Imunofan” intramuscular injection of 1.0 ml per day for 10 days and antioxidant “Olifen” intravenously 2 ml of a 7% solution of 400 ml of isotonic 2 times in day of 10 days, then orally 1 tablet 3 times a day for 10 days. The method allows more accurate is the GLA.

The method of individual selection of pharmacotherapy in patients with acute purulent obstructive pyelonephritis with metabolic X-syndrome.

The invention is used in medicine, namely in urology.

Feature pharmacotherapy of acute suppurative obstructive pyelonephritis in patients with metabolic X-syndrome, which is characterized by excess body weight, hypertension, hyperglycemia, along with the appointment of antibacterial agents and detoxification therapy use of immunomodulating drugs (Lopatkin N.A. Manual of urology. - Volume 2. - M.: Medicine, 1998), and correction of metabolic abnormalities with the appointment of antioxidants (Makarov, F. Y., Grebennikov C. A., Ametov C. K., Cousin, H. A., Alexanov A. So Positive experience of olivina in the treatment of urogenital infections. // 53-I final scientific conference, Rostov-on-don, 1999: abstracts of the papers and materials science Day students, young scientists and specialists of the Rostov state medical University. Rostov n/a, 1999. S. 161). For individual selection of drugs in clinical trials are time-consuming and costly laboratory methods (Vinnytsia L. And 000. 45, No. 12. C. 12-16. Khaitov R.M P. M., Pinegin B. C. Modern immunomodulators: basic principles of their application // Immunology. - 2000. No. 5. - S. 4-7). When assigning antioxidants are applied biochemical research methods, the use of which is in wide clinical practice is also limited (acavity S. C., Smirnov, A. C. Antioxidants. // Experimental and clinical pharmacology. 2001. - So 64, No. 3. S. 76-80). For all of the above methods are characterized by the use of sophisticated laboratory techniques, necessary equipment, reagents, significant staff time.

There is a method that uses the index is determined based on biochemical indices of blood serum (lust I. C., Stagevsky A. C., Gruzdeva O. C., Ivanov E. A., Karpov, R. S. the Integral indicator of antioxidant defense and its components in the serum of patients with non-insulin-dependent diabetes mellitus. // Bul. the experimental. Biol. and the honey. 1999. Mgr. 1. S. 27-28), however, to determine this diagnostic criterion requires expensive equipment and reagents.

The technical result is to increase the efficiency of treatment of patients with acute purulent obstructive pyelonephritis is farmacoterapia taking into account the severity of the condition, defined using a new diagnostic criterion is the ratio of gravity to calculate the following indicators of clinical blood analysis (number of cells, the size of segmented and band neutrophils), indicators of biochemical analysis of blood serum of patients (urea, creatinine, glucose, AST), pre-converted by the formula (1):

where Ai- the value of one of the studied blood parameters (number of leukocytes, the number of segmented neutrophils, the number of band neutrophils, urea, creatinine, glucose, AST) identified in a patient with acute purulent obstructive pyelonephritis with metabolic X-syndrome;

The am and Amin - limits changes in laboratory parameters in healthy individuals and patients with acute purulent obstructive pyelonephritis (see table).

As a result of reforms made by the formula (1), receive modified parameters laboratory parameters with subsequent calculation of the coefficient of gravity (CT) by the formula (2):

where Il is the number of leukocytes, SN - number of segmented neutrophils, PN - the number of package the s is estimated as heavy, which requires the appointment in addition to conventional therapy immunomodulator “Imunofan” antioxidant “Olifen”.

CT<9.E. the condition of patients is assessed as satisfactory that does not require additional destination immunomodulator “Imunofan” antioxidant “Olifen”.

In healthy individuals CT=2-6.E.

The estimated coefficient of gravity (CT) is used to assess the severity of patients with acute purulent obstructive pyelonephritis with metabolic X-syndrome, and individual mode of pharmacotherapy. At the same time, patients with a positive effect after a course of therapy severity ratio CT<9.E.

Example: Kovalenko Tatyana Aleksandrovna, no history - 1087 Age 65 HP, weight 73 kg, BMI of 31.6 kg/m2. Was in the urology Department of the Belgorod hospital (15.03.2002-12.04.2002) with a diagnosis of kidney Stones, the stone of the left ureter. Acute pyelonephritis. Epistemology pyelonephritis left. Hypertension II century, progressive course. Ischemic heart disease. Atherosclerotic cardiosclerosis.

The results of laboratory tests at admission (16.03.2002): leukocytes 12,5×109/l, stab neutrophile u/L. a

The estimated value of CT=15,33.E.

The patient underwent surgery (27.03.2002): Pyelolithotomy left. Decapsulate, pyelostomy left.

In the postoperative period due to a serious condition in addition to antibacterial and detoxification therapy has been appointed as immunomodulator “Imunofan” intramuscular injection of 1.0 ml per day for 10 days and the antioxidant Olifen” intravenously 2 ml of a 7% solution of 400 ml of isotonic 2 times in day of 10 days, then orally 1 tablet 3 times a day for 10 days.

At the control laboratory study on the 7th day postoperative period (3.04.2002) leukocytes 6,2×109/l, stab neutrophils - 4%, segmented neutrophils - 68%, urea - 7.56 mmol/l, creatinine - to 95.3 mmol/l, glucose - 4.0 mmol/l, ASAT - 27,4 u/L. a

The estimated value of CT=6,18.E., reflecting the rapid positive dynamics of the state. The post-operative period is 16 beds/day.

Example: the patient Pashkova Matrona F., 63 years old, weight - 100 kg, BMI of 36.3 kg/m2were in the urology Department of the regional hospital, Belgorod (18.02.2002 - 12.04.2002) with a diagnosis of kidney Stones, the stone of the left kidney and/3 left much is atherosclerotic, atherosclerosis of the aorta.

The results of laboratory tests at admission (18.02.2002): leukocytes 12,4×109/l, stab neutrophils - 9%, segmented neutrophils - 88%, urea - 12,18 mmol/l, creatinine - 130 µmol/l, glucose - 8.0 mmol/l, ASAT and 57.6 u/L. a

The estimated value of CT=18,64.E.

The patient had an operation (01.03.2002) - ureteropyelostomy, ureteropyelostomy. Decapsulate left. Drainage of the retroperitoneal space to the left.

In the postoperative period was only antibacterial and detoxification therapy. At the control laboratory study on the 7th day postoperative period (8.03.2002) leukocytes 9,0×109/l, stab neutrophils - 2%, segmented neutrophils - 72%, urea - 9.3 mmol/l, creatinine - 120 µmol/l, glucose - 6.7 mmol/l, ASAT - 41,2 u/L. a

The estimated value of CT=11,0 have.E., what determines the patient's condition as serious. The post-operative period - 43 beds/day.

Thus, determination of the CT scan allows individual choice of pharmacotherapy based on the severity of condition of patients with acute purulent obstructive pyelonephritis with metabolic X-Sindh the indicators of blood, which are broadly defined in hospitals. To define a new diagnostic criterion does not require new laboratory equipment, expensive reagents and additional costs of working time.

The method of individual selection of pharmacotherapy in patients with acute purulent pyelonephritis with metabolic X-syndrome, which consists in the study of blood, characterized in that after determining the clinical and biochemical indicators of blood, which transform according to the formula (1)

, (1)

where ai- the value of one of the studied parameters;

Aminand Amax- limits of changes in laboratory parameters in healthy individuals and patients with acute purulent obstructive pyelonephritis,

with the subsequent calculation of the coefficient of gravity (CT) by the formula (2)

, (2)

where Ilthe number of leukocytes;

ICH- the number of segmented neutrophils;

Imothe number of band neutrophils;

Im- urea;

Ikr- creatinine;

ICH- glucose;

IAC- AST;

CT = 2-6.E. - norm



 

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