Method for predicting efferent detoxication therapy efficiency in the cases of pyo-inflammatory diseases

FIELD: medicine.

SUBSTANCE: method involves studying blood samples with venous blood mixed with vital stain like methylene blue. Degree of vital stain absorption by erythrocytes is determined by applying photocolorimetry. The value drop being more than 25%, extracorporal detoxication is to be predicted as ineffective.

EFFECT: simplified method.

6 tbl

 

The proposal relates to the field of medicine, in particular to clinical diagnosis, namely to the clinical laboratory prediction of the effectiveness of detoxification therapy in the treatment of endogenous intoxication (EI)induced inflammatory pathological conditions, in particular peritonitis, peritonsillar abscess, common pyoderma.

In particular, the method is designed to predict the efficiency of extracorporeal detoxification in the wounded with gunshot peritonitis and peritonitis that developed as a complication of acute surgical diseases and pellet injury to the abdomen in patients with purulent-inflammatory complications of chronic tonsillitis, peritonsillar abscess, as well as common pyoderma, aimed at evaluating the severity of endogenous intoxication and effectiveness of extracorporeal hemocorrection in any other acute purulent-septic processes in surgery, otorhinolaryngology, dentistry, dermatology, manifested by the development of severe endogenous intoxication.

However, these methods are either expensive or complex for everyday use and require special technical support and trained staff researchers.

Biochemical, nonspecific methods of laboratory diagnostics is IKI offer us data which are integral indicators of the toxicity of a particular environment of the body, mainly plasma, linking the concept of toxemia mainly with molecules of low and medium mass, the main source of education which is strengthening not enzymatic proteolysis, including proteins in the blood, which formed products high functional activity (Gabrielian NI, Dmitriev A.A. Kulakov G.P.,1981; Tulikov Z.A., 1983; Obolensky SV, Malakhov ME, Ershov A.L.,1989; Malakhov MA,1995, Knaus W.A., E.A. Draper, Wagner, D.P. et al.,1991).

The concept of toxemia is generally associated with molecules of low and medium mass. The main source of education - increased non-enzymatic proteolysis, including proteins in the blood, which formed products high functional activity.

Today in clinical practice to determine (EI) used the method of determining the weight polypeptides (SMP) according to the method Myamalfoy (1995), the essence of which consists in the deposition of macromolecular particles in blood plasma and erythrocytes solution tetrachloroquinone acid at a concentration of 150 g/l and recording spectral characteristics of aqueous supernatant in the zone of wavelengths from 238 to 300 nm.

However, the spectrogram of the blood plasma of each person, which determines its metabolic status, rather the individual is the individual. Essentially, we are dealing with a new indicator of the internal environment of the organism. The changing nature of the spectrograms characterize the measure of the metabolic response of human body to any aggression. Normal spectrogram of the blood plasma at wavelengths 238 and 242 nm has zero extinction - size optical layer. As a rule, in the specified range are logged substance catabolic origin, xenobiotics, the decay products of the cells.

In the biological fluids of a healthy person such substances, if any, in small quantities, i.e. below the threshold of sensitivity of the method. Since 246 nm, OK spectrogram has a uniformly ascending values of extinction with maximum values at a wavelength of 282 nm.

The novelty of our method lies in the dynamic analysis of the degree of uptake of the vital dye (STC) of erythrocytes during hemocorrection operation, which allows to predict the effectiveness of treatment.

The essence of the proposed method is the ability of erythrocytes to absorb vital dye (in particular, methylene blue), where the concentration is determined by photocalorimetry and when it declines by 25% or more say about the effectiveness of extracorporeal detoxification, and in the absence of the decrease in cf is the ranking from the source less than 25% say unfavorable course of the disease and the inefficiency of extracorporeal detoxification.

For the determination of pyruvic acid, we used the method Yew (Averushkin, Iveco and other "Laboratory work", 1988, No. 9, C22-24), lies in the sampling of venous blood from the patient and after placing it in a test tube was mixed with the last of the vital dye methylene blue, incubated received a sample at room temperature for 10 minutes, after which the sample centrifugally for 10 minutes. The supernatant (1 ml) was placed in a cuvette of fotoelektrokalorimetry if the length of the layer 10 mm and investigated in comparison with the initial solution of the vital dye.

Used as a vital dye methylene blue is offered by us in connection with its different from the other ability not to damage the living cell with its intense colouring, as well as creating a more static monochrome solution, providing elektrofotometricheskie with minimal error studies (Teacherhestia, Lgema, Bgjogujh "Structural and functional changes of erythrocyte membranes in experimental atherosclerosis" - bull. the experts. Biol., 1980, No. 6, pp.28-32).

Specific example:

- from a vein of the patient take 4 ml of blood in a test tube containing 1 ml of 3.8% solution of sodium citrate;

- mix and separate the erythrocytes by centrifugation for 10 minutes at 3000 rpm m is n;

the plasma is removed;

1 ml of erythrocyte mass paint 5 ml of 0.025% solution of methylene blue, mix;

- incubated for 12 minutes at room temperature;

- centrifuged for 10 minutes;

- the supernatant is transferred into a cuvette of fotoelektrokalorimetry, the study used a red filter (630-690 nm).

- amount of absorbed dye is calculated by the formula

STC(%)=100-100/A,

where STC (%) - the amount of absorbed vital dye;

A (units extinction) is the optical density of the original mortar;

In (units extinction) is the optical density of the dye solution after incubation with erythrocytes of the patient.

The balance between the erythrocytes and the solution comes in 5-6 min, while keeping the sample in a thermostat at a temperature of 37°not required. The increase in adsorption is the first 5 minutes of incubation, the end of which the red blood cells maximally saturated with dye, a further increase in the incubation time does not change indicators (Tab, Avicelase, Ivison, Ramkrishna, 1987).

Significantly (p<0.005 percent)that the red blood cells of a healthy donor absorb from 0.025% solution of methylene blue to $ 37.12±1,43% of the vital dye. The result of STC has a high specificity, and none of the healthy donor has not gone beyond the clarification is Noah standards (35-39%).

An example of the calculation of STC (from a healthy donor, K., 20 years). If fotoelektrokalorimetry of the investigated samples and control were used filter with a wavelength of 670 nm;

And (the optical density of the original solution)=0,84% extinction.

In (optical density of the supernatant liquid)=0,53% extinction.

STC=100-0,53 100/0,84=100-63,09=36,91%

The method was applied for the diagnosis and dynamic control of EI during extracorporeal detoxification treatment in 12 patients with purulent-septic diseases of the extremities, 16 patients with peritonsillar abscesses, 78 wounded with advanced firearms peritonitis, 12 patients with common ulcerative pyoderma.

STC patients with purulent-septic diseases of the limbs was significantly above normal in the beginning of extracorporeal detoxification to 59,5±4,11% (p<0.05) and decreased by the end of the operation to 41.3±2,3%, wounded with gunshot peritonitis, respectively 69,9±2,64% and 47.1±3,14% (p<0,05)in patients with peritonsillar abscesses 49,5±2,23% (p<0.05) and decreased by the end of the operation do,3±1,3%, in patients with piodermitov these indicators were measured during treatment 47,5±2,1% (p<0,05).

Examples of STC - monitoring and predicting the course of EI with firearms peritonitis, peritonsillar abscess, common pyoderma.

Example 1. Wounded R. 26 years old (case History No. 2096, 1998) the diagnosis:

Gunshot, penetrating gunshot wound of the abdomen with damage to the transverse colon. After laparatomy, suturing wounds of the intestine. Spilled firearms peritonitis toxic phase, endotoxicosis II degree. On the third day after the injury. The condition of the patient is heavy, slow, expressed signs of a toxic encephalopathy. AD - 110/95 mm RT. Art. Pulse -126 BPM 1 min dry Language. Abdomen moderately swollen, tense, symptoms of peritoneal irritation. Peristaltic noises are absent. The total number of carbon hemoperfusion was 1.5 circulating blood volume (CBV) (9,650 liters of blood), the operation time is 1 hour and 45 minutes, survey markers intoxication was carried out in the course of hemosorption (HS) in 1 hour when the perfusion volume 5,500 liters, immediately after its completion and after 6 hours. The results are shown in table 1.

Table 1

Laboratory indices of endogenous intoxication in a patient R.
Indicators EIBefore surgeryAfter 1 hour from the start of the operation (HS)At the end of the operation (HS)6 hours later (HS)
STC (%)63,242,141,350,7
SMP (c.u)0,5320,530 0,4760,482
Leukocyte index of intoxication (LII) (c.u)4,1the 3.8a 3.94,2
Paramarine time (min)11131515

Patient R. after the session GS marked improvement, decreased effects encephalopathy, appeared adequate consciousness, tachycardia decreased to 98 BPM 1 minute, appeared sluggish peristalsis.

Thus, we applied a method for predicting the effectiveness of therapy indicates the successful application of the HS at the wounded man. The performance of STC in the detoxification operations decreased by more than 25% from the original and is equal to 34.7%, which is a good prognostic sign. After the second session of the HS at the wounded were cropped symptoms of EI and recovered intestinal peristalsis. On the 5th day, the patient was transferred from the emergency Department. Recovery.

Example 2. Wounded N. 29 years old (case History No. 2896, 1998) with a diagnosis of:

Gunshot, penetrating shrapnel wound in the stomach with damage to the right lobe of the liver, transverse colon. After laparatomy, suturing wounds of the liver and intestine. Spilled firearms peritonitis terminal phase, endotoxicosis III degree. 3.5 days after the injury and OPE the promotion. The patient's condition is severe, the symptoms of toxic encephalopathy II century AD - 150/105 mm RT. Art. Pulse - 128 BPM 1 min dry Language. Abdomen moderately swollen, tense, symptoms of peritoneal irritation. Peristalsis no. The total number of carbon hemoperfusion was 2.1 BCC (12,250 liters of blood), the operation time is 2 hours 25 minutes, survey markers intoxication was conducted during HS in 1 hour when the perfusion volume 4,900 liters, immediately after its completion and after 6 hours. The results are shown in table 2.

Table 2

Laboratory indices of endogenous intoxication in a patient N.
Indicators EIBefore surgeryAfter 1 hour from the start of the operation (HS)At the end of the operation (HS)6 hours later GS
STC (%)75,868,262,869,2
SMP (c.u)0,7420,5300,4760,582
LEAH (c.u)the 4.7the 3.8a 3.94,2
Paramarine time (min)9111113

Patient H after HS session are saved phenomena encephalopathy, a positive dynamic is key is not marked. Tachycardia of 110 beats in 1 minute, peristalsis is absent.

Given that the dynamics of PVA during the operation of the HS did not exceed 25% of the original and is equal to 17.2%, which is not prognostically favorable, it became apparent development of extremely heavy flow of peritonitis among the wounded and the lack of positive results from the use of efferent methods of detoxification.

Further, despite intensive multimodality therapy and repeated sessions HS and plasmapheresis positive result, as expected, had been received. With the increasing phenomena of EI and renal-hepatic insufficiency the patient died 11 days after receipt of the injury.

Example 3: Patient A. 19 years old (case history No. 1206, 2001). Was admitted to the hospital with a diagnosis of chronic decompensated tonsillitis, peritonsillar abscess - Abscess opened. After the operation, the average severity remained severe pains in the throat when swallowing, chills, weakness, lack of appetite. Tachycardia up to 116 BPM 1 minute, BP - 100/60 mm RT. Art.

Assigned detoxification therapy extracorporeal ultraviolet irradiation of autologous blood in a dose of 2 ml per 1 kg at a rate of 20 ml in 1 minute by the “Isolde”, the estimated radiation dose to 4.2 joules. 5 sessions, daily. Studies of markers of intoxication were examined before surgery autolit the violet irradiation of blood AUTOC, immediately after its completion, after 24 hours, before 2 session, after the completion of radiation therapy. The results are shown in table 3.

Table 3

Laboratory indices of endogenous intoxication in a patient with A.
Indicators EIBefore surgeryAfter 1 hour from the start of the operation (HS)At the end of the operation (HS)6 hours later GS
STC (%)51,048,354,538,2
SMP (c.u)0,2860,2240,2710,212
LEAH (c.u)3,72,43,31,1
Paramarine time (min)17161422

After the first session AUTOC after 6-8 hours A. patient noted a decrease in pain in the throat when swallowing, reduced body temperature of the patient to subfebrile, night slept quietly, before 2 session appetite. Sore throat subsided after 3 sessions. Body temperature returned to normal on day 4 of treatment.

The performance of STC during treatment dynamically reflect the pathological process and correlated with clinico-biochemical and biological. After the first session of PVA decreased by 25.1% compared to the original, which allowed to predict smooth during the pathological process.

Example 4. Patient, 27 years old (case History No. 1827, 2001) was admitted with a diagnosis of chronic decompensated tonsillitis, complicated peritonsillar abscess. The abscess opened for admission to the Department. Within 3 days after surgery, the patient remained headaches and pain in the throat, increased body temperature to 38-39,1°tachycardia 110-120 BPM 1 min, AD - 135/70-85 mm RT. senior Purulent discharge from the surgical wound is not. Assigned detoxification therapy extracorporeal ultraviolet irradiation of autologous blood in a dose of 2 ml per 1 kg at a rate of 20 ml in 1 minute by the “Isolde”, the estimated dose of 4.1 j. 5 sessions, daily. Studies of markers of intoxication were examined before surgery AUTOC, immediately after its completion, after 24 hours, before 2 session 3 session conducted after re-operation - opening of purulent Sadekov and at the end of the course. The results shown in table 4.

Table 4

Laboratory indices of endogenous intoxication in a patient with C.
Indicators EIBefore surgeryAfter 1 hour from the start of the operation (HS) At the end of the operation (HS)6 hours later GS
STC (%)63,242,141,350,7
SMP (c.u)0,5320,5300,4760,482
LEAH (c.u)4,1the 3.8a 3.94,2
Paramarine time (min)11131515

After the first session of irradiation of autologous blood from the patient remained pain in the throat, although there was a reduction of body temperature to 37,7-38,0°, improved overall health, appetite. High rates of STC, the difference with the original figures are not exceeded before 2 session 5.3 per cent, given the opportunity to assume the formation of Saakov in peritonsillar area, revision of the wound revealed purulent numb up to 3 ml. Drainage of purulent cavity and conducting the session AUTOC 6 hours after surgery, improved overall health, reduced pain in the throat, decreased body temperature. The difference in STC was after 3 sessions 28.3%, which confirmed the successful surgical tactics in the patient and the effectiveness of detoxification. Laboratory blood counts normalized to the end of the course AUTOC.

Example 5: Bol is Noah K. 67 years old (case history No. 2066, 2000). Was admitted to the hospital with a diagnosis of Chronic deep ulcerative pyoderma legs. Complaints about severe pains in the legs, difficulty walking, chills, weakness, lack of appetite, poor sleep. The state of moderate severity. Tachycardia up to 121 BPM 1 minute, AD - 140/100 mm RT. senior Status localis: Pathological skin is common symmetric in nature, localized mainly on the legs. Has a clear polycyclic borders, presents ulcer fringing in the form of a cuff bottom 2/3 of the leg. The edges of the ulcer are raised in the form of a roller with saped edges, lividno pink. The bottom of the ulcer is uneven, covered with lush, easy bleeding granulations. Detachable ulcers are very copious, purulent character, mixed with decaying tissue, which has an unpleasant putrid smell.

Assigned detoxification therapy extracorporeal ultraviolet irradiation of autologous blood in a dose of 2 ml per 1 kg at a rate of 20 ml in 1 minute by the “Isolde”, the estimated radiation dose to 4.2 joules. 5 sessions, daily. Studies of markers of intoxication were examined before surgery AUTOC, immediately after its completion, after 24 hours, before 2 session, after the completion of radiation therapy. The results are shown in table 5.

Table is 5

Laboratory indices of endogenous intoxication in a patient K.
Indicators EIBefore treatmentAfter 1 session AUTOCBefore the second session after 48 hoursAfter the course (5 sessions)
STC (%)50,1to 49.352,537,2
SMP (c.u)0,2840,2250,2710,212
LEAH (c.u)3,72,33,21,1
Paramarine time (min)18171321

After the first session AUTOC after 6-8 hours the patient K. was noted a decrease in pain, improvement in General condition of reducing the body temperature of the patient to subfebrile, night slept quietly, before 2 session appetite. The pain subsided after 3 sessions. Body temperature was reduced to subfebrile on the 4th day of treatment.

The performance of STC during treatment dynamically reflect the pathological process and correlated with clinico-biochemical and biological. After the first session of PVA decreased by 17.2% compared to the original, which allowed to predict an unfavorable course of the pathological process. Despite comprehensive Ter the Pius failed to achieve a full recovery.

Example 6: the Patient And. 19 years old (case history No. 2065, 2000). Was admitted to the hospital with a diagnosis of Impetigo skin of the lower extremities. Complaints about severe pains in the legs, difficulty walking, chills, weakness, lack of appetite, poor sleep. The state of moderate severity. Tachycardia up to 121 BPM 1 minute, AD - 120/90 mm RT. senior Status localis: Rashes are common symmetric in nature. Localized predominantly on the lower 1/3 of the tibia. Polymorphic rash presents bubbles with sluggish tire size from 1 to 7 cm, with serous-purulent content, bordered acute inflammatory erythematous rim. In place of blowing bubbles erosion. In places the exudate dries form a thick, soft, straw-yellow crusts.

Assigned detoxification therapy extracorporeal ultraviolet irradiation of autologous blood in a dose of 2 ml per 1 kg at a rate of 20 ml in 1 minute by the “Isolde”, the estimated radiation dose to 4.2 joules. 5 sessions, daily. Studies of markers of intoxication were examined before surgery AUTOC, immediately after its completion, after 24 hours, before 2 session, after the completion of radiation therapy. The results are shown in table 6.

Table 6

Laboratory indices of endogenous intoxication in a patient And.
pokazateli EI Before treatmentAfter 1 session AUTOCBefore the second session after 48 hoursAfter the course (5 sessions)
STC (%)51,1to 49.352,537,2
SMP (c.u)0,2840,2230,2710,212
LEAH (c.u)3,52,43,21,1
Paramarine time (min)17161521

After the first session AUTOC after 6-8 hours the patient K. was noted a decrease in pain, improvement in General condition, decrease in body temperature of the patient to 37.5-37,3°that night he slept quietly, before 2 session appetite. The pain subsided after 3 sessions. Body temperature was reduced to subfebrile on day 3 of treatment.

The performance of STC during treatment dynamically reflect the pathological process and correlated with clinico-biochemical and biological. After the first session of PVA decreased by 25.3% compared to the original, which allowed to predict smooth during the pathological process.

Thus, the monitoring of endogenous intoxication during hemocorrection operation of our proposed method allows the valuation of the effectiveness of the treatment, timely diagnosing the development of a purulent complications, as well as to predict effectively. Generalized test the predictive accuracy of the proposed method when comparing with the method of the prototype was conducted retrospectively, the results of clinical observations and dynamic laboratory tests 116 patients in whom development of the underlying disease was characterized by the increase of endogenous intoxication, and demanded efferent methods of detoxification.

The method provides the possibility of monitoring the effectiveness of detoxification therapy during surgery, allows us to predict the pathological process and prospects of application of methods of extracorporal hemocorrection.

Thus, our proposed method has significant advantages - simplicity, speed studies, high specificity. The execution of the method widely available, does not require additional biological material. Allows you to monitor detoxification during extracorporeal operations and to predict the effectiveness of extracorporeal hemocorrection and, therefore, the end result of use of the claimed method is to improve the quality of treatment of patients with endogenous intoxication methods the efferent therapy.

The method is intended for use by Express laboratories, intensive care units and departments of efferent therapy municipal and district hospitals, military hospitals and other medical institutions. The simplicity and accessibility of the method can be used in conditions of military field medicine and disaster medicine.

A method for predicting the effectiveness of detoxification of efferent therapy, including the study of blood, characterized in that the venous blood of the patient is mixed with the vital dye methylene blue and is determined by photocolorimetry the degree of absorption of the vital dye red blood cells and reducing by 25% or more predict the effectiveness of extracorporeal detoxification, and in the absence of the decrease compared to baseline in less than 25% predicted extracorporeal detoxification as ineffective.



 

Same patents:

FIELD: medicine, analytical biochemistry.

SUBSTANCE: invention relates to laboratory methods of investigations. Method involves sampling specimen from patient to be inspected, extraction of serotonin and histamine from a specimen, chromatography of extract and determination of concentration of serotonin and histamine by the fluorescence intensity value. Saliva is used as biological fluid. Saliva by volume 1 ml is extracted with 4 ml of 1 N hydrochloric acid solution, 2 g of anhydrous potassium carbonate and 5 ml of mixture of butanol and chloroform in the ratio 3:2 are added, extract is shaken up and centrifuged. Organic phase (4 ml) is sucked off from extract and passed through chromatography column (diameter is 3 mm, height is 16 mm) filled with ion-exchange resin KB-4 or KB-4P-2 or Bio Rex-70 in H+-form, size of granules is 0.1 ± 0.02 mm. Histamine is eluted with 4 ml of 0.1 N hydrochloric acid at the rate of eluting solution 0.4 ml/min. Histamine concentration is determined by reaction with ortho-phthalic aldehyde dissolved in ethanol. Serotonin concentration is determined by reaction with ninhydrin in organic passed through column. Method provides assaying the saliva concentration of serotonin and histamine with high precision.

EFFECT: improved assay method.

The invention relates to medicine, namely to surgery

The invention relates to the encoded Micronesia, which is encoded using a stored code written by bleaching of fluorescent molecules on the surface of or inside microsites using impact Micronesian light radiation from a source with high spatial resolution

The invention relates to medicine, namely to laboratory diagnosis

The invention relates to the food and pharmaceutical industries and can be used in assessing the quality of medicines and biologically active additives to food with antioxidant properties; selection of optimum process conditions in the allocation of natural fat-soluble antioxidants; in search of an effective system of antioxidant synergists
The invention relates to medicine, in particular for dentistry
The invention relates to medicine, namely to diagnostic methods research
The invention relates to medicine, in particular to liquorrhea

The invention relates to medicine, in particular to rheumatology, Orthopaedics and traumatology

FIELD: medicine, clinical toxicology.

SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.

EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

The invention relates to medicine, namely to Perinatology, and can be used to determine the status of the fetus of female health workers

The invention relates to medicine, namely to Oncology

The invention relates to medicine, reflexogenic

The invention relates to medicine, namely to Oncology, and can be used in neurology, traumatology, surgery, forensic medical examination to determine pain syndrome

The invention relates to the field of medicine and veterinary medicine, and specifically to obstetrics and gynecology, and can be used in the diagnostic process of the physiological state of the female reproductive system, pregnancy planning or adopting measures for protection from unwanted pregnancy, and can also be used in animal husbandry when determining the period of ovulation in animals

The invention relates to medicine, in particular to the treatment and intraoperative diagnosis of diseases of the hepatobiliary zone

The invention relates to medicine, namely, neurology, and can be used in patients with tick-borne encephalitis to predict the possible development of focal forms in the early stages of the disease

The invention relates to medicine, in particular to pediatric Nephrology

FIELD: medicine, clinical toxicology.

SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.

EFFECT: higher accuracy of prediction.

2 ex, 3 tbl

Up!