Method for carrying out pharmacological correction of endothelial dysfunction in postoperative period in cardiosurgical patients
SUBSTANCE: method involves administering Noliprelum in postoperative period for reducing left ventricle hypertrophy.
EFFECT: enhanced effectiveness of treatment in early postoperative period.
The invention relates to medicine, namely to surgery.
There is a method of correction of endothelial dysfunction in patients with acquired heart disease, including the use of ACE inhibitors: captopril at a dose of 50-100 mg / day, enalapril dose of 20-40 mg / day, ramipril dose of 2.5-5 mg per day, perindopril dose of 2-4 mg per day, trandolapril at a dose of 0.5-1 mg per day, and others On this background for bulk unloading of the heart are prescribed diuretics: tiazidove diuretics - dihlotiazid at a dose of 50-100 mg per day, loop diuretics - furosemide dose of 40-80 mg / day, ethacrynic acid in a dose of 50-100 mg per day (Makolkin VI Treatment of circulatory failure in patients with acquired heart diseases In medicine. - 1998. No. 2. - P.8-9).
The disadvantage of this method is that in case of simultaneous use of ACE inhibitors and diuretics drugs may lower blood pressure, which significantly disrupts the hemodynamics in the postoperative period. The absence of such treatment leads to the progression of endothelial dysfunction and causes the development in the late postoperative period of chronic heart failure.
Known drug noliprel (low dose combination of the ACE inhibitor perindopril 2 mg and diuretic indapamide 0.625 mg)used in the treatment of hypert the clinical disease (Kabalah II These programs ARGUS // Cardiology. - 2000. No. 12. - S-71). However, this drug has never been used as a pharmacological correction of endothelial dysfunction in cardiac surgical patients.
The technical result of the invention is to improve the effectiveness of treatment.
The technical result is achieved by the fact that in addition to traditional therapy, the patient with a 3-day postoperative period are assigned noliprel 1 tablet per day for 30 days.
Clinical example 1. Patient W., 46 years old, medical history, No. 10657/2, was admitted to the cardiac surgery Department №1 of the Voronezh regional clinical hospital 24.10.02 with a diagnosis of Rheumatic fever, inactive phase. Combined mitral heart disease with prevalence of failure. FC 3 (classification of new York heart Association, 1964). Diagnosed on the basis of these clinical observations, laboratory and radiological examinations, parameters, Echocardiography with Doppler. 27.10.02 made surgery - mitral valve replacement low profile disc prosthesis AMEX No. 31 in conditions of artificial blood circulation. In the early postoperative period patient was in the intensive care unit, where he held the traditional intensive therapy. 01.11.02 transferred to the cardiac surgery ward No. 1, where on the 3rd day the after the operation was further appointed noliprel 1 tablet per day for 30 days.
In the early postoperative period in 3-4 days, the patient noted increased pulse pressure, an index of rigidity of the walls of large arteries and an independent risk factor for development of cardiovascular complications. After the appointment of noliprel on the 30th day has decreased pulse pressure 18.6 mm Hg, which shows the effective reduction of rigidity of the walls of arteries.
Mean arterial pressure of the patient also had a tendency to increase with 3-4 days, reflecting the increasing rigidity of the walls of arteries. Mean arterial pressure after the course of treatment rolipram significantly decreased from 110 to 93 mm Hg
Dynamics EchoCG reflects a trend towards the reduction of left ventricular hypertrophy, which is the 30th day decreased by 14.3.
The patient was discharged 01.12.02 in satisfactory condition.
Drug for pharmacological correction in cardiac surgery patients with heart disease in the postoperative period was tested on 38 patients (13 women, 25 men). Received positive statistically significant (p<0.01) results. Positive clinical dynamics was observed in 11 women and 25 men. The use of the invention makes it possible to optimize parameters such as mean arterial and pulse pressure, without unwanted hypotonic the coy response. However, 94.7% of patients according to Echocardiography, there was a statistically significant (p<0.01) decrease in the degree of left ventricular hypertrophy on average, 24, 6% of the original.
Clinical example 2. Patient K., case history No. 974/2, was admitted to the cardiac surgery Department №2 of the Voronezh regional clinical hospital 14.03.2003 with a diagnosis of Rheumatic fever, inactive phase. Combined mitral heart disease with prevalence of failure. FC 3 (the NYHA classification, 1964). The diagnosis is confirmed by laboratory, x-ray, Echocardiography with Doppler, which was marked hypertrophy of the left ventricle to 24 mm 18.03.2003 made surgery - mitral valve replacement low profile disc prosthesis AMEX No. 31 in conditions of artificial blood circulation. After a complex of traditional measures of intensive therapy on the 5th day operations of assigned complex drug noliprel 1 tablet per day for 30 days. Throughout the course of pharmacotherapy tolerance noliprel was good, there were no signs of hypotension. With 14 days there was a trend to reduction of left ventricular hypertrophy to 19.7 mm, and 30-th day the degree of hypertrophy decreased statistically 11.8 mm and amounted to 12.2 mm the above example shows that the use of noliprel in p is lesoperational period within 30 days reduces the degree of hypertrophy of the left ventricular myocardium in heart disease in the postoperative period.
The use of the invention allows to normalize parameters such as pulse pressure, mean arterial pressure, reduce left ventricular hypertrophy according to Echocardiography on well tolerated noliprel and the absence of hypotension, as well as to avoid the progression of chronic heart failure in the late postoperative period due to early correction of endothelial dysfunction in the postoperative period.
The use of noliprel as a means of reducing left ventricular hypertrophy in cardiac surgery patients with heart disease in the postoperative period.
FIELD: medicine, endocrinology, pharmacology, pharmacy.
SUBSTANCE: invention relates to a pharmaceutical combined composition used for treatment or prophylaxis of hypertension in patients suffering with diabetes mellitus. The composition comprises AT1-antagonist valsartan or its pharmaceutically acceptable salt and calcium channel blocking agent or its pharmaceutically acceptable salt, and pharmaceutically acceptable carrier. The composition elicits synergistic effect and expanded spectrum effect.
EFFECT: improved and valuable medicinal properties of composition.
10 cl, 3 tbl
or its pharmaceutically acceptable salts, which have the properties of inhibitors of the enzyme Lp-PLA2and can be used to treat or prevent a painful condition associated with the activity of the specified enzyme
FIELD: organic chemistry, chemical technology, medicine.
SUBSTANCE: invention relates to synthesis of new biologically active substance, namely, to γ-hydroxypropylammonium-5-hydroxynicotinate of the formula (I): , eliciting an anti-ischemic, anti-arrhythmic and hypolipidemic activity. This compound shows low toxicity and absence of cardiodepressive effect. Compound of the formula (I) is prepared by interaction of 5-hydroxynicotinic acid with 3-amino-1-propanol in the presence of a solvent at heating.
EFFECT: valuable medicinal properties of compound.
1 cl, 7 tbl, 3 ex
FIELD: medicine, cardiology.
SUBSTANCE: traditional therapy of myocardial infarction should be supplemented with granocyte introduced either subcutaneously or intravenously at the dosage of 0.48 mln IU/kg body weight daily for 5 d.
EFFECT: higher efficiency of therapy.
FIELD: medicine, cardiology.
SUBSTANCE: patient with stenocardia should be introduced with efficient quantity of omapathrylate or its pharmaceutically acceptable salt either separately or in combination with another pharmaceutically active agent. Another pharmaceutically active substance could be represented by organic nitrate, beta-adrenergistic blocking agent, blocking agent of calcium supply or antithrombocytic preparation. It is suggested to apply omapathrylate or its pharmaceutically acceptable salt to prepare medicinal preparations for treating and/or decreasing stenocardial symptoms.
EFFECT: higher efficiency.
16 cl, 2 dwg, 2 ex, 8 tbl
FIELD: medicine, ophthalmology.
SUBSTANCE: one should introduce 1.0% serotonin adipinate solution intravenously due to infusion once daily for 10-12 d. The method enables to increase visual functions due to decreased tissue hypoxia and normalization of retinal microcirculation, resorption of hemorrhages, reverse development of retinal edema, normalization of functional thrombocytic activity and hemostatic values.
EFFECT: higher efficiency for therapy.
FIELD: medicine, cardiology.
SUBSTANCE: the suggested method should be performed at the background of medicinal therapy with preparations out of statins group, tevetene, polyoxidonium and conducting seances of plasmapheresis by removing 800 ml plasma twice weekly with N 5 due to additional intramuscular injection of immunophan 0.005%-1.0 with N 10 and fluimucyl 300 mg intravenously daily with N 5-10, total course of therapy lasts for 2 mo. The method provides modulation of leukocytic functional activity, moreover, due to altered cytokine profile and, thus, through disintegration of protein-lipid complexes participating in the development of atherosclerotic platelets.
EFFECT: higher efficiency of therapy.
FIELD: organic chemistry, medicine, chemical-pharmaceutical industry, pharmacology, pharmacy.
SUBSTANCE: invention relates to a medicinal agent used for prophylaxis and treatment of diseases and disorders associated with dysfunction of benzodiazepine receptors. This medicinal agent comprises compound of the formula (I)
. Compound of the formula (I) elicits high cardioprotective, neurotrophic, renoprotective activity and enhanced bioavailability.
EFFECT: valuable medicinal properties of compounds.
5 cl, 1 tbl, 1 ex
SUBSTANCE: method involves building tunnel to posterior eyeball pole in inferoexterior and superexterior quadrants. The tunnel is used for implanting flexible polymer magnetolaser implant to the place, the subretinal neovascular membrane is localized. The implant has a permanent magnet shaped as a cut ring and is provided with drug delivery system and a short focus scattering lens of laser radiator connected to light guide. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 5-7 mTesla units intensity. It is arranged with its north pole turned towards sclera at the place of the subretinal neovascular membrane projection with extrascleral arrangement of laser radiator lens membrane being provided in the subretinal neovascular membrane projection area. The other implant end is sutured to sclera 5-6 mm far from the limb via holes made in advance. The implant is covered with conjunctiva and retention sutures are placed thereon. Light guide and drug supply system lead is attached to temple with any known method applied. Drugs are supplied via the implant drug supply system in retrobulbary way in any order. Triombrast is given in the amount of 0,4-0,6 ml and dexamethasone or dexone in the amount of 0,4-0,6 ml during 3-4 days every 12 h. 0.1-1% aqueous solution of khlorin is intravenously introduced at the third-fourth day after setting the implant as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, at a bolus dose of 0.8-1.1 mg/kg. Visual control of subretinal neovascular membrane cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the subretinal neovascular membrane with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at general dose of 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the subretinal neovascular membrane via laser light guide and implant lens, repeated laser irradiation of the subretinal neovascular membrane is carried out with radiation dose of 30-60 J/cm2.
EFFECT: accelerated subretinal edema and hemorrhages resorption; regression and obliteration of the subretinal neovascular membrane; prolonged vision function stabilization.