Method for carrying out pharmacological correction of endothelial dysfunction in postoperative period in cardiosurgical patients

FIELD: medicine.

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.



 

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