Method for compensating blood loss in case of operations upon lungs in tuberculosis-suffering patients

FIELD: medicine, phthisiology, anesthesiology.

SUBSTANCE: during the day of operation one should perform autohemotransfusion, then introduce epocrine intravenously by drops at the dosage of 50-200 U/kg patient's body weight; next day after interference one should inject epocrine subcutaneously at the dosage of 25-100 U/kg; at hematocrit level being below 35% 48 h after operation it is necessary to repeat subcutaneous injection of the above-mentioned preparation at the dosage not exceeding 50 U/kg. The present innovation favors hemopoiesis stimulation in postoperational period, that, in its turn, accelerates postoperational rehabilitation in patients of this group and enables, also, to avoid allotransfusions being dangerous because of immunoconflicting reactions.

EFFECT: higher efficiency of compensation.

1 ex, 1 tbl

 

The invention relates to medicine, namely to fisierului and anesthesiology, and can be used to replenish blood loss during operations on the lungs of patients with tuberculosis.

Autoguemotransfuzii widely used in various surgical procedures on the chest, abdomen, and great vessels and orthopedic operations. In physiobiological practice method is used intraoperative redundancy of the patient's blood in the number 400-500 ml (7-10% BCC) at the first stage of the operation after intubation and stabilization of anesthesia. Redundant autochrome always returned to the patient after performing the main stage of the operation and the final stop bleeding, either during the first postoperative hours. Redundant autochrome saves erythrocyte volume, coagulation factors, plasma. Autoguemotransfuzii reduces or eliminates the use of donor blood, reducing the risk of adverse immunological reactions, a positive effect on the rheological properties of blood of the patient. However, improvement of blood rheology and increase cardiac output when autohemotransfusions does not prevent the natural development of postoperative anemia, the most severe to 3-7 postoperative days (Repin, Y.M. fundamentals of surgical tuberculosis. - L., 1976. - S-112).

When the spread is nennig forms of tuberculosis of the lungs is disturbed metabolism of erythrocytes (Kaminska GO, Abdullayev RU Metabolism of erythrocytes in terms of chemotherapy in patients with pulmonary tuberculosis //Probl. the tubes. - 1993. No. 6. - S32-35). Autoimmune aggression when tuberculosis affects erythropoiesis and maturation of red blood cells (Minin mathematical SCIENCES. Artamonova VY anti-erythrocytary antibodies and anemic syndrome in tuberculosis // Probl. the tubes. - 2002. No. 1. - P.41).

The objective of the invention is the prevention of postoperative anemia during operations on the lungs while reducing volumes of transfused donor blood.

The problem is solved by stimulation of own erythropoiesis patient. As a regulator, affecting late precursors of erythrocytes, we used recombinant domestic erythropoietin Epocrin developed State. Research Institute of highly pure biopreparations, approved for use State. farmkomiteta health Ministry 27.02.1997, on the day of surgery produce autoguemotransfuzii, then enter apocrine intravenously at a dose of 50-200 IU/kg of body weight of the patient, on the next day after the intervention produce subcutaneous introduction apocrine dose of 25-100 IU/kg, at the level of hematocrit less than 35% after 48 hours after the operation is repeated subcutaneous administration of the drug at a dose not exceeding 50 IU/kg

The method of stimulation of hemopoiesis in the postoperative period in patients with pulmonary tuberculosis and is the absolutely new. Application of the method of filling intraoperative losses shown in the blood of 20% or more of the volume of circulating blood. In the postoperative period in the conditions of removal of the primary tuberculous lesion of the source of intoxication and autoaggression - dose erythropoietin for patients with pulmonary tuberculosis should not be so high as the dose recommended in surgery developers of the drug (Reference VIDAL. Drugs in Russia. ): Astra Pharm Service, 2001)focused on the method of preoperative autologous blood procurement in contrast to the proposed intraoperative method authorizedservice on the type of acute normovolemic hemodilution.

The scheme and dose assignment apocrine depending on the level of hematocrit.

The method is as follows.

Method of reservation of blood and hemodilution: blood sampling in pulmonology patients spend directly on the operating table after the introduction of anaesthesia from the femoral artery or femoral vein. For preservation of autologous blood using heparin - 375 IU in 10 ml of saline solution per 100 ml of autologous blood. Parallel to exposee are hemodilution by injection of double the amount of solution gelatinosa and 5-10% glucose solution through the subclavian vein. After the main phase of the operation and the Duma Deputy and hemostasis begin to drip reinfusion redundant blood with a speed of 10-20 drops per minute into the cubital vein in parallel with the main infusion solutions through a subclavian catheter.

The method further stimulation of hemopoiesis in the postoperative period: the first introduction apocrine produced intravenous drip in 150 ml of 5% glucose solution immediately after the main phase of the operation. Calculation of the dose of 50-200 IU/kg of body weight of the patient depended on the level of hematocrit before the introduction of apocrine (table 1). The choice of intravenous method of administration due to more rapid drug effect on erythropoiesis.

24 hours after surgery, the dose of apocrine reduced by half to 25-100 IU/kg is Used subcutaneous administration of the drug, which provides the maximum effect on erythrocyte sprout after 12-18 hours.

The need of the drug within 48 hours after surgery at a dose not exceeding 50 IU/kg, determined by the reduction of the level of hematocrit less than 35%. When you achieve the optimal level of hematocrit and hemoglobin of apocrine was not introduced.

Clinical example.

Sick-n, 31, No. I.B. 284 operated 04.12.01, for a recurrence of fibrous-cavernous tuberculosis in previously operated light (1998). Made the final left-hand pleuropneumonectomy.

The weight of the patient was 62 kg, initial hematocrit of 45%. Should blood volume calculated from the Moog, defined as 4340 ml Before surgery under General anesthesia were exfuze 400 ml of blood, th is was 10% due BCC. For stabilization of autologous blood is used 1500 IU of heparin, its reinfuse carried out after removal of the drug and end of hemostasis. Intraoperative blood loss was 1200 ml, i.e. 27,6% due BCC. Transfused intraoperatively 1800 ml solutions of crystalloids and colloids + 800 ml for reimbursement of authorizedservice. Thus, the volume of intraoperative infusion was 2600 ml and qualitative composition consisted of 200 ml of donor erythromyci. 400 ml of cryoplasty, 400 ml of Gelatines, 400 ml of Mathusala, 1200 crystalloids. The hematocrit at the end of operation - 36%, respectively, the dose of apocrine at the rate of 100 U/kg (see table 1) is defined as 6200 ED. The drug is introduced intravenously in 150 ml of 5% glucose at the end of the main phase of the operation. 24 hours after the intervention, the level of hematocrit (Ht) was reached 35%. Dose apocrine at the rate of 50 IU/kg - 3100 ED - introduced subcutaneously. To 48 hours after surgery indicators of red blood were as follows: erythrocytes - 3,8×1012, hemoglobin 112 g/l, hematocrit was 38%. Apocrine did not enter. Transfusion of donor RBC mass in the postoperative period is not produced.

Table 1

Dose (U/kg) and the ways of introducing apocrine
The level of hematocrit in time for the introduction of apocrineDay the operations 24 hours after surgery48 hours after surgery
30-35%200/100 n/a25-50 n/a
35-40%10050Not entered
over 40%5025Not entered

When the hematocrit less than 30%, it is advisable to transfusion of donor RBC mass.

For comparative evaluation of the effectiveness of the proposed method replenish blood loss based on the autohemotransfusions followed by emotially apocrine surveyed 45 fisiopatolygica patients. The criterion for selection is the amount of the proposed intraoperative blood loss of 20% of BCC and more. The main group consisted of 20 patients who during the operation pulmonectomy were autoguemotransfuzii on the basis of intraoperative sampling of autologous blood and used apocrine the scheme developed. The control group included 25 similar patients who were autohemotransfusions on the prototype method and have not been applied post-operative stimulation of erythropoiesis.

The contraindications to the autohemotransfusions were: phase nekapasyanago exacerbation specific process in the lungs, the deficit of the patient's body weight more than 20%, pulmonary heart disease grade II and more ventilation violations of III degree and more with an index of ventilation 3600-2500 and below, as well as the source anemia with hemoglobin less than 100 g/l

The average intraoperative blood loss at similar volumes interventions amounted to: in the main group 1444,4±to 72.6 g in the control 1268,3±to 106.0, Tactics infusion-transfusion therapy in both groups was targeted reduction in the volume of transfused donor red blood cell mass up to 15-25% of BCC from intraoperative blood loss. The total amount of intraoperative infusion exceeded the amount of blood loss in 1,5-1,7 times.

In the postoperative period in the first three days, including the day of the intervention, erythrocyte mass was poured in the control group when the reduced hemoglobin 70 g/l, the number of erythrocytes 2,9×1012and below. In the main group in the first three days of erythrocyte mass does not overflow, using as an alternative to allotropy introduction apocrine on the method developed by us.

Application apocrine against autohemotransfusions the following impact on the dynamics of red blood.

The level of hemoglobin in the main group III day was 106,8±13.5 g/l, which was significantly higher than the control group of 87.6%±3.8 g/l To X days of hemoglobin main group recovered to the original level of 124.7±2.7 g/l, to the twenty-first day t is d recovered - 139,5±3.2 g/l with a tendency to exceed its original value. At the same time in the control group, the recovery rate began to XIV days, not fully reaching the initial level to the twenty-first postoperative day.

Dynamics of recovery in the number of erythrocytes testified to moderate their reduction to III-VII days, significantly less pronounced in the main group - 3,47±0,10×1012than in the control group -2,72±0,13×1012. Reaching the lower limit of normal is already to VII days after the operation indicator is fully restored to XIV days, and in the control group anemicare persists until the first day after surgery.

The hematocrit level of the main group does not fall below 35%, increases smoothly with the seventh day XIV to 40-42%, compared with 30-32-35% hematocrit control group.

Use apocrine against autoguemotransfuzii avoids alloresponse, dangerous immunocorrecting reactions and possible transmission of viral infectious agents. Correlation analysis reveals stable direct relationship between dose apocrine and increase hemoglobin hematocrit, and used in combination with erythropoietin iron preparations and vitamin B12increases the effectiveness of the treatment.

Way to replenish blood loss during operations on the lungs of patients with tuberculosis, characterized in that the day of the operation produce autoguemotransfuzii, then enter apocrine intravenously at a dose of 50-200 IU/kg of body weight of the patient, on the next day after the intervention, conduct subcutaneous introduction apocrine dose of 25-100 IU/kg, at the level of hematocrit less than 35% after 48 h after the operation is repeated subcutaneous administration of the drug at a dose not exceeding 50 IU/kg



 

Same patents:

The invention relates to pharmaceutical industry and relates to a method of producing iron-containing drug for the treatment and prevention of iron deficiency anemia in animals by the interaction of organic acids with gemostimuliruyuschee properties, isolated from extracts of peat, with a hydroxide of iron (11), selected from water-soluble salts of iron (11) the deposition of the alkaline solution with the subsequent laundering of water impurities

The invention relates to preparations for the prevention and treatment of Pets and farm animals, as well as to maintain the microelemental composition of the feed, and can be used in animal breeding and fur farming

The invention relates to experimental medicine, may find application in radiobiological experiments, and further in clinical practice

The invention relates to organic chemistry and pharmacology, and relates new connection - 1-(1,1-dissociator-3)-2-morpholinobenzenediazonium hydrochloride, increasing resistance to acute hypoxia with hypercapnia

The invention relates to biotechnology and is used for the preparation of recombinant human erythropoietin (EPO)
The invention relates to medicine, surgery and intensive care, to a method of replacement of massive blood loss of any Genesis

The invention relates to medicine, in particular to the pharmaceutical industry, and can be used as adjuvant iron deficiency anemia

The invention relates to medicine, in particular Infectology and Hematology

The invention relates to pharmacology and medicine, namely to receive the preformed stable recombinant erythropoietin, which can be used to treat various anemic conditions

The invention relates to pharmaceutical compositions that increase fetal hemoglobin of the patient or accelerating differentiation of cells containing an effective amount of butyrate precursor drug of formula I in which a and D are independently from each other selected from the group comprising hydrogen, barbiecollector.com or C(1-4) straight or branched alkyl, S(2-4), straight or branched alkenyl or quinil, which may be independently substituted by hydroxy, alkoxy, carboxylation, alkylamides and so on, provided that a and D are not both hydrogen, R is oxygen, NH, NC(1-5) alkyl straight or branched chain or NHС(2-5)of alkenyl straight or branched chain, any of which may be optionally substituted by a residue of carbocycle or heterocycle, Z is hydrogen, C(1-4) alkyl straight or branched chain, With(2-4) alkenyl or quinil straight or branched chain, carbocyclic or heterocyclic residue and so on, and each stereogenic carbon atom can be R or S configuration, and pharmaceutically acceptable adjuvant or carrier

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.

3 ex

The invention relates to pharmaceutical industry and relates to the preparation of dalargin for injection, used as a medicine in the acute gastric ulcer and duodenal ulcer, acute pancreatitis and pancreonecrosis

The invention relates to medicine and relates to a medicinal product and method of treatment of neurological diseases in children from infant age up to 7 years

The invention relates to the field of biotechnology, specifically to peptides active in the attachment, respectiveiy and detaching cells, and can be used to study activity in the attachment of cells, mediated by different proteins of the extracellular matrix, to develop peptides, adhesion, and also for medicinal purposes

The invention relates to the section of experimental medicine and can be used to create a new antiarrhythmic drug

The invention relates to medicine, in particular to the pharmacology and treatment of infectious diseases
The invention relates to medicine, namely to dermatology, and can be used for treatment of allergic dermatoses

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.

3 ex

Up!