Method for evaluating efficiency in treating critical ischemia of inferior limbs

FIELD: medicine, surgery.

SUBSTANCE: one should evaluate clinical state of a patient and as objective parameters one should calculate rheological and brachio-malleolar indices, detect fractional tension of oxygen in capillary blood. At observing clinical improvement accompanied by increased rheological and brachio-malleolar indices by more than 0.1, increased blood saturation with oxygen by more than 10 mm mercury column one should state upon a "good" therapeutic effect. At detecting clinical improvement accompanied by the increase of either one or several objective parameters, or if dynamics of these values is not available - effect should be considered as a "satisfactory" one. At kept ischemic pain at rest without decrease of its intensity, impossibility to keep a limb in horizontal position for a long period of time, the absence of positive dynamics of trophic disorders, at kept ischemic edema and at no alterations in objective parameters - should be determined as "no dynamics". In case of enhanced ischemic pain and edema of foot, at progressing necrotic alterations in foot - one should detect "deterioration" of patient's state. The method increases the number of diagnostic means.

EFFECT: higher accuracy of evaluation.

1 ex, 1 tbl

 

The invention relates to medicine, namely to surgery, and can be used to assess the effectiveness of conservative treatment of critical ischemia of the lower extremities.

Closest to the claimed solution is a method to assess the effectiveness of surgical treatment by calculating the average score on the scale proposed by Rutherford R.B. et. al., 1997 [Rutherford R.B., Baker JD, Ernst C, K.W. Johnston, Porter J.M., Ahn, S., Jones, D.N. Recommended standards for reports dealing with lower extremity ischemia: Revised version.// Journal of Vascular Surgery, 1997; 25:517-38], [Russian consensus: Recommended standards for evaluation of results of treatment of patients with chronic ischemia of lower extremities. - Moscow, 2001. - p.5].

However, this method cannot be applied to evaluate the effectiveness of conservative treatment, as assessed under him, indicators and proposed grading their changes are possible only after reconstructive vascular operations and may not characterize the result of drug therapy, and widely used, public, and standardized methods of evaluating the effectiveness of conservative therapy in the available literature we have not met.

The objective of the invention is the development of criteria for the effectiveness of conservative treatment in patients with critical ischemia of the lower extremities.

This object is achieved in that for about Enki the effectiveness of conservative treatment in patients with critical ischemia of the lower extremities is used the scale changes clinical and instrumental parameters.

The method is as follows. A study of indicators is carried out immediately prior to conservative therapy and on the next day after her in standardized conditions: 1 hours after sleep (9-10 hours), before meals, medicinal drugs, the room temperature should range 22-24°C. Instrumental examination (rheovasography, skin thermometry, Doppler ultrasound, measurement of partial oxygen tension in capillary blood) is carried out according to standard techniques.

Clinical "improvement" is considered to be mild or significant reduction in pain intensity at rest, increasing the maximum distance walk more than 25 meters, the warming, the result of the foot, the reduction or disappearance of ischemic edema of the foot. If there is a positive dynamics from trophic disorders (translation of "wet" gangrene in the dry necrosis, the spread of necrosis, positive-side dynamics trophic ulcers: purification, reduction of area and depth, granulation development, the formation of a dry scab from a healing process under the scab relief peresmenok inflammation). When reducing the painful symptoms of the patients reported improvement in General condition, improved sleep, a length is the emotional time in a horizontal position when it is not necessary to lower the lower limb.

"Good" is considered to be the effect involving "clinical improvement", the increase eographical index more than 0.1, regional systolic pressure of more than 10 mm Hg, placelocation index more than 0.1, the improvement capillaroscopic pattern, increasing blood oxygen saturation more than 10 mm Hg

"Satisfactory" is considered to be the effect in which along with "clinical improvement" has a gain of one or more objective indicators (eographical index, regional systolic pressure placelocation index, oxygen tension) or objective measures do not have significant change.

"No speakers" is characterized by the preservation of ischemic pain at rest without significant reduction of its intensity, the inability for lower limb long to be in a horizontal position, no change from trophic disorders, preservation of ischemic edema in the absence of significant changes in the indicators used instrumental methods.

"Impairment" is characterized by increased pain ischemic symptoms, increase ischemic edema stop the progression of necrotic changes in the foot that leads to amputation of the lower limb. The presence of clinical the improvement on the background of negative dynamics of instrumental methods, later accompanied by amputation, regardless of the level is also considered to be "deteriorating".

In patients with the proposed primary amputation at the level of the middle third of the thigh holding on treatment amputation at the level of the tibia with preservation of the knee joint in the presence of "clinical improvement" is considered to be "satisfactory" effect.

Holding the amputation of feet with wound healing while maintaining the basic function of the lower limb in patients with necrosis of the fingers or distal foot on the background of clinical improvement and positive dynamics in the characteristics of instrumental methods of examination (rheovasography, ultrasonic dopplerography) evaluated as "good" effect.

Carrying out amputations of the lower limb regardless of the level on the background of negative clinical dynamics is "deteriorating".

To assess the effectiveness of conservative therapy in patients with critical ischemia of the lower extremities is rated on a scale of changes in clinical-instrumental status of patients immediately before and after conservative therapy.

The proposed method allows to standardize the results of conservative treatment of critical ischemia of the lower extremities.

In the absence of a single standardized method to assess the effectiveness of a particular method is conservative (medical) treatment is difficult to give preference to various drugs, as well as schemes of their application. Also it is almost impossible to compare the efficacy of conservative therapy in patients with critical ischemia of the lower extremities, treated in different hospitals.

Using this proposed method is possible with high reliability to compare the different methods of conservative therapy for selecting priority areas. So when comparing the group of patients receiving a standardized conventional conservative therapy (50 people), group of patients in addition to this therapy was used the drug (seratonine adipate 1% to 1.0 by well-known methods) (70) (from 1999 to 2003 at the Department of vascular surgery of the Kursk regional clinical hospital) received:

in patients with standard conservative therapy with good clinical effect was achieved in 12% (6 people) patients, satisfactory - 30% (15 people), lack of dynamics was observed in 28% (14 persons) patients. The progression of ischemia with subsequent deterioration occurred in 15 (30%) patients.

in patients of the second group of good clinical effect was achieved in 40% (28 che is.) patients satisfactory - in 37% (26 people), lack of dynamics observed in 20% (14 persons) patients. The progression of ischemia with subsequent deterioration occurred in 2 (3%) patients.

Thus, it is obvious priority enable serotonin adipinate 1%-1,0 in complex conservative therapy for patients with critical ischemia of the lower extremities.

A method of evaluating the effectiveness of treatment of critical ischemia of the extremities, including the assessment of changes in performance before and after treatment, wherein assess the clinical condition of the patient, and as objective indicators are calculated eographically and placentomegaly indexes, determine the partial pressure of oxygen in capillary blood and observed clinical improvement, accompanied by an increase eographical and placelocation indexes more than 0.1, the increase in the blood oxygen saturation of more than 10 mm Hg, the treatment effect was evaluated as “good”; when observed clinical improvement, accompanied by an increase of one or more objective indicators, or in the absence of the dynamics of these indicators the effect is assessed as “satisfactory”; while maintaining ischemic pain at rest without reducing its intensity, it is impossible for a long time to hold the limb in the horizontal is ulozhenie, the lack of positive dynamics of trophic disorders, preservation of ischemic edema and no change of objective indicators is defined as “lack of dynamics; if the intensity of ischemic pain and swelling of the foot, the progression of necrotic changes in the foot define “impairment” status.



 

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