Method for determining prevailing vegetative responses in children possessing surgical and somatic disturbances (xanthinol niacinate test)

FIELD: medicine.

SUBSTANCE: method involves recording arterial blood pressure, heart beat rate, respiration frequency, sublingual body temperature and rectal body temperature. The measurements are repeated 3, 5, 7, 9, 11, 13, 15, 20 min later after introducing xanthinol niacinate. Difference of maximum and minimum values of each factor is calculated, respectively. Parasympathetic patient responses predominance is determined from calculated values.

EFFECT: high accuracy in determining organism tolerance to reactive vasoconstriction.

2 cl, 4 tbl

 

The invention relates to medicine, namely to abdominal surgery.

There are various ways to study autonomic reactivity in children (pharmacological, physical, effects on reflex zones and others) to monitor the development of vegetative reactions in response to external and internal stimuli, which consists in registration of objective indicators and subjective sensations (changes blood pressure, pulse, respiration, body temperature and so on).

Closest to the proposed method is a method in which by using pharmacological test objectives: objectively determined change in the vegetative reactivity and evaluated the nature of the vegetation shifts (Vegetative disorders: clinical course, treatment, diagnosis. / Edited Amiina. - M: Medical information Agency, 2000. P.44-70).

The task is to develop a method for determining vegetative reactions of the child, which would have allowed for properly and optimally select doses, method and frequency of administration of medicines (vascular drugs, antispasmodics) and thereby quickly restore blood flow in pathologically altered organs, including the affected parts of the intestine for the prevention of adhesions diseases of the abdominal cavity and dynamic intestinal obstruction.

Technical result achieved when using the invention - improving the accuracy and reducing the time of determination.

This technical result is achieved due to the fact that carry out the registration of the initial values of blood pressure (BP), heart rate (PS), breathing frequency (BH), sublingual (TL) and rectal (TR) body temperature, the values of each index after the introduction of ksantinola nicotinate, which registration is carried out through the 3, 5, 7, 9, 11, 13, 15, 20 minutes after administration, and then determine the ratio of blood pressure (ΔAD), the ratio of heart rate (ΔPS), the ratio of breathing frequency (ΔBH), the coefficient sublingual temperature (ΔTL), the coefficient of rectal temperature (ΔTR) as the difference between the maximum and minimum values of each indicator, respectively, and when the value of ΔHELL is not less than 5 mm Hg, ΔPS 5 ΔBH more than 4, ΔTL ΔTR is not less than 0.5°With the patient to determine the prevalence of parasympathetic reactions and therefore more high tolerance of the organism to reactive vasoconstriction.

Our proposed method is as follows: the patient's measured blood pressure (BP), heart rate (PS), breathing frequency (BH), electronic thermometer temperature the body sublingually (t° L) and rectal (t°R). Then intravenously or intramuscularly ksantinola nicotinate in the age dosage and monitor changes in each of the above indicators each 3, 5, 7, 9, 11, 13, 15, 20 minute for 20 minutes and calculate their odds - the difference between the maximum and minimum indicators: ΔHELL by the formula: ΔAD=ad max-ad min; ΔPS according to the formula: ΔPS=ps max ps min; ΔBH according to the formula: ΔBH=BH max-min BH; ΔTL ΔTR by the formula: ΔTL=tL max-tL min and ΔTR=max tR-tR min. So, studies have shown that intravenous or intramuscular ksantinola nicotinate in a dosage of age, the patient experienced a more rapid change to these objective indicators within the first 20 minutes. Change sublingual and rectal body temperature by 0.5°and more, lowering blood pressure (both systolic and diastolic) at 5 mm Hg or more, the change in the number of respiratory movements per minute to more than 4 and the change in heart rate per minute for more than 5 heartbeat speaks about the prevalence of parasympathetic reactions in which the tolerance of the organism to reactive vasoconstriction when exposed to pathological start much higher. In these patients, surgery on the organs of abdominal cavity, postoperative paresis of the intestine not on what was lodales, quickly restored the function of the affected organs and tissues. The claimed method was examined in 38 patients.

The proposed method is illustrated by the following examples.

EXAMPLE 1.

Patient B., case history No. 5422, 9 years old, was admitted on an emergency basis with a diagnosis of acute adhesive intestinal obstruction after 8 hours from the onset of the disease. After preoperative preparation of the patient produced laparoscopic removal of intestinal obstruction. In the early postoperative period to ascertain the adequacy of medical therapy and to determine the degree of recovery of microcirculation in organs and tissues made ksantinola nikotinova test (CAT): age single dose of Sol. xantinoli nicotinatti 15% (m/V) 1.0 ml daily to 4.0 ml.

Initial temperature: sublingual - 36,9°With rectal - 36,9°C.

The introduction of age-dose medication in a child introduced changes to the indicators of objective and subjective reactions of the autonomic nervous system of the body and have been calculated their odds: sublingual temperature coefficient (ΔTL) was 0.7, and rectal temperature coefficient (ΔTR) was 0.6, the ratio of blood pressure (ΔBP) was more than 5, the ratio of heart rate (ΔPS) amounted to 8, the ratio of breathing frequency ΔBH stood the Il 5, appeared peristalsis of the intestine, skin redness and itching, which indicates adequate vascular reactions (see table 1).

Thus, by determining the adequacy of vegetative reactions, the patient is assigned a treatment regimen that helped to organize the work of the intestine during the first hours after surgery, and the first chair was obtained after 12 hours. Discharged the patient on day 7.

EXAMPLE 2

Patient L., and/b No. 4681, 12 years old, was admitted on an emergency basis with a diagnosis of acute appendicitis, peritonitis. After preoperative preparation of the patient produced laparoscopic appendectomy and sanitation of the abdominal cavity. In the first days after the operation to ascertain the adequacy of the vascular response and early recovery of intestinal peristalsis made ksantinola nikotinova sample (PNC): age single dose of Sol. xantinoli nicotinatti 15% (m/V) of 1.0 ml. of the Initial body temperature: sublingual - 37,5 t°With rectal - 37,8 t°C.

Conclusion: during the PNC sublingual temperature decreases from 37.5 to 37.0°and ΔTL=0,5, rectal temperature decreased from 37.8 to 37.2°and ΔTR=0,6. There have also been changes and other parameters: ΔHELL was 5/10, ΔBH - 6, ΔPS was 6, appeared bowel movements, itching, redness of the skin, which indicates position is positive vascular response to the introduction ksantinola nicotinate and good prognosis (table 2). The patient was discharged on the 8th day in a satisfactory condition.

EXAMPLE 3

Patient O., and/b No. 1708, 4 years old, he entered 25.03.03, with complaints of fever up to 39°, shortness of breath, cough, abdominal pain, stool retention. After the examination diagnosed with acute right-sided pneumonia. Ill for weeks. Made ksantinola nikotinova sample (PNC): age single dose of Sol. xantinoli nicotinatti 15% (m/V) of 0.5 ml.

Initial temperature: sublingual - 37,8°With rectal - 37,9°C.

After the introduction of age-dose medication in a child during the first minutes of introduced changes to the indicators of objective and subjective reactions of the autonomic nervous system of the body and have been calculated their odds: the ratio of blood pressure (ΔAD) amounted to 8, the ratio of heart rate (ΔPS) was 10, sublingual temperature coefficient (ΔTL) was 0.8, and rectal temperature coefficient (ΔTR) was 0.6, increased bowel movements, appeared redness of the skin and itching that is adequate vegetative response and good prognosis of recovery (table 3).

As a result of treatment, the child infiltration in the lung regressed on day 7. Was discharged in good condition on the 9th day.

EXAMPLE 4

Patient P., and b/W No. 4941, 9 years old, Postup is l with a diagnosis of closed cranial trauma. Brain contusion severe. Made ksantinola nikotinova sample (PNC): age single dose of Sol. xantinoli nicotinatti 15% (m/V) of 1.0 ml.

After the introduction of age-dose medication in a child in the first minutes of introduced changes to the indicators of objective and subjective reactions of the autonomic nervous system of the body and have been calculated their odds: sublingual temperature coefficient (ΔTL) amounted to 0.4, and rectal temperature coefficient (ΔTR) amounted to 0.4, the ratio of blood pressure (ΔAD) amounted to 3, the ratio of heart rate (ΔPS) was 5, the ratio of breathing frequency (ΔBH) amounted to 1, increased intestinal peristalsis, have a faint redness skin and poor skin itching (table 4). All this indicates a weak vegetative reactions and the need for correction of drug therapy.

As a result of korregirovaniya assignments, the child has decreased brain swelling and recovered consciousness.

102
Table 1.
Indicators of patient B., age 9
Minutes0357911131520
t°L-sublingual36,936,636,336,236,236,436,736,936,9
t°R-rectal36,936,736,536,336,336,636,736,936,9
PS per minute104108112112110108105104106
BH per minute242426282324242323
Skin itching (++/-)-++++++/---
Hyperemia of skin pokr.++/-+/-+++++++++++/---
HELL mmHg124/82118/69/td> 119/71116/76123/74125/80123/80126/82125/80
Peristalsis ++/--++++++++++++
Table 2.
Indicators of patient L., age 12
Minutes0357911131520
t°sublingual37,537,337,137,037,237,337,237,337,3
t°With rectalof 37.837,637,437,437,237,437,537,537,5
PS per minute104106108110106104102103
BH per minute202226222020222220
Skin itching (+/-)+/-++++/-----
Hyperemia of skin pokr.+/-+/-+++++++++/----
HELL mmHg120/80116/70118/70115/70120/78120/80118/80120/80118/78
Peristalsis +/--+++++++++

Table 3.
Indicators of patient O., 4 years
Minutes0 57911131520
t°-sublingualof 37.837,637,437,137,237,037,037,037,1
t°-rectilineaof 37.937,737,537,337,337,337,337,337,3
PS per minute10610810810610410410510098
BH per minute383432303030283030
Skin itching (++/-)-++++++/---
Hyperemia of skin pokr.++/-+/-+++++++++++/---
HELL mmHg108/70105/67102/65100/65103/64105/70103/70105/72105/70
Peristalsis ++/ -++++++++++++
Table 4.
Indicators of the patient P., age 9
Minutes0357911131520
t°-sublingual37,637,237,237,337,337,537,637,637,5
t°-rectilineaof 37.937,537,537,537,537,537,6of 37.8of 37.8
PS per minute879290898987878787
BH per minute262626262626272627
Skin itching (++/-)-++/-------
Hyperemia of skin pokr.++/--++/-- -----
HELL mmHg102/59102/59104/60105/62103/62105/60105/60102/62105/60
Peristalsis ++/-+/-++++-++/--+/--

1. The method of determining the predominant vegetative reactions in children with surgical and somatic pathology, including registration of the initial values of blood pressure (BP), heart rate (PS), breathing frequency (BH), sublingual body temperature (TL) and their values after administration of the medicinal product, which registration is carried out through the certain time intervals, characterized in that as a drug injected ksantinola nicotinate, advanced register values of rectal temperature (TR)and the registration of change of each indicator is carried out through the 3, 5, 7, 9, 11, 13, 15, 20 min after injection, and then determine the ratio of blood pressure (ΔAD), the ratio of heart rate (ΔPS), the ratio of breathing frequency (ΔBH), the coefficient sublingual temperature (ΔTL), the coefficient of rectal temperature (ΔTR as the difference between the maximum and minimum values of each indicator, respectively, and if the value is ΔHELL is not less than 5 mm Hg, ΔPS 5 ΔBH more than 4, ΔTL ΔTR is not less than 0.5° the patient determine the prevalence of parasympathetic reactions and a higher tolerance of the organism to reactive vasoconstriction.

2. The method according to claim 1, characterized in that as a drug injected ksantinola nicotinate in the age dosage.



 

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