Method for predicting cardiorespiratory disorders in postoperative period in pulmonary cancer patients after radical operation

FIELD: medicine.

SUBSTANCE: method involves determining microcirculation indices in rest state by applying Doppler laser flowmetry method and capillary blood circulation reserve indices in occlusion sample under cuff pressure being 30 mm of mercury column as high as the systolic patient blood pressure during 3 min. Cardiorespiratory disorders development is predicted in postoperative period, The microcirculation indices being greater than 6.0 perfusion units in combination with capillary blood circulation reserve indices being greater than 300% or microcirculation indices being below than 4.5 perfusion units in combination with capillary blood circulation reserve indices being greater than 200%.

EFFECT: high accuracy of prognosis.

 

The invention relates to medicine, namely to functional diagnostics, and can be used to predict cardiorespiratory disorders in patients with lung cancer after radical operations

The methods for predicting cardiorespiratory disorders in patients with lung cancer after radical operations are not described in literature.

The invention is aimed at solving problems: the possibility of forecasting the future of cardiovascular and pulmonary complications in lung cancer patients in the postoperative period.

The method consists in using the method of laser Doppler flowmetry (LDF) to predict cardiorespiratory disorders in patients with lung cancer in the postoperative period by calculating the index of microcirculation (PM) alone and indicator reserve capillary blood flow (PKK) in occlusal sample. When the PM value above 6.0 perfusion units in combination with RCM above 300% or PM below 4.5 perfusion units in combination with RCM above 200% predict the development of cardiorespiratory disorders in the postoperative period.

The method is as follows.

In the preoperative period lying within 10 minutes of the patient through the installation point of the laser on the skin of the back surface of the brush at a point between I and II metacarpal bones method the hole is Noah Doppler flowmetry to measure within 2 minutes of the initial level of the microcirculation. Data processed by the personal computer: hold frequency and harmonic analysis of fluctuations. Then the cuff of the sphygmomanometer create an occlusion of arterial blood flow by raising the pressure in the cuff to 30 mm RT. Art. above the systolic pressure of the patient, the occlusion continue for 3 minutes, after which the blood flow in the brachial artery is restored. All this time the registration parameters of microcirculation: basal level (during occlusion), postocclusion flushing and restoring blood flow to the original level. Recording is carried out for 3 minutes. Maximum postocclusive hyperemia characterizes the number of non-functioning of vessels and their ability to open in response to postocclusion the flow of blood. One of the measured characteristics are: value PM - characterizes the flow of red blood cells per unit time in the amount of the sensed tissue and ALAC - % the ratio of the maximum value of the index of microcirculation during reactive postocclusive hyperemia to the original value of the microcirculation (before occlusion).

When determining a patient of PM values above 6.0 perfusion units in combination with RCM below 200%, the PM values from 4.5 to 6.0 perfusion units in combination ALAC 200-300%, PM values below 4.5 perfusion units in combination with ALAC more than 300%, a value which deposits PM less than 4.5 perfusion units in combination with RCM below 200% predict no cardiorespiratory disorders in the postoperative period when the standard patient management in the intensive care unit. When determining a patient of PM values above 6.0 perfusion units in combination with RCM above 300% or PM values below 4.5 perfusion units in combination with RCM above 200% predict the development of cardiorespiratory disorders in the early postoperative period in the standard management of the patient in the intensive care unit.

The study was conducted with the apparatus LACC-01 production SPE "Lazma" , Moscow.

The advantage of this method lies in the possibility of predicting cardiorespiratory disorders in the early postoperative period in patients undergoing radical surgery for cancer of the lung without the burdened history.

Examples of specific performance.

Example 1. Patient CWF, 66 years. Diagnosis: squamous cell usernotification adenocarcinoma of the right upper lobe bronchus. T2N2Mx. 12.05.03 was held LDF with occlusive breakdown: defined values PM=6,64 perfusion units in combination with RCM=435,35%, i.e. the patient has a poor prognosis for the development of cardiorespiratory disorders in the postoperative period. 13.05.2003, the standard pulmonate right, under endotracheal anesthesia. Intraoperative period without complications. 15.05.03, with a smooth postoperative period and standard therapy marked cardio-respiratory disorders: Mercan the e fibrillation, tachysystolic form, frequency of contractions of the ventricles - 120-130 per minute, shortness of breath up to 30 breaths a minute, acrocyanosis, cold moist skin.

Example 2. Patient XAI, 61 years. Diagnosis: squamous cell usernotification adenocarcinoma of the proximal bronchus on the left. T2N1M0. 26.05.2003 was held LDF with occlusive breakdown: defined values PM=7,63 perfusion units in combination with RCM=302,42%, i.e. the patient has a poor prognosis for the development of cardiorespiratory disorders in the postoperative period. 27.05.03, made extended pulmonate left. In the postoperative period of severe respiratory failure requiring prolonged mechanical ventilation within 8 hours, stabilization of hemodynamics by sympathomimetics. Maintaining cardiorespiratory disorders to 11 days after surgery: a feeling of lack of air, BH up to 28 per minute, tachycardia-104 min, hypotension, acrocyanosis.

Example 3. Patient VDK, 61. Diagnosis: squamous cell usernotification adenocarcinoma of the proximal bronchus left with the transition to the orifice of the left main bronchus T3N2M0. 03.04.2003 was held LDF with occlusive breakdown: set PM=8,763 perfusion units in combination with RCM=199,8% patient no data about the development of cardiorespiratory disorders in poslove the sure period. 04.04.03, made extended pulmonate left without features. Anaesthesia smooth. Postoperative period was unremarkable.

The use of the proposed method to predict cardiorespiratory disorders of lung cancer patients in the postoperative period, which shows radical surgery, and their prevention in the preoperative period.

A method for predicting cardiorespiratory disorders in the postoperative period in patients with lung cancer after radical intervention is by definition in the preoperative period by laser Doppler flowmetry of the microcirculation index (PM) alone and indicator reserve capillary blood flow (PKK) in occlusal sample when the pressure in the cuff to 30 mm RT. Art. above the systolic pressure of the patient duration of 3 min and forecasting development of cardiorespiratory disorders in the postoperative period when the PM value above 6.0 perfusion units in combination with RCM above 300% or PM below 4.5 perfusion units in combination with RCM above 200%.



 

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