Method for treating patients for uterine hemorrhages

FIELD: medicine.

SUBSTANCE: method involves administering 1-2 interrupted plasmapheresis sessions before performing radical operation. Next to it, seven low intensity intravasal blood laser radiation sessions and 1-2 interrupted plasmapheresis sessions are given in postoperative period.

EFFECT: reduced risk of periuterine stump inflammation, rise in temperature and adaptation syndrome occurrence.

 

The present invention relates to medicine, in particular for surgical gynecology.

The most accepted way of doing gynecological patients with uterine bleeding caused by fibroids or endometriosis in need of radical surgery, is that initially stop the bleeding by scraping. In the period prior to radical surgery, is anti-inflammatory (anti-bacterial), symptomatic therapy, including the introduction of erythrocyte mass and anemia caused by profuse bleeding, and is determined by the histological diagnosis to clarify the extent of surgery (7-8 days). Then the patient is operated radically (supracervical amputation or hysterectomy) /Acclamated, Iterative IT "Emergency care under extreme conditions in gynecology", "Medical book" M, 2003 p.41/.

The disadvantages of this method are the long period of high temperature, high frequency percolation, prolonged adaptation syndrome.

The objective of the invention is a method of management of patients with uterine bleeding in urgent gynecology, allowing to reduce the number of complications by reducing the frequency of percolation and periods of increased temperature and adaptation syndrome.

The problem is solved by the method lies in the om, against the background of anti-inflammatory therapy and transfusion of erythrocyte mass before radical surgery performed 1-2 sessions of intermittent plasmapheresis followed by 7 sessions of low-intensity intravascular laser irradiation of blood (ELOC) and 1-2 sessions of intermittent plasmapheresis in the postoperative period.

The following examples illustrate the method according to the invention.

Example 1

Patient C., 50 years admitted to the gynecological Department with complaints abundant menstrual bleeding for the past 2 years. At the time of admission - abundant bleeding from the genital tract. The body of the uterus enlarged to the size of 6-7 weeks of pregnancy, dense, mobile, moderately painful to palpation and offset. Appendages on both sides are not palpated. The blood-anemia (er. - 2,3·1012Hb 74 g/l, Ht - 0,80).

Diagnosis: uterine fibroids, menorrhagia, posthemorrhagic anemia.

Diagnostic and therapeutic purposes on the day of receipt under intervene anesthesia produced curettage of the uterus, a deformation of the uterus on the rear wall and at the bottom of the uterus interstitielle-submucous site, scraping moderate.

After curettage of uterine bleeding stopped. With the aim of substitution produced blood transfusion 500,0 erythrocyte mass.

On the background protivovospalitel the nutrient therapy with oxacillin (1,0× 5 times a day/muscle) and receive reseption and antifungal agents conducted a discrete sessions of plasmapheresis to remove 30-50% of the volume of circulating plasma and elasmotherium saline solution in a ratio to the remote plasma volume 1.2 to 1.5:1. Then the patient within 7 days sessions irradiation of blood through monovacancy quartz fiber injected into the cubital vein, helium-neon laser with a wavelength of 628 nm, output power of 1.5 mW, with the duration within the first 5 procedures for 15 min and for 2 the last 30 minutes pre-operative period was uneventful.

The patient was operated radically in the amount of supracervical amputation of the uterus without appendages. In the postoperative period in the first days session discrete plasmapheresis in the previously described mode.

The postoperative period smooth: maximum daily temperature rise - 37°S, the duration of the painful period of 6 days, the phenomena of pericallia at discharge the patient from hospital no. The duration of the postoperative period of 7 days.

Example 2

Patient M., 36 years old, was admitted to the emergency procedure and hospitalized in the gynecological Department with complaints copious bloody discharge from the genital tract within 2 weeks.

Inspected. At the time of admission - bloody rich ejecta is from the genital tract. The body of the uterus enlarged to the size of 8-9 weeks of pregnancy, dense, moderately painful. Appendages on both sides are not palpated. The blood - severe anemia (er. - 1,96·1012Hb 62 g/l, Ht - t %).

Diagnosis: uterine fibroids, menorrhagia, posthemorrhagic anemia. Diagnostic and therapeutic purposes on the day of receipt under intervene anesthesia produced curettage of the uterus. When the scraping of the uterus was detected submucous site, scraping rich.

After scraping the uterine lining and the bleeding stopped.

With the aim of substitution produced blood transfusion 510,0 erythrocyte mass.

On the background of anti-inflammatory therapy session held discrete plasmapheresis to remove 30% of the volume of circulating plasma and elasmotherium saline solution in a ratio to the remote plasma volume 1.2 to 1.5:1. Then the patient within 7 days sessions irradiation of blood through monovacancy quartz fiber injected into the cubital vein, helium neon laser with a wavelength of 628 nm, output power of 1.5 mW, with the duration within the first 5 procedures for 15 min and for 2 the last 30 minutes pre-operative period was uneventful.

The patient was operated radically in the amount of supracervical amputation of the uterus without appendages.

In the postoperative period, there was a session of discrete plasmasphere is as in the previously described mode. The patient performed 2 sessions of plasmapheresis.

The postoperative period smooth: maximum daily temperature rise - 37,2°S, the duration of the painful period of 7 days, the phenomena of pericallia no. The duration of the postoperative period of 9 days.

The claimed method were 12 patients, none of the cases was not marked puericultura, in all cases there was a reduction in periods of increased temperature and adaptation in comparison with the known method of treatment of patients with uterine bleeding.

The method of treatment of patients with uterine bleeding, including curettage of the uterus, anti-inflammatory therapy and blood transfusion of erythrocyte mass, characterized in that before radical surgery performed 1-2 sessions of intermittent plasmapheresis followed by 7 sessions of low-intensity intravascular laser irradiation of blood and 1-2 sessions of intermittent plasmapheresis in the postoperative period.



 

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