Method for predicting the development of gastrointestinal tract paresis in patients with vertebral traumas

FIELD: medicine, surgery, resuscitation, intensive therapy.

SUBSTANCE: in patients with vertebral traumas for about 2-3 h after lesion one should simultaneously determine the level of hormone cortisol, malonic dialdehyde (MDA) in blood serum, and, also, the value of total bioelectric activity (TBEA) of gastrointestinal tract (GIT) and at cortisol values being 981.7 nM/l and higher, and MDA values - 8.35 mM/l and higher and values of TBEA being 387.75 mcV and lower it is possible to predict the development of GIT paresis.

EFFECT: higher accuracy of prediction.

2 ex, 2 tbl

 

The invention relates to medicine, namely to surgery, resuscitation and intensive therapy, and can be used in patients with guns and mine-explosive injuries and spinal cord injuries.

If the spinal injury is a violation of bone tissue, bleeding with the formation of more or less hematoma retroperitoneal space, the injury of the nervous structures (Zulkharneev R.A., Dobrushin SV, 1996).

According to Galperin, Y.M. (1975) functional (dynamic) obstruction is the result of paresis and subsequent paralysis of the intestine.

In practical medicine are still missing methods, giving an objective assessment of motor-evacuation function of the stomach and is also a predictor of paresis of the intestine in patients with spinal cord injuries.

A known method for predicting the development of paresis of the intestine on the basis of pre-operative examination (Popov FT, Tamazashvili T.SH., Shestopalov A. the Syndrome of intestinal failure in surgery. -- M.: Medicine, 1991, P.160). X-ray symptoms of paresis of the intestine and the identification of polyelectrolyte profound inhibition of motility in combination with severe hypokalaemia had to configure surgeons to conduct preventive measures.

The disadvantage of this method is the lack of early is prognozirovaniya development of paresis of the intestine during the first day, in the first hours, the difficulty of implementation in extreme conditions.

A known method for the diagnosis/prognosis of gastrointestinal paresis (patent No. 2225158 from 23.02.01 And 61 5/00; Kirilina SR) consists in the fact that using photoheterotroph determine the frequency of intestinal noise per unit time (CCS), calculate the level of endogenous intoxication by the formula leukocyte index in this time interval (FRI), determine the coefficient of particnote (Cu), the ratio of LII to CCS and if you increase it relative to the original value diagnose/predict the level of development of paresis of the intestine.

The disadvantage of this method is the low information content, the possibility of false noise and low reliability of the records.

The claimed invention is directed to solution of the problem consisting in the development of a method for predicting the development of paresis of the gastrointestinal tract in patients with spinal cord injuries.

The solution to this problem will allow to significantly increase the efficiency of treatment of patients with this disease, prevent the development of paresis of the gastrointestinal tract, thus reducing the number of deaths.

To achieve this, the technical result of the claimed invention includes the following significant features: within 2-3 hours after injury in serum simultaneously determine the levels of the hormone to the of Risala, malondialdehyde (MDA), as well as the total bioelectric activity (SBAA) tract and the values of the hormone cortisol 981,7 nmol/l and above, and the values of MDA 8,35 nmol/ml and above and the values of SBAA blood 387,75 Μv and lower predict the development of paresis of the gastrointestinal tract.

Between the features and the result has the following cause-and-effect relationship.

It is established that as a result of any stress increases levels of the hormone cortisol in the blood, which causes changes in the functions of the various organs and systems (Ashmarin I.P., Vorob'ev N.A. 1962).

It is known that increased levels of the hormone cortisol in the blood is one of the components of the stress response of the body along with the release of adrenalin from the brain tissue of the adrenal glands.

In this regard, it is quite natural is detected it is facilitating effect of cortisol on quantum secretion of transmitter at the neuromuscular synapse, which shows the stimulating effect on enterolitica (Vander Kloot W., Molgo J., 1994). This joint action is to ensure the effective mobilization of the neuromuscular system during acute stress reaction.

Prolonged or excessive stress response increase in blood cortisol leads to a weakening of intestinal motility (Poletaev GI and others, 1985; Braun S,et al.; 1993).

With Resse is also uncontrolled activation of processes of lipid peroxidation (LPO). This is accompanied by increasing values of malondialdehyde (MDA), which is a consequence of deep disorders of membrane and intracellular homeostasis of the intestine.

The result is that the exponents of total bioelectric activity (SBAA).

The combination of these indicators, levels of the hormone cortisol, the level of malondialdehyde and total bioelectric activity may characterize the state of the digestive tract and serve as a forecast of the development of paresis of the intestine.

According to the authors the information set of essential features that characterize the essence of the claimed invention, is not known from the prior art, which allows to make a conclusion about conformity of the invention, the criterion of"novelty".

According to the authors, the essence of the claimed invention to a person skilled not obvious from the prior art, since it is not detected above the specified effect on the resulting technical result, namely, to significantly increase the efficiency of treatment of patients with this disease, prevent the development of paresis of the stomach, to reduce the number of deaths, which allows to conclude that the criterion of "inventive step".

The set of essential features that characterize the invention, in principle, can be repeatedly IP is Oldowan in surgery, resuscitation and intensive therapy with the results of forecasting the development of paresis of the gastrointestinal tract, reducing the frequency of deaths.

The inventive method for predicting the development of paresis of the gastrointestinal tract in patients with spinal cord injuries is as follows.

All patients were treated in intensive care units intensive care unit Vladikavkaz military hospital of the Ministry of Defense, where did they directly from the zone of hostilities. The state of the victims were assessed as severe (8,3±0.7 points on a scale TOLC-P (PR)).

We selected the observation group 100 victims aged 19-21 years with firearms and mine blast injuries of the spine at the level of Th11-L5without compression or destruction of the substance of the spinal cord. The diagnosis was established on the basis of the conclusion of the doctor of the neurologist and confirmed by radiograph and computed tomography.

Feature wounds localization is involvement in post-traumatic processes more organs and systems due to the overall contusion-commotional reactions of the organism.

After receipt of the patient with a spinal injury in the hospital he made the sampling of venous blood to determine the level of the hormone cortisol is malondialdehyde. The activity of lipid peroxidation was studied in the concentration of MDA (the final product FLOOR) method Temirbulatov R.A., Selezneva H. (1981).

Simultaneously estimated total bioelectric activity (SBAA) gastro-intestinal tract with the help of measuring and diagnostic systems, technically implemented on the device assembled on modern element base (chip series 140, 1113, 572, 574) and is designed to work with IBM joint computer (RF patent No. 2088147, MKI 6 And 61 In 5/04 from 27.08.1997). Record SBAA was performed with the patient supine. Three electrodes are treated with a special paste, superimposed respectively on the right forearm and the right and left tibia from the lateral side. Then he made the recording of signals leads to the original dataset for 45-50 minutes (series 7.5 min). The recording was made on an empty stomach. The obtained raw data were processed in an automatic mode, and the results were displayed on the computer display.

When the values of the hormone cortisol 981,7 nmol/l and above, the values of MDA 835 nmol/ml and above, the values of SBAA blood 387,75 Μv and below predicted the development of paresis of the intestine in 96.3% of cases. Much earlier started a special intensive therapy had achieved a positive effect.

Example 1. Patient S., aged 20, was hospitalized 20.03.2001 GV 3 hours 5 minutes in an intensive care unit intensive care unit Vladikavkaz military hospital. Was diagnosed with Gunshot gunshot wound in the back. Gunshot fracture of the spinous process and the temples of the 12th thoracic vertebra. The shock of the II degree.

Two hours prior to admission while being on active duty was injured in the emergency order by air delivered to the stage of providing skilled care.

The state of admission regarded as heavy (8.6 points on a scale TOLC - P (PR)), BP 90/60 mm Hg heart rate is 120 per minute. Wounded and placed in the intensive care unit the intensive care unit.

Was drawing blood from a vein for determination of cortisol levels and malondialdehyde. Then was registered total bioelectric activity of the digestive tract and the results are shown in table 1.

Table 1
Indicators total bioelectric activity, cortisol levels and MDA patient S.
IndicatorsA normal healthy personIndicators of a patient with a spinal injury
Cortisol nmol/l428,1±26,2992,5
MDA nmol/ml1,56±0,028,95
SBAA Μv450,0±17,5300,95

On the basis of Yes is the data in table 1, the projected development of paresis of the gastrointestinal tract.

The patient was conducted conventional intensive therapy, respectively, the nature and severity of the injury.

1. Evacuation of gastric contents through a constant probe;

2. Restoration of disturbed homeostasis;

3. Detoxification therapy (hemo - and imposible, plasmapheresis, enterosorption and others);

4. Antibacterial therapy;

5. Stimulation of intestinal peristalsis (epidural anesthesia, neostigmine, pituitrin, hypertonic enemas, combining different methods);

6. Procaine blockade (round ligament of the liver, sacrospinal).

On the second day the patient's condition deteriorated. Appeared bloating, intestinal peristalsis did not listen, vomiting stagnation of intestinal contents, the chair was not, gases do not depart. These symptoms point to the development of the patient clinic paresis of the gastrointestinal tract, which fully confirmed our forecast.

In the future, the use of traditional methods of treatment of paralysis of the gastrointestinal tract helped to arrest its manifestation only 9 days. This caused later medical evacuation to the next stage of rendering of specialized medical care that adversely reflected on the target achiev is tatah treatment of wounds.

Example 2.

Patient Sergey K., age 19, was hospitalized 20.03.2001, in 3 hours and 15 minutes in the intensive care unit of the hospital of Vladikavkaz military hospital. Diagnosis at admission: Gunshot gunshot wound in the back. Gunshot fracture of the spinous process and the temples of the 12th thoracic vertebra. The shock of the first degree.

Two hours before admission during patrol and sentinel duty at the shootout was injured. Delivered by helicopter. To transportation conducted resuscitation event.

The state of admission heavy (8.5 points on a scale TOLC - P (PR)), BP 90/60 mm Hg, pulse rate is 115-120 per minute.

After drawing blood from a vein for biochemical research (cortisol and MDA) the recording was made, the total of bioelectric activity of the digestive tract. The results are shown in table 2.

Table 2
Indicators total bioelectric activity of the gastrointestinal tract, the level of cortisol and MDA patient Sergei K.
IndicatorsA normal healthy personIndicators of a patient with a spinal injury
Cortisol nmol/l428,1±26,2432,4
MDA nmol/ml1,56±00,21,1
SBAA Μv450,0±17,5449,27

Based on the data presented in table 2, the development of paresis of the gastrointestinal tract is unlikely.

Patient Sergey K. was conducted syndromic intensive therapy aimed at mild shock. 1.5 hours after receipt of the casualty's condition stabilized, HELL rose up to 120/80 mm Hg, was held under multi-component ketamine-ventanillas anesthesia revision of the field injured, removed, destroyed tissue and bone fragments produced by decompression of the spinal cord, stopping the bleeding. The surgery went without complications.

On the second day the patient's condition remained serious. Gastro-intestinal signs of paresis is not registered. Vomiting was not, the abdomen is not swollen, palpation soft. Auscultation heard peristalsis, independently moved gases, was a chair.

In the future, was held conventional treatment and for 5 days the victim was evacuated to the next stage of rehabilitation.

Thus, the forecast of development of paresis of the gastrointestinal tract in a patient Sergei K. fully justified.

Therefore, the proposed method for predicting the development of paresis of the intestine in patients with spinal cord injuries will greatly increase the power of the treatment of patients with this pathology and thereby reduce the number of deaths.

A method for predicting the development of paresis of the gastrointestinal tract (GIT) in patients with spinal cord injuries, characterized in that within 2-3 h after injury in the serum at the same time determine the level of the hormone cortisol, malondialdehyde (MDA), as well as the total bioelectric activity (SBAA) tract and the values of the hormone cortisol 981,7 nmol/l and above, and the values of MDA 8,35 mmol/l and above, the values of SBAA blood 387,75 µv and lower predict the development of paresis of the intestine.



 

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