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The present invention relates to medicine, namely to anesthesiology and critical care medicine.

It is known that surgery on the spine, tubular bones, large joints, as well as organ transplantation or removal of fatty tissue are characterized by the risk of fat embolism (N.V. Kornilov, Shrubs V.M. Fat embolism. SPb.: Mortar AB, 2001. - P.18, P.36-44).

The known method of prevention of fat embolism, which consists in injecting drug of LIPOSTABIL (Essentiale) during surgery at a dose of 20-40 ml, followed by the introduction in the same dose for 3-4 days (N.V. Kornilov, Shrubs V.M. Fat embolism. SPb.: Mortar AB, 2001. - S).

The disadvantages of this method include the fact that the effective action of LIPOSTABIL (Essentiale) is seen only with long-term use of large doses (1.5-2 g/day), and the introduction of the drug in 20-40 ml once or within a few days does not affect the removal of the fat globules of the blood (Klimov A.N., Nikulicheva N.G. Metabolism of lipids and lipoproteins and its disorders. - SPb: Peter Kom, 1999. - S-434). This was confirmed by experimental researches of the authors of the proposed method (Tvorogova S. Comparative evaluation of the effectiveness of drug prevention and treatment of fat embolism / author-t Diss.... CMN, 2005. - P.14-15).

The closest in technical essence to the present invention is a method for drug prevention of fat embolism, including intravenous administration of a 5%solution of ethyl alcohol in 5%glucose solution during surgery (Shifman E.M. Fat embolism: clinical physiology, diagnosis and intensive therapy., 2nd ed. Corr. and more. - Petrozavodsk: Intelteck, 2003. - P.23).

The disadvantages of this method include no identifying markers of fat embolism and monitoring the effectiveness of the removal of the fat globules of the blood. The disadvantages of this method include a narrow therapeutic breadth of action of the drug, and low utilization of ethyl alcohol, as even a preventive dose, in some cases, causes the intoxication side effects in the form of motor excitation, nausea, vomiting.

The task of the invention is to prevent the development of fat embolism during operations with a high risk of developing this complication.

The technical result of the proposed method is to prevent the development of fat embolism in the perioperative period due to early detection markers of fat embolism fat globules, recycling, and eliminating the toxic effects of an administered drug.

The technical result of the achievement is highlighted by the fact that the way to prevent the development of fat embolism in the perioperative period include intravenous drug and 5%glucose solution.

Distinctive techniques of the proposed method lies in the fact that 40 minutes before surgical intervention at the same time begin to enter the drug "Hepatol a and 5%glucose solution in a volume ratio of 1:1. "Hepatol And" administered in the recommended dose of 4.0 to 8.0 ml/kg of body weight at 40 drops per minute.

The difference of the proposed method lies in the fact that at the end of key stage operations are performed microscopic analysis of blood for the presence of fat globules, detection of which is smaller than 5 μm in the total amount of more than 10 or larger than 5 μm in the amount of one or more, in 8 fields of view, the analysis considered positive and the introduction of Jasola a and 5%glucose solution continue.

The distinctive techniques of the proposed method is also considered that in the absence of the fat globules in the blood or if their size is less than 5 μm in a quantity less than 10, also in 8 fields of view, the analysis considered negative and the introduction of Jasola a and 5%glucose solution ceased.

The distinctive reception of the proposed method should also be considered that the blood test for the presence and quantity of the fat globules is autonaut 12 hours after the last injection of the drug "Hepatol. When registering a positive analysis in the postoperative period the introduction of the drug "Hepatol a and 5%glucose solution at the specified dose again.

If you double-register negative results for the presence of fat globules made with an interval of 12 hours, the introduction of Jasola And" do not hold.

The comparative analysis of the proposed method and the prototype shows that the inventive method differs from the known above-mentioned techniques. These differences allow to draw a conclusion on the conformity of the proposed technical solution the criteria of the invention of "novelty."

Analysis of patent literature allowed the authors to establish that the proposed solution has features that distinguish it not only from the prototype, but also on other technical solutions in this field of medicine. We have not found way to prevent the development of fat embolism in the perioperative period, containing distinctive techniques of the proposed method.

It is known that "Hepatol A" combined preparation for parenteral nutrition of patients with hyperammonemia. Provides metabolic, liver and detoxification effect. The solution for infusion contains: arginine, aspartic acid, sorbitol, nicotinamide, malic acid, Na+, K+CI+, Riboflavin, decante the ol and pyridoxine (Reference Vidal. Medicines Russia: a Handbook. M: Attraversare, 2006, SB-400-B-401).

The indication for the drug "Hepatol And is the treatment of liver failure of various etiologies. The drug is administered intravenously at a dose of 4.0 to 8.0 ml/kg of body weight at 40 drops per minute. The introduction of the drug can be repeated every 12 hours.

The authors of the proposed method is established that the introduction of the drug "Hepatol And promotes rapid utilization of fat globules by maintaining the initial concentration of apoprotein b and activity of plasma lipoproteinlipase, which provide emulsifying properties of blood plasma.

The introduction of the drug before surgery, is equal to 40 min, determined by the time of synthesis of apoprotein b in plasma, a substrate is L-arginine, which is part of the drug "Hepatol.

Unlike the prototype of this drug is devoid of side effects, has good therapeutic latitude of action and is easily utilized when introducing it in combination with glucose solution.

The inventive method reduces the risk of fat embolism by 31%-57% compared with other existing methods and improves the outcomes of surgical treatment of diseases and injuries of musculoskeletal system.

This allows to make a conclusion on compliance of technical is one solution to the criterion of "inventive step".

The method constituting the invention, intended for use in health care. The possibility of its fulfillment is confirmed as described in the application techniques and equipment. The inventive method achieves perceived by the applicant of the technical result, namely improving the efficiency prevent the development of fat embolism due to early detection markers of fat embolism fat globules, recycling, and eliminating the toxic effects of an administered drug.

From the above it follows that the claimed invention meets the condition of patentability "industrial applicability".

The way to prevent the development of fat embolism in the perioperative period, perform the following way:

When entering the patient into the operating perform puncture catheterization peripheral vein and start a drip "Jasola And" in a dose of 4.0 to 8.0 ml/kg of body weight at 40 drops per minute. In parallel, via the auxiliary channel of the catheter in the same vein impose a 5%glucose solution in a volume ratio of 1:1. After 40 minutes from the start of injection perform surgery. After the completion of the main phase of the operation, for example, opening and processing of bone marrow channel, spend analysis and calculation of the fat glob is l in a smear of blood plasma by light microscopy.

If in 8 fields of view to determine at least one fatty globule larger than 5 μm or 10 globules smaller size, i.e. less than 5 μm, it is possible and the drain of the globules, the analysis considered positive and a drug "Jasola And 5%glucose solution in the above mode and dosage continue.

In case of detection in 8 fields of view of the total number of globules of not more than 10, the amount of which does not exceed 5 μm, or in the absence of fat globules analysis considered negative and the introduction of Jasola And 5%glucose solution ceased.

Laboratory monitoring is performed within 12 hours after the last injection "Hepatol.

After each positive test result for the presence of fat globules perform infusion "Hepatol a and 5%glucose solution at the recommended dose.

Prevention of fat embolism by introducing "Jasola And stopped at double negative analysis performed with an interval of 12 hours.

The proposed method is illustrated by a specific example.

Extract from the history of patient A., aged 57, weight 85 kg, which is diagnosed with bilateral coxarthrosis right of III-IV degree, to the left of the II degree. Contracture of the right hip joint, was admitted to the clinic of traumatology and orthopedics for surgical treatment. Of comorbidity marked x is oncesi obstructive bronchitis, peptic ulcer in remission.

Conducted in the period of pre-clinical, biochemical analyses of blood and urine tests within normal limits.

The patient routinely performed operation - total cement hip replacement design "ESI". The patient entered the operating room with the HELL - 140/80 mm RT. Art., pulse 76 in minutes After puncture of the catheter and a peripheral vein started parallel infusion of the drug "Hepatol a and 5%glucose solution in a volume ratio of 1:1, with a rate of 40 drops per minute. Then made a puncture of the subarachnoid space and intrathecal 0.5% solution of marcaine 20 mg Sedation of the patient is ensured by the introduction of a solution Relanium - 10 mg, dosed infusion of Diprivan - 400 mg of the Operation began after 40 minutes from the start of infusions "Jasola And 5%glucose solution.

During anesthesia smooth to the stage of implantation of the femoral component of the prosthesis, which is made with the use of bone cement to 45 minutes after the start of the operation. At this stage marked transient reduction of blood pressure to 90/50 mm Hg, which did not require any action to be taken and quickly stabilized independently at the same digits - 110/80 mm RT. Art. On the stage of implantation of the femoral component is made fence CROs and from a Central vein for analysis for the presence of fat globules.

In a smear of blood plasma in 8 fields of view, discovered 20 of the fat globules in the range of 0.1-0.2 μm, 4 - size of 1-2 microns. The analysis is positive. Decided to continue before surgery infusion "Jasola And 5%glucose solution. Until the operation is complete hemodynamic parameters were stable, the NPV 12-16, saturation of hemoglobin, 97%-99% by insufflation of oxygen through a nasal catheter - 2 l/min

The duration is 90 minutes, the duration of anesthesia - 130 minutes. Blood loss was 600 ml, the volume of infusion therapy - 2200 ml. infusion of the drug "Hepatol And in a dose of 5 ml/kg of 5%glucose solution completed one hour after the end of the operation.

In the postoperative period, there was a twofold analysis of the smears of blood plasma (after 12 and 24 hours after surgery): the fat globules are absent. Re-infusion "Jasola And in the early postoperative period did not.

The postoperative period was uneventful. The patient was discharged 10 days after surgery.

In the example at the stage of implantation of the femoral component of the endoprosthesis there was a massive inflow of bone marrow fat in the bloodstream, which is clinically manifested by a decrease in blood pressure and confirmed by laboratory tests. The introduction of Jasola And allowed received in the bloodstream fat fragmenter the VAT on globule size smaller, not dangerous in terms of the development of embolism.

Repeated blood tests for the presence of fat globules carried out after 12 and 24 hours after surgery were negative. Therefore, a single infusion of 500.0 ml "Jasola And"started 40 minutes prior to surgical intervention, was enough to prevent the development of fat embolism on intraoperative stage and in the postoperative period.

The authors of the proposed method were conducted comparative clinical trial of prevention of fat embolism with the use of "Jasola and known drugs - Essentiale N, 5% solution of ethyl alcohol.

For patients undergoing total hip arthroplasty, were divided into three groups.

In the first group consisted of 70 patients to prevent the development of fatty globularia before and during surgery injected drug "Hepatol a and 5%glucose solution.

The second group consisted of 85 patients who received Essentiale N during and after a transaction.

The third group consisted of 39 people, which during the operation was injected intravenously 5% solution of ethyl alcohol in 5%glucose solution.

For blood tests for the presence of fat globules performed fences blood from a Central vein at the following stages: intraoperative who - before the operation, during processing of bone marrow channel, at the end of surgery and in the postoperative - in the first, second, third day after the operation.

Identification and counting of fat globules in a plasma venous blood, stained with Sudan III, was performed using light microscopy (Diagnostics fat globularia with injuries and operations on the bones: Method. rivers: status. Navarrow, Auvasotec, Vmesto. - SPb., 2000. 24).

Before surgery all patients analyzed for the presence of fat globules was negative.

Comparative results of the frequency detection of the fat globules in the intraoperative phase is presented in table 1.

Table 1
Medication N ZG/ZG N without The absolute risk Chance
Hepatol And 38/32 0,54* 1,17*
Essentiale N 67/18 0,79* 3,76*
5% solution of alcohol : 26/13 0,67 2,03
* - p<0,05 (χ2with the amendment of Yates)

where N ZG - number of patients with positive analysis on the presence of fat globules,

N without ZG - number of patients with a negative analysis on the presence of fat globules.

From the table 1 it follows that for intraoperative stage introduction "Jasola And allowed significantly (p<0,05) reduced the absolute risk and the chance of development of fat embolism compared with the introduction of table I. relative risk Reduction (COP) development of fat embolism in the group introducing Hepatol a in comparison with group introduction Essentiale N was 31%and the NNT, which characterizes the number of patients who need to treat Essentiale to get the same effect as using "Jasola And"equal to 4.

The introduction of Jasola And" were also significantly reduce the absolute risk and the chance of development of fat embolism in the early postoperative period (see table 2).

Table 2
Medication N ZG/ZG N without AR Chance SOR NNT
Hepatol And 11/59 0,15*** 0,18*** 0 1
Essentiale N 30/55 0,35* 0,54* 56% 5
5% solution of alcohol : 14/25 0,36** 0,56** 57% 5
- ** - p<0,05 (χ2with the amendment of Yates)

where N ZG - number of patients with positive analysis on the presence of fat globules,

N without ZG - number of patients with a negative analysis on the presence of fat globules,

AR - absolute risk of fat embolism

SOR - reduction of relative risk of fat embolism,

NNT is a measure of the number of patients who need to treat this drug to get the same effect.

From table 2 it follows that the SOR group introducing Jasola And compared with a group introduction Essentiale N was 56%, and with a group introduction alcohol solution is 57%. Figure NNT in the last two groups compared with the group of Jasola And amounted to 5 people.

Thus, these data characterize significantly more pronounced prolonged prophylactic effect to prevent the development of fat embolism from the introduction of "Hepatol.

Drug Hepatol As" well tolerated and no severe side effects.

The way to prevent the development of fat embolism in the perioperative period, including simultaneous introduction of a 5%glucose solution and another drug, characterized in that as other drug use Hepatol And that started to introduce a dose of 4.0 to 8.0 ml/kg separately from 5%RAS is the thief of glucose, these funds are administered in equal volumes for 40 min before surgery, on the completion of the main phase of the operation performed microscopic analysis of blood for the presence of fat globules, when detected, which in 8 fields of view in a total amount of more than 10 globules, the size of which is less than 5 μm, or in the amount of one or more globules larger than 5 μm, the analysis considered positive and a drug "Hepatol a and 5%glucose solution continue, and in the absence of fat globules or if their size is less than 5 μm in the total quantity of less than 10 globules, analysis think negative and the introduction of the drug "Hepatol a and 5%glucose solution stop, the blood test for the presence of fat globules repeated after 12 h after the last injection of the drug "Hepatol a" and, if the register tested positive for the presence of fat globules, the introduction of the drug "Hepatol a and 5%glucose solution again, and if you register twice, with an interval of 12 h, the negative results for the presence of fat globules, the introduction of the drug "Hepatol And" do not hold.

 

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