Method of early prediction of pneumonia development in case of acute poisoning with psychotropic drugs

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular toxicology and resuscitation science and can be used for early prediction of pneumonia development in patients. On the first day of staying in hospital functional state of albumin in blood serum is analysed in patients by fluorescent method. Intensity of K-35 probe fluorescence in blood serum albumin in medium with high ionic power is determined. If value of K-35 probe fluorescence intensity in albumin is lower than or equals 36 conv.units, development of pneumonia in patient is predicted.

EFFECT: method allows to increase efficiency of performed treatment in said category of patients.

2 tbl, 4 ex

 

The invention relates to medicine, in particular to toxicology and resuscitation.

Pneumonia in acute poisoning psychotropic drugs are observed to 25% of cases, and causes about 60% of deaths (Luzhniki E.A., G. Kostomarov Acute poisoning, 2000, M, Medicine, 434 C.). Clinical manifestations of pneumonia scarce. In the vast majority of observations typical for pneumonia complaints and symptoms are absent. The clinical symptomatology is veiled symptoms related complications (coma, venous congestion, pulmonary edema). Cough is not typical for this complication, as it appears in the majority of cases in violation of the tracheobronchial patency due to the accumulation of mucus or Muco-purulent secretion in the Airways. Not typical and also temperature the reaction, which may occur due to the development of tracheobronchitis, phlebitis and other inflammatory complications. Physical data is very poor: managing voice shake and percussion sound to mention rare, especially in patients in a coma or on the way out of it, and only in patients with confluent pneumonia revealed dullness of percussion sound, strengthening voice shake and bronchophony. Auscultatory picture in connection with the focality of process and non-uniform flow in different loci for the Ah extraordinarily polymorphic and dynamic.

Given the low information value of clinical signs, it is necessary to use instrumental research methods for the diagnosis of pneumonia in acute poisoning. Important diagnostic value in the early stages of pneumonia, and in the development of the pathological process in the lungs has an x-ray of the chest.

The greatest number of pneumonia is registered on the 3rd day of stay of patients in hospital and is 43.5% of the total number of examined patients (Ilyashenko K.K., Luzhniki E.A. Toxic damage of the respiratory system in acute poisoning, M.: EMIGRANTKA-M, 2004, pp.96-97).

However, x-ray diagnosis of pneumonia that develops on the background of venous congestion in the lungs, in the early period of intoxication (12-24 hours from the time of receipt) causes difficulty, and against the background of pulmonary edema is almost impossible. Radiological assessment of obscurities in the interpretation of the images in front of the projection in the horizontal position of patients in the neurosurgical Department represents a significant challenge (Ilyashenko K.K., Luzhniki E.A. Toxic damage of the respiratory system in acute poisoning, M.: EMIGRANTKA-M, 2004, p.98-99).

Currently, there are no laboratory methods that provide information about opportunities for the development of mon is vmoney in patients with acute poisoning by psychotropic drugs.

The objective of the invention was to develop a biophysical technique for early forecasting of development of pneumonia in acute poisoning with psychotropic drugs.

We have conducted research on the status of connecting the centers of the molecules of albumin in 12 healthy individuals and 41 patients with acute poisoning by psychotropic drugs severe on the first day of hospital stay.

For recording changes albumen binding was used fluorescent probe-35, original, specific dye, which in the serum or plasma of fluorescent practically only of albumin (Miller SCI, Dobretsov G. Molecular basis fluorescent method to determine the binding capacity of albumin in the blood serum. Clinical laboratory diagnostics, 1994, No. 5, p.20-23). Measurement of fluorescence intensity was performed using an analyzer AKL-01. Instrument calibration was performed so that the calibrator GSO 6296-91 with intensity parameter "536" consistent evidence "100" on the display device. We have registered a significant (p<0,05) changes in the fluorescence intensity of the K-35 of albumin in the blood serum of patients when compared with healthy individuals (table 1). From the data presented in the table shows that in healthy individuals, the intensity of the fluorescence To-35 sostav the em 54±2 ( used), and in patients with acute poisoning with psychotropic drugs - 44±2 (used), which was significantly lower at 23% of the values in healthy. Fluorometrically research linking the centers of albumin in patients on the first day of hospital stay revealed significant differences (p<0,05) the fluorescence intensity of the K-35 in patients with pneumonia and without (table 2). In table 2 data indicate significant differences (p<0.05) in 1.3 times the intensity of fluorescence To-35 albumin in patients with pneumonia 37±3 (used) and without pneumonia 47±2 (used).

Table 1
The intensity of the fluorescence To-35 albumin in healthy persons and in patients with acute poisoning by psychotropic drugs in 1 day of hospital stay (M±m)
ExaminedThe fluorescence intensity
K-35,c.u
Number of examined persons
Healthy people54±212
Patients SFC44±241
Note: once the Itza between groups according to reliable non-parametric criterion of Mann-Whitney: p< 0,05.

Table 2
The intensity of the fluorescence To-35 albumin in healthy persons and in patients with acute poisoning by psychotropic drugs in 1 day of hospital stay (M±m)
Surveyed patients SFCThe intensity of the fluorescence To-35, c.uNumber of examined persons
With pneumonia37±312
Without pneumonia47±229
Note: the difference between groups according to reliable non-parametric criterion of Mann-Whitney: p<0,05.

The obtained data allowed us to predict the development of pneumonia in patients with acute poisoning by psychotropic drugs, when the value of the fluorescence intensity of the K-35 less than or equal to 36 used already in the first day of hospital stay.

The method is as follows. Blood from patients take in a dry test tube without preservative. Separate the serum by centrifugation for 10-15 minutes at 1500 rpm ZAT is m serum was diluted 20 times with phosphate buffer (pH 7.4) and 3 parts of diluted sera was added 1 part of a 2.5 M solution of KCl in phosphate buffer (pH 7.4) and mixed (final ionic strength of the solution is equal of 0.625 M). Then to the mixture was added 28 μl of a solution of a fluorescent probe To 35, and again, mix and measure the intensity of fluorescence at the wavelength of excitation of 450 nm and emission wavelength of 530 nm and the intensity value of fluorescence of the probe is less than or equal to 35 36 usled predict the development of pneumonia in a patient.

The principle of the method is based on the fact that the balance of electrostatic forces in the albumin patients and healthy is different, and in patients with pneumonia, these differences are even more pronounced, that, apparently, affects the centers in the molecule of albumin, which bind the fluorescent probe To-35.

Thus, the method of early prediction of the development of pneumonia in patients with acute poisoning by psychotropic drugs allows to identify patients with a high risk of developing pneumonia in the first day of hospital stay according to the intensity of fluorescence To-35 albumin serum in the medium of high ionic strength.

CLINICAL EXAMPLES

1. Sick Hours,54 years. Diagnosis: acute poisoning with a mixture of psychotropic drugs III degree. Upon admission to the hospital: coma with respiratory disorders by mixed type, level of consciousness on a scale Glasgow 3 points, radiological signs of pneumonia is not detected. The patient's condition is extremely serious. 1 day clinical analysis of blood: hemoglobin is - 96 g/l, hematocrit of 28%, leukocytes and 6.2·109/l, stab neutrophils - 15%, segmented neutrophils - 55%, lymphocytes - 21%, monocytes - 9%, ESR - 27 mm/h. Biochemical blood test: whole protein, 60 g/l, urea - 7.2 mmol/l, creatinine - 158 μmol/l, total bilirubin -7,75 µmol/l, glucose - 7.0 mmol/L. chest x-ray signs of pneumonia is not detected. The intensity of fluorescence at high ionic strength equal to 31 c.u.. Pneumonia radiographically diagnosed over 4 days, and in spite of intensive therapy on the 6th day the patient died.

2. Patient C., 67 years old. Diagnosis: acute poisoning with a mixture of psychotropic drugs II-b class. Upon admission to the hospital: coma with respiratory disorders by mixed type, level of consciousness on a scale Glasgow 9 points, radiological signs of pneumonia is not detected. The condition of the patient is severe. 1 day clinical analysis of a blood: a hemoglobin - 162 g/l, hematocrit of 48%, leucocytes - 7,8·109/l, stab neutrophils - 26%, segmented neutrophils - 60%, lymphocytes 10%, monocytes - 4%, ESR - 34 mm/h. Biochemical blood test: whole protein - 54,2 g/l, urea - 6.8 mmol/l, creatinine - 112 µmol/l, total bilirubin to 7.75 mmol/l, glucose - 4.5 mmol/L. chest x-ray signs of pneumonia is not detected. The fluorescence intensity in the high ionic strength equal to 36 used Pneumonia radiographically diagnosed over 4 days, and in spite of intensive therapy on day 15, the patient died.

3. Patient R., 58 years. Diagnosis: acute poisoning by psychotropic drugs II-b class. Upon admission to the hospital: coma with respiratory disorders by mixed type, level of consciousness on a scale Glasgow 4 points, radiological signs of pneumonia is not detected. The condition of the patient is severe. 1 day clinical analysis of a blood: a hemoglobin - 127 g/l, hematocrit 37%, leukocytes and 12.7·109/l, stab neutrophils - 16%, segmented neutrophils - 75%, lymphocytes - 5%, monocytes - 4%, ESR - 20 mm/hour. Biochemical blood test: whole protein - 67 g/l, urea - 3.0 mmol/l, creatinine - 76 µmol/l, glucose - 5.8 mmol/L. the Intensity of fluorescence at high ionic strength equal to 37 used on chest x-ray changes of light is not detected. Conducted intensive care patient withdrew because of her condition and on the 8th day he was discharged.

4. Patient F., 34 years. Diagnosis: acute poisoning with a mixture of psychotropic drugs II-b class. Upon admission to the hospital: coma with respiratory disorders by mixed type, level of consciousness on a scale Glasgow 3 points. The condition of the patient is severe. 1 day clinical blood analysis: hemoglobin -104 g/l, hematocrit 31%, leukocytes and 8.1·109/l pulock the nuclear neutrophils - 22%, segmented neutrophils - 63%, lymphocytes - 12%, monocytes - 4%, ESR - 53 mm/h. Biochemical blood test: whole protein - 67 g/l, urea - 9.3 mmol/l, creatinine - 140,7 µmol/l, total bilirubin - 5.17 mmol/l, glucose - 6.0 mmol/L. the Intensity of fluorescence at high ionic strength equal to 47 used, the radiological examination, the patient changes from the side light is not detected. The patient was conducted intensive care and on the 19th day she was discharged home.

The use of the proposed method for early prediction of the development of pneumonia in patients with acute poisoning psychotropic drugs can improve the treatment efficiency.

The method of early prediction of the development of pneumonia in patients with acute poisoning by psychotropic drugs by measuring the fluorescence intensity of the probe To-35 albumin serum in the medium of high ionic strength on the first day of stay of patients in hospital and when its value is less than or equal to the boundary value 36 usled predict the development of pneumonia.



 

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