Diagnostic technique for reperfusion syndrome

FIELD: medicine.

SUBSTANCE: peripheral blood lactate level is measured. If the postischemic lactate level exceeds 10 mmol/l, reperfusion syndrome is diagnosed.

EFFECT: improved diagnostic accuracy.

5 dwg, 1 ex


The present invention relates to medicine, namely to abdominal surgery, and can be used for the diagnosis of ischemia-reperfusion syndrome.

The prototype of the invention is a method of diagnosis of reperfusion syndrome, based on the determination of the levels of products of lipid peroxidation in tissues during ischemia and reperfusion (Mwinilunga. Ischemic and reperfusion injury of organs. - M.: Medicine. 1989. - 368 C.). The disadvantage of this method is its low accuracy, high variability indicators, the level of products of lipid peroxidation is often little different from their levels in the preceding stage - ischemic period.

As you know, after the restoration of blood flow during ischemia resulting damage is much heavier and is called reperfusion injury. Reperfusion syndrome occurs not always, its manifestation depends on the time and severity of the preceding ischemia (Kashibadze PHD, Nakashidze IM Oxidant-antioxidant processes in tissues in ischemic and reperfusion injury of the small intestine. Pathological physiology and Experimental therapy. 2009. - 32. - p.19-22: Mwinilunga. Ischemic and reperfusion injury of organs. - M.: Medicine. 1989. - 368 C.). In clinical practice, critical diagnostics Vozniknovenie and severity of reperfusion syndrome for extra early to prevent complications and intensive care.

The objective of the invention is to develop a method for early diagnosis of reperfusion syndrome.

The technical result when using the invention - improving the accuracy of diagnosis.

The proposed method for the diagnosis of reperfusion syndrome is as follows. Measure the lactate levels in the peripheral blood before ischemia, at the stage of ischemia and again within 2 hours after removal of ischemia. When the value of lactate more than 10 mmol/l diagnosed syndrome reperfusion. Lactate is a product of anaerobic oxidation of glucose and is the most sensitive to oxygen deficiency.

The invention is illustrated as follows: figure 1 shows the seal kidney cells, the violation of their circulation and destructive changes in nephrons of experimental animals. Paint hematoxylin-eosin. Micrograph 10, Ob; figure 2 is a stagnation of blood in the capillary network of the cortical substance of the kidney of experimental animals. Paint hematoxylin-eosin. Micrograph 10, Ob; figure 3 - the destruction of the Central vein of liver segments and destruction of adjacent hepatocytes in experimental animals. Paint hematoxylin-eosin. Micrograph 10, Ob; figure 4 is compressed area light, visible inflammatory process. Paint hematoxylin-eosin. Micrograph 10, Ob; figure 5 is a dense area formed the CSOs in experimental animals. Paint hematoxylin-eosin. Micrograph 10, Ob.

To confirm the possibility and reliability of the proposed method, we performed experiments on 7 pigs weighing 10-12 kg Model of ischemia of organs of the abdominal cavity created by a busy pneumoperitoneum (>2 hours). To busy pneumoperitoneum by the end of the period of intra-abdominal hypertension (stage ischemia) and before removing busy pneumoperitoneum in the peripheral blood of pigs was determined by the level of lactate (lactic acid), re-lactate was determined during the first 2 hours after removal of ischemia (stress pneumoperitoneum), when you call the reperfusion syndrome. After the death of the animal was performed laparotomy and sampling of internal organs for histological examination. The results are in the normal level of lactate is 2.6+/ - 0.3 mmol/l, during the period of ischemia was 8.8+/and-0.6 mmol/l and in the development of reperfusion syndrome in all cases more than 10 mmol/l and in General was 12.2+/-0,73 mol/l (P<0,05).

Example. The pig weighing 10-12 kg in terms of endotracheal anesthesia was performed puncture of the anterior abdominal wall trocar diameter 10 mm

Measured the level of lactate peripheral blood - 2.5 mmol/L. Trocar connected to insufflator air pressure gauge. Note time and was pumped into the abdominal cavity of the atmospheres of the first air up to 30 mm Hg, so busy creating pneumoperitoneum. Exposure busy pneumoperitoneum was 2 hours. Identified lactate peripheral blood by the end of the period of intra-abdominal hypertension - 8.7 mmol/L. Then performed decompression of the abdominal cavity, eliminating stressful pneumoperitoneum and measured the lactate level after the first 2 hours after removal of ischemia, which amounted to 12.1 mmol/L. Diagnosed syndrome reperfusion.

The animal was taken from the experience by injecting lethal doses of muscle relaxants. Made laparotomy, took pieces of organs for histological examination.

The results of histological research.

In the immediate vicinity of the portal histological structure of the kidney are areas significantly altered patterns as kidney cells, and nephron tubules (figure 1). When this calf kidney sealed and the network of blood capillaries is not defined, and the gap space between the inner and outer capsules renal bullock greatly expanded. Along with changes in overall structure of the parenchyma of the kidney, are determined by expressed human renal blood flow in experimental animals. Especially characteristic is the stagnation of blood in the blood capillaries surrounding the renal tubules (figure 2).

Slices of liver with destructive changes in the ons Central vein (figure 3), when the endothelial cells are not detectable in the immediate vicinity of the hepatocytes exposed to destructive processes, while hepatocytes lyse and fragmented. Vnutritrekovye sinusoidal capillaries saved, but they greatly expanded and perisinusoidal edema. In the lumen of the capillaries are defined by the formed elements of blood.

There are small areas of lung tissue with a marked infiltration and compacted fabric structure (Fig.4-5). When the alveoli are not often such changes of the respiratory part of the lung are located in close proximity of the bronchioles and bronchi different caliber.

Method for the diagnosis of reperfusion syndrome in the experiment, including the determination of biochemical indicator during and after ischemia, characterized in that in the peripheral blood as biochemical indicators determine the lactate and when it is in the postischemic period of more than 10 mmol/l diagnosed syndrome reperfusion.


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