Method of internal hemorrhage diagnostics

FIELD: medicine.

SUBSTANCE: hematocrit is determined in patient's blood and in drainage content. Ratio of drainage content hematocrit to blood hematocrit is calculated. If its value is less than 0.05 absence of hemorrhage is diagnosed, if the value is from 0.05 to 0.2 capillary hemorrhage is diagnosed, from 0.2 to 0.5, diffusive hemorrhage is diagnosed, over 0.5 vascular hemorrhage is diagnosed.

EFFECT: methods application makes it possible to increase accuracy of internal hemorrhage diagnostics in short terms and at early stages of disease.

2 ex

 

The invention relates to medicine, surgery, anesthesiology and reanimatology and intensive care, and can be used to diagnose internal bleeding.

Internal bleeding is one of the most common pathologies in patients of intensive care.

While diagnosing internal bleeding is often a very difficult task. The main signs of internal bleeding - functional and Hematology. Functional manifested by pallor of the skin, reduction of arterial and Central venous pressure, reducing the rate of diuresis. The disadvantage of using functional traits is their nespecificnomu. The symptoms included in the number of patients in critical States can have almost any reason (Marino, P. Intensive therapy (Per. s angl.) / Pyrina. - M, GEOTAR - Medicine, 1998).

Hematological manifestations are characterized by a decrease in the dynamics of the number of erythrocytes, haemoglobin concentration, hematocrite value. Hematological manifestations of internal bleeding, confirming functional, have a significant delay in time, appearing after 4-12 h from the beginning that can lead to delayed diagnosis threatening condition (Cashiers, I.A. Klinicheskaya Hematology. / Iascinski, Gaaleries. - M.: Medicine, 1970).

The closest way to diagnose is to evaluate the discharge to drains, catheters and probes located at the alleged source of bleeding (Emelyanov, SR General surgery. / Siemeling, Muddebihal, A.v.fedorov. - M: Medical information Agency, 2003). However, this method has the disadvantage of excessive subjectivity of the method, since the determination of the nature of the discharge occurs solely by it's color.

We first proposed a method for the diagnosis of internal bleeding, which in comparison hematocrit of the patient's blood with a hematocrit separated by drainage (catheter probe), which is in the cavity of the body or the place of operative intervention.

To use this method, you must have a functioning drainage (catheter tube) at the place of intended bleeding. If you suspect internal bleeding blood samples were taken from a vein of the patient. In the blood sample is determined hematocrite value. Is the fence contents of the drainage catheter, probe), which is determined by the same indicator. Methods for the laboratory testing of blood and the contents of the drainage catheter, probe) does not matter; it is used routine method for determination of hematocrit, Rinata in a particular clinic. It is determined by the amount of blood and the contents of the drainage catheter, probe).

After the results are intercomparison of the studied blood parameters and contents of a drainage catheter, probe); calculated index Sadchikov by the formula:

Is=Hta/Htb,

where Hta - hematocrit content of drainage,

Htb - hematocrit of venous blood,

Is - index Sadchikov.

Depending on the size of the index, we identify three quality, which indicates the index:

StateNo bleedingCapillary bleedingDiffuse bleedingVascular bleeding
Index valueLess than 0.05of 0.05-0.20,2-0,50,5-1,0

We studied 52 patients with functional features it was supposed to be internal bleeding. Of these 22 patients with suspected bleeding from ulcers of the gastrointestinal tract, 18 patients with suspected bleeding from the bladder, 12 patients with alleged paleoprecipitation. They have to arm/exclusion diagnosis applied the proposed method, verified by using fibroesofagogastroduodenoscopia (patients with ulcers of the gastrointestinal tract), videocategory (patients with suspected bleeding from the bladder), revisions in the area of operation (patients with presumed postoperative bleeding).

The control group was 27 patients with similar patterns of causes of bleeding; the control group differed from the basic fact that for arming/exclusion diagnosis was used the traditional method (functional performance and character of the discharge from the drainage).

Functional characteristics and nature of the discharge from the drainageThe proposed method
The true resultFalseAverage time diagnosticsThe true resultFalseAverage time diagnostics
Defined bleeding16(80%)4(20%) 4 h40(93,02%)3(5,8%)30 min
Defined no bleeding5(71,42%)2(28,52%)8(88,88%)1(11,12%)

Compared with the traditional way, using the proposed method decreased the number of erroneous diagnosis of bleeding, as well as the obvious advantage that less time is required for diagnosis.

Specificity is 88,88%, which in combination with the sensitivity 93,02% accounts for its high diagnostic value.

The value of the designated index Sadchikov not depend on the indices of Central venous pressure and circulating blood volume. The simplicity of the proposed method accounts for its technical reproducibility.

Example 1. Sick Gonchar SCI, 72 years, the case history No. 7207. Date of receipt of the oar KB them. Sriratana SSMU 24.07.10. Diagnosis: Primary: prostatic Hypertrophy. Complications: Acute urinary retention. Bilateral pyelonephritis. Background: Chronic renal failure.

The patient was performed percutaneous needle nephrostomy, then for several days in the urine of nephrostomes observed what up blood, evaluated by different experts from moderate to severe. Discussed the question about the necessity of surgical intervention for the purpose of hemostasis. Was made on the determination of hematocrit in the blood and urine of nephrostomes. In urine hematocrit of 2%in the blood - 33%, the calculated index Sadchikov is 0.06, indicating that capillary bleeding. The need for surgical intervention was rejected. Hematocrit urine in the patient consistently declined over the two days, the third day blood in the urine was not significantly detected.

Example 2. Sick of Darina A.I., 82 years. Case history No. 7608. Date: 9.08.10. Diagnosis: Primary: Cancer of the antrum. Condition after antral resection of the stomach. The failure of the gastrojejunostomy. Arrozivnym bleeding.

In the postoperative period lasted Department scant serous-hemorrhagic content from drains. For 8 days the patient's condition deteriorated: there are hypotension, tachycardia, paleness of the skin. Sample collection blood and the contents of the drainage. Blood hematocrit was 32%, in the discharge of drainage 30%, the index Sadchikov 0,94%, indicating a vascular bleeding.

Was relaparotomy identified and eliminated the source of bleeding: the vessel in the area of the anastomosis.

As can be seen from the description of the deposits, in the following examples, the proposed method allows to diagnose internal bleeding in the early stages, requires significantly less time, is more objective and accurate than the traditionally used methods.

The way to diagnose internal bleeding, including determination of hematocrit in the blood of the patient, characterized in that it further determine the hematocrit content of drainage, calculate the ratio of hematocrit drainage of the content to the hematocrit of the blood and when it is less than 0.05 diagnose the absence of bleeding, a value of from 0.05 to 0.2 diagnose capillary bleeding, from 0.2 to 0.5 diagnosed diffuse bleeding, above 0.5 diagnose vascular bleeding.



 

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2 ex, 4 tbl

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3 ex, 1 tbl

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2 tbl, 4 ex

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1 tbl

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1 cl, 1 ex, 1 tbl

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