Method for homeostatic disorder correction in children with hepatic hemangiomas. RU patent 2483737.

FIELD: medicine.

SUBSTANCE: invention relates to medicine, particularly to paediatrics, X-ray surgery, paediatric surgery, and concerns the hemostatic disorder correction in the children with hepatic hemangiomas. For this purpose, three days before the endovascular embolisation of the hepatic hemangioma, Protromplex 600 - a preparation of plasma factors II, VII, IX, X is administered intravenously in a dose of 20 IU/kg at max. 2 ml/min; on the first postoperative day, Protromplex is administered in the same dose, and further Fraxiparine is administered subcutaneously in a dose of 158 IU/kg of body weight for 3 days.

EFFECT: presented dose schedule of the preparations provides the effective and safe correction of hemostatic disorders in the children with hepatic hemangiomas due to normalising the internal and external mechanisms of blood coagulation and fibrinolysis.

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The invention relates to medicine, particularly to a x-ray-surgery, pediatric surgery, and can be used for the correction of hemostasis during endovascular operations on the occasion of liver hemangiomas in children.

Diseases of the liver leads to a complex violations of the hemostasis system during the preservation of unstable balance between coagulation and anticoagulation systems of blood (Minov A.F., a.m., Rummo THE Violation of hemostasis, with the diseases of liver. - Bulletin of Transplantology and artificial organs. - Volume XII №2, 2010. P.82). Hemostasis disorders, developing for hemangiomas liver affect all its links, including a system of fibrinolysis. There are four groups of violations by hemostasis in liver pathology: synthesis reduction coagulation factors; reduction of concentration factors by spending as a result of koagulopatii consumption; synthesis of abnormal clotting factors; quantitative and qualitative changes of platelets; reducing the number of .

In recent years, surgery provides an alternative to method of treatment of liver hemangiomas.

There is a method of Express-estimation of the functional state of hemostasis system. The essence of the method consists in measuring the electrical conductivity of blood samples when passing through it with alternating current with frequency of 200 Hz, write and define it chronometric and amplitude characteristics: amplitude decrease functional curve, mV; T - time reduce the amplitude of functional curve to the minimum value in minutes. With a decrease or increase the value A/T with respect to the norm judge about violations in the system of hemostasis: when values of A/T, equal 3-5, assess the condition of hemostasis as the norm, with values And/T less than 3 identify gipokoagulyatia and settings A/T over 5 - . (Patent RF №2413954).

There is a method of correction of hemostasis system through the use of ozonized physiological solution, in which to obtain effect use a gas mixture containing 800-2000 mg/l of ozone. It passed through capacity with 200 ml of 0.9%solution of sodium chloride for 10 minutes at a speed of gas flow is 0,5-1 l/min misleading intravenous drip at the rate of 5-10 procedures. For acceleration of the blood coagulation for local hemostasis use saline treated with ozone-oxygen gas mixture at the content of ozone 3500-5000 mcg/L. the Method allows to influence the indicators of the system of hemostasis. This increases efficiency and safety of correction hemostasis (RF Patent №2166949). The disadvantage is the lack of any data about the system of hemostasis in patients suffering from liver hemangiomas and its effective correction in the pre - and aftercare period.

There is a method of correction violations of hemostasis, with extensive operations in the hepatopancreatoduodenal zone, including subcutaneous introduction of the Fraxiparine dose of 0.3-0.6 ml, the correction of hemostatic spend intraoperative, and Fraxiparine enter through 40-80 minutes from the beginning of operations in conjunction with intravenous drip of Mexidol, which is injected in a dose of 5-6 mg/kg of the patient's weight, dissolved in 400 ml of 0.9%solution of NaCl, with a speed of 60 drops per minute (RF Patent №2279853).

The disadvantages of this method are the contraindications of Mexidol in violation of the liver and kidneys. For hemangiomas the liver is decreasing levels of prothrombin complex, platelets, the deficit inhibitors violation of blood coagulation and fibrinolysis system, the proposed method has a very low degree of effectiveness of the correction of disorders of hemostasis, as has, in fact, only antitromboticescoe to act in conjunction with the improvement of rheological properties of blood.

This method chosen by us as a prototype.

The objective of the invention is development of effective way of correction of hemostasis system in patients with liver hemangiomas.

Effect : higher efficiency and safety of the method of correction of hemostasis system.

The essence of the invention lies in the fact that 3 days before endovascular embolization of liver hemangiomas spend preoperative correction hemostasis, why prescribe medication 600 at a dose of 20 IU/kg, which is injected intravenously at a speed of not more than 2 ml/min, the first day after surgery again appointed drug 600 at a dose of 20 IU/kg, additionally, with the first day of the postoperative period, appoint hypodermic injection of the drug Fraxiparine, in dosage 158 IU/kg body weight for 3 days.

These assignments are due to the fact that the study in the preoperative period of hemostasis in children suffering from liver hemangiomas, were identified changes in all its segments. Was revealed gipokoagulyatsia, due to the decreased activity of factors protrombinovogo complex. Moreover, changes in both the internal and the external device is not accompanied by a breach of blood clotting final stage. In the study of platelet-vascular hemostasis was noted with and oppression of the inner road of fibrinolysis. All this contributed to the increase of the trend towards increased thrombosis. After conducting of endovascular embolization (occlusion) of liver hemangiomas identified a deficiency of factors of internal and external mechanisms of blood clotting, namely To- factors (II, VII, IX, X, XII). When studying platelet-vascular hemostasis there was an increase of platelet activity and ADP-aggregation with the oppression of the inner road of fibrinolysis high and lower production of antithrombin III. These violations contribute to the emergence of processes . In such a for more predictable course of the disease, and favourable postoperative period was necessary timely and adequate correction of hemostasis, which was the appointment of the drug 600 3 days before endovascular embolization of liver hemangiomas, repeated application of the preparation was carried out after the endovascular embolization on the 1 day of the postoperative period. In parallel with the first day of the postoperative period, was to therapy with Fraxiparine within 3 days.

600 is a complex of factors such as blood clotting, the action of which is based on replacing the missing factors (II, VII, IX and X), providing a haemostatic and restorative effect in patients with deficiency of these factors.

The method is as follows.

To increase protrombinovogo complex, preoperative hemostasis correction begin to 3 days before endovascular embolization of liver hemangiomas. Preparation of the solution of the drug 600 carry out according to the present instruction. The drug is injected slowly, at a speed of not more than 2 ml/min, the dosage of 20 IU/kg Repeated administration of a drug after endovascular embolization of liver hemangiomas on the 1 day of the postoperative period in the same dosage.

In parallel, from the 1 day of the postoperative period within 3 days, exercise therapy with Fraxiparine by subcutaneous administration in the dosage of 158 IU/kg body weight. Correction of hemostatic disorders carry out under the control of the hemostasis system.

Clinical example of the method.

Boy P., 1 year 3 months. Diagnosis: multiple hemangiomas of the right liver lobe. We know from history that when a routine ultrasound of the abdomen were identified multiple focal education right lobe of the liver (cavernous hemangioma?) sizes from 10 x 15 mm to 30 x 50 mm In the preoperative period has conducted a number of instrumental diagnostic studies, including study of hemostasis (all data are relatively normal parameters of hemostasis): in link of hemostasis revealed a reduction in the maximum of the coagulation activity in test (MA ACT) by 11%. Was lengthening of the activated time recalzificace (ABP) 6.1 seconds, activated partial thromboplastin time (APTT) 2.2 seconds. Thrombin and prothrombin time was increased by 1.8 seconds. Moderately decreased number of fibrinogen to 2.7±0.16 g/HP When studying with a snake poison test was extended by 3.4 seconds compared with the control group and made 30.7±0,21". When studying platelet-vascular hemostasis platelet count compared with the control group was reduced to 231,2±10,15±10 9 . The aggregative function with platelet ADP increased by 3.0 seconds. In addition, the increase in the index of platelet activity to 26.5±0.2% and von Willebrand factor (by 17.5%. In the study of fibrinolytic system showed a significant increase XII-dependent fibrinolysis 2.3 minutes. When determining the primary physiological anticoagulants moderate decrease in activity AT III to 97.4 ą 1.3%. Define markers intravascular coagulation shows an increase test 2.3 times, with negative test.

To increase protrombinovogo complex, preoperative correction hemostasis was carried out drug 600 3 days before endovascular embolization. The contents of the vial immediately before use was dissolved in 20 ml of sterile 0.9% sodium chloride solution. The resulting solution should be transparent and should not contain suspended solids. In applying the drug does not require you to define a group and rhesus facilities recipient. The introduction of the preparation was carried out by intravenously, slowly, at a speed of not more than 2 ml/min, the dosage of 20 IU/kg over 3 days underwent endovascular superselective embolization hemangiomas of the right liver lobe areas of PVA and spirals . The condition of the patient corresponded to the gravity and scope of conducted endovascular treatment. Complications were noted. On the 1 day of the postoperative period re-introduction of the drug 600 as described above. On the same day was launched concurrent therapy with Fraxiparine. Drug dosage 158 IU/kg body weight, injected into the patient lying, subcutaneously, in-sided anterolateral or surface of the abdomen. The needle was introduced perpendicular, in fold of skin that is formed by the thumb and forefinger. Skladku skin was maintained during the entire period of the introduction of the drug. Drug Fraxiparine introduced following the above scheme within 3 days of the postoperative period. At the end of therapy Fraxyparina follow-up study of indicators of hemostasis system.

In the result of carried out researches of parameters of hemostasis system on the 3rd day of the postoperative period were revealed the following changes: a study of coagulation hemostasis revealed a slight reduction in the maximum of the coagulation activity in test (MA ACT) by 1.5%. Was lengthening of the activated time recalzificace (ABP) 1.4 seconds, activated partial thromboplastin time (APTT) 2.7 seconds. Revealed a slight increase trombinovogo time of 0.6 seconds with normal prothrombin time 16.1±0.4 sec. Moderately decreased number of fibrinogen to 2.8±0.13 g/L. When studying with a snake poison test extended for 1 second compared to the control group amounted to 28.3±0,52". When studying platelet-vascular hemostasis platelet count compared with the control group did not significantly change (271,2±10 x 10 9 ), does not change the index of the platelet activity (24,4±0,4%). The aggregative function with platelet ADP accelerated slightly (21,5 ą 0.3"). However, there is an increase of von Willebrand factor 13.8%. Study of the fibrinolytic system revealed increase in XII-dependent fibrinolysis 2.4 minutes. When determining the primary physiological anticoagulants moderate decrease in activity AT III to 97.4 ą 1.3%. Define markers intravascular coagulation revealed increase test 1.1 times with negative test. In satisfactory condition the child was discharged.

Thus, changes in the indices in the system of hemostasis on the 3rd day of the postoperative period, after the us of a specific therapy, pointed to the positive dynamics of all the indicators of hemostasis system in comparison to the norm. Was marked by minor gipokoagulyatsia while retaining normal indicators total activity of physiological anticoagulants with minor changes in the vascular- link of hemostasis.

Use of the method can improve the efficacy and safety of correction of violations hemostasis in children with liver hemangiomas.

Method of correction of violations hemostasis in children with liver hemangiomas, including hypodermic injection of the drug antithrombotic activity, such as Fraxiparine, wherein 3 days before endovascular embolization of liver hemangiomas intravenously at a speed of not more than 2 ml/min enter drug plasma factors (II, VII, IX, X) blood clotting, such as 600 at a dose of 20 IU/kg, in the first day after the operation, re-enter the same dosage, and additionally injected subcutaneously Fraxiparine in dosage 158 IU/kg body weight for 3 days.