Method for pain management following total hip replacement in deforming coxarthrosis

FIELD: medicine.

SUBSTANCE: in the preoperative period, a patient is questioned to determine a degree of manifestation of the length of pain syndrome caused by the presence of deforming coxarthrosis. A diastolic blood pressure and a pulse rate are determined to assess the autonomic nervous system activity by calculating a Kerdo index. A normal autonomic neurotony is presented by the range of values -10≤Kerdo ind.≤10, a prevailing parasympathetic autonomic neurotony is shown by the values of Kerdo ind.<-10, and a sympathetic autonomic neurotony - be the values of Kerdo ind.>10. The venous blood is sampled to analyse the hemocoagulation. The derived parameters are evaluated according to the 3-score scale. The total score is calculated, and the results are used for the purpose of the postoperative pain management using the drug preparations. If the total score is 4-6, a non-selective cyclooxygenase inhibitor is used; the total score of 7-9 enables a selective neuronal K+ channel activator to be preferred, while the total score of 10-12 provides choosing a selective cyclooxygenase-2 inhibitor.

EFFECT: invention provides the more effective postoperative pain management by a rational choice of the drug preparation adequate to functional disorders resulted from the pain syndrome.

3 ex

 

The invention relates to medicine, namely to orthopedics, anesthesiology and intensive care. This solution can be used for analgesia in the early postoperative period when total hip arthroplasty in patients with deforming coxarthrosis stage III.

Known methods of postoperative pain relief, consisting of use of various drugs and methods of their introduction [patent RU invention№212241, №2192859, №2228173].

There is also known a method of pain relief after total hip arthroplasty, in which different patients received on the first day, 4 g perfalgan; double injection of morphine 20 mg+double injection tramadol 100 mg [Information materials, website http://www.consilium-medicum.com/article/10250].

However, these methods are not considered criteria for the selection of drugs for postoperative pain management, based on the severity of pain, the variability of which is determined by individual pain reactivity. Irrational drug choice, without taking into account the characteristics of pain can lead to the development of unwanted side effects and complications.

The closest analogue to the claimed invention is a method of postoperative obtb the management in total hip arthroplasty in patients with deforming coxarthrosis [Emcure O.L. Topical issues of traumatology, orthopedics, neurosurgery and vertebrology: Sat. proc. nauch.-practical use. proc. young, academic Saratov, 30 November 2012 S-23]. On the basis of the obtained by the visual analogue scales of data on the severity of the pain syndrome was carried out by the selection method of postoperative pain management. To do this every 4-6 hours during the day was carried out by introduction of analgesics, namely non-steroidal anti-inflammatory drugs (Ketorolac) in the presence of 1-3 points on the visual analogue scale, opioids medium (tramal) analgesic potential in the presence of 4-6 points on the visual analogue scale and high (promedol) analgesic potential in the presence of 7 or more points on the visual analogue scale.

However, this method does not allow to objectify the severity of the pain syndrome in mind genetically determined pain threshold and subjective perception of pain, and the lack of additional criteria that characterize the system response of the body to pain, which makes it difficult selecting the right drug for postoperative pain management.

The task of the invention is to increase the efficiency of postoperative pain management by ensuring rational drug choice, hell is a cotton evolved as a result of the pain syndrome, functional disturbances.

The essence of the invention is characterized by the fact that in the method of analgesia after total hip arthroplasty in deforming coxarthrosis in the preoperative period to produce a survey of the patient to determine the severity and duration of pain, due to the presence of deforming coxarthrosis, determine diastolic blood pressure, pulse rate, which assess the activity of the autonomic nervous system by calculating the index of Cargo Indk, and for normal tonus of the vegetative nervous system take the value range -10≤INDC≤10, the predominance of parasympathetic tone values Indk<-10, the predominance of sympathetic tone - values Indk>10; taking venous blood and examine the condition of gemokoagulyatsii; estimate the parameters obtained by 3-point scale, where:

the severity of the pain syndrome

weak - 1 point,

medium - 2 points,

strong - 3 points,

the duration of the pain syndrome

up to 5 years - 1 point,

from 5 to 10 years - 2 points,

from 10 years and above 3 points,

the activity of the autonomic nervous system

normal tone - 1 point,

the predominance of parasympathetic tone - 2 points,

the predominance of sympathetic tone - 3 points,

SOS is the right of gemokoagulyatsii

normalise - 1 point,

hypocoagulation - 2 points,

hypercoagulation - 3 points,

carry out the calculation of the amount of points and on the basis of the results obtained in the postoperative period produce analgesia using drugs: if the total points are equal to 4-6, use a non-selective inhibitor of cyclooxygenase, 7-9 - selective activator of neuronal K+channels, with 10-12 - selective inhibitor of cyclooxygenase - 2.

The technical result of the claimed invention.

It is claimed in this application the combination of parameters allows us to objectify the total body's response to chronic pain syndrome that develops in deforming coxarthrosis and leading to impaired activity of the autonomic nervous system and internal organs and functional systems of the body, including coagulation level of hemostasis. This, ultimately, leads to violations of the General functional dynamic homeostasis of the organism. I.e. obtained by data analysis of the four selected authors of the parameters determining the system response of the body to pain, allow rational drug choice in a particular clinical situation that determines personalized approach to tactics poslove which include analgesia and minimizes the risk of complications, in particular thromboembolic. The studied parameters are closely related, namely the autonomic tone is one of the factors determining the severity of the pain syndrome, which is defined based on hemocoagulation potential. Long-existing chronic pain leads to a change in reactivity of the nervous system, including its autonomic tone up to a complete inversion of the features that characterize the predominance of the parasympathetic and sympathetic influences, which, in turn, can lead to changes in the collapsing of the blood system in the form of Hypo - and hypercoagulable.

Application for assessing the status of the autonomic nervous system developed by the authors ranges (extended compared to the one described in literary sources) due to the possibility of exclusion of the influence on the resulting ultimately the result of random factors, namely hypertension, psycho-emotional stress, physical stress, etc.

Developed by the authors 3-point system, in particular, the distribution of signs on points in accordance with the degree of their intensity, allowed to objectively and accurately assess the severity of pain, and consequently, to increase the efficiency primaryeducation drugs for postoperative pain management.

Consideration of the proposed parameters in the preoperative period allows us to estimate the source of pain background and to exclude the influence of surgical stress, which is determined by the adequacy of the selection of medicines for intraoperative anesthesia, trauma operations, volume of blood loss, etc.

The presence of pain determines the choice of drug for postoperative pain management with regard to the pharmacodynamics of the drug and the severity of pain, the mechanisms of which are defined as the mechanical effects of the pathological focus, and development of the inflammatory process that requires a variety of clinical settings prescription with pre-emptive analgesic or anti-inflammatory action. The distribution of drugs within a certain range of total points claimed in this application due to their pharmacological effects.

Method of analgesia after total hip arthroplasty in deforming coxarthrosis is as follows.

Criteria for the selection of patients for the performance of the proposed method are:

- the presence of deforming coxarthrosis stage III, requiring total hip arthroplasty;

- sick t is Gospodinova age;

- the absence of chronic diseases or their remission.

In the preoperative period collect medical history by asking the patient to determine the severity and duration of pain, due to the presence of deforming coxarthrosis. The degree of pain assessed by visual analogue scales, which give the patient, for example, the line length of 10 cm, the ends of which correspond to extreme degrees of severity of pain. The ruler can be both horizontal and vertical. The patient propose to do on this line mark corresponding to the intensity they experienced in the moment of pain. The distance between the end of the line and made a sick mark is measured in inches and rounded. Assess pain as weak when values of 0-3 cm; average - at 4-6 cm, as strong - 7-10 see To assess the severity of the pain syndrome can use other variations of visual analogue scales, which are called graphic rating scales.

Determine diastolic blood pressure and pulse rate. The test should be performed sitting (leaning back in his chair, relaxed and not crossed legs, arm rests on the table at heart level), in a calm atmosphere, after 5-minute rest. During measurement is not possible should actively move and talk.

Taking into account the last two parameters to estimate the activity of the autonomic nervous system. To do this, calculate the index Cargo ind.To=100·(1-DAD/Pulse), where DAD - diastolic blood pressure, mm Hg; Pulse - heart rate, beats per min

For normal tonus of the vegetative nervous system take the value range -10≤ind.To≤10, the predominance of parasympathetic tone values ind.To<-10, the predominance of sympathetic tone - values ind.To>10.

Taking about 10 ml of venous blood. In centrifuge test tube add 1 ml of anticoagulant, and then add the venous blood 10 ml mix Thoroughly without foaming. After 10-15 minutes after blood collection produce centrifugation at 3000 rpm./min 20 min in a centrifuge. Then the plasma is taken into another clean dry test tube and examine tests of coagulation no later than two hours after blood collection with the definition of the parameters: activated partial thromboplastin time APTT, prothrombin time, thromboview time, activated fibrinolysis, fibrinogen and soluble hybridmonolith complexes. Analyzing the studied blood parameters, assess the condition of the gemokoagulyatsii using diagnostic criteria normalerwesie, hypercoagulation, gipokoagulyatsii.

Appreciate all the floor is i.i.d. parameters on 3-point scale, where:

the severity of the pain syndrome

weak - 1 point,

medium - 2 points,

strong - 3 points,

the duration of the pain syndrome

up to 5 years - 1 point,

from 5 to 10 years - 2 points,

from 10 years and above 3 points,

the activity of the autonomic nervous system

normal tone - 1 point,

the predominance of parasympathetic tone - 2 points,

the predominance of sympathetic tone - 3 points,

the state of gemokoagulyatsii

normalise - 1 point,

hypocoagulation - 2 points,

hypercoagulation - 3 points.

Carry out the calculation of the amount of points and on the basis of the results obtained in the postoperative period produce analgesia using drugs. When you receive the amount of points equal to 4-6, use a non-selective inhibitor of cyclooxygenase, such as Ketorolac. When the amount equal 7-9, selective activator of neuronal K+channels, for example, katadolon. When the amount equal to 10-12, selective inhibitor of cyclooxygenase - 2, for example, arcoxia. When the maximum values of the studied traits, i.e. a score of 10-12, and failure actions prescribed drugs in the form of persistent or slowly declining severity of pain, measured by the visual analogue scale of pain once daily, administered in addition to with the collective the inhibitor of cyclooxygenase - 2 using a selective activator of neuronal K+channels.

Example 1.

Patient K., aged 47, joined the Department of orthopedics with complaints of pain in the right hip joint, irradia in the groin, a violation of the support ability of the lower extremity without visual signs of lameness. On the basis of history, clinical and radiographic methods research was diagnosed with "Idiopathic right coxarthrosis stage III", which was the indication for total hip right hip.

During the history taking revealed that the duration of the pain syndrome is 7 years. When determining the degree of severity of pain according to the visual analogue scale in the line the patient noted 3 points, which corresponded to its low degree.

At objective examination blood pressure was 125/75 mm Hg, pulse rate 70 beats per minute. Was calculated index Cargo, which was equal to 7, which corresponded to the normal tonus of the vegetative nervous system.

When clinical and laboratory study of hemostasis showed evidence of normalerwesie.

Estimated parameters obtained by 3-point scale, where a weak degree of pain corresponded to 1 score, duration of existence is the existence of pain, is 7 years, 2 points, normal tonus of the vegetative nervous system - 1 point, normalise - 1 point.

The sum of the score was 5 points. It was decided to use for postoperative pain management non-selective inhibitor of cyclooxygenase.

Under spinal anesthesia, underwent total hip replacement.

In the early postoperative period during the first five days was carried out by the anesthesia drug Ketorolac in tablets of 0.01 g every 6 hours.

The assessment of the degree of pain every day according to the visual analogue scale showed from 0 to 3 points, testified about the effectiveness of analgesia.

Example 2.

Patient R., 51 years old, was admitted in the Department of orthopedics with complaints of pain in the left hip joint, irradia in the groin, a violation of the support ability of the lower limb with visual signs of lameness. On the basis of history, clinical and radiographic methods research was diagnosed with "Idiopathic left coxarthrosis stage III", which was the indication for total hip left hip.

During the history taking revealed that the duration of beings is of the pain syndrome is 9 years. When determining the degree of severity of pain according to the visual analogue scale in the line, the patient noted 6 points, which corresponded to the middle class.

At objective examination blood pressure was 140/90 mm Hg, pulse rate 70 beats per minute. Was calculated index Cargo, which was equal to 28, which corresponded to the predominance of parasympathetic tonus of the vegetative nervous system.

When clinical and laboratory study of hemostasis showed evidence gipokoagulyatsii.

Estimated parameters obtained by 3-point scale, where the average severity of pain was consistent with 2 points, duration of pain, is 9 years, 2 points, the predominance of parasympathetic tonus of the vegetative nervous system - 2 points, hypocoagulation - 2 points.

The sum of the score was 8 points. It was decided to use for postoperative pain management is a selective activator of neuronal K+channels.

Under spinal anesthesia, underwent total arthroplasty of the left hip.

In the early postoperative period during the first five days was carried out by the anesthesia drug drug katadolon in tablets of 100 mg every 6 hours.

The assessment of the degree to which ragonetti pain syndrome every day according to the visual analogue scale showed from 1 to 4 points, that testified to the effectiveness of analgesia.

Example 3.

Patient E., 39 years old, was admitted in the Department of orthopedics with complaints of pain in the left hip joint, irradia in the groin, a breach of support ability, LLD with severe visual signs of lameness. On the basis of history, clinical and radiographic methods research was diagnosed: "Dysplastic left coxarthrosis stage III with elements racemose realignment of the femoral head", which was the indication for total hip left hip.

During the history taking revealed that the duration of the pain syndrome is 14 years. When determining the degree of severity of pain according to the visual analogue scale in the line, the patient noted 9 points, which corresponded to its strong degree.

At objective examination blood pressure was 135/75 mm Hg, pulse rate is 100 beats per minute. Was calculated index Cargo, which was equal to 25, which corresponded to the prevalence of sympathetic autonomic nervous system.

When clinical and laboratory study of hemostasis showed evidence of hypercoagulability.

Estimated parameters obtained by 3-Ballin the th scale where the average severity of pain was consistent with 3 points, duration of pain, is 14 years, 3 points, the prevalence of sympathetic autonomic nervous system - 3 points, hypercoagulation - 3 points.

The sum of the score was 12 points. It was decided to use for postoperative pain management is a selective inhibitor of cyclooxygenase - 2.

Under spinal anesthesia, underwent total arthroplasty of the left hip.

In the early postoperative period during the first five days was carried out by the anesthesia drug, arcoxia in tablets of 90 mg every 24 hours.

The assessment of the degree of pain every day according to the visual analogue scale showed from 1 to 5 points, testified about the effectiveness of analgesia.

Method of analgesia after total hip arthroplasty in deforming coxarthrosis, characterized in that in the preoperative period to produce a survey of the patient to determine the severity and duration of pain, due to the presence of deforming coxarthrosis, determine diastolic blood pressure, heart rate, according to the who estimate the activity of the autonomic nervous system by calculating the index of Cargo ind. Toand for the normal tonus of the vegetative nervous system take the value range -10≤ind.To≤10, the predominance of parasympathetic tone values ind.To<-10, the predominance of sympathetic tone - values ind.To>10; taking venous blood and examine the condition of gemokoagulyatsii; estimate the parameters obtained by 3-point scale, where:
the degree of pain
weak - 1 point,
medium - 2 points
strong - 3 points
the duration of the pain syndrome
up to 5 years - 1 point,
from 5 to 10 years - 2 points
from 10 years and above 3 points,
the activity of the autonomic nervous system
normal tone - 1 point,
the predominance of parasympathetic tone - 2 points
the predominance of sympathetic tone - 3 points
the state of gemokoagulyatsii
normalise - 1 point,
hypocoagulation - 2 points
hypercoagulation - 3 points
carry out the calculation of the amount of points and on the basis of the results obtained in the postoperative period produce analgesia using drugs: if the total points are equal to 4-6, - use non-selective inhibitor of cyclooxygenase, 7-9 - selective activator of neuronal K+channels, with 10-12 - selective inhibitor of cyclooxygenase - 2.



 

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2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: rheoencephalography (REG) is performed to measure a cerebrovascular reactivity index during hypercapnia, to record audio and cognitive induced potentials, to measure N2 spike amplitude of the audio induced potentials, length of latency P300, and blood plasma noradrenaline. A canonical variate (Cv) is calculated including the derived values. If Cv is equal to or more than a constant, the presence of the early manifestations of mercurial intoxication is stated; Cv being less than a constant enables diagnosing first degree of chronic mercurial intoxication.

EFFECT: method provides more reliable assessment that is ensured by selecting more informative values.

2 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: circulatory reserve coefficient and coefficient of respiratory changes in stroke volume are calculated. If the circulatory reserve coefficient is more than 130%, while the coefficient of respiratory changes in stroke volume is more than 140% 30-40 minutes later, a clinical manifestation of the recurrent gastrointestinal haemorrhage is predicted.

EFFECT: method enables high-sensitivity, high-specificity and non-invasive prediction of the recurrent gastrointestinal haemorrhage in the patients suffering non-varicose gastrointestinal haemorrhage 30-40 minutes before the clinical manifestation that is ensured by informativity, reliability and timeliness of the detected hemodynamic parameters the variation of which is more sensitive to the internal haemorrhage renewal.

1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment. A blood pressure metre comprises a first pneumatic chamber in a first cuff applied on a shoulder, a second pneumatic chamber in a second cuff applied on a lower limb, a measuring unit for synchronous blood pressure measurement in the first and second chambers, a detection unit for obtaining first and second blood pressure values by measuring internal pressure in the first and second pneumatic chambers respectively, and a computer assembly. The computer assembly performed a first computing procedure of calculating a first pulse wave velocity derived from the first and second blood pressure values, and a detection procedure to detect applicability of the first pulse wave velocity using the first and/or second blood pressure value.

EFFECT: using the invention enables providing higher accuracy of blood pressure measurement in arteriosclerosis.

7 cl, 10 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment. A blood pressure metre comprises a first pneumatic chamber in a first cuff applied on a shoulder, a second pneumatic chamber in a second cuff applied on a lower limb, a measuring unit for synchronous blood pressure measurement in the first and second chambers, a detection unit for obtaining first and second blood pressure values by measuring internal pressure in the first and second pneumatic chambers respectively, and a computer assembly. The computer assembly performed a first computing procedure of calculating a first pulse wave velocity derived from the first and second blood pressure values, and a detection procedure to detect applicability of the first pulse wave velocity using the first and/or second blood pressure value.

EFFECT: using the invention enables providing higher accuracy of blood pressure measurement in arteriosclerosis.

7 cl, 10 dwg

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine. A method for measuring blood pressure is implemented by an electronic sphygmomanometer. That is combined with obtaining the information describing a set of types of various measurement conditions at the moment of current blood pressure measurement by means of obtaining the condition information. The various measurement conditions are stored at the moment of measurement at the moment of measurement together with blood pressure by means of a recorder. The blood pressure measurement parameter is corrected using an information record by a corrector, when the information record of the previous measurement close to the various measurement conditions at the moment of the measurement is obtained by using the information record from the recorder. The stage of obtaining the information record close to the various measurement conditions is configured to extract the information record of the measurement with the most matching measurement conditions.

EFFECT: using the group of inventions enables specifying the optimum measurement parameter for specific user by correcting on the basis of the information record of the previous measurement close to the conditions at the moment of the measurement.

6 cl, 6 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment. A medical sleep-disordered breathing detector comprises an adhesive plaster for attaching the detector to a human body, a microphone for controlling respiratory murmur, and logical units for analysing respiratory murmur. The microphone is coupled with the logical units to transmit signals. The microphone and logical units are integrated into the adhesive plaster. The logical units are connected with output media for respiratory murmur analysis result. With the detector fixed on the human body, the microphone is immediately adjacent to the neck skin around the carotid artery and/or on the chest.

EFFECT: using the invention enables the unassisted domestic control of respiratory disturbances to be early detected.

9 cl, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves recording heart beat rate and systolic arterial blood pressure before and after two-stage exercise stress. The first stage is of 50 W within 3 min and the second one is of 75 W during 2 min. Patient rest pause is available between loading stages to recover initial heart beat rate. Prognostic estimation of cardiopulmonary complications is carried out with mathematical formula applied.

EFFECT: reduced risk of complications in performing tests.

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