Method for prevention of diffuse intra- and postoperative blood loss in surgery of abdominal aorta

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiovascular surgery, and concerns preventing a diffuse intra- and postoperative blood loss in surgery of abdominal aorta. To this effect, performing the aortoiliac operations is combined with measuring preoperative antithrombin III; if the measured value is less than 87±3%, a thromboelastography is performed from the moment of an anaesthetic support started with determining a coagulation index. If the coagulation index is less than 2.89±0.25 as early as at the start of the stage of approaching the abdominal aorta, before any surgically significant blood loss, fresh-frozen plasma of the identical group in a min. amount of 600 ml is administered into the patient. If the following dynamic control shows a decrease of the coagulation index below 1.10±0.28, at least 600 ml of fresh-frozen plasma is additionally administered, providing thereby the coagulation index by the end of the operation not less than 0.52±0.27.

EFFECT: method provides effective prevention of intra- and postoperative blood loss by prevention of intraoperative homeostatic disorders.

 

The invention relates to medicine, namely to cardiovascular surgery. When performing operations on the aorto-iliac segment (aneurysm of the aorta, occlusion of the aorta) there is always the risk of intraoperative bleeding is not only due to technical problems executing the action, but also the so-called bleeding parenchymal type, due to the extensive injury to the retroperitoneal space. The main reason for the development of such bleeding is coagulopathy, an extreme expression of which is disseminated intravascular coagulation (DIC) (Robert W. Colman et all., 2001; T. O. DeLoughery, 2004; C. S. Kitchens et all., 2004). According to various estimates coagulopathy occurs in 25-35% of patients after reconstruction of aorto-iliac segment and is a frequent cause of death of patients, which according to some authors can reach 2-20% (Century A. Pokrovsky, 2004; C. M. Samama, 2001).

The problem of development of bleeding of this type is dangerous because the bus stop only surgical methods with a massive injury to the retroperitoneal space and paraaortal fiber is technically very difficult (A. I. Vorobiev et al., 2001). Extensive wound surface is a diffuse ("weeping") field. Through the use of hardware means of preserving blood (the use of the device "CellSaver") for the partially solve the problem on the intraoperative phase, but this does not solve the problem of global correction of the original compromised hemostasis system. So in the early postoperative period, the bleeding may continue. The problem is that the original hemostatic potential in patients with multifocal atherosclerosis lesions already before the operation is shifted towards hypercoagulation and is characterized by the progression of consumption coagulopathy (centuries Debts et al., 2005; A. P. Momot, 2006).

The main component transfusion therapy post-traumatic coagulopathy is fresh frozen plasma (FFP). The need for its timely application anyone no doubt (I. B. Zabolotsky et al., 2004). But under the current regulations (Order of Ministry of health of the Russian Federation of 25 November 2002 N 363) transfusion of blood may be started only when established or continued bleeding.

The proposed method of reducing intraoperative blood loss through correction of hemostasis in patients with reconstruction of aorto-iliac segment based on the developed algorithm performance assessment of hemostasis and a clear definition of the staging component of infusion-transfusion therapy.

As a prototype, we used a method of correction of blood loss by the apparatus of the CSOs saving blood "CellSaver". When using this method, you lose during the operation, blood is collected, mixed with an anticoagulant, is cleared from small pieces of tissue and other macrostructure. Erythrocytes are associated in the process of cleaning by centrifugal forces, while the plasma is removed together with the free hemoglobin, anticoagulant, activated coagulation factor (ACT), activated platelets. After wash cycle, RBC mass poured into the bloodstream.

However, the known method has significant drawbacks:

1. The method is tedious, requires the use of additional expensive, bulky equipment and the availability of expendable property to him.

2. In the process of getting washed erythrocyte mass is permanent loss of plasma (with all plasma coagulation factors) and activated platelets.

The proposed way to reduce intraoperative blood loss in patients during the reconstruction of the aorta-iliac segment is based on proactive "prosthetics" identified preoperatively and growing during the operation of consumption coagulopathy.

The problem is solved in the following way:

- Before the operation the patient is the study of the level of anti-thrombin III. When it is below 87±3% on the day of surgery, since anesthesia oricheskogo benefits is staging, monitoring of plasma and platelet levels of the hemostatic system by means of the method of thromboelastography. When the value of coagulation index below 2,89±0,25, already in the early stages of access to the abdominal aorta, without waiting for any significant surgical blood loss, the patient is injected at least 600 ml single-group of fresh frozen plasma and continues the dynamic monitoring of the coagulation index at all subsequent stages of the operation. At lower values of coagulation index below - 1,10±0,28 additionally enter not less than 600 ml single-group of fresh frozen plasma. By the end of the operation when the ongoing dynamic control of coagulation index, its value should not be below - 0,52±0,27.

The proposed way to reduce intraoperative blood loss in patients during the reconstruction of the aorta-iliac segment used in 48 patients. The indication for surgery was served infrarenal and thoraco-abdominal aneurysm type IV according to Crawford, the occlusion of the aorta. Method of registration was elected thromboelastography, which is recognized by most authors as an effective method of rapid diagnosis of the condition of hemostasis (I. I. Dementieva et al., 2007; M. C. Koh, 2003; B. J. Hunt, 2003; R. A. Swallow et all., 2006). All patients noted significant (P<0.001) and 2.3-fold decrease in operatsionnogo volume of blood loss, compared with the control group, as well as reducing the duration of the operation and stabilization of hemostasis according to intraoperative thromboelastography. All patients noted a smooth postoperative period and the minimum period of recovery after the operation.

As an example, here is an extract from patient records.

The case history of the patient from the main group:

Patient B., 68, history No. 15302/774, was admitted to the vascular surgery Department of surgery faculty Clinics "Samara state medical University" 16.05.2012, the Diagnosis of Atherosclerosis. Aneurysm infrarenal aorta with parietal thrombosis. Ischemic heart disease. Hypertension Art. III, 3 tbsp., risk 4. NYHA II. COPD. Chronic obstructive bronchitis without exacerbation. Computed tomography: the position of the aorta usual, there intrarenal localization of the aneurysm, the form is mixed, fusiform with multiple saccular sizes up to 70 mm, clear contours and smooth, there is heterogeneity in the structure of the lumen of the aorta due to the presence in it of thrombotic masses, Crescent-shaped, the thickness of thrombotic masses on average 28 mm, low density compared to the density values of the functioning of the lumen. 21.07.2012, operated: Bifurcation of aorta-adrenne prosthetics.

Accesses along the line of Ken in the upper third of the thighs selected femoral artery: the left and right tributary adequate; femoral artery - diffuse atherosclerotic change, without hemodynamic significant stenosis.

Median laparotomy. At the stage of selection of the aorta was performed transfusion 600 ml odnogroupna fresh frozen plasma. Over 4 cm below the renal arteries to the bifurcation with the spread of both common iliac arteries mixed aneurysm (fusiform and multiple saccular) to 7.0 cm in diameter with areas of thinning of the wall and intra-parietal thrombosis; one plot saccular bulging almost perforated, covered by a blood clot. NBA - occluded diameter of 2 mm is cut off. The aorta is crossed in the transverse direction at 3 cm below the renal arteries. The proximal anastomosis on the type of "end-to-end between the prosthesis B. Braun Uni-Graft KDV 18*9*9 mm Distal anastomoses: left and right by type of end-to-side with BOTH with the transition to the PBA. Revision on hemostasis and foreign bodies. Suturing the wound closed. Aseptic dressing.

The duration of operation - 230 min, clamping of the aorta - 32 min, blood loss was 350 ml, reinfuse - 0 ml. Smooth postoperative course. Was discharged in good condition after two weeks after the operation.

The case history patients control group:

Patient I., 66 years old, medical history, No. 2783/234, was admitted to the vascular surgery Department of surgery faculty Clinics "Samara state medical University" 17.03.2008, the Diagnosis of Atherosclerosis. Aneurysm infrarenal aorta with parietal thrombosis. Ischemic heart disease. Hypertension Art. III, 3 tbsp., risk 4. NYHA II. COPD. Chronic obstructive bronchitis without exacerbation. Computed tomography: the position of the aorta usual, there intrarenal localization of the aneurysm, the form is mixed, fusiform with a single saccular sizes up to 65 mm, clear contours and smooth, there is heterogeneity in the structure of the lumen of the aorta due to the presence in it of a wall thrombotic masses, the thickness of thrombotic masses on average 15 mm, low density compared to the density values of the functioning of the lumen. 25.03.2008, operated: Bifurcation of aorta-femoral prosthesis. Accesses along the line of Ken in the upper third of the thighs selected femoral artery: the left and right tributary adequate; femoral artery - diffuse atherosclerotic change, without hemodynamic significant stenosis.

Median laparotomy. Beginning with the initial allocation of the aorta using apparatus "CellSaver". Over 4 cm below the renal arteries to the bifurcation with the spread of both common iliac artery the mixed aneurysm (fusiform and isolated saccular) to 6.5 cm in diameter with areas of thinning of the wall and intra-parietal thrombosis. NBA - occluded diameter of 2 mm is cut off. The aorta is crossed in the transverse direction is about 2 cm below the renal arteries. The proximal anastomosis on the type of "end-to-end between the prosthesis B. Braun Uni-Graft KDV 18*9*9 mm Distal anastomoses: left and right by type of end-to-side with BOTH with the transition to the PBA. Technical difficulties are not marked. Diffuse bleeding tissue is maintained throughout the operation. Revision on hemostasis and foreign bodies. Suturing the wound closed. Aseptic dressing. The duration is 280 min, clamping of the aorta - 48 min, estimated blood loss - 780 ml, reinfuse - 220 ml. In the postoperative period was conducted component therapy developed disorders of coagulation hemostasis. Was discharged in good condition after two weeks after the operation.

When applying the method of prevention of diffuse intra-operative blood loss in patients during the reconstruction of the aorta-iliac segment complications due to massive intraoperative blood loss was not observed in any case, in comparison with the prototype, which thrombosis hemorrhagic complications developed in 13% of cases.

Sources of information:

1. Vorobiev, A. I., Gorodetsky C. M., soludo E. M., Vasiliev S. A. Acute massive blood loss. - M.: GEOTAR-MED, 2001, 176 S.

2. Dementieva, I. I., Charney, M. A., Morozov, Y. A., F is Sheva Century, Thromboelastography surgery. - M., 2007.

3. Debt centuries, Svirin P. C. Laboratory diagnosis of disorders of hemostasis. - M., 2005.

4. Zabolotskikh I. B., Sinkov S. C., Averyanov L. E. Protocol for diagnosis and treatment of disseminated intravascular coagulation (DIC) // Clinical anesthesiology and critical care medicine. - 2004, vol. 1, No. 3, S. 89-90.

5. The Ghazanchyan P. O. Popov, C. A. Complications in surgery of aneurysms of the abdominal aorta. - M.: Publishing house of MPEI, 2002, 304 S.

6. Momot A. P. Pathology of hemostasis principles and algorithms for clinical laboratory diagnostics. - SPb., 2006.

7. Pokrovsky A. C. Clinical angiology. - M.: JSC "Publishing house Medicine., 2004, 808 S.

8. T. G. DeLoughery Hemostasis and Thrombosis 2nd Edition. Landes Bioscience, 2004, p.218.

9. Kitchens C. S., Alving C. M., Kessler, C. M. Consultative Hemostasis and Thrombosis. - W. B. SAUNDERS COMPANY, 2004.

10. Koh, M. B., Hunt, B. J. The management of perioperative bleeding. Blood Rev 2003; 17:3:179-185.

11. Robert W. Colman et all. Hemostasis and Thrombosis. Basic Principles and Clinical Practice, 2001.

12. C. M. Samama Perioperative activation of hemostasis in vascular surgery patients // Anesthesiology, 2001, Vol. 94, p.74-78.

13. Swallow R. A., Agarwal R. A., Dawkins, K. D., Curzen N. P. Thromboelastography: potential bedside tool to assess the assess of antiplatelet therapy? // Platelets, 2006, Vol. 17:6, p.385-392.

The way to prevent diffuse intra - and early postoperative blood loss during open surgery on an aneurysm infrarenal aorta, characterized in that before the operation the patient is the study of the level of anti-thrombin III, and so is its value below 87±3% on the day of surgery since anesthesia is a landmark performance monitoring plasma and platelet levels of the hemostatic system by means of the method of thromboelastography and when the value of coagulation index below 2,89±0,25 already in the early stages of access to the abdominal aorta, without waiting for any significant surgical blood loss, the patient is injected at least 600 ml single-group of fresh frozen plasma and continues the dynamic monitoring of the coagulation index at all subsequent stages of operation and at lower values of coagulation index below - 1,10±0,28 additionally enter not less than 600 ml single-group of fresh frozen plasma with continued monitoring of coagulation index and by the end of the operation, the value of coagulation index should not be less than - 0,52±0,27.



 

Same patents:

FIELD: medicine, pharmaceutics.

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36 cl, 18 tbl, 16 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to a composition, adapted for intravenous introduction, intended for the treatment or prevention of pathological processes of crystallisation or calcification in a person, subjected to dialysis. The composition contains inositol phosphate and/or its pharmaceutically acceptable salt, with a dose of inositol phosphate and/or its salt constituting from 1 nmol/kg to 0.1 mil/kg. The invention also relates to a combined method of treatment, including the intravenous introduction of the said composition of the dialysis liquid simultaneously.

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10 cl, 4 dwg, 1 tbl, 9 ex

FIELD: medicine.

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1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine and aims at intraoperative and early postoperative infusion therapy. A method involves administering a crystalloid balanced solution of sterofundin iso and a balanced colloidal solution of tetraspan. In the intraoperative period, sterofundin is administered with tetraspan in the volume ratio 3:1. In the early postoperative period, for the first day, sterofundin and tetraspan are administered in the volume ratio 6:1.

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1 ex, 1 tbl

FIELD: chemistry.

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14 cl, 1 tbl, 3 ex

FIELD: medicine.

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2 ex

FIELD: medicine, pharmaceutics.

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2 cl, 9 ex

FIELD: medicine.

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1 ex

FIELD: medicine.

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3 ex

FIELD: medicine.

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3 ex

FIELD: medicine.

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2 ex

FIELD: medicine.

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2 tbl, 2 ex

FIELD: medicine.

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2 ex

FIELD: medicine, pharmaceutics.

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EFFECT: using the declared group of inventions is effective for cell protection against the cytopathogenic action of hepatitis C virus.

2 cl, 2 tbl, 1 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to the pharmaceutical industry, namely to a method of industrial production of fibrin-monomer from the blood plasma. The method of industrial production of fibrin-monomer from the blood plasma consists in defrosting fresh frozen human plasma with continuous mixing, with further addition into plasma of a saturated ammonium sulphate solution, the obtained mixture is kept at a temperature, after which it is centrifuged, a supernatant liquid is poured out; after that, urea is dissolved in a phosphate buffer and heated, with further dissolution in the buffer of the earlier obtained fibrinogen sediment, then, human thrombin is added and mixed; the mixture is kept at a room temperature, further, the obtained mixture is divided into three parts, the phosphate buffer is introduced into a reservoir with one of the three parts of the initial fibrinogen solution, a fibrin clot, formed in the reservoir is collected, washed in distilled water and pressed, as a result, three washed fibrin clots are obtained, after that, washing of the fibrin clot is repeated two more times in the same way, the final product - fibrin-monomer is obtained by dissolution of the washed fibrin clot in an acetate buffer with urea, the obtained fibrin-monomer is poured into flasks, after that, flasks with fibrin-monomer are frozen and freeze-dried under specified conditions.

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2 ex

FIELD: medicine.

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EFFECT: complete and effective synthesis of the bone tissue continuity by creating conditions of proliferative process isolation and osteoresorption process deceleration in the autogenous bone with no undesired immunological responses in the plasty area.

1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: with underlying conventional treatment, a leukocyte serum preparation is used that is produced by incubation of 20-30 ml of a patient's whole blood bottled in three sealed flasks in a thermostat at a temperature of 37-38°C for 24, 48 and 66-68 hours respectively; then the flasks are removed from the thermostat; the leukocyte serum is aspirated by a sterile syringe; the leukocyte serum preparation prepared at different times is introduced into the patient three times subcutaneously in a dose of 2-5 ml daily or triduan.

EFFECT: method provides higher clinical effectiveness and reduced length of treatment.

2 tbl, 1 ex

FIELD: chemistry.

SUBSTANCE: invention relates to medicine and specifically to trauma surgery and orthopaedics, and can be sued for surgical treatment of ununited fractures and false joints of cylindrical bones when there is a shortage of soft tissue. The method involves, 5-6 days before an operation, performing needle biopsy of bone and soft tissue fragments from the damage centre of the cylindrical bone and determining presence and nature of obligate intracellular viral infection (OIVI). Super-selective angiographic analysis of the microvascular channel to the capillary link is also performed. Valtrex is administered to the patient 2-4 days before the operation in a dose of 500 mg twice a day. Further, the method involves performing osteosynthesis or re-osteosynthesis with resection of the ends of bone fragments, opening marrowy canals, bone stimulation and batting the space of the bone defect with a gel-like nanostructured composite implant. In the presence of OIVI, resection of bone fragments is carried out in a larger volume until the onset of "pinpoint bleeding", i.e. to areas with satisfactory intrabone blood supply. The composite implant contains thrombocyte-rich autoplasma, mixed in ratio of 1:(1-2) with granules of a complex alloplastic preparation (CAP) based on hydroxyapatite which contains 50-60 wt % collagen. The composite implant also contains either 0.08-2.8 wt % colloidal solution of nanoparticles of zero-valent silver metal Ag0, or gold Au0, or copper Cu0, or palladium Pd0, or platinum Pt0, or 5-12 wt % nanoparticles of said metals in dry form. The nanoparticles have size of 2-40 nm. A colloidal solution of said nanoparticles or colloidal nanoparticles of said metals in dry form is added to the CAP granules. Further, the prepared granules of the gel-like complex alloplastic preparation are laid in a selected ratio on the layer of thrombocyte-rich autoplasma, without mixing, for subsequent transfer into the bone defect space. In case of performing resection of bone fragments in a larger volume until the onset of "pinpoint bleeding", corticotomy is further performed on the cylindrical bone being operated on, with subsequent distraction of the bone regenerate using any existing method. Further, the bone fragments are repositioned, followed by metallo-osteosynthesis. Before wound suturing, the surface of the area with shortage of soft tissue in the projection of the ununited fracture and false joints is covered by a semi-permeable flexible plate made of the complex alloplastic preparation based on hydroxyapatite, which contains 50-60 wt % collagen. The plate has thickness of 0.25-1.2 mm. The surface area of the plate is 10-20% greater than the area with shortage of soft tissue in the corresponding projection. The part of the erythrocyte mass remaining from preparing the thrombocyte-rich autoplasma and the plasma are returned into the bloodstream of the patient by intravenously using a drip during the surgical procedure or in the early post-operation period. After the operation, valtrex is administered to the patient in a dose of 500 gm once a day for two weeks and then in a dose of 500 mg every other day for two weeks.

EFFECT: method provides reliable prevention of OIVI at a damage centre, normalisation of local microcirculation of blood, avoiding ischemic processes, and compensation for the shortening of the length of the limb of the patient being operated on while preventing weakening of the process of reparative osteogenesis and allergic reactions of the body.

6 cl, 4 ex

FIELD: medicine.

SUBSTANCE: common procedure is used to prepare platelet rich plasma to be administered at three stages. At the first stage, the platelet rich plasma is injected using an insulin syringe along a lateral surface of a penis in a bilateral direction: the autoplasma 1.0 ml is injected in a proximal, medial and distal direction; totally the autoplasma 3.0 ml is injected into each cavernous body. At the second stage, the autoplasma 2.0 ml is injected under an albugineous coat of the penis under ultrasonic control. The third stage involves injecting the autoplasma into sciatic-cavernous muscles 1.0 ml each with the penis slightly massaged to distribute the autoplasma. The procedure is repeated for three times every 1 week. The method enables stimulating the growth and development of the cavernous vessels promoting its revascularisation, improves the penis innervation, as well as enhances the functional capacities of the endothelium. The higher tone of the sciatic-cavernous muscles promotes better venous-occlusive component.

EFFECT: regular spontaneous sleeping erections, improved morning erections, higher quality of patient's sex life.

1 cl, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used for normalising (improving, recovering, stimulating) the mammalian, especially human, reproductive function. That involves the oral administration of a preparation representing high-lactate milk whey (HLMW) that contains 7% of dry substances, including 5% of milk whey and 2% of sodium hydroxide, or ammonium carbonate, or calcium hydroxide prepared by hydrolysis of milk whey pasteurised at temperature 53-57°C in the culture environment of Lactobacillus acidophilum and Lactobacillus bulgaricum at culture temperature 36 to 40°C and neutralisation of formed lactic acid with sodium hydroxide, or ammonium carbonate, or calcium hydroxide to achieve a weight fraction of lactose no more than 0.2%.

EFFECT: method enables normalising the reproductive function, as well as its usage provides increasing the specific and non-specific body resistance and improving the erythropoiesis.

4 cl, 7 tbl

FIELD: medicine, ophthalmology.

SUBSTANCE: one should apply an autohemocomponent preparation being supernatant liquid of patient's autoblood at increased serotonin content obtained due to irreversible thrombocytic aggregation due to the impact of 0.5 mg ATP per 1.0 ml plasma followed by a 30-min-long centrifuging at the rate of 1000, 2000 and 3000 rot./min for 20, 7 and 3 min, correspondingly. In case of no exudative phenomena on patient's eye bottom the obtained preparation should introduced at the quantity of 7-10 ml once in 48 h for 1 mo (totally, 15 injections). In case of exudative-hemorrhagic phenomena it should be introduced parabulbarly at the volume of 0.5 ml and parenterally - 7.0-10.0 ml once in 48 h for 1 mo per 15 injections, correspondingly. The preparation enables to improve visual functions due to decreased tissue hypoxia and normalization of microcirculation in visual analyzer.

EFFECT: higher efficiency of therapy.

2 cl, 7 dwg, 2 ex

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