RU2706541C1 - Method for assessing the quality of preoperative preparation in patients with connective tissue dysplasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for assessing the quality of preoperative preparation in patients with connective tissue dysplasia. Level of alkaline phosphatase (E/l) and a level of matrix metalloproteinase IX (ng/ml) are determined. Examination is carried out at hospital admission and 6 hours prior to the operation; the ratio of the level of matrix metalloproteinase IX to alkaline phosphatase is calculated. If this ratio increases by 13 % and more, the preoperative preparation is qualitatively conducted, and the surgical operation can be performed. Otherwise, preoperative preparation is not performed qualitatively and it is recommended to postpone the surgical period.

EFFECT: method provides reliable detection of patients with low quality of preoperative preparation among surgical patients with connective tissue dysplasia due to analysis of clinical-biochemical laws of development of wound process on connective tissue dysplasia.

1 cl, 2 ex

Description

FIELD OF THE INVENTION

The invention relates to medicine, namely to surgery.

State of the art

Connective tissue dysplasia is a group of systemic diseases of the connective tissue caused by impaired development of the connective tissue in the embryonic and postnatal periods and manifested by various pathological signs that are somehow related to defects in the fibrous structures and / or the main substance of the connective tissue. Differentiated forms of connective tissue dysplasia (Ehlers-Danlos, Marfan, Stickler syndromes, imperfect osteogenesis, etc.) are distinguished - diagnosis is possible due to the vivid clinical manifestations of hereditary syndromes, and undifferentiated forms of connective tissue dysplasia - diagnosis requires additional research methods due to the polymorphism of symptoms .

When planning preoperative preparation in the National Guidelines for the management of patients with connective tissue dysplasia, it was proposed to supplement the existing protocols and standards with the appointment of magnesium preparations, B and C vitamins, levocarnitine, chondroprotectors and other measures. However, to date, there are no clear indications for a change in the scheme of preoperative preparation in such patients, which makes it difficult to justify the additional spending of funds by a medical institution. On the other hand, the occurrence of early or late postoperative complications leads to a fine imposed by the MHIF or by an insurance company on a medical institution. Our development allows us to solve this problem.

As a prototype, we adopted the description of the "Method for evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis" (RF patent for the invention No. 2191386 from 11/22/2000). The authors propose evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis by analyzing hemodynamics and immune status, characterized in that before and after preoperative preparation, quantitative and qualitative indicators of tissue hemodynamics of the thyroid gland are determined by ultrasound dopplerography and the levels of concentration of immunoglobulin G and circulating immune complexes in blood serum and when normalized, they consider preoperative preparation effective and complete true, and when the values of the determined indicators are above the norm, they consider 2-3 times the preoperative preparation ineffective and incomplete.

We can say that the hemodynamic assessment in the area of operation and the state of immunity of the patient are used. However, this method has the following disadvantages:

1) indicators of the immune response are used, which can give a false positive or false negative result in patients who have had acute respiratory infections, in patients with chronic persistent infection and in patients with impaired immune systems;

2) an ultrasound dopplerographic examination is required, which is not provided for in most standards for the provision of medical services and should be paid for at the expense of the patient;

3) the appointment of determining the level of concentration of immunoglobulin G and circulating immune complexes in serum can be carried out within the framework of the compulsory medical insurance policy only if there is a concomitant diagnosis - immunodeficiency, which will require additional examination according to the protocol and will raise questions from the insurance company or MHIF.

Thus, the development of a new method for assessing the quality of preoperative preparation in patients with connective tissue dysplasia is required. In the claimed method, the listed disadvantages are eliminated.

Disclosure of invention

The objective of the invention is to improve the quality of medical services to the population, by assessing the quality of preoperative preparation in patients with connective tissue dysplasia.

The technical result of the method is to ensure reliable identification of patients with low quality of preoperative preparation among surgical patients with connective tissue dysplasia, by analyzing the clinical and biochemical patterns of development of the wound process, against the background of connective tissue dysplasia.

The implementation of the invention

The claimed technical result can be achieved as follows:

- When a patient is admitted to a surgical hospital, a biochemical blood test is taken, including determining the level of matrix metalloproteinase IX (ng / ml), and the level of alkaline phosphatase (E / L).

- Preoperative preparation is carried out in accordance with the standards and protocols in force for this nosology

- 6 hours before surgery, the study is repeated.

- Patients with decompensated connective tissue dysplasia are characterized by a decrease in the level of matrix metalloproteinase IX and an increase in alkaline phosphatase. Moreover, the more pronounced dysplastic process, the greater the differences in indicators, compared with the average population values.

- If the preoperative preparation did not take into account the patient’s dysplastic process, then before the operations there will either be no change in these indicators, or the negative tendency to worsen. While when prescribing additional drugs, whose effect can normalize the metabolic manifestations of connective tissue dysplasia, the studied parameters will return to the average population, which will lead to an increase in the ratio of the level of matrix metalloproteinase IX to the level of alkaline phosphatase; at the same time, an increase in this ratio by 13% or more will be diagnostically significant.

The novelty of the proposed method is that:

- for the first time, to assess the quality of preoperative preparation in patients with connective tissue dysplasia, the indicators indicated in the clinical guidelines for the treatment and examination of patients with connective tissue dysplasia are used, namely, the level of alkaline phosphatase (E / L) and the level of matrix metalloproteinase IX (ng / ml) ;

- for the first time, a method of assessing the patient's readiness for surgery, independent of the subjective opinion of the doctor, appears.

- the study is carried out using ready-made factory laboratory test systems, which reduces the risk of erroneously overestimated or erroneously underestimated results of the analysis.

Distinctive features of the method:

- the study is carried out upon admission to the hospital and 6 hours before surgery,

- calculate the ratio of the level of matrix metalloproteinase IX to the level of alkaline phosphatase,

- with the increase of this ratio by 13% or more, preoperative preparation is carried out qualitatively, and the surgical operation can be performed, otherwise the preoperative preparation is not performed qualitatively, and it is recommended to postpone the term of the surgical operation.

The proposed method is illustrated by the following examples.

Clinical example No. 1.

Patient K., 41 years old, has phenotypic signs of connective tissue dysplasia. Received in a surgical hospital for elective surgery for cholelithiasis. Upon admission, a biochemical blood test was performed: the level of matrix metalloproteinase IX is 436.97 ng / ml, and the level of alkaline phosphatase is 544.51 U / L. Postoperative preparation was carried out in accordance with the treatment protocol. A second biochemical blood test was performed 6 hours before surgery: the level of matrix metalloproteinase IX is 407.34 ng / ml, and the level of alkaline phosphatase is 569.27 U / L. Thus, in the second analysis, a decrease (by 10%) in the ratio of the level of matrix metalloproteinase IX to the level of alkaline phosphatase is observed.

Consequently, the volume and quality of the preoperative preparation was insufficient to compensate for dysplastic changes and taxation may develop during the operation. Recommended to reschedule a scheduled operation.

Clinical example No. 2.

The patient, aged 35, has phenotypic signs of connective tissue dysplasia. He entered a surgical hospital for elective surgery for an inguinal hernia. On admission, a biochemical blood test was performed: the level of matrix metalloproteinase IX is 446.35 ng / ml, and the level of alkaline phosphatase is 537.64 U / L. Postoperative preparation was carried out in accordance with the treatment protocol. A second biochemical blood test was performed 6 hours before surgery: the level of matrix metalloproteinase IX is 524.12 ng / ml, and the level of alkaline phosphatase is 505.56 U / L. Thus, in the second analysis, an increase (by 25%) in the ratio of the level of matrix metalloproteinase IX to the level of alkaline phosphatase is observed.

Consequently, the volume and quality of preoperative preparation was sufficient to compensate for dysplastic changes. It is recommended to carry out a planned operation.

Claims (1)

A method for assessing the quality of preoperative preparation in patients with connective tissue dysplasia, which consists in determining the level of alkaline phosphatase (E / L) and the level of matrix metalloproteinase IX (ng / ml), characterized in that the study is carried out upon admission to the hospital and 6 hours before by operation, the ratio of the level of matrix metalloproteinase IX to the level of alkaline phosphatase is calculated, with an increase in this ratio by 13% or more, the preoperative preparation is qualitatively performed, and the surgical operation can can be performed, otherwise the preoperative preparation is not performed well and it is recommended to postpone the term of the surgical operation.