MD655Z - Method of wound hemostasis after necrectomy in patients with severe coagulopathies against decompensated hepatic cirrhosis - Google Patents
Method of wound hemostasis after necrectomy in patients with severe coagulopathies against decompensated hepatic cirrhosisInfo
- Publication number
- MD655Z MD655Z MDS20120156A MDS20120156A MD655Z MD 655 Z MD655 Z MD 655Z MD S20120156 A MDS20120156 A MD S20120156A MD S20120156 A MDS20120156 A MD S20120156A MD 655 Z MD655 Z MD 655Z
- Authority
- MD
- Moldova
- Prior art keywords
- necrectomy
- patients
- thrombin
- cryoprecipitate
- dose
- Prior art date
Links
- 238000000034 method Methods 0.000 title claims abstract description 17
- 230000023597 hemostasis Effects 0.000 title claims abstract description 12
- 206010053567 Coagulopathies Diseases 0.000 title claims abstract description 9
- 208000019425 cirrhosis of liver Diseases 0.000 title claims abstract description 9
- 108090000190 Thrombin Proteins 0.000 claims abstract description 16
- 229960004072 thrombin Drugs 0.000 claims abstract description 16
- 108010049003 Fibrinogen Proteins 0.000 claims abstract description 8
- 102000008946 Fibrinogen Human genes 0.000 claims abstract description 8
- 229940012952 fibrinogen Drugs 0.000 claims abstract description 8
- 108010054218 Factor VIII Proteins 0.000 claims abstract description 6
- 102000001690 Factor VIII Human genes 0.000 claims abstract description 6
- 229940105778 coagulation factor viii Drugs 0.000 claims abstract description 6
- 239000000203 mixture Substances 0.000 claims abstract description 6
- 206010052428 Wound Diseases 0.000 claims description 20
- 208000027418 Wounds and injury Diseases 0.000 claims description 20
- 208000015294 blood coagulation disease Diseases 0.000 claims description 4
- 239000003814 drug Substances 0.000 abstract description 2
- 230000001338 necrotic effect Effects 0.000 description 8
- 210000001519 tissue Anatomy 0.000 description 7
- 208000032843 Hemorrhage Diseases 0.000 description 5
- 230000000740 bleeding effect Effects 0.000 description 4
- 230000001788 irregular Effects 0.000 description 4
- 238000011477 surgical intervention Methods 0.000 description 4
- 238000001356 surgical procedure Methods 0.000 description 3
- 238000002560 therapeutic procedure Methods 0.000 description 3
- 108010094028 Prothrombin Proteins 0.000 description 2
- 102100027378 Prothrombin Human genes 0.000 description 2
- 206010041660 Splenomegaly Diseases 0.000 description 2
- 208000025865 Ulcer Diseases 0.000 description 2
- 230000003115 biocidal effect Effects 0.000 description 2
- 244000309466 calf Species 0.000 description 2
- 230000009852 coagulant defect Effects 0.000 description 2
- 239000000306 component Substances 0.000 description 2
- 238000003745 diagnosis Methods 0.000 description 2
- 210000003743 erythrocyte Anatomy 0.000 description 2
- 201000004108 hypersplenism Diseases 0.000 description 2
- 210000003141 lower extremity Anatomy 0.000 description 2
- 208000007232 portal hypertension Diseases 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
- 238000011321 prophylaxis Methods 0.000 description 2
- 229940039716 prothrombin Drugs 0.000 description 2
- 230000001172 regenerating effect Effects 0.000 description 2
- 231100000397 ulcer Toxicity 0.000 description 2
- 206010051814 Eschar Diseases 0.000 description 1
- 206010060840 Ischaemic cerebral infarction Diseases 0.000 description 1
- 206010033892 Paraplegia Diseases 0.000 description 1
- 206010040047 Sepsis Diseases 0.000 description 1
- 208000014306 Trophic disease Diseases 0.000 description 1
- 206010048038 Wound infection Diseases 0.000 description 1
- 239000003242 anti bacterial agent Substances 0.000 description 1
- 229940088710 antibiotic agent Drugs 0.000 description 1
- 239000012503 blood component Substances 0.000 description 1
- 230000015271 coagulation Effects 0.000 description 1
- 238000005345 coagulation Methods 0.000 description 1
- 230000003831 deregulation Effects 0.000 description 1
- 238000001784 detoxification Methods 0.000 description 1
- 230000018109 developmental process Effects 0.000 description 1
- 231100000333 eschar Toxicity 0.000 description 1
- 238000005469 granulation Methods 0.000 description 1
- 230000003179 granulation Effects 0.000 description 1
- 230000007170 pathology Effects 0.000 description 1
- 230000008929 regeneration Effects 0.000 description 1
- 238000011069 regeneration method Methods 0.000 description 1
- 210000000954 sacrococcygeal region Anatomy 0.000 description 1
- 210000004872 soft tissue Anatomy 0.000 description 1
- 208000011580 syndromic disease Diseases 0.000 description 1
- 201000005060 thrombophlebitis Diseases 0.000 description 1
- 210000003462 vein Anatomy 0.000 description 1
Landscapes
- Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)
- Materials For Medical Uses (AREA)
Abstract
Description
Invenţia se referă la medicină, în special la metode de hemostază a plăgilor după necrectomie la pacienţii cu coagulopatii severe pe fundal de ciroză hepatică decompensată. The invention relates to medicine, in particular to methods of hemostasis of wounds after necrectomy in patients with severe coagulopathies on the background of decompensated liver cirrhosis.
Este cunoscută metoda de hemostază a plăgilor după necrectomie la pacienţii cu coagulopatii severe care costă în efectuarea tamponadei compresive cu meşe de tifon a plăgilor neregulate după excizia ţesuturilor necrotizate [1]. The method of hemostasis of wounds after necrectomy in patients with severe coagulopathies is known, which costs in performing compressive tamponade with gauze of irregular wounds after excision of necrotic tissues [1].
Dezavantajele metodei constau în aceea că are loc hemostaza temporară a plăgii cu hemoragie profuză şi dereglarea drenării plăgii, ceea ce duce la complicaţii septice cu necesitatea aplicării antibioticoterapiei şi prelungirea perioadei de spitalizare a pacientului. The disadvantages of the method consist in the fact that there is temporary hemostasis of the wound with profuse bleeding and the deregulation of wound drainage, which leads to septic complications with the need to apply antibiotic therapy and prolong the patient's hospitalization period.
Este cunoscută metoda de hemostază a plăgilor după necrectomie la pacienţii cu coagulopatii severe care constă în aplicarea peliculei biologice (tahacom) pe plagă, unde 1 cm2 conţine 5,5 mg de fibrinogen şi 2,0 UI de trombină [2]. The method of hemostasis of wounds after necrectomy in patients with severe coagulopathy is known, which consists in applying the biological film (tahacom) to the wound, where 1 cm2 contains 5.5 mg of fibrinogen and 2.0 IU of thrombin [2].
Dezavantajele metodei constau în aceea că este foarte costisitoare, totodată este imposibil de a fi aplicată pe o suprafaţă neregulată după înlăturarea ţesuturilor necrotizate şi necesită aplicarea mai multor pelicule biologice. The disadvantages of the method consist in the fact that it is very expensive, at the same time it is impossible to be applied on an irregular surface after the removal of necrotic tissues and requires the application of several biological films.
Problema pe care o rezolvă invenţia constă în elaborarea unei metode de hemostază a plăgilor după necrectomie la pacienţii cu coagulatorii severe pe fondal de ciroză hepatică decompensată, care să producă o hemostază rapidă şi eficientă în timp redus pentru plăgi neregulate cu posibilitatea aplicării în condiţii de ambulatoriu fără utilizarea unui aparataj specializat în caz de hemoragii profuze. The problem that the invention solves consists in the development of a method of hemostasis of wounds after necrectomy in patients with severe coagulators on the background of decompensated liver cirrhosis, which produces a fast and effective hemostasis in a short time for irregular wounds with the possibility of application in outpatient conditions without the use of specialized equipment in case of profuse bleeding.
Conform invenţiei, metoda revendicată constă în aceea că pe plagă se aplică o meşă de tifon cu suprafaţa de 100 cm2, în două straturi, îmbibată cu un amestec ce conţine crioprecipitat şi trombină, luate în raport de 2:4 doze respectiv, unde o doză de crioprecipitat conţine factorul de coagulare VIII în cantitate de 100 UI şi 250 mg de fibrinogen, iar o doză de trombină conţine 125 UI. According to the invention, the claimed method consists in the fact that a gauze mesh with a surface of 100 cm2, in two layers, soaked with a mixture containing cryoprecipitate and thrombin, taken in a ratio of 2:4 doses respectively, is applied to the wound, where a dose of cryoprecipitate contains coagulation factor VIII in an amount of 100 IU and 250 mg of fibrinogen, and a dose of thrombin contains 125 IU.
Rezultatul invenţiei constă în efectuarea unei hemostaze rapide şi eficiente a plăgilor neregulate după înlăturarea ţesuturilor necrotizate cu regenerarea mai rapidă a plăgilor, profilaxia complicaţiilor purulente în plagă şi micşorarea perioadei de spitalizare a pacientului cu ciroză hepatică decompensată ce provoacă dereglări de coagulare severe. The result of the invention consists in performing a rapid and efficient hemostasis of irregular wounds after the removal of necrotic tissues with faster wound regeneration, prophylaxis of purulent complications in the wound and reduction of the hospitalization period of the patient with decompensated liver cirrhosis that causes severe coagulation disorders.
Avantajele metodei constau în aceea că la aplicarea meşelor îmbibate cu crioprecipitat, care conţine fibrinogen, se obţine o coagulare rapidă a plăgilor după înlăturarea ţesuturilor necrotizate, ca rezultat are loc profilaxia complicaţiilor purulente în plagă, ceea ce duce la micşorarea perioadei de spitalizare a pacientului cu patologii ce provoacă dereglări de coagulare severe. The advantages of the method consist in the fact that when applying gauze soaked with cryoprecipitate, which contains fibrinogen, a rapid coagulation of the wounds is obtained after the removal of necrotic tissues, as a result, the prophylaxis of purulent complications in the wound takes place, which leads to the reduction of the hospitalization period of the patient with pathologies that cause severe coagulation disorders.
Metoda se efectuează în modul următor. The method is performed as follows.
După internare, pacientul, care în cele mai dese cazuri este în stare decompensată, este pregătit pentru intervenţie chirurgicală, fiind investigat clinic şi paraclinic. Se efectuează intervenţia chirurgicală cu înlăturarea ţesuturilor necrotizate, apoi pe plaga cu hemoragie profuză, prelucrată preliminar cu soluţie de H202 de 3%, se aplică meşe de tifon cu suprafaţa de 100 cm2 îmbibate cu un amestec de crioprecipitat şi trombină, luate în raport de 4 doze de trombină la 2 doze de crioprecipitat, unde o doză de crioprecipitat conţine factorul de coagulare VIII în cantitate de 100 UI şi 250 mg de fibrinogen, iar o doză de trombină conţine 125 UI. After hospitalization, the patient, who in most cases is in a decompensated state, is prepared for surgical intervention, being clinically and paraclinically investigated. The surgical intervention is performed with the removal of the necrotic tissues, then on the wound with profuse hemorrhage, preliminarily treated with a 3% H202 solution, gauze pads with a surface area of 100 cm2 soaked with a mixture of cryoprecipitate and thrombin, taken in a ratio of 4 doses of thrombin to 2 doses of cryoprecipitate, where one dose of cryoprecipitate contains coagulation factor VIII in the amount of 100 IU and 250 mg of fibrinogen, and one dose of thrombin contains 125 IU.
Metoda revendicată a fost aplicată la 14 pacienţi cu dereglări trofice şi ulcere necrotice masive ale ţesuturilor moi la membrele inferioare, şi anume în regiunea gambelor şi plantelor, cauzate de sindromul postromboflebitic sau de tromboflebite ale venelor membrelor inferioare asociate cu coagulopatii severe pe fondal de ciroză hepatică decompensată. The claimed method was applied to 14 patients with trophic disorders and massive necrotic ulcers of the soft tissues of the lower limbs, namely in the calf and plantar region, caused by post-thrombophlebitic syndrome or thrombophlebitis of the veins of the lower limbs associated with severe coagulopathies on the background of liver cirrhosis decompensated.
Exemplul 1 Example 1
Pacientul A., 52 ani, a fost internat în secţia chirurgie septică cu diagnosticul: ciroză hepatică decompensată, hipertensiune portală. Splenomegalie. Hipersplenism. Ulcer necrotic masiv în regiunea gambei stângi. La internare: protombina 50%, trombocite 52x109 ml, Hb 80 g/l, eritrocite 2,8x1012/l. Pacientul a fost pregătit pentru intervenţie chirurgicală, după aceasta a fost supus necrectomiei în limitele ţesuturilor sănătoase cu utilizarea metodei revendicate, şi anume s-au aplicat meşe de tifon, cu o suprafaţă de 100 cm2, îmbibate cu un amestec de crioprecipitat şi trombină. Concentraţia componentelor este de 4 doze de trombină la 2 doze de crioprecipitat, unde o doză de crioprecipitat conţine factorul de coagulare VIII în cantitate de 100 UI şi 250 mg de fibrinogen, la care se adaugă trombină cu concentraţia unei doze de 125 UI. Hemostaza a fost eficientă şi rapidă. După înlăturarea meşelor peste 24 ore, plaga fără semne de hemoragie activă. S-au utilizat preparate regenerative, la externare starea satisfăcătoare. Patient A., 52 years old, was hospitalized in the septic surgery department with the diagnosis: decompensated liver cirrhosis, portal hypertension. Splenomegaly. Hypersplenism. Massive necrotic ulcer in the region of the left calf. On admission: prothrombin 50%, platelets 52x109 ml, Hb 80 g/l, erythrocytes 2.8x1012/l. The patient was prepared for surgical intervention, after which he was subjected to necrectomy within the limits of healthy tissues using the claimed method, i.e. gauze pads, with an area of 100 cm2, soaked with a mixture of cryoprecipitate and thrombin were applied. The concentration of the components is 4 doses of thrombin to 2 doses of cryoprecipitate, where one dose of cryoprecipitate contains coagulation factor VIII in the amount of 100 IU and 250 mg of fibrinogen, to which is added thrombin with the concentration of a dose of 125 IU. Hemostasis was efficient and fast. After removal of meshes over 24 hours, the wound without signs of active bleeding. Regenerative preparations were used, at discharge the condition was satisfactory.
Exemplul 2 Example 2
Pacienta K., 62 ani, a fost internată în secţia chirurgie septică cu diagnosticul: ciroză hepatică decompensată, hipertensiune portală. Splenomegalie. Hipersplenism. Stare după infarct cerebral ischemic. Paraplegie pe stânga. Escare masive necrotice în regiunea sacrală. Sepsis. La internare protrombina 56%, trombocite 47x1012/l ml, Hb 70 g/l, eritrocite 2,5x109. Pacienta a fost pregătită pentru intervenţie chirurgicală, după aceasta a fost supusă necrectomiei în limitele ţesuturilor sănătoase cu aplicarea metodei revendicate, şi anume s-au aplicat meşe de tifon, cu o suprafaţă de 100 cm2, îmbibate cu un amestec de crioprecipitat şi trombină. Concentraţia componentelor este de 4 doze de trombină la 2 doze de crioprecipitat, unde o doză de crioprecipitat conţine factorul de coagulare VIII în cantitate de 100 UI şi 250 mg fibrinogen, la care se adaugă trombină cu concentraţia unei doze de 125 UI. Concomitent s-a utilizat antibioterapia cu antibiotice de spectru larg şi terapia de dezintoxicare. Transfuzii de componente sangvine. Hemostaza a fost eficientă şi rapidă. După înlăturarea meşelor peste 24 ore, plaga fără semne de hemoragie activă. S-au utilizat preparate regenerative. În faza de granulare peste 4 săptămâni pacienta a fost externată. Patient K., 62 years old, was admitted to the septic surgery department with the diagnosis: decompensated liver cirrhosis, portal hypertension. Splenomegaly. Hypersplenism. Condition after ischemic cerebral infarction. Paraplegia on the left. Massive necrotic eschar in the sacral region. Sepsis. On admission, prothrombin 56%, platelets 47x1012/l ml, Hb 70 g/l, erythrocytes 2.5x109. The patient was prepared for surgical intervention, after which she was subjected to necrectomy within the limits of healthy tissues with the application of the claimed method, i.e. gauze pads, with an area of 100 cm2, soaked with a mixture of cryoprecipitate and thrombin were applied. The concentration of the components is 4 doses of thrombin to 2 doses of cryoprecipitate, where one dose of cryoprecipitate contains coagulation factor VIII in the amount of 100 IU and 250 mg of fibrinogen, to which is added thrombin with the concentration of a dose of 125 IU. At the same time, antibiotic therapy with broad-spectrum antibiotics and detoxification therapy were used. Transfusions of blood components. Hemostasis was efficient and fast. After removal of meshes over 24 hours, the wound without signs of active bleeding. Regenerative preparations were used. In the granulation phase over 4 weeks the patient was discharged.
1. Кузин М., Костиченюк Б. Раны и раневая инфекция. Москва, 1990, p. 591 1. Kuzin M., Kostichenyuk B. Wounds and wound infection. Moscow, 1990, p. 591
2. Апарцин К. Хирургия тяжелых гнойных процессов. Под ред. Григорьева Б. Г. Новосибирск, 2003, p. 346 2. Апарцин К. Surgery of heavy purulent processes. Ed. Григорьева Б. G. Novosibirsk, 2003, p. 346
Claims (1)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20120156A MD655Z (en) | 2012-11-08 | 2012-11-08 | Method of wound hemostasis after necrectomy in patients with severe coagulopathies against decompensated hepatic cirrhosis |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| MDS20120156A MD655Z (en) | 2012-11-08 | 2012-11-08 | Method of wound hemostasis after necrectomy in patients with severe coagulopathies against decompensated hepatic cirrhosis |
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| Publication Number | Publication Date |
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| MD655Y MD655Y (en) | 2013-07-31 |
| MD655Z true MD655Z (en) | 2014-03-31 |
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| Application Number | Title | Priority Date | Filing Date |
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| MDS20120156A MD655Z (en) | 2012-11-08 | 2012-11-08 | Method of wound hemostasis after necrectomy in patients with severe coagulopathies against decompensated hepatic cirrhosis |
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Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD2328G2 (en) * | 2003-07-14 | 2004-07-31 | Константин ЦЫБЫРНЭ | Fibrinous adhesive and use thereof for endoscopic hemostasis of variceal hemorrhages in hepatic cirrhosis |
| MD372Z (en) * | 2010-11-30 | 2011-12-31 | Георге АНГЕЛИЧ | Endoscopic method of hemostasis of bleeding ulcer in decompensated hepatic cirrhosis |
-
2012
- 2012-11-08 MD MDS20120156A patent/MD655Z/en not_active IP Right Cessation
Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| MD2328G2 (en) * | 2003-07-14 | 2004-07-31 | Константин ЦЫБЫРНЭ | Fibrinous adhesive and use thereof for endoscopic hemostasis of variceal hemorrhages in hepatic cirrhosis |
| MD372Z (en) * | 2010-11-30 | 2011-12-31 | Георге АНГЕЛИЧ | Endoscopic method of hemostasis of bleeding ulcer in decompensated hepatic cirrhosis |
Non-Patent Citations (2)
| Title |
|---|
| Апарцин К. Хирургия тяжелых гнойных процесcов. Под ред. Григорьева Б. Г. Новосибирск, 2003, p. 346 * |
| Кузин М., Костиченюк Б. Раны и раневая инфекция. Москва, 1990, p. 591 * |
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| Publication number | Publication date |
|---|---|
| MD655Y (en) | 2013-07-31 |
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