RU2133966C1 - Method for determining indications for performing early stage necronectomy in patients possessing severe burns - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out biochemical examination of urine to determine medium molecular mass peptides contents in the urine. The value dropping to 3.1-3.9 units, time for carrying out operative intervention is to be determined. EFFECT: simplified method; no additional examination methods needed.

Description

 The invention relates to medicine, in particular to combustiology and can be used to treat patients with severe burns.

 In the literature, there are no methods for determining the readiness of the body for early necrectomies, however, the timing of early necrectomies is described based on the clinical experience and qualifications of a specialist - combustiologist (Gerasimova L.I., Zhizhin V.N., Kizhaev E.V., Putintsev A. N. "Thermal and radiation burns", M., Med., 1996, p. 128; Turnikov Yu.I., Evteev A. A. "Organization of early surgical treatment of deep burns in a burn center", Materials of the city scientific and practical conference "New medical technologies in treatment heavily burned ", M., 1997, p. 13 - 20).

 The proposed method for determining the readiness of the body for early necrectomies in patients with severe burns is to determine the level of average molecular peptides in the urine.

 This method helps the combiologist to more objectively approach the optimal timing of early necrectomies, reflecting the readiness of the body.

 The method is as follows.

 In burn patients, starting from 2 days after the injury, a morning portion of urine is collected daily in a clean, dry dish without preservatives for biochemical determination of the level of average molecular peptides.

 Definition: take 1.0 ml of urine, dilute 10 times with distilled water, then take 1.0 ml of this dilution and precipitate the proteins by adding 0.5 ml of 10% trichloroacetic acid, mix, centrifuge at 3.5 - 4.0 thousand rpm A 0.5 ml centrifugate is diluted 10 times with distilled water and spectrophotometric at a wavelength of 254 nm against distilled water. The result is multiplied by the dilution of urine. Get the value of the average molecular peptides in the patient’s urine and with values from 3.1 to 3.9 units. he is scheduled for surgery (early necrectomy) on the same day or the next morning.

 Clinical examples.

 Patient S., 59 years old. The diagnosis is a burn with a flame of I-II-III AB degree on an area of 25% of the body surface, of which deep - 15%.

 By methods of intensive therapy, the patient was taken out of a state of shock. On the 2nd day, the average molecular peptides in the urine were 8.13 units, on the 3rd day - 5.97 units. Despite the high content of medium-molecular peptides in the urine, the patient under general anesthesia performed early necrectomy on the 3rd day for health reasons. The patient's condition progressively worsened and despite the ongoing intensive infusion-transfusion therapy, the patient died on the 6th day after the injury.

 Patient K., 59 years old. The diagnosis is a burn with a flame of I-II-III AB degree on an area of 25% of the body surface, of which 15% are deep. Intensive care methods removed from the state of shock. On the 5th day, the average molecular peptides in the urine of 3.29 units, on the same day an early necrectomy was performed under general anesthesia. The postoperative course is smooth. Autodermoplasty was performed on day 19, and subsequently discharged in satisfactory condition.

 Patient G., 45 years old. The diagnosis is a burn of a flame of II-III AB - IV degree on an area of 30% of the body surface, of which 25% are deep. methods of intensive care removed from the state of shock. Medium-molecular peptides in urine on the 5th day 3.2 units. On the same day, an early necrectomy was performed under general anesthesia. The postoperative course is smooth, autodermoplasty was performed on day 20, and subsequently discharged in satisfactory condition.

 The proposed method allows to determine the readiness of the patient with severe burns for early necrectomies without the use of additional examinations.

 We examined 52 patients with deep burns, a positive effect was observed in 41 patients, which amounted to 78%.

Claims (1)

 A method for determining indications for early necrectomy in patients with severe burns, characterized in that the level of medium-molecular peptides is determined in the patient’s urine and their value is from 3.1 to 3.9 units. prescribe surgery.