RU2153871C2 - Method of preparation of patients for coronarography - Google Patents

Abstract

FIELD: medicine, particularly, cardiosurgery. SUBSTANCE: method includes daily introduction of antioxidants to patients during 5-7 days before performance of coronarography. EFFECT: considerable reduction of cardiovascular complications of coronarography. 2 ex

Description

 The invention relates to medicine, namely to cardiac surgery.

 A known method of preparing patients for coronary angiography (CAG) (see "Cardiology", 1994, N 1, pp. 11-17, publishing house "Cardiosphere", Moscow), including the introduction of sedatives, intravenous infusion of nitroglycerin and antianginal drugs.

 There is also a method of preparing patients for conducting CAG (see the journal "Blood circulation", 1986, N 6, pp. 22-25, publishing house of the Academy of Sciences of the Armenian SSR, Yerevan). The known method, taken as a prototype, is to prescribe sleeping pills, sedatives and antihistamines to patients on the eve of CAG and administering seduxen, pipolfen, atropine and promedol 40-60 minutes before CAG. Immediately before the CAG, and if necessary during the CAG, nitroglycerin is given under the tongue.

 A disadvantage of the known methods is that they reduce the stability of cell membranes and the level of the natural antioxidant - ceruloplasmin, and also activate lipid peroxidation (LPO) processes, which can lead to complications (coronarospasm, myocardial infarction, ventricular fibrillation, etc.).

 The essence of the claimed invention lies in the fact that according to the method of preparing patients for coronary angiography by using medications, additionally 3-7 days before the coronary angiography, patients receive antioxidant therapy daily.

 The use of the proposed method prevents the reduction of natural antioxidants, reduces the activation of lipid peroxidation processes and the destabilization of membrane structures, which, as a result, leads to a significant reduction in cardiovascular complications of coronarography.

 The method is as follows. With an unstable course of angina pectoris, we achieve stabilization of the clinic, ECG, hemodynamics for at least 1 week (antianginal therapy, intravenous heparin, injectable nitroglycerin, potassium preparations, concentrated solutions of glucose-insulin mixture, aspirin).

 Antioxidants are prescribed for 3-7 days before the CAG and on the day of the procedure, for example, vitamin E (α-tocopherol acetate) 700 mg per day (600 mg orally and 100 mg intramuscularly) or emoxipine (1% solution 10 ml intravenously in 100 ml of physiological solution).

 On the eve of the CAG, nitrates of prolonged action in maximum therapeutic doses are used, according to indications - other antianginal drugs (β-blockers and calcium antagonists), aspirin (0.075 mg per day) and 2 tablets of tazepam at night.

 In the morning on the day of the CAG, Relanium 2.0 ml is prescribed intramuscularly, with a low clinical and functional class (III-IV) - intravenous infusion of nitroglycerin in physiological saline, and planned therapy is also used. 30% prior to the study, analgin 50% - 4.0 ml is administered intravenously with diphenhydramine 1% - 1.0 ml, with a low functional class (III-IV), analgin is replaced by promedol 2% - 1.0 ml intramuscularly.

 Example 1. Patient A., 47 years old, was admitted to the clinic on September 3, 1997 for conducting a CAG with a diagnosis of coronary artery disease. Stable angina pectoris, FC II. Atrial premature beats. Primary arterial hypertension, stage II, mild form. H I.

 The LPO level at admission was 142.3 imp / sec, ceruloplasmin - 1.014 mg / ml, membrane stability - 160.2 sec, platelet aggregation - 55%. Three days before CAG, the antioxidant α-tocopherol was prescribed at 700 mg / day (600 mg orally, 100 mg intramuscularly). On the eve of the CAG, prolonged-acting nitrate nitrosorbide and 2 tazepam tablets were given overnight. In the morning before the procedure, Relanium 2.0 ml was injected intramuscularly and Analgin 50% - 4.0 and diphenhydramine 1% - 1.0 intravenously.

 During CAG, chest pains and ECG changes were not noted. On the coronarogram: the left type of blood supply to the heart. Occlusion of the proximal segment of the anterior interventricular branch, stenosis up to 25% of the lower third of the proximal artery envelope. The left coronary artery is normal.

 In a second study, the level of LPO was 139.2 cps, ceruloplasmin 1.102 mg / ml, membrane stability 183 sec, platelet aggregation 59%.

 Example 2. Patient B., 46 years old, was admitted to the hospital 03/23/97 with a diagnosis of CHD. Stable angina pectoris, FC II. Polytopic extrasystole (II FC on Laun). H I.

 The level of lipid peroxidation upon receipt of 148.9 imp / sec, the stability of the membranes - 143.6 sec. Prescribed treatment with calcium antagonists (nifelate), aspirin, antioxidant emoxipin (intravenously drip 1% solution of 10 ml in 100 ml of isotonic sodium chloride solution). On the eve of the CAG, 2 tazepam tablets were given at night. In the morning before the procedure, Relanium 2.0 ml was injected intramuscularly and Analgin 50% - 4.0 and diphenhydramine 1% - 1.0 intravenously.

 There was no pain syndrome in the course of CAG; ECG changes were not recorded on the monitor. The lipid peroxidation level after invasive examination was 127.6 cps / sec, erythrocyte membrane stability - 186 sec.

Claims (1)

 A method of preparing patients for coronary angiography by using medications, characterized in that in addition to 3 to 7 days before coronary angiography, patients receive antioxidant therapy daily.