RU2157267C2 - Method for treating the patients with sudden infant death syndrome and hypocoagulation after hemorrhages in the cases of abdominal organ traumas - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves exposing blood to intravascular helium-neon laser radiation in combination with traditional intensive medical care methods applied. Wavelength is 0.63 mcm, power density at the light guide exit is 1.5-2 mW/cm². Irradiation treatment is carried out from the first days after the operation. Session time is 30 min long. One session time is 30 min. The total number of sessions is 5-7. EFFECT: increased coagulating blood activity. 1 dwg, 6 tbl

Description

 The invention relates to surgery and resuscitation and can be used in the complex therapy of patients with DIC and hypocoagulation in case of trauma of the abdominal organs.

 As is known, the result of massive intraperitoneal bleeding from the parenchymal organs of the abdominal cavity after an injury is DIC, in the development of which there are several clinical stages. The first stage is blood hypercoagulation, the formation of intravascular aggregates and the development of microcirculation blockade in organs. The second stage is hypocoagulation with consumption coagulopathy, characterized by a deep depletion of coagulation factors and the accumulation of coagulation and aggregation inhibitors in the blood. Profuse bleeding occurs.

 Currently, the main components of the comprehensive treatment of DIC are transfusion of freshly frozen plasma and heparin therapy (2.5-5 thousand ED of heparin is administered dropwise, daily dose of 10-15 thousand ED). Transfuse blood substitutes and blood in order to replenish blood loss; prescribe native and freshly frozen plasma, which serves as a donor of blood coagulation factors; use drugs that improve microcirculation, antiplatelet agents, antifibrinolytics and antiproteolytics (trasilol at a dose of 75-100 thousand ED or contracal) [1, 2, 3].

However, this therapy of DIC with hypocoagulation has several disadvantages:
1) transfusion of blood and plasma in large quantities supports the process of diffuse blood coagulation, enhances fibrinolysis, increasing the content of plasminogen, impairs microcirculation [4];
2) transfusion of blood substitutes in shock and blood loss causes a decrease in the concentration of a number of coagulation factors [5];
3) with acidosis and impaired microcirculation, a decrease in heparin activity is possible [6];
4) the complexity of the dosage of drugs inhibitors of proteolysis; the possibility of enhancing hemorrhages with their overdose [7], [8];
5) the effect of these drugs develops gradually.

 In recent years, work has appeared on the effect of VLOK on the blood coagulation system [9]. However, long-term intravenous laser blood irradiation for up to 45 min with a power of 4-5 mW, shown in the work of Chalyk Yu.V. et al. [9], can lead to the development of "laser disease" and secondary exacerbation syndrome [10].

We were the first to propose a method for increasing blood coagulation in patients with DIC with hypocoagulation, which includes intravenous laser blood irradiation (VLOK) with the AFL-01 helium-neon laser in the complex of “traditional” intensive care. The wavelength of 0.63 μm, the power density at the output of the fiber is 1.5-2 mW / cm ² . Irradiation was carried out using a quartz fiber with a diameter of 200 μm. The fiber was introduced into the cubital vein by 5 cm. Irradiation was carried out from the first day after the operation. Session time 30 minutes. Each patient had 5-7 sessions. The parameters of laser radiation are selected as generally accepted for intravenous laser irradiation of the blood of patients.

The experimental part of the work was carried out on white Wistar male rooftops weighing 250-300 g. Under nembutal anesthesia, rats underwent laparotomy and bloodletting in the amount of 1 / 5-1 / 6 of the circulating blood volume (BCC = 1/13 of body weight) by puncture of the mesenteric vessel and an incision in the liver parenchyma. Thus, the model of DIC with hypocoagulation was reproduced. Then, blood was irradiated with a helium-neon laser (wavelength 0.63 μm, power density 2 mW / cm ^2, irradiation time 30 minutes). Blood for research was taken before bloodletting, after the development of signs of DIC with hypocoagulation in a rat, and 30 minutes after laser irradiation of blood.

 The integral indicators of hemocoagulation were determined on a thromboelastograph "Thrombus-4". The adhesion-aggregating properties of platelets were studied on an extracellular matrix (ECM, Israel), which is a complex of biologically active products produced by the endothelium of a bull’s cornea.

 Results.

 1.5 hours after the bloodletting, the rat developed DIC with hypocoagulation, which was confirmed by thromboelastography and a change in the adhesive-aggregation properties of platelets on an ECM. As can be seen from the table. 1, after bloodletting, there was a significant lengthening of the reaction time (R), the time of formation of the fibrint platelet structure (K), the general indicator of the duration of blood coagulation (R + K), a decrease in the maximum amplitude (MA), the indicator of total blood coagulation (T), and the elasticity coefficient clot (E), coagulation index (Ci) and thrombodynamic potential index (ITP).

 The adhesive and aggregation properties of platelets also changed, which was expressed in a decrease in the total number of objects fixed on an ECM, the area of objects, the number of single platelets, the area of single platelets, the number of aggregates, the area of aggregates, and the average size of aggregates (see Table 2).

 As can be seen from tables 1 and 2, after a 30-minute laser irradiation of blood there was a significant shortening of R, S, an increase in MA, the area and number of single platelets and aggregates on the ECM increased compared to the values obtained 1.5 hours after bloodletting, t .e. there was a tendency towards an increase in blood coagulation activity and the adhesion-aggregation properties of platelets after He-Ne laser irradiation in DIC with hypocoagulation in the experiment. The obtained positive results in animal experiments were an experimental justification for testing the possibility of using low-intensity laser irradiation of blood in a clinic with the aim of correcting hypocoagulation disorders in postoperative DIC.

 We operated on 60 patients with various injuries of the abdominal organs (see table 3).

 All patients showed significant abnormalities in the blood coagulation system, regarded as a manifestation of DIC with hypocoagulation, which was confirmed by the clinical picture of the patient's condition (gastric, renal, skin hemorrhages) and the results of special research methods / ethanol test, electrocoagulography, thromboelastography / . All patients underwent drug therapy aimed at normalizing the parameters of the blood coagulation system / transfusion of freshly frozen plasma, heparin therapy, blood substitutes, and microcirculation improving agents.

 In the 1st group of patients in the intensive care complex was included VLOK (30 people). Patients of the II group received "traditional" therapy (30 people).

In the group of patients receiving laser therapy, the restoration of coagulogram indices had the following features:
1) as can be seen from the table. 5, after the VLOK session, there was a significant shortening of R, S, an increase in MA, E, Ci, ITP in the thromboelastogram, which characterizes the rapid effect of laser irradiation of blood, aimed at increasing blood coagulation;
2) there was an acceleration of blood coagulation time, a decrease in plasma recalcification time, an increase in the prothrombin index, the amount of fibrinogen, and a decrease in fibrinolysis (see table. 4);
3) normalization of coagulogram indices occurred by 3-5 days in patients of group I (treated with VLOK), against 7-8 days in patients who did not receive VLOK (see Tables 4A, 5A);
4) a decrease in the number of complications in patients receiving VLOK (see table. 6), 3.2 times.

As can be seen from the description of the method, the use of VLOK in the complex treatment of patients with DIC and hypocoagulation has several advantages:
1) rapid receipt of the expected effect (immediately after the VLOK session);
2) the time to normalize the indicators of the blood coagulation system is 2-3 days earlier than with "traditional"therapy;
3) a decrease in mortality and the number of complications in patients in the postoperative period by 3.2 times.

 As an example, we can give the medical history of the patient R.I. 12 years delivered to 6 mountains. a hospital from the scene of the incident on May 29, 1995

 The patient was hit by a truck. Upon admission, the patient's condition is serious. The skin and mucous membranes are pale. Heart sounds are muffled by blood pressure 90/60 mm RT. Art., pulse 110 per minute. Vesicular breathing with a frequency of up to 30 per minute. Lumbar region without visible changes. Urine is red. The tongue is wet. The abdomen is not involved in the act of breathing, rigid, painful on palpation in the left half. Bluntness in flat parts of the abdomen is determined. The liver and spleen are not enlarged. Peristalsis is weakened.

 Diagnosis: Severe road injury. Closed abdominal injury with damage to internal organs. Intra-abdominal bleeding. Shock III degree. An emergency operation has been performed. In the abdominal cavity up to 2 liters of liquid blood. An audit revealed the separation of the spleen and left kidney from the vascular legs. The right kidney is not changed. The vessels of the legs of the spleen and kidney are alloyed, the bleeding is stopped. Splenectomy, nephrectomy on the left. The retroperitoneal space is drained through the lumbar region on the left. The abdominal cavity is drained in the left hypochondrium. Stitches on the wound. Diffuse bleeding from tissues during suturing is noted. During the operation, 1.5 l of blood was reinfused. Poured 500 ml of canned blood; 2.5 thousand units heparin; 150 ml of freshly frozen plasma; 600 ml of physiological saline; 30 mg of prednisolone; 30 thousand units contrikala; 400 ml reopoliglyukin; 60 ml of 40% glucose; heart remedies.

 In the early postoperative period, infusion therapy, plasma and blood transfusions were performed. In order to correct hemostatic disorders, heparin therapy and antifibrinolytic therapy were carried out.

 From the first hour after the operation, a VLOK He-Ne laser session was performed. Sessions were held for 5 days daily for 30 minutes.

 After VLOK sessions, there was an increase in blood coagulation activity on the thromboelastogram. On the 2nd day after the operation, positive dynamics were noted, and by 5 days normalization of the coagulation system parameters. In FIG. 1 shows thromboelastograms before and after the VLOK session. There is an increase in blood coagulation activity in DIC with hypocoagulation in a patient with intra-abdominal bleeding after a VLOK session.

 The data obtained indicate a positive effect of VLOK on the blood coagulation system.

Sources of information:
1. A.A. Bunyatyan. Anesthesiology and resuscitation. M., 1984

 2. D.P. Pavlovsky. Thrombohemorrhagic complications in surgery and obstetrics. Kiev, 1984

 3. I.N. Bochkarev. Intravascular coagulation. Kiev, 1989

 4. C.Raby. Coagulations intracasculaires disseminees et localisees. Paris, "Masson et Cie", 1970.

 5. S. S. Panchenko. Change in hemocoagulation factors when exposed to blood emulsions of perfluorinated organic compounds in vitro. Hematology and transfusiology N 10, 1986

 6. R. M Hardaway. Disseminated intravascular coagulation. J. A. el. A., 1974.

 7. Z.S. Barkagan. Hemorrhagic diseases and syndromes. M., 1980

 8. N. Fermilen. M. Ferstrate. Hemostasis. M., 1984

 9. Yu.V. Chalyk et al. The use of VLOK in the complex treatment of combined abdominal injuries in the book "Low-Intensity Lasers in Medicine", Obninsk, 1991

 10. Yu.K. Tokmachev et al. Secondary exacerbation syndrome ("Laser Disease") is the problem of laser medicine in the book "New Advances in Laser Medicine". Moscow-St. Petersburg, 1993

Claims (1)

A method for treating patients with DIC and hypocoagulation after bleeding in an abdominal injury, comprising traditional therapy and additionally intravenous irradiation of blood with a helium-neon laser, wavelength 0.63 μm by introducing a fiber into the cubital vein from the first day after surgery every day 5 to 7 days, characterized in that they use a density of 1.5 to 2 mW / cm ² at the output of the fiber, and the session time is 30 minutes.

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