RU2160449C2 - Method for evaluating severity degree and predicting pathological process development in the cases of urgent pathology - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves determining the first and the second fractions of medium molecular weight blood serum peptides in patient having urgent pathology. The second fraction value is determined by measuring optical density using spectrophotometer device at 282 nm wavelength. Ratio of the first to the second fraction is calculated. The value being less than 1, heavy state of patient with negative disease dynamics is judged to be the case. EFFECT: enhanced objectivity of severity degree and disease progress dynamics prediction.

Description

 The invention relates to medicine, namely to assess the severity of the condition of patients with urgent pathology.

 The choice of tactics for emergency therapeutic measures in patients with emergency conditions is impossible without an objective assessment of severity. A modern method for assessing the severity of patients with urgent pathology is the assessment of the patient's condition on the APACHE scale ("Surgical Intensive Care'by Ph.S. Barie, GT Shires / Boston-Toronto-London, 1993, p.21-23 /). includes 34 physiological parameters - cardiovascular, respiratory, gastrointestinal, hematological, bacteriological, metabolic and neurological. The severity rating is given by a set of indicators, which requires considerable time for examination (up to 5-7 days). This is a disadvantage for emergency care and patients with emergency conditions.

 Studies have shown that laboratory parameters included in the APACHE scale, such as the level of protein, bilirubin, creatinine, glucose and urea in the blood serum of patients with emergency conditions, can be stable and are within the lower limit of the normal level. However, the condition of the patients remains serious.

 As a prototype, a method has been adopted for determining the level of endogenous intoxication by medium molecular weight serum peptides by the express method according to Gabrielyan (Journal of Laboratory Affairs, 1984, No. 3, pp. 138-140).

 The disadvantage of this method is that when it is used in patients with urgent pathology, the absolute values often remain at the normal level or below normal values, which masks the patient’s true condition and does not allow to trace the dynamics of the pathological process.

 The objective of the invention was to develop a method for assessing the severity of the condition of patients with urgent pathology, allowing more objectively and quickly to assess the severity of the condition and the dynamics of the pathological process for its immediate correction.

 The problem is solved in that in the method for assessing the severity and prognosis of the pathological process in patients with urgent pathology, by determining the values of the first and second fractions of medium molecular peptides in the patient’s blood serum, the ratio of the second fraction to the first fraction is calculated and, when its value is less than unity, the patient’s serious condition with the development of negative dynamics of the pathological process.

 The basis of the proposed method is the observation of 3000 studies in the blood serum of 900 patients with emergency conditions who were treated at the Research Institute of Emergency Medicine. N.V. Sklifosovsky. In these patients, the level of endogenous intoxication was determined by the express method according to Gabrielyan. After a thorough analysis of the relationship between the magnitude of the 1st and 2nd fractions of medium molecular peptides and the severity of the condition of patients in emergency conditions, it was established that the value of the ratio of the fractions as the ratio of the 2nd fraction to the 1st fraction is not so much the absolute value. It was found that when the ratio is less than unity, a severe condition of patients was observed with the development of negative dynamics of the pathological process.

 The method is as follows.

 Blood serum is treated with a 10% trichloroacetic acid solution, the ratio of serum to acid is 1: 0.5. Centrifuged at 3 thousand rpm, for 30 minutes The supernatant is diluted 10 times with distilled water and the absorbance is measured on a spectrophotometer in ultraviolet light at a wavelength of 254 nm - the 1st fraction of medium molecular peptides, at a wavelength of 282 nm - the 2nd fraction of medium molecular peptides. Next, the ratio of the 2nd fraction to the 1st fraction is determined and, with a value of this value less than unity, the patient is in a serious condition with the development of negative dynamics of the pathological process.

Clinical examples
Patient S., 28 years old. Diagnosis: Acute amitriptyline poisoning. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.282, the second fraction of 0.216, the ratio of the second fraction to the first is less than one. The total protein is 60.5 g / L, creatinine 60.7 μmol / L, total bilirubin 6.72 μmol / L, direct bilirubin 1.74 μmol / L, indirect bilirubin 4.98 μmol / L, glucose 8.6 mmol / l. Normal values: total protein 60 - 80 g / l, total bilirubin 3.5 - 19 μmol / l, direct bilirubin up to 7 μmol / l, indirect bilirubin up to 12 μmol / l, creatinine 62 - 132 μmol / l, fasting glucose 3 , 5 - 6.1 mmol / l (GI Kozinets "Interpretation of blood and urine tests and their clinical significance", M., "Triad - X", 1998, 104 pp.). The patient's condition is serious, resuscitation measures were carried out, in a day the average molecular peptides of blood serum: the first fraction 0.577, the second fraction 0.387, the ratio of the second fraction to the first is less than unity. The total protein is 73.0 g / l, creatinine 92.1 μmol / l, total bilirubin 9.4 mmol / l, direct bilirubin 3.3 μmol / l, indirect bilirubin 6.1 μmol / l. Despite the therapy, the patient died of bilateral bronchopneumonia as a result of amitriptyline poisoning.

 Patient L. 25 years. Diagnosis: Poisoning with a mixture of psychopharmacological drugs. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.385, the second fraction of 0.327, the ratio of the second fraction to the first is less than one. The patient underwent resuscitation; a day later, the average molecular peptides of blood serum, the first fraction 0.320, the second fraction 0.340, the ratio of the second fraction to the first more than one. The patient was discharged in satisfactory condition for outpatient treatment.

 Patient J., 58 years old. Diagnosis: Acute poisoning with lyponex, delirium tremens, pneumonia. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.266, the second fraction of 0.216, the ratio of the second fraction to the first is less than one. The patient underwent resuscitation measures, after 2 days the average molecular peptides of blood serum: the first fraction of 0.489, the second fraction of 0.321, the ratio of the second fraction to the first is less than unity. The patient underwent resuscitation measures, after 4 days the first fraction 0.356, the second fraction 0.422, the ratio of the second fraction to the first more than one. The patient was discharged in satisfactory condition for outpatient treatment.

 Patient Sh., 41 years old. Diagnosis: Combined trauma, severe traumatic brain injury, fracture of the base of the skull, bruise of the brain, fracture of ribs on both sides, rupture of the sacroiliac joint with impaired pelvic ring integrity, intra-abdominal rupture of the bladder. Blood loss 2.4 l. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.205, the second fraction of 0.194, the ratio of the second fraction to the first is less than one. The patient underwent intensive resuscitation measures, on the 3rd day the average molecular peptides of blood serum: the first fraction 0.531, the second fraction 0.332, the ratio of the second fraction to the first is less than unity. By the 7th day of the disease, average molecular peptides of blood serum: the first fraction 0.213, the second fraction 0.257, the ratio of the second fraction to the first more than one. The patient was transferred from the intensive care room to the ward and was subsequently discharged in satisfactory condition.

 Patient D., 18 years old. Diagnosis: Combined trauma, traumatic brain injury, brain contusion, fracture of the left forearm, rupture of the liver, tear of the duodenum 12, retroperitoneal hematoma. Blood loss 1.0 l. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.297, the second fraction of 0.217, the ratio of the second fraction to the first is less than one. The patient underwent resuscitation, hemodynamics stabilized on the first day, the average molecular peptides of blood serum: the first fraction of 0.288, the second fraction of 0.287, the ratio of the second fraction to the first is less than one. After 3 days, the average molecular peptides of blood serum: the first fraction of 0.275, the second fraction of 0.279, the ratio of the second fraction to the first is more than one. The patient was discharged for outpatient treatment from the hospital in a satisfactory condition.

 Patient K., 53 years old. Diagnosis: traumatic brain injury. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.249, the second fraction of 0.245, the ratio of the second fraction to the first is less than one. Despite ongoing resuscitation care, the patient's condition remained serious. The patient died on the 12th day after the injury from cerebral edema.

 Patient M., 43 years old. Diagnosis: traumatic brain injury. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.262, the second fraction of 0.222, the ratio of the second fraction to the first is less than one. The patient underwent resuscitation measures, on the 3rd day the average molecular peptides of blood serum: the first fraction 0.300, the second fraction 0.320, the ratio of the second fraction to the first more than one. The patient was discharged in satisfactory condition from the hospital for outpatient treatment.

 Patient M., 44 years old. Diagnosis: Exacerbation of salpingitis. Upon receipt of the average molecular peptides of blood serum: the first fraction of 0.355, the second fraction of 0.308, the ratio of the second fraction to the first is less than one. The patient underwent conservative therapy, medium molecular peptides of blood serum: the first fraction 0.536, the second fraction 0.293, the ratio of the second fraction to the first is less than unity. The patient was prescribed powerful antibiotic therapy. On day 7, the average molecular peptides of blood serum: the first fraction of 0.310, the second fraction of 0.327, the ratio of the second fraction to the first is more than one. The patient was discharged from the hospital in satisfactory condition.

 The proposed method makes it possible to more objectively assess the condition of patients in emergency conditions and to predict the dynamics of the development of the pathological process. When using the proposed method, the doctor gets the opportunity to strengthen resuscitation or intensive care in the hospital department.

Claims (1)

 A method for assessing the severity and predicting the development of the pathological process in patients with urgent pathology by determining the value of the first fraction of medium molecular peptides in the patient’s blood serum, characterized in that the value of the second fraction of medium molecular peptides in the patient’s blood serum is additionally determined by measuring the optical density on a spectrophotometer with a length waves of 282 nm, determine the ratio of the magnitude of the second fraction to the magnitude of the first fraction and when the ratio of earlier units state the patient’s serious condition with predicting the development of negative dynamics of the pathological process.