RU2195652C2 - Method of diagnosing endogenous intoxication in case of severe trauma - Google Patents

Abstract

FIELD: traumatology. SUBSTANCE: method consists in determining chemiluminescence of whole blood and that of population of monocytes, from which intoxication index is calculated. EFFECT: accelerated procedure and increased objectivity of information. 2 tbl, 3 ex

Description

 The invention relates to medical diagnostics, in particular to methods for assessing the degree of endogenous intoxication.

 A known method for the diagnosis of intoxication, based on measuring the ratio of different populations of blood cells / Kalf-Kalif Y. Ya. Leukocyte intoxication index and its practical significance. Medical business, 1941, N 1, p. 31-36 /.

LII = (C + 2P + 3U + 4Miel) • (Pl + 1) / (L + Mo) • (E + 1),
where the content of cell populations is indicated in%: C - segmented, P - stab-shaped, S-young, Myel - myelocytes, Pl - plasma cells, L - lymphocytes, Mo - monocytes, E - eosinophils.

 The disadvantage of this method is the inability to differentiate the reaction to stress and traumatic toxicosis from the blood.

 Closest to the claimed method according to the technical essence is a method for the diagnosis of intoxication with shockogenic trauma, based on the determination of the level of average molecules, the concentration of creatinine and urea, the content of free hemoglobin and myoglobin in the blood, as well as the scoring of the traumatic shock injury / Tarelkina M.N. Intoxication with shockogenic injury and its complications. Abstract. diss. for the academic degree. doctor of medical sciences SPb., 1991, 23 pp. /.

 The disadvantage of the method selected as a prototype is its multicomponent nature, and therefore, the duration and complexity of the diagnosis.

 Another disadvantage of this method is the lack of information in the diagnosis of intoxication due to infectious agents.

 The objective of the invention is the speed and high information content of the diagnosis of endogenous intoxication in patients with mechanical trauma.

где БШТ - балл шокогенности травмы, ХЛцк - хемилюминесценция цельной крови, индуцированная зимозаном (в мв), ХЛм - хемилюминесценция моноцитов крови, индуцированная зимозаном (в мв),
и при величине ИИ больше либо равно 0,8 относительных единиц диагностируют наличие эндогенной интоксикации.According to the invention, a method for diagnosing endogenous intoxication in severe mechanical trauma by blood counts and scoring of the shock morbidity of the trauma consists in measuring the chemiluminescence of whole blood and the chemiluminescence of a population of monocytes and determining the intoxication index of AI using the formula

where BST is the injury shockogenicity score, Hlck is the chemiluminescence of whole blood induced by zymosan (in mv), Hlm is the chemiluminescence of blood monocytes induced by zymosan (in mv),
and when the value of AI is greater than or equal to 0.8 relative units, the presence of endogenous intoxication is diagnosed.

 The measurement of chemiluminescence of whole blood induced by zymosan reflects the level of reactive oxygen species both in blood plasma and due to the activation of monocytes, polymorphonuclear leukocytes and platelets under the influence of bacterial and tissue antigens. The chemiluminescence of blood monocytes induced by zymosan characterizes their metabolic potential, which is important for the long-term implementation of the antibacterial and antitoxic function of the cells of this population.

 The advantage of the proposed method is speed: a characteristic of the level of endogenous intoxication can be determined within 2-2.2 hours from the moment of blood flow to the study.

 Another advantage is objectivity. This is achieved by using the following parameters: clinical diagnosis data and the results of measuring the luminescence of blood and blood cells on the device, which eliminates the subjectivity of the assessment of cellular activity.

 The informational content of the method is determined by the fact that a new indicator of the level of endogenous intoxication in case of shockogenic injury allows it to be detected before the appearance of pronounced clinical and biochemical signs, to determine the adequacy of the activation of blood monocytes of the severity of mechanical tissue damage, or BST, primarily determining the level of traumatic endotoxemia.

 According to scientific, technical and patent literature, the measurement of chemiluminescence of whole blood for the diagnosis of intoxication is unknown.

 The method is as follows. The score of shock injury is determined by the number and severity of damage (Table 1).

Тяжесть интоксикации или отсутствие интоксикации определяют в соответствии с величиной индекса интоксикации: 1) уровень компенсаторной активации клеток, 2) слабо выраженная интоксикация (I степени), 3) средней степени интоксикация (II), 4) тяжелая интоксикация (III), 5) очень тяжелая интоксикация (IV). Диапазоны величин индекса представлены в табл.2.The chemiluminescence of whole blood and a population of monocytes isolated by centrifugation on a density gradient of ficollverographin (30 minutes), followed by washing with Hanks medium without phenol red (25 minutes), was measured on a 1251 luminometer (Bio-Orbit) for an hour with an interval of 10 minutes, followed by summation results. The intoxication index is determined by the formula

The severity of intoxication or the absence of intoxication is determined in accordance with the value of the intoxication index: 1) the level of compensatory activation of cells, 2) mild intoxication (I degree), 3) moderate intoxication (II), 4) severe intoxication (III), 5) very severe intoxication (IV). The ranges of index values are presented in table 2.

 Example 1

 Patient E. (and.b. 3877), 61 years old. Diagnosis: concussion. Multiple unilateral rib fractures. Closed fracture of the left radial bone. Multiple pelvic fractures. Closed fracture of both bones of the right tibia. Shock III degree.

 At the time of receipt, the value of AI was 2.3 relative units. (I degree), on the 3rd day after the injury - 17.1 (severe intoxication) and on the 10th day - 16.0 rel. units (severe intoxication).

Величина ЛИИ составила при поступлении 3,73, на 3-и сутки - 0,62 и на 10-ые сутки - 5,12. Величина ЛИИ у практически здоровых взрослых не превышает 1,0.

The value of LII was 3.73 upon admission, on the 3rd day - 0.62, and on the 10th day - 5.12. The value of LII in practically healthy adults does not exceed 1.0.

 The course of the post-traumatic period from the 3rd day after the injury was complicated by the development of pyelonephritis, the following days there was the development of focal pneumonia, suppuration of the hematoma of the soft tissues of the right lower leg, which led to the presence of severe endogenous intoxication. Against the background of the course of these infectious complications, the activation of chemiluminescence of blood cells, including monocytes, was not observed, which led to a high level of endogenous intoxication.

 When comparing the dynamics of the values of AI and LII in patients with a shock-induced injury, it can be seen that a change in the index value reflecting the functional activity of blood cells occurs earlier during the development of the infectious process than a change in the index characterizing the ratio of leukocyte populations in the blood.

 Example 2

 Patient G. (and.b. 8484), 38 years old. Diagnosis: severe brain contusion. Subdural hematoma. Subarachnoid hemorrhage. Dislocation syndrome of the III-IV degree. Shock I degree.

 At the time of receipt, the value of AI was 0.09 relative units. (at the level of compensatory activation of cells), on the 3rd day after injury - 0.43 (also at the level of compensatory activation of cells), and on the 10th day after injury - 5.32 rel. units, i.e. mild intoxication develops against the background of the development of an infectious process (cystitis) with mild clinical symptoms. Conducting antibiotic therapy quickly stopped the infection process. The patient was discharged on day 22.

Величина ЛИИ составила при поступлении 2,39 относ.ед., на 3-и сутки - 0,61 и на 10-ые сутки - 2,21 относ.ед.

The amount of LII was upon receipt 2.39 relative units, on the 3rd day - 0.61 and on the 10th day - 2.21 relative units.

 The dynamics of the magnitude of the AI in this patient reflected a relatively favorable course of the post-traumatic period and at the same time made it possible to draw attention to the development of the infectious process in a timely manner and to conduct additional studies to identify the focus of inflammation.

 Example 3

 Patient S. (IB 6052), 36 years old. Diagnosis: multiple pelvic fractures. Shock I degree.

 At the time of receipt, the value of AI was 2.3 relative units. (I degree), on the 3rd day after the injury - 0.76, on the 10th day - 0.24 rel. units, i.e. mild intoxication was observed only at the time of receipt of the victim and smoothly switched to the level of compensatory activation of cells in the following days. The course of the post-traumatic period was uncomplicated and culminated in the restoration of the integrity of the damaged pelvic bones.

Величина ЛИИ составила при поступлении 2,3 относ.ед., на 3-и сутки - 2,13 и на 10-ые сутки - 0,85 относ.ед.

The value of LII was upon receipt of 2.3 relative units, on the 3rd day - 2.13 and on the 10th day - 0.85 relative units.

 The dynamics of the value of AI in this patient reflected the favorable course of the post-traumatic period, in which, by the 3rd day after the injury, according to the laboratory examination and the general condition of the patient, there were no signs of intoxication.

 The advantages of the proposed method compared to other methods for assessing endogenous intoxication are that the severity of tissue damage is assessed, affecting the level of tissue and bacterial antigens, protein catabolism products, and the activity of phagocytes that perform antitoxic function, absorbing antigens and turning them into less toxic or non-toxic substances that must be removed through the excretory organs or used in new metabolic cycles. The method allows early detection of the development of infectious processes and the accompanying intoxication, as well as their prediction. An important advantage of the proposed method is the speed of execution and obtaining the result: a characteristic of the level of endogenous intoxication can be determined within 2-2.2 hours from the moment the blood enters the study.

 The scope is clinical immunology, resuscitation and anesthesiology, traumatology, departments of combined injuries.

Claims (1)

A method for diagnosing endogenous intoxication in severe mechanical trauma by blood counts and scoring of the shock morbidity of a trauma, characterized in that the whole blood chemiluminescence and the monocyte population chemiluminescence are measured and the AI intoxication index is determined by the formula

where BShT - shock shockogenicity score;
HLck - chemiluminescence of whole blood induced by zymosan, mv;
HLm - chemiluminescence of blood monocytes induced by zymosan, mv,
and when the value of AI is greater than or equal to 1.0 rel. units diagnose the presence of endogenous intoxication.

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