RU2234095C1 - Method for diagnosis of endogenous intoxication syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to intensive therapy and can be used in diagnosis of endogenous intoxication syndrome. Method involves evaluation of erythrocyte membrane permeability, in particular, determination of erythrocytes with membranes blocked by immune complexes. The permeability of erythrocyte membranes is evaluated in the presence of NaCl an aqueous solution in dilutions. From a tube with minimal amount of nonhemolyzed erythrocytes liquid is taken off for determination of erythrocytes amount in Goryaev's chamber and amount of erythrocytes exceeding 1.0 with the concentration of NaCl corresponding them is accepted for control value in this patient. In control NaCl dilution hemolysis is studied at erythrocytes concentration exceeding the standard concentration level by 10 times and then repeated study in Goryaev's chamber is carried out and amount of nonhemolyzed erythrocytes is determined. In their amount exceeding control value by 10 times the endogenous intoxication syndrome is diagnosed. Invention provides enhancing precision in diagnosis of endogenous intoxication syndrome and its degree.

EFFECT: improved diagnosis method.

1 tbl, 6 ex

Description

The invention relates to medicine, namely to intensive care, and can be used in the diagnosis of endogenous intoxication syndrome (SEI).

A known method for the diagnosis of endogenous intoxication syndrome by examining the leukocyte reaction of the body to endogenous intoxication (EI) and including determining the magnitude of leukocytosis, leukocyte intoxication index (LII) (Kalf-Kalif Ya. Ya. On leukocyte intoxication index and its practical value // Doctor. . - 1941. - T.1. - S.32-35). However, according to some researchers, the use of this method is limited to diseases with an inflammatory component and cannot characterize EI in patients with acute critical conditions, because leukocyte response becomes pronounced no less than 12-24 hours after the onset of the disease.

A known method for the diagnosis of endogenous intoxication syndrome by increasing the level of medium-weight molecules (MSM) (Gabrielyan N.I., Dmitriev A.A., Sevostyanova O.A. et al. Medium molecules and the level of endogenous intoxication in resuscitation patients // Anesthesiology and Resuscitation. - 1985. - No. 1. - S.36-38). However, this method can detect an increase in the level of MSM in the absence of clinical signs of EI.

A known method for the diagnosis of endogenous intoxication syndrome to increase the index of nuclear shift (INS) (Dashtayants GA Clinical hematology. - Kiev: Health, 1978. - S.287). An increase in INS indicates a pronounced toxemia in the compensation phase, followed by a significant decrease in this indicator in the phase of EI decompensation, which indicates the depletion of the hematopoiesis system.

A known method for the diagnosis of endogenous intoxication syndrome, adopted as a prototype, which includes determining the sorption ability of red blood cells (SSE) and membrane permeability of red blood cells (TEM) (Marusanov V.E. Classification of endogenous intoxication and detoxification program for multiple organ failure. St. Petersburg, 1994, Endogenous intoxication Abstract International Symposium June 14-16, 1994, s78). The TEM index studies erythrocyte hemolysis under the influence of urea erythrocyte membrane penetration. The main criteria for the diagnosis of stages of endogenous intoxication are given in the table.

The known method has several disadvantages. The erythrocyte membrane research methods used in the method involve intensive physical (centrifugation in the case of SSE) and chemical (mitlen blue in the case of SSE, urea in the case of TEM) effects on the red blood cell in the process of determining its state.

Fluctuations of these indicators in the framework of the development of one process involve the registration of the same values at different stages of endogenous intoxication. For example, the TEM level of 15.2 srvc. units characteristic for endogenous intoxication of mild degree, and 12.4 srvc. units - for an extremely severe degree of endogenous intoxication. This does not provide the necessary accuracy in the diagnosis of endogenous intoxication and its degree.

The objective of the invention is to improve the accuracy of diagnosis of endogenous intoxication and its degree.

The problem is solved in that in a method for diagnosing endogenous intoxication syndrome, including an assessment of the permeability of erythrocyte membranes, erythrocytes having a membrane blocked by circulating immune complexes are determined, for which purpose the permeability of erythrocyte membranes in the presence of an aqueous solution of NaCl in dilutions is estimated from a test tube with the least amount erythrocytes, a fluid is taken to determine the number of red blood cells in the Goryaev chamber, the number of red blood cells in excess of 1.0 s, respectively your concentration of NaCl, taken for control in this patient, in a control dilution of NaCl, hemolysis is studied in a concentration of red blood cells 10 times higher than the standard concentration level, a second study is performed in the Goryaev’s chamber, the number of non-hemolyzed red blood cells is determined and their number is more than 10 times exceeding the control, they diagnose endogenous intoxication syndrome.

The author conducted studies aimed at studying changes in the immune status, changes in the state of biological membranes against the background of the clinical course of SEI. The choice fell on the red blood cell due to the fact that it is it that is exposed to immune complexes during the development of SEI, and also due to the fact that the study of the erythrocyte membrane is technically the most accessible process. Evaluation of the permeability of erythrocyte membranes in the presence of an aqueous solution of NaCl in dilutions allows us to study the state of erythrocyte membranes in conditions of maximum approximation to the physiological functioning of the studied cells. Counting the number of non-hemolyzed red blood cells in the Goryaev’s chamber, used in laboratory practice to calculate the level of red blood cells, allows you to register an increase in hemolized red blood cells with the necessary accuracy.

We examined 229 patients aged 17 to 86 who were in critical conditions, complicated by the formation of multiple organ failure due to the progressive development of acute peritonitis, destructive pancreatitis, acute sepsis, severe pneumonia, and traumatic disease. Most patients (75.5%) had lesions of 2-3 organs, and 92% of them primarily developed lung damage. In addition, 36 patients with uncomplicated pneumonia, acute appendicitis, isolated trauma in the first 6-12 hours from the onset of the disease or injury were examined. The control group consisted of 15 healthy donors.

Studies have shown that endogenous intoxication is the development of tissue hypoxia as a result of disruption of the dissociation of hydroxy and carboxyhemoglobin against the background of blocking of red blood cells by circulating immune complexes.

As a result of the studies, all patients in the main group showed a clear excess of more than 10 times the number of non-hemolyzed red blood cells compared with the control, and the greater the greater, the more severe the degree of endogenous intoxication. In the control group, the excess of non-hemolyzed red blood cells was less than 10.

The method is carried out, for example, as follows.

For the study, venous blood is collected at the patient’s bed by puncture of peripheral veins or by connecting to a catheter located in the central veins.

The standard methodology estimates the permeability of erythrocyte membranes in the presence of an aqueous solution of NaCl in dilutions. After that, from a test tube with the least amount of non-hemolyzed red blood cells, according to standard rules, a liquid is taken to determine the number of red blood cells in the "Goryaev’s cell". If when calculating the number of red blood cells in the Goryaev’s cell according to the standard method, their level exceeds 1.0, then the first test tube in which this excess is found and the corresponding NaCl concentration is taken for control in this patient. Then, in a control dilution of NaCl, hemolysis is studied at a concentration of red blood cells 10 times the standard concentration level; re-study in the "chamber Goryaeva."

If when determining in the “Goryaev’s chamber” the number of red blood cells in the experimental concentration exceeds the number of red blood cells in the standard concentration by less than 10 times, then put a mark “+” and judge the absence of endogenous intoxication syndrome. If it is exceeded by more than 10 times, the syndrome of endogenous intoxication is diagnosed, and the degree of EI is the more severe the greater the excess. So if you exceed 10 to 20 times, put a mark with the "++" sign, if you exceed 20 to 30 times - the sign "+++", if you exceed 30 to 40 times - the sign "++++", if you exceed 40 to 50 times - the sign "+++++".

The method is illustrated by the following clinical examples.

Example 1. Patient M .; 19 years. Diagnosis: Postinjection phlegmon of the right thigh. The patient was admitted to the purulent-septic department on an emergency basis, three days after the end of the course of intramuscular vitamin therapy in the clinic at the place of residence.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse 94 beat); the skin is pale, visible mucous membranes are pale, dry.

Laboratory data: INS = 1.8, LII = 11.3 indicate the presence of severe endogenous intoxication. The level of MSM = 0.49 indicates the presence of severe intoxication, which entered the stage of decompensation. The level of TEM = 18.1 and the level of SSE = 29.2 indicate the absence of endogenous intoxication in the patient.

A study was conducted on the proposed method. In the control sample, the concentration of NaCl was 0.28%, the number of red blood cells in the study in the "Goryaev's chamber" 1. In the experimental study, the number of red blood cells 7. The excess was 7 times or "+", which indicated the absence of endogenous intoxication in the patient.

The patient under general anesthesia performed an autopsy phlegmon. In order to prevent postoperative complications, a course of intramuscular antibacterial therapy has been prescribed. No infusion detoxification therapy was performed.

At the time of discharge from the hospital nine days after admission. Clinical data for the presence of endogenous intoxication have not been identified.

Laboratory data: INS = 0.8 and LII = 3.4 indicate the persistence of phenomena of endogenous intoxication. The level of MSM = 0.39 and the level of TEM = 17.2 indicated the presence of a borderline state between the absence of endogenous intoxication and mild endogenous intoxication. The level of SSE = 30.8 indicated the absence of endogenous intoxication in the patient.

The proposed method revealed an increase in the number of red blood cells by 3 times (1 and 3 red blood cells) or "+", which indicated the absence of endogenous intoxication in the patient.

Example 2. Patient C .; 28 years. Diagnosis: Erysipelas of the left lower leg, purulent-necrotic form. The patient was admitted to the purulent-septic department eight days after the onset of the disease. She was treated at home with folk remedies. There is a focus of necrosis on the left tibia measuring five by seven centimeters.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse 102 beats); the skin is pale, visible mucous membranes are pale, dry;

increased irritability of the patient is noted.

Laboratory data: INS = 1.8 and LII = 9.2 spoke about the presence of severe endogenous intoxication. The level of MSM = 0.57 indicated the presence of endogenous intoxication, which is under compensation. The level of TEM = 18.9 and the level of SSE = 23.6 spoke of the presence of a boundary state between endogenous intoxication of mild degree and endogenous intoxication of moderate severity.

The proposed method revealed an increase in the number of red blood cells by 15.8 times (1.2 and 19 red blood cells) or "++", which indicated the presence of endogenous intoxication of mild severity.

A patient under general anesthesia performed necrectomy. In order to prevent postoperative complications, a course of intramuscular antibacterial therapy has been prescribed. Infusion detoxification therapy was carried out in a traditional volume.

At the time of discharge from the hospital, nine days after admission. Clinical data for the presence of endogenous intoxication have not been identified.

Laboratory data: INS = 1.31 spoke about the presence of severe endogenous intoxication. LII = 3.6 spoke of the presence of phenomena of endogenous intoxication. The level of MSM = 0.38 indicated the presence of a borderline state between the absence of endogenous intoxication and mild endogenous intoxication. The level of PEM = 17.5 indicated the presence of a borderline state between the absence of endogenous intoxication and mild endogenous intoxication. The level of SSE = 32.1 spoke of the presence of mild endogenous intoxication.

The proposed method revealed an increase in the number of red blood cells by 1.9 times (2.7 and 5.3 red blood cells) or "+", which indicates the absence of endogenous intoxication in the patient.

Example 3. Patient B .; 64 years old. Diagnosis: Acute intestinal obstruction. Spilled purulent peritonitis. Received on the second day after the development of clinical signs of the disease.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse 128 beats); the skin is pale, visible mucous membranes are pale, dry; psycho-emotional retardation of the patient is noted.

Laboratory data: INS = 2.1 and LII = 10.6 spoke of the presence of severe endogenous intoxication. The level of MSM = 0.38 indicated the presence of a borderline state between the absence of endogenous intoxication and mild endogenous intoxication. The level of TEM = 23.5 indicated the presence of moderate endogenous intoxication. The level of SSE = 29.5 spoke of the absence of endogenous intoxication in the patient.

The proposed method revealed an increase in the number of red blood cells by 30 times (1.8 and 54 red blood cells) or "+++", which indicated the presence of moderate endogenous intoxication.

A patient under general anesthesia underwent a left-sided hemicolectomy, the abdominal cavity was drained. In order to prevent postoperative complications, a course of intramuscular antibacterial therapy has been prescribed. Infusion detoxification therapy was carried out for twenty-three days in the intensive care unit for six days.

At the time of discharge from the hospital, twenty-eight days after admission.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse 104 beat); the skin is pale, visible mucous membranes are pale.

Laboratory data: INS = 0.23 indicated the presence of mild endogenous intoxication. LII = 1.6 spoke of the absence of phenomena of endogenous intoxication. The level of MSM = 0.27 indicated the presence of a borderline state between the absence of endogenous intoxication and mild endogenous intoxication. The level of PEM = 21.4 indicated the presence of severe endogenous intoxication. The level of SSE = 32.4 spoke of the presence of mild endogenous intoxication.

The proposed method revealed an increase in the number of red blood cells by 8.46 times (1.3 and 11 red blood cells) or "+", which indicates the absence of endogenous intoxication in the patient.

Example 4. Patient W.; 55 years. Diagnosis: Hemorrhagic pancreatic necrosis.

The patient was admitted to the surgical department on an emergency basis four days after the first signs of the disease. He was treated at home with folk remedies, and took spasmolytics on his own.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse 86 beats); the skin is pale, visible mucous membranes are pale, dry; psycho-emotional retardation of the patient is noted.

Laboratory data: INS = 2.7 and LII = 12.9 talked about the presence of severe endogenous intoxication. The level of MSM = 0.62 indicated the presence of endogenous intoxication in the compensation stage. The level of PEM = 19.5 indicated the presence of a borderline state between the absence of endogenous intoxication and mild endogenous intoxication. The level of SSE = 33.8 indicated the absence of endogenous intoxication in the patient.

The proposed method revealed an increase in the number of red blood cells by 35.2 times (1.9 and 67 red blood cells) or "++++", which indicates the presence of severe endogenous intoxication in the patient.

The patient underwent necrectomy surgery, drainage of the stuffing box. Two times under general anesthesia, dressings were performed, during which repeated necrectomies were performed. Sixteen days the patient was given a course of antibacterial therapy. Nineteen days a course of infusion detoxification therapy was performed.

At the time of discharge from the hospital, twenty-one days after admission.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse 104 beat); the skin is pale, visible mucous membranes are pale.

Laboratory data: INS = 0.04 and LII = 1.8 talked about the absence of phenomena of endogenous intoxication. The level of MSM = 0.35 indicated the presence of a borderline state between the absence of endogenous intoxication and endogenous intoxication of mild severity. The level of TEM = 17.7 spoke of the absence of phenomena of endogenous intoxication. The level of SSE = 29.1 spoke of the presence of phenomena of endogenous intoxication of mild severity.

The proposed method revealed an increase in the number of red blood cells in 8.2 (1.7 and 14 red blood cells) or "+", which indicates the absence of phenomena of endogenous intoxication.

Example 5. Patient K .; 36 years. Diagnosis: Acute ischiorectal paraproctitis. Gas perineal gangrene. The patient was admitted to the emergency proctology department three days after the appearance of the first clinical signs of the disease.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse of 145 beats); the skin is pale, visible mucous membranes are pale, dry; psycho-emotional agitation of the patient is noted.

Laboratory data: INS = 2.2 and LII = 14.5 spoke of the presence of severe endogenous intoxication. The level of MSM = 0.61 indicated the presence of endogenous intoxication in the compensation stage. The level of PEM = 22.1 indicated the presence of severe endogenous intoxication. The level of SSE = 30.8 indicated the absence of endogenous intoxication in the patient.

The proposed method revealed an increase in the number of red blood cells by 42.2 times (2.2 and 93 red blood cells) or "+++++", which indicates the presence of extremely severe severity of endogenous intoxication in the patient.

Under general anesthesia, the patient underwent surgery to open para-proctitis, necrectomy, drainage of the pararectal region. During the patient’s stay in the hospital, necrectomy was performed three more times. For thirty-four days, the patient underwent a course of antibacterial therapy. Twenty-eight days a course of infusion detoxification therapy was performed.

At the time of discharge from the hospital, twenty-one days after admission.

Clinical data for the presence of endogenous intoxication - tachycardia (pulse of 92 beats); the patient is in a psycho-emotional inhibited state.

Laboratory data: INS = 0.16 spoke about the presence of mild endogenous intoxication phenomena. The level of LII = 5.7 spoke about the presence of phenomena of pronounced endogenous intoxication. The level of MSM = 0.41 indicated the presence of a boundary state between the absence of endogenous intoxication and endogenous intoxication of mild severity. The level of TEM = 16.8 spoke of the absence of phenomena of endogenous intoxication. The level of SSE = 29.7 spoke of the presence of a borderline state between mild endogenous intoxication and moderate severity of intoxication.

According to the proposed method, an increase in the number of red blood cells of 13.3 (1.2 and 16 red blood cells) or "++" was detected, which indicates the presence of mild endogenous intoxication phenomena.

Example 6, In test X. from the control group, in the absence of clinical signs of any disease, studies were conducted.

Clinical data for the presence of endogenous intoxication have not been identified.

Laboratory data: INS = 0.06 and LII = 1.4 talked about the absence of endogenous intoxication in the patient.

The proposed method revealed an increase in the number of red blood cells by 28.4 times (1.3 and 37 red blood cells) or "+++", which indicated the presence of moderate endogenous intoxication.

Five hours later, the researcher developed a clinical picture of paratonsilar abscess against lacunar angina.

A day after the first study:

Clinical data for the presence of endogenous intoxication - tachycardia (pulse 108 beats); the skin is pale, visible mucous membranes are pale, dry; pronounced psycho-emotional arousal is noted.

Laboratory data: INS = 1.4 indicated the presence of severe endogenous intoxication. The level of LII = 3.7 spoke of the presence of mild endogenous intoxication phenomena.

An autopsy of the paratonsilar abscess was performed. A course of antibacterial therapy for ten days.

At the time of discharge, after fourteen days.

Clinical data for the presence of endogenous intoxication is tachycardia (pulse 88 beats).

Laboratory data: INS = 0.8 and LII = 1.9 spoke about the absence of endogenous intoxication in the patient.

The proposed method revealed a 4-fold increase in the number of red blood cells (1 and 4 red blood cells) or "+", which suggests that the patient had no endogenous intoxication.

Using the proposed method can improve the accuracy of diagnosis of endogenous intoxication and its degree.

Claims (1)

A method for the diagnosis of endogenous intoxication syndrome, including an assessment of the permeability of erythrocyte membranes, characterized in that erythrocytes having a membrane blocked by immune complexes are determined, for which the permeability of erythrocyte membranes in the presence of an aqueous solution of NaCl in dilutions is evaluated from a test tube with the least amount of non-hemolyzed red blood cells determine the number of red blood cells in the Goryaev’s chamber, the number of red blood cells in excess of 1.0 with the corresponding concentration of NaCl is taken they are in control of this patient, in the control dilution of NaCl, hemolysis is studied at a concentration of red blood cells 10 times higher than the standard concentration level, a second test is performed in the Goryaev’s chamber, the numbers of non-hemolyzed red blood cells are determined and, when their number is more than 10 times higher than the control, they are diagnosed endogenous intoxication syndrome.