RU2273497C2 - Method for treating patients for uterine hemorrhages - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering 1-2 interrupted plasmapheresis sessions before performing radical operation. Next to it, seven low intensity intravasal blood laser radiation sessions and 1-2 interrupted plasmapheresis sessions are given in postoperative period.

EFFECT: reduced risk of periuterine stump inflammation, rise in temperature and adaptation syndrome occurrence.

Description

The present invention relates to medicine, in particular to operative gynecology.

The most accepted way of treating gynecological patients with uterine bleeding caused by myoma or endometriosis and in need of radical surgery is to initially stop the curettage by curettage. In the period preceding radical surgery, anti-inflammatory (antibacterial), symptomatic therapy is carried out, including the introduction of red blood cells in case of anemia caused by heavy bleeding, and a histological diagnosis is determined to clarify the scope of the operation (7-8 days). Then the patient is operated on radically (supravaginal amputation or hysterectomy) / E.K. Aylamazyan, I.T. Ryabtseva I.T. "Emergency care in extreme conditions in gynecology" "Medical book" M., 2003 p. 41 /.

The disadvantages of the method are the long duration of the period of elevated temperature, a high frequency of recultivations, a prolonged adaptation syndrome.

The objective of the invention is a method for managing patients with uterine bleeding in urgent gynecology, which allows to reduce the number of complications by reducing the incidence of recultitis and periods of fever and adaptation syndrome.

The problem is solved by the method consisting in the fact that, against the background of anti-inflammatory therapy and blood transfusion of the erythrocyte mass, before the radical operation, 1-2 sessions of intermittent plasmapheresis are carried out, followed by 7 sessions of low-intensity intravascular laser irradiation of blood (ELOK) and 1-2 sessions of intermittent plasmapheresis after surgery .

The following examples illustrate the method of the invention.

Example 1

Patient S., 50 years old, was hospitalized in the gynecological department with complaints of heavy menstrual bleeding over the past 2 years. At the time of admission - abundant spotting from the genital tract. The body of the uterus is enlarged to the size of 6-7 weeks of pregnancy, dense, mobile, moderately painful on palpation and displacement. Appendages on both sides are not palpable. According to blood tests, anemia (er. - 2.3 · 10 ¹² , Hb - 74 g / l, Ht - 0.80).

Diagnosis: uterine fibroids, menorrhagia, posthemorrhagic anemia.

For diagnostic and therapeutic purposes, on the day of admission under intravenous anesthesia, a uterine curettage was made, uterine deformity was established along the posterior wall and in the bottom of the uterus with an interstitial-submucous node, and scraping was moderate.

After curettage of the uterus, bleeding is stopped. A blood transfusion of 500.0 erythrocyte mass was performed with a substitute purpose.

Against the background of anti-inflammatory therapy with oxacillin (1.0 × 5 times a day intramuscularly) and taking uroseptics and antifungal drugs, discrete plasmapheresis sessions were performed with 30-50% of the circulating plasma volume removed and plasma replacement with physiological solution in relation to the removed plasma volume 1.2 -1.5: 1. Then the patient for 7 days conducted blood irradiation through a monofilament quartz fiber inserted into the ulnar vein, a helium-neon laser with a wavelength of 628 nm, an output power of 1.5 mW, with a duration of 5 minutes for 15 minutes and for 2 last for 30 minutes. The preoperative period was uneventful.

The patient was operated on radically in the amount of supravaginal amputation of the uterus without appendages. In the postoperative period, on the first day, a discrete plasmapheresis session was performed in the previously described mode.

The course of the postoperative period is smooth: the maximum daily temperature rise is 37 ° C, the duration of the pain period is 6 days, there are no pericultitis phenomena when the patient is discharged from the hospital. The postoperative period is 7 days.

Example 2

Patient M., 36 years old, was admitted on an emergency basis and was hospitalized in the gynecological department with complaints of copious spotting from the genital tract for 2 weeks.

Inspected. At the time of admission - abundant spotting from the genital tract. The body of the uterus is enlarged to the size of 8-9 weeks of pregnancy, dense, moderately painful. Appendages on both sides are not palpable. According to blood tests - severe anemia (er. - 1.96 · 10 ¹² , Hb 62 g / l, Ht - t%).

Diagnosis: uterine fibroids, menorrhagia, posthemorrhagic anemia. For diagnostic and therapeutic purposes, the uterine curettage was performed on the day of admission under intravenous anesthesia. When scraping the uterus, a submucous node was found, scraping abundant.

After curettage of the walls of the uterus, bleeding is stopped.

A blood transfusion of 510.0 erythrocyte mass was performed with a substitute purpose.

Against the background of anti-inflammatory therapy, a discrete plasmapheresis session was performed with 30% of the circulating plasma volume removed and plasma replacement with physiological solution in relation to the removed plasma volume 1.2-1.5: 1. Then the patient was exposed to blood for 7 days through a monofilament quartz fiber inserted into the ulnar vein, helium with a neon laser with a wavelength of 628 nm, an output power of 1.5 mW, with a duration of 5 minutes for 15 minutes and 2 the last 30 minutes The preoperative period was uneventful.

The patient was operated on radically in the amount of supravaginal amputation of the uterus without appendages.

In the postoperative period, a discrete plasmapheresis session was performed in the previously described mode. The patient underwent 2 plasmapheresis sessions.

The course of the postoperative period is smooth: the maximum daily temperature rise is 37.2 ° C, the duration of the pain period is 7 days, there are no pericultitis phenomena. The postoperative period is 9 days.

The claimed method conducted 12 patients, in no case was pericultitis noted, in all cases there was a reduction in periods of fever and adaptive compared with the known method of treating patients with uterine bleeding.

Claims (1)

A method of treating patients with uterine bleeding, including curettage of the uterus, anti-inflammatory therapy and erythrocyte mass transfusion, characterized in that before the radical operation they carry out 1-2 sessions of intermittent plasmapheresis followed by 7 sessions of low-intensity intravascular laser irradiation and 1-2 sessions of intermittent plasmapheresis in the intermittent plasmapheresis in intermittent plasmapheresis period.