RU2297220C2 - Method for correcting stress-induced hemostasis system changes caused by surgical interventions in metabolic syndrome cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering Thyroxin at a dose of 50 mg/day in a combination with Metformin at a dose of 500 mg/day, Detralex at a dose of 800 mg/day within a month before forthcoming operation to patients. Low molecular weight heparin is subcutaneously introduced two hours before surgical intervention. Hydroxyethylized starch infusion is carried out at a dose of 0.5-1.0 ml/kg during operation. Low molecular weight heparin is subcutaneously introduced 7 days long after the surgical intervention.

EFFECT: enhanced effectiveness of treatment; prevented thrombogenetic complications and hemodynamic instability; improved metabolic processes in blood platelets, blood vessel walls; decreased thrombophilic orientations of hemostasis system.

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Description

The invention relates to medicine and can be used in anesthesiology, general surgery, neurosurgery.

The prior art method of anti-ischemic protection of limb tissues during operations and injuries of the musculoskeletal system (Patent No. 2082396, publ. 06/27/1997, IPC A61K 31/00; A61K 31/74). This method includes the introduction of reopoliglyukin, trental, compliment, vitamin E before, during and after the operation. Moreover, during the operation, regional prolonged anesthesia is carried out with an anesthetic solution additionally containing a drug with the properties of a synovial fluid, a water-soluble antioxidant and a glucocorticosteroid drug in medium therapeutic doses at a solution temperature of +4, + 5 ° C, anesthesia is completed by the introduction of an antideaggregant, and in the recovery period, this solution is administered in yshechnuyu zone paratendinalno and paraneural before and in the rehabilitation process, moreover, further to and after surgery or injury, after alpha-blocker is administered in high therapeutic doses. This method provides anti-ischemic protection of tissues by reducing the metabolism in them, but requires the use of drugs in a refrigerated (up to +4, + 5 ° C) form and does not fully stabilize metabolic processes in cells at the temperature of the human body and does not allow hemodynamic prophylaxis violations.

A known method of spinal anesthesia (Patent RU No. 2200030 publ. 2003.03.10, IPC A61M 21/00; A61P 23/00), which consists in the fact that the patient is injected intramuscularly three times 0.18-0 intramuscularly with the patient during the day before the planned operation. , 22 mg / kg, droperidol 0.078-0.083 mg / kg, obzidan 0.016-0.022 mg / kg, and diphenhydramine 0.13-0.18 mg / kg, Relanium 0.09-0.16 mg / kg, simultaneously carry out spinal anesthesia in the usual way, while in emergency anesthesiology the patient is injected intramuscularly 30–50 minutes before surgery without behexonium 0.18-0.22 mg / kg, droperidol 0.078-0.0 83 mg / kg, obzidan 0.016-0.022 mg / kg, then directly on the operating table, intrahexonium 0.06-0.085 mg / kg, droperidol 0.039-0.043 mg / kg, obzidan 0.016-0.022 mg / kg, and diphenhydramine 0 are administered , 13-0.18 mg / kg, Relanium 0.12-0.16 mg / kg.

This method prevents the development of arterial hypotension and contributes to the normalization of peripheral circulation. But it does not allow you to correct metabolic processes in platelets, the vascular wall, and also does not reduce atherogenic dyslipoproteinemia.

Closest to the claimed is a method of preoperative preparation of the patient (Patent No. 2099060, publ. 1997.12.20, IPC A61K 31/715; A61K 31/355; A61K 31/44), which is selected as a prototype. The essence of this method lies in the fact that in a planned manner, intramuscular administration of the lipopolysaccharide preparation Pyrogenal is performed twice. The first injection at a dose of 1 μg / kg (not more than 30 μg) is carried out 48 hours before surgery. At the same time, twice in 48 hours and 24 hours before surgery, tocopherol is prescribed at a dose of 20 mg / kg intramuscularly, pyridoxine 1 ml / 10 kg, but not more than 5 ml. This method increases the body's resistance to damaging factors of the operating period (trauma, blood loss, stress), and also enhances non-specific anti-infection resistance.

However, this method does not fully prevent thrombohemorrhagic complications and hemodynamic instability during surgical interventions in patients with metabolic syndrome.

The technical result of the proposed method for the correction of stress-induced changes in the hemostatic system during surgical interventions in patients with metabolic syndrome is to increase the effectiveness of the prevention of thrombohemorrhagic complications in patients with metabolic syndrome in diseases with impaired glucose tolerance or type 2 diabetes accompanied by subclinical forms of hypothyroidism.

This result is achieved due to the fact that the method of correction of stress-induced changes in the hemostasis system during surgical interventions in patients with metabolic syndrome with impaired glucose tolerance or type 2 diabetes, accompanied by subclinical forms of hypothyroidism, is that within a month before surgery Thyroxine is administered at a dose of 50 mg / day in combination with metformin at a dose of 500 mg / day and Detralex at a dose of 800 mg / day, and two hours before surgery and for seven days after surgery low molecular weight heparin is injected subcutaneously, and hydroxyethylated starch is infused intraoperatively at a dose of 0.5-1.0 ml / kg.

The purpose of the complex, including a combination of thyroid hormone (thyroxine), and a drug that affects the metabolism of glucose (metformin), contributes, first of all, to the improvement of metabolic processes in platelets, blood vessels, as well as the correction of atherogenic dyslipoproteinemia. This, in turn, helps to reduce the thrombophilic orientation of the hemostasis system in this category of patients, as well as to increase the reserve of natural anticoagulants and the consistency of regulatory influences (both neuronal and humoral) in the secretion of elements of plasma, vascular and platelet units.

The inclusion of a microionized fraction of flavonoids provides an increase in the background level of protein C, both in platelets and in the walls of blood vessels, which, together with the pronounced venotonic effect of the drug and the effect on tissue lymphatic drainage, increases the resistance of the venous-lymphatic channel and creates a favorable background for the course of reparative processes.

The rational introduction of an adequate volume of intravenous infusion of hydroxyethylated starch (rephtan) preparations into anesthetic support promotes its binding to activated forms of plasma factors on phospholipid elements in blood plasma, thereby limiting the cascade of coagulation mechanisms, and at the same time allowing easy cleavage by tissue enzymes without interfering with the natural flow of the blood coagulation process at the site of the operative reception.

The following observations can serve as an illustration of the rather high efficiency of the proposed method for the correction of stress-induced changes in the hemostatic system during surgical interventions in patients with metabolic syndrome.

Example 1

Patient K., 67 years old, was admitted to the surgical department for planned surgical treatment for rectal adenocarcinoma T2NxM0. Concomitant diseases: coronary heart disease, angina pectoris of the second functional class, hypertension 3 stages, 3 degrees, risk 3. Postthrombophlebitis syndrome (PTFS) recanalized form 4 stages, chronic venous insufficiency (CVI) 4 degrees, urolithiasis (ICD), chronic pyelonephritis in remission, grade 3 obesity, metabolic syndrome, autoimmune thyroiditis.

The complex of conservative preoperative preparation includes oral administration of thyroxine at a dose of 50 mg / day for a month in combination with metformin at a dose of 500 mg / day and detralex at a dose of 800 mg / day. Two hours before surgery and for seven days after it, low molecular weight heparin is injected subcutaneously (fraxiparin 0.3 ml × 1 time / day). Hydroxyethylated starch is infused intraoperatively at a dose of 0.5-1.0 ml / kg. The patient was operated with laparoscopic access, performed an aortic ileal lymphadenectomy, anterior rectum resection. The dynamics of the indicators of the coagulogram are presented in table 1.

In the postoperative period, antibiotic therapy was carried out (metrogil 100.0 ml of a 5% solution 3 times a day intravenously for 5 days, abactal 400 mg intravenously 2 times a day for 5 days, amikacin 1.0 × 1 time per day intramuscularly for seven days), analgesics. The postoperative period without features, the patient was discharged on the eighth day.

Example 2

Patient K., 52 years old, was admitted to the surgical department for planned surgical treatment for retrocervical endometriosis of 3-4 degrees with rectal germination. Concomitant diseases: coronary heart disease, angina pectoris of the second functional class, hypertension 2 stages, 2 degrees, risk 2. PTFS recanalized form 4 stages, CVI 4 degrees, ICD, chronic pyelonephritis in remission, obesity 3 degrees, metabolic syndrome, autoimmune thyroiditis.

The conservative preoperative preparation complex includes the administration of thyroxine at a dose of 50 mg per day in combination with metformin at a dose of 500 mg per day and detralex at a dose of 800 mg per day. Two hours before surgery and for seven days after it, low molecular weight heparin is injected subcutaneously (fraxiparin 0.3 ml once a day). Oxyethylated starch is infused intraoperatively at a dose of 0.5-1.0 ml / kg. The patient was operated with laparoscopic access, excision of the uterus with appendages, anterior resection of the rectum was performed.

The dynamics of the coagulogram indices are presented in Table 2. In the postoperative period, antibiotic therapy was carried out (metrogil 100.0 ml 3 times a day intravenously 5 days, abactal 400 mg intravenously 2 times a day 5 days, amikacin 1.0 1 time per day intramuscularly seven days ), analgesics. The postoperative period without features, the patient was discharged on the eighth day.

Table 1 Indicator Group The timing 1 day 3 days 5 days AT III the main 18.2 ± 3.6% 20.9 ± 4.1% 12.6 ± 3.2% control 10.2 ± 2% 12.1 ± 2.4% 6.4 ± 1.6% APTTV the main 34.66 ± 0.36% 32.91 ± 0.38% 34.2 ± 0.41% control 40.8 ± 0.42% 39.2 ± 0.45% 40.9 ± 0.49% Fibrinogen the main 5.6 ± 1.2% 6.8 ± 0.4% 6.9 ± 0.38% control 5.2 ± 1.1% 4.8 ± 0.28% 4.9 ± 0.27% RFMK the main 4.2 ± 0.21% 6.5 ± 0.68% 6.3 ± 0.52% control 4.4 ± 0.22% 5.2 ± 0.54% 4.4 ± 0.36% Table 2 Indicator Group The timing 1 day 3 days 5 days AT III the main 18.2 ± 3.6% 20.9 ± 4.1% 12.6 ± 3.2% control 8.3 ± 1.64% 10.2 ± 2% 6.9 ± 1.75% APTTV the main 34.66 ± 0.36 32.91 ± 0.38 34.2 ± 0.41 control 10.2 ± 0.1% 39.1 ± 0.45% 40.2 ± 0.48% Fibrinogen the main 5.6 ± 1.2% 6.8 ± 0.4% 6.9 ± 0.38% control 5.4 ± 1.16% 4.8 ± 0.28% 4.8 ± 0.26% RFMK the main 4.2 ± 0.21% 6.5 ± 0.68% 6.3 ± 0.52% control 4.4 ± 0.22% 5.0 ± 0.52% 4.0 ± 0.33%

Claims (1)

A method for the correction of stress-induced changes in the hemostatic system during surgical interventions in patients with metabolic syndrome with impaired glucose tolerance or type 2 diabetes, accompanied by subclinical forms of hypothyroidism, which involves administering thyroxine at a dose of 50 mg / day for a month before surgery in combination with metformin at a dose of 500 mg / day and detralex at a dose of 800 mg / day, and two hours before the operation and for seven days after the operation, low molecular weight heparin and intra peratsionno carried HES infusion at a dose of 0.5-1.0 ml / kg.