RU2459212C1 - Method for prediction of clinical course of postoperative period of perforated duodenal ulcer - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves the preoperative patient's blood examination to evaluate the relation of polypeptides of average molecular weight/total protein. If the relation exceeds 64 "OE"/g/l, the purulent-septic complications are predicted.

EFFECT: use of the method enables well-timed prescription of the group of therapeutic interventions, and also a reduced number of postoperative complications.

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Description

The invention relates to medicine, in particular to emergency surgery, and can be used in clinical practice to predict the course of the postoperative period of a perforated duodenal ulcer.

A known method for predicting purulent-inflammatory complications of peptic ulcer of the duodenum by the content of total haptoglobin (NRT) in blood plasma, an index indicator - leukocyte-T-cell index (LTI) (End G.I. Prediction and prevention of purulent-inflammatory complications in surgery peptic ulcer of the duodenum taking into account immunological monitoring. Author's abstract. Diss. Candidate of Medical Sciences. Yaroslavl, 1990, p.19-20) (prototype).

The disadvantage of this method is that it cannot serve as a reliable prognostic criterion for the course of the postoperative period of a perforated duodenal ulcer. According to the forecast, purulent-inflammatory complications developed only in 60-62% of cases.

The objective of the invention is to develop a method that allows with a higher probability to predict the development of purulent-septic complications in the postoperative period of a perforated duodenal ulcer.

The task is achieved by the fact that in the patient’s blood upon admission, before the operation, the ratio of the average molecular weight polypeptide (PSMM) / total protein is determined and, with its values above 64 OE / g / l, the development of purulent-septic complications is predicted.

The choice of this ratio is due to the following. As shown by previous studies, the average molecular weight polypeptide plays an important role in the toxicity of exudate, flushing from the peritoneum, blood plasma in acute peritonitis, and acute diseases of the abdominal cavity (Reis B.A. et al. Study of the toxin in septic peritonitis. Surgery, 1983, No. 6, p. 77-80). At the same time, the isolated determination of only PSMM does not fully reflect the real dynamics of its metabolism, the severity of anabolic or catabolic processes. The PSMM / total protein ratio more accurately reflects the dynamics of protein catabolism.

When the PSMM / total protein ratio before surgery is higher than 64 OE / g / l, patients with a perforated duodenal ulcer develop purulent-septic complications and peritonitis in the postoperative period.

When the ratio of PSMM / total protein before surgery 56-64 OE / g / l in patients there is an uncomplicated course of the postoperative period.

The method is as follows.

In a patient with a perforated duodenal ulcer, upon admission, prior to surgery, venous blood is taken in an amount of 1 ml into a test tube into which 0.02 ml of an official heparin solution is poured. Then the blood is centrifuged at 1500 rpm for 10 minutes, plasma is taken. In plasma, the total protein content in g / l is determined by the biuret method, PSMM in optical units (OE) by the express method according to N.I. Gabrielyan and at a level above 64 OE / g / l, the development of purulent-septic complications is predicted (Pharmacist S.G. ., Pokrovsky A.A. Methods of studying the state of protein metabolism // Biochemical research methods in the clinic / Edited by A.A. Pokrovsky.M .: Medicine, 1969, pp. 53-106; Gabrielyan N.I. et al. The prognostic value of some laboratory parameters in patients with acute renal failure. Anesthesia and resuscitation., 1983, No. 1, p. 48-50).

Example 1. Patient C., upon receipt of a clinical diagnosis: perforated duodenal ulcer.

The patient before the operation produce a sampling of peripheral venous blood, in the plasma of which according to the proposed methods determine the content of total protein, PSMM, their ratio. In this case, it amounted to 66 OE / g / l, which gives reason to predict purulent-septic complications in the postoperative period. The obtained prognosis was confirmed by the clinical course of the disease, the patient was reoperated for peritonitis. Recovery came only after 36 days.

Example 2. Patient M., upon receipt of a clinical diagnosis: perforated duodenal ulcer.

The patient before the operation produce a sampling of peripheral venous blood, in the plasma of which according to the proposed methods determine the content of total protein, PSMM, their ratio. In this case, it amounted to 76 OE / g / l, which corresponded to the complicated course of the disease. The prognosis obtained was confirmed by the clinical course of the disease. The patient was operated on twice for ulcers in the abdominal cavity and was discharged after 48 days.

The proposed method examined 65 patients with peptic ulcer of the duodenum. The coincidence of the prognosis and the nature of the course of the postoperative period, the development of purulent-septic complications was revealed in 59 patients (91% of cases).

The advantage of the proposed method in comparison with the prototype is that it allows predicting the course of the postoperative period, the development of purulent-septic complications within an accuracy of 91% even before surgery, which contributes to the timely appointment of a complex of therapeutic measures to patients and will reduce the number of postoperative complications lethality.

Claims (1)

A method for predicting the course of the postoperative period of a perforated duodenal ulcer by examining a patient’s blood, characterized in that prior to the operation, the ratio of the average molecular weight polypeptide (PSMM) / total protein is determined, and with its value exceeding 64 OE / g / l, the development of purulent-septic complications is predicted .