RU2517110C2 - Method for prediction of probability of favourable or lethal outcome in patients suffering from infectious-inflammatory urinary diseases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely urology, and may be used for prediction of the favourable or lethal outcome in patients suffering from infectious-inflammatory urinary diseases. That is ensured by the laboratory-clinical examination of blood eosinophils and lymphocytes; that is followed by determining an absolute eosinophil count prior to the first session of indirect electrochemical oxidation (IECO) of blood with 0.06% sodium hypochlorite and an absolute eosinophil count after the first session of the IECO of blood, as well as an absolute blood lymphocyte count in 1, 3 and 7 days after the first session of the IECO of blood. The derived values are included into discriminant functions of a tentative prognosis and a definitive prognosis. The patient is referred to a group with the maximum classification function value.

EFFECT: invention enables using prediction of the favourable or lethal outcome to choose the most effective approach to the group of patients with the unfavourable prognosis.

4 tbl, 4 ex

Description

The invention relates to medicine, namely to urology, and can be used in clinical practice to predict a favorable or fatal outcome in the treatment of patients with infectious and inflammatory diseases of the urinary system.

A known method for predicting death in nephrological patients (Malishevsky M.V., Golodnev Yu.V. et al. Patent for the invention No. 2254803. RU. C1. June 27, 2005). This method of predicting a fatal outcome also uses the method of mathematical computer multivariate discriminant analysis of 2 groups of patients who were on program hemodialysis. The 1st group consisted of deceased patients, and the 2nd - patients continuing treatment. In both groups, the central hemodynamic parameters were analyzed: left ventricular myocardial mass and diastolic reserve. The obtained discriminant functions for each of the patient groups make it possible to predict a fatal outcome in the most severe dialysis patients with end-stage chronic renal failure. This method of predicting a fatal outcome concerns only dialysis patients and did not apply to patients with infectious and inflammatory diseases of the urinary system.

A known method for the diagnosis of predicting the course of acute and chronic inflammatory process (method II Dzerzhinsky) (Dzerzhinsky II, Darenkov AF and other guidelines. Moscow. 1987. C 23.). The method is based on the calculation of the absolute and relative number of rosette-forming neutrophils of human peripheral blood. Subpopulations of neutrophils capable of early and late E-rosette formation (E-RONR, E-RON), double rosette formation (D-RON), EA and EAC-rosette formation (EA-RON and EAC-RON) were distinguished. With inflammation, including with infectious and inflammatory diseases of the urinary system, changes in the number of neutrophil subpopulations and their ratio occur in the patient’s peripheral blood. This method allows you to diagnose acute and chronic inflammatory process, sepsis. The disadvantage of this method is its complexity, the need for a trained specialist and sophisticated equipment. The method does not allow to predict the outcome of an infectious and inflammatory disease, but is limited to the classification of the severity of the inflammatory process.

A known method for predicting the likelihood of death in patients with surgical sepsis (Grebenyuk V.V., Yusan N.V. et al. Patent for the invention No. 2385150. RU. C1. 03.27.2010). In this method, the results of clinical and laboratory studies are evaluated in the pre-, intra- and postoperative period. The following are taken into account: the relative content of lymphocytes, the immunoregulatory index, the level of the receptor antagonist of interleukin-1, the data of a clinical examination, the psychological status of the patient. The forecast accuracy is 10-90% with a duration of hospital stay of 1 to 120 days. The disadvantage of this method is its complexity, duration, the need for special laboratory equipment for determining subpopulations of lymphocytes (flow cytometry), low accuracy of the forecast.

The aim of the invention is to increase the effectiveness of the treatment of patients with infectious and inflammatory diseases of the urinary system in urology. Assessing the likelihood of a favorable or fatal outcome of the disease will allow more rational use of expensive drugs, methods of examination and treatment.

This goal is achieved by the fact that the complex of conservative treatment of patients with infectious and inflammatory complications includes the method of transfusiological aid indirect electrochemical oxidation (NEHO) of blood with 0.06% solution of sodium hypochlorite (GN) (Russian Medicines Register of the Radar Station Encyclopedia of drugs. 14 vol. / Ch.edited by G.L. Vyshkovsky. M .: Radar 2006. S.553-554.). The drug GN is an oxidizing agent. The reaction of the patient with an infectious and inflammatory disease to NEHO blood is evaluated by the dynamics of the blood formula: the absolute number of eosinophils and lymphocytes.

NEHO blood is as follows. A solution of sodium hypochlorite for intravenous infusion was prepared on a DEO-01-MEDEC apparatus based on a sterile isotonic sodium chloride solution according to the guidelines for the use of sodium hypochlorite and the provisions of the technical documentation. The concentration of each batch of the prepared sodium hypochlorite solution was determined by the method of oxidometric titration. The sodium hypochlorite solution was infused into the central veins (subclavian, jugular) through a plastic catheter at a speed of 1.6 ml per minute or 100 ml / hour (Fedorovsky NM Indirect electrochemical detoxification. Moscow. "Medicine". 2004. P.143 ) An infusion pump was used for dosed administration of drugs. The volume of the injected sodium hypochlorite solution did not exceed 1/10 of the patient’s circulating blood volume. On average, 200-400 ml of a 0.06% solution of GN were used in one NEHO blood session. The course of treatment with intravenous infusions of a 0.06% GN solution consisted of 1 or 10 sessions performed daily or every other day depending on the availability of indications, contraindications and sufficiency criteria for conducting NEHO blood tests (Ivashchenko V.V. Indirect electrochemical blood oxidation with sodium hypochlorite solution in a complex of conservative therapy of acute pyelonephritis. Author. Abstract. Thesis of Candidate of Medical Sciences. Moscow. 1999. S. 22).

Using the method of mathematical computer multivariate discriminant analysis, discriminant functions were obtained for a group of patients with a favorable outcome of infectious and inflammatory diseases of the urinary system - 32 people (Group 1) and a group of patients with fatal outcome - 4 people (Group 2).

A method for predicting the likelihood of a favorable or fatal outcome in patients with infectious and inflammatory diseases of the urinary system is that when conducting NEHO blood tests with a 0.06% solution of GN, laboratory and clinical studies of eosinophils and blood lymphocytes are carried out, the absolute value of eosinophils is determined before the first session NECHO blood 0.06% solution of GN (AChEdo) and the absolute value of eosinophils after the first session NECHO blood 0.06% solution of GN (achEpo), as well as the absolute values of blood lymphocytes 1 day after the first session of NECHO blood (achL1 days), 3 days after the first session of NECHO blood (achL3 days), 7 days after the first session of NECHO blood (achL7 days) with a 0.06% GN solution, the results obtained include in the discriminant functions of the preliminary forecast for 3 days after the NEHO blood test:

Group 1 (favorable outcome) = achEPo × 12.5 + achL1 day. × 4.36 + achL3 days. × 1.1-7.5;

Group 2 (fatal outcome) = achEPO × 2.37 + achL1 day. × 1.64 + achL3 days. × (-0.014) -2.77

and the final forecast for 7 days after the NEHO blood test:

Group 1 (favorable outcome) = achEDoch × 3.8 + achL7 days. × 7.26-7.1;

Group 2 (fatal outcome) = achEDo × 0.02 + achL7 days. × 2.1-2.72,

in this case, the patient belongs to the group for which the classification value of the function is maximum.

Final forecasting is necessary in order to avoid errors in the classification of severe cases with a high probability of death.

Example 1. Patient Ch., 24 years old, medical history No. 118, was admitted to a urological hospital on 10.01.1996 with complaints of fever up to 38 ° C, chills, nausea, vomiting, general weakness.

From the anamnesis it was known that in 1991 the patient underwent surgery - a resection of the lower pole of the right kidney - about the carbuncle of the kidney. The last exacerbation of pyelonephritis was noted in 1991. The patient associated the deterioration of the condition with hypothermia.

The skin is moderately moist, hyperemic. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, the rhythm of cardiac activity is correct. Blood pressure - 120/80 mm Hg, heart rate - 84 in 1 min. The abdomen is soft, painless on palpation. Symptom Pasternatsky - sharply positive on the right; marked pain in the right kidney during palpation.

According to a survey radiograph of the urinary system and a series of images of excretory urography, there is no violation of the passage of urine. Ultrasound of the kidneys: The kidneys are enlarged (right - 12.5 × 6.5 cm, left - 12.1 × 6.0 cm), the contours are clear, even. The thickness of the parenchyma is 1.5-1.7 cm. The CLS is not expanded. There are no calculi.

Laboratory data. Clinical blood test: hemoglobin - 117.0 g / l, leukocytes - 11.2 × 10 ⁹ / l, p / I neutrophils - 10%, s / i neutrophils - 73%, eosinophils - 0, basophils - 0, lymphocytes - 15%, monocytes - 2%, ESR - 25 mm / hour. Biochemical blood test: urea - 5.2 mmol / L, creatinine - 0.1 mmol / L, potassium - 5.0 mmol / L, total protein - 70 g / L, total bilirubin - 16.5 mmol / L. General urine analysis: specific gravity - 1010, urine reaction - acidic (pH 6.0), protein - 0.165 g / l, white blood cells cover the entire field of view, bacteria - a significant amount. Urine culture on flora - bacteriuria was not found.

Based on the patient’s complaints, medical history, objective examination data, laboratory and instrumental examination methods, the patient was diagnosed with acute pyelonephritis without disturbing the passage of urine.

Conservative treatment has been prescribed. From antibacterial drugs, the patient received: nitroxoline and gentamicin for 6 days, cefamizine and biseptol for 8 days. Despite the ongoing therapy, 2 weeks after admission to the hospital, the patient's condition worsened: body temperature increased to 39 ° C in the morning and evening, nausea, chills, severe sweating persisted. 01/22/1996, a clinical blood test: Hb - 122.0 g / l, erythrocytes - 3.6 × 10 ¹² / l, white blood cells - 16.2 × 10 ⁹ / l, n / a neutrophils - 1%, s / I am neutrophils - 80%, eosinophils - 1%, basophils - 0, lymphocytes - 11%, monocytes - 7%, ESR - 60 mm / hour. Severe toxic granularity of leukocytes. Biochemical analysis of blood: urea - 3.6 mmol / L, creatinine - 0.12 mmol / L, potassium - 4.6 mmol / L, total protein - 68.8 g / L, fibrinogen - 3.1 g / L. Median blood molecules DV 254: 0.6 opt. units Creatinine clearance - 63.6 ml / min. Ultrasound of the kidneys: there is no negative dynamics.

In order to treat acute pyelonephritis 01/23/1996, the patient was prescribed a course of NEHO blood with a solution of GN. Through a catheter in the subclavian vein, 5 daily infusions of a 0.06% GN solution were performed in a volume of 1/20 BCC (200 ml of a 0.06% GN solution). The infusion rate was 1.6 ml / min. (100 ml / hour).

1 day after the start of the NEHO blood course, a decrease in body temperature to normal values was noted. The general condition of the patient improved: chills, nausea, weakness, sweating disappeared; Appetite appeared.

On the 3rd day from the beginning of the NEHO blood course, a clinical blood test: Hb - 117.0 g / l, erythrocytes - 3.0 × 10 ¹² / l, white blood cells - 10.1 × 10 ⁹ / l, n / a neutrophils - 6%, agricultural neutrophils - 60%, eosinophils 1%, basophils - 1%, lymphocytes - 30%, monocytes - 2%, ESR - 42 mm / hour. Medium blood molecules DV 254 - 0.32 opt. units General urine analysis: specific gravity - 1010, acid reaction (6.0), protein - 0.33 g / l, white blood cells - 25-38 in the field of view, red blood cells - 2-7 in the field of view, bacteria - a significant amount.

On the 7th day of the NEHO blood course (after 5 sessions): the patient's condition is satisfactory, her body temperature is normal, she has no complaints. Clinical blood test: Hb - 111.0 g / l, erythrocytes - 3.0 × 10 ¹² / l, white blood cells - 4.4 × 10 ⁹ / l, n / a neutrophils - 4%, s / i neutrophils - 61% , eosinophils - 0, basophils - 0, lymphocytes - 27%, monocytes - 8%, ESR - 35 mm / hour. Biochemical blood test: urea - 4.7 mmol / l, creatinine - 0.1 mmol / l, potassium - 4.6 mmol / l, total protein - 60.0 g / l, total bilirubin - 15.9 mmol / l fibrinogen - 3.5 g / l; glucose - 4.8 mmol / l. Medium urine molecules DV 254 - 0.64 opt. units Creatinine clearance - 78.1 ml / min. General urine analysis: specific gravity - 1012, acid reaction (6.0), protein - no, white blood cells - 7-9 in the field of view, red blood cells - 2-4 in the field of view, no bacteria.

In order to predict the outcome of an infectious and inflammatory disease in a patient, the dynamics of the absolute number of peripheral blood eosinophils and lymphocytes before and after the start of NEHO blood sessions was studied, table 1.

Table 1. Absolute values of eosinophils and blood lymphocytes before and after the start of NEHO blood sessions. Indicator Up to 1 session of NEHO blood After 1 session of NEHO blood After 1 day of the beginning of NEHO blood After 3 days of the beginning of NEHO blood After 7 days of the beginning of NEHO blood The absolute value of eosinophils, × 10 ⁹ / l 0.16 0.12 - - - The absolute value of lymphocytes, × 10 ⁹ / l - - 3.03 2,5 1,2 * - the table shows only those values that are necessary to predict the outcome of the disease.

Preliminary forecasting was performed on the 3rd day after the 1st blood NEHO session with 0.06% GN solution. Group 1 = achEPo × 12.5 + achL1 day. × 4.36 + achL3 days. × 1.1-7.5. Group 2 = achEPo × 2.37 + achL1 day. × 1.64 + achL3 days. × (-0.014) -2.77.

Group 1 = 0.12 × 12.5 + 3.03 × 4.36 + 2.5 × 1.1-7.5 = 9.96

Group 2 = 0.12 × 2.37 + 3.03 × 1.64 + 2.5 × (-0.014) -2.77 = 2.45

The patient belongs to group 1 of patients, since the classification value for group 1 is greater than the same value for group 2. Therefore, on the 3rd day after the start of NEHO blood sessions, the patient had a favorable prognosis of the outcome of the infectious and inflammatory disease.

The final forecasting is carried out on the 7th day after the first NEHO blood test with a 0.06% solution of GN. Classification functions are as follows. Group 1 = achEDo × 3.8 + achL7 days. × 7.26-7.1. Group 2 = achEDo × 0.02 + achL7 days. × 2.1-2.72.

Group 1 = 0.16 × 3.8 + 1.2 × 7.26-7.1 = 2.21

Group 2 = 0.16 × 0.02 + 1.2 × 2.1-2.72 = -0.197

The patient belongs to group 1 of patients, since the classification value for group 1 is greater than the same value for group 2. Therefore, on the 7th day after the start of NEHO blood sessions, the patient had a favorable prognosis of the outcome of the infectious and inflammatory disease.

During the course of the NEHO blood course with a solution of GN, additional therapeutic agents, including antibacterial drugs, were not prescribed. 5 days after its completion, in satisfactory condition, the patient was discharged from the hospital.

Example 2. Patient F., 29 years old, medical history No. 1954, was admitted to the Federal State Budget Scientific Research Institute of Urology of the Ministry of Health of the Russian Federation on 03/03/2012 with complaints of fever up to 39 ° C, pain in the right half of the lumbar region, frequent urination.

From the anamnesis it was possible to find out that over the past 5 years the patient has repeatedly received course treatment for chronic prostatitis, chronic cystitis. 05/22/2012, he had a stricture of the distal ureter on the right, antegrade surgery, laser endoureterotomy, and installation of an internal ureteric stent on the right. 07/02/2012 in connection with the deterioration of the condition, the patient was hospitalized in a urological hospital.

The skin is hyperemic. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, the rhythm of cardiac activity is correct. Blood pressure 125/80 mm Hg, heart rate - 78 beats per 1 min. The abdomen is soft, painless on palpation. Symptom Pasternatsky - slightly positive on the right; the kidneys are painless on palpation. Per recnum: The sphincter is tonic. The prostate is painful, enlarged, swollen, with a tight-elastic consistency.

Ultrasound of the kidneys: The right kidney is 12.2 × 5.2 cm. The thickness of the parenchyma is 1.5-1.8 cm. The pelvis of the right kidney is expanded to 2.5 cm, the calyx to 0.9 cm. The proximal ureter is not expanded. Signals from the stent, coarsely dispersed suspension, are recorded in the pelvis. The left kidney is 12.0 × 5.4 cm, the thickness of the parenchyma is 2.0 cm, not swollen. The pyelocaliceal system is not expanded. Calculi, volume formations are not identified. The walls of the bladder are thickened. Dimensions of the prostate gland - 4.6 × 4.3 × 4.2 cm, volume - 44 cm ³ . Echogenicity of the prostate gland is reduced, focal changes are not detected.

Laboratory data. Clinical blood test on 07/03/2012: hemoglobin - 124.0 g / l, leukocytes - 21.4 × 10 ⁹ / l, s / I neutrophils - 1%, s / I neutrophils - 88%, eosinophils - 1, basophils - 0, lymphocytes - 5%, monocytes - 1%, ESR - 28 mm / hour. Biochemical analysis of blood: urea - 8.8 mmol / L, creatinine - 127 μmol / L, potassium - 4.0 mmol / L, sodium - 132 mmol / L, calcium 1.16 mmol / L. Coagulogram: PTV - 16.4 seconds. MHO - 1.4. IPT - 52%. APTTV - 38.6 sec. Fibrinogen 6.2 g / l. TV - 14.3 seconds

Based on the patient's complaints, medical history, objective examination data, laboratory and instrumental research methods, the diagnosis was made: Chronic pyelonephritis, active phase. Internal stent on the right. Violation of the outflow of urine from the right kidney. Chronic prostatitis, exacerbation. Chronic cystitis, exacerbation.

In order to restore an adequate passage of urine from the right kidney on an emergency basis, 03/07/2012, the patient underwent percutaneous puncture nephrostomy on the right.

The early postoperative period was complicated by chills, headache, fever up to 39 ° C, hypotension up to 80/60 mm Hg. The patient was transferred to the intensive care unit for further treatment.

Infusion therapy was aimed at correcting water-electrolyte disturbances and hypovolemia. From antibacterial drugs, the patient received cefotaxime 1.0 gram intravenously 2 times a day, doriprex 100 mg intravenously 2 times a day.

07/04/2012 Clinical blood test: Hb - 116 g / l, erythrocytes - 3.65 × 10 ¹² / l, white blood cells - 18.1 × 10 ⁹ / l, s / I neutrophils - 9%, s / I neutrophils - 71%, eosinophils - 1%, basophils - 0, lymphocytes - 16%, monocytes - 3%, ESR - 60 mm / hour. Biochemical blood test: urea - 5.4 mmol / L, creatinine - 127 μmol / L, potassium - 4.0 mmol / L, sodium - 136 mmol / L, total protein - 55 g / L, fibrinogen - 6.85 g / l

Ultrasound of the kidneys: The right kidney is 14 × 6 × 5.5 cm. The thickness of the parenchyma is 2.1 cm. All groups of the cups of the right kidney are expanded to 1.0 cm. The proximal ureter is not expanded. The left kidney is 12.2 × 5.9 × 4.7 cm, the thickness of the parenchyma is 2.1 cm, and is not swollen. The pyelocaliceal system is not expanded. The size of the prostate gland is 4.5 × 3.3 × 4.2 cm, the volume is 32 cm ³ . Echogenicity of the prostate gland is reduced, focal changes are not detected.

07/05/2012, the patient's condition improved slightly, blood pressure stabilized at 115/80 mm Hg. In the complex of conservative therapy of the systemic inflammatory response syndrome, the active phase of chronic pyelonephritis, an NEHO blood session was prescribed with a solution of GN. 100 ml of a 0.06% solution of GN were injected intravenously. After being transferred to the urology department, the patient continued with antibacterial and infusion therapy.

Body temperature returned to normal on July 9, 2012, i.e. 4 days after NEHO blood. During the entire observation period, the patient complained of general weakness, difficulty urinating.

In order to predict the outcome of an infectious and inflammatory disease in a patient, the dynamics of the absolute number of peripheral blood eosinophils and lymphocytes before and after a single NEHO blood test with a 0.06% GN solution was studied, table 2.

Table 2. Absolute values of eosinophils and blood lymphocytes before and after one session of NECHO blood with a solution of GN. Indicator Up to 1 session of NEHO blood After 1 session of NEHO blood After 1 day of the beginning of NEHO blood After 3 days of the beginning of NEHO blood After 7 days of the beginning of NEHO blood The absolute value of eosinophils, × 10 ⁹ / l 0.18 0.32 - - - The absolute value of lymphocytes, × 10 ⁹ / l - - 2.13 2.97 2.48 * - the table shows only those values that are necessary to predict the outcome of the disease.

Preliminary forecasting was performed on the 3rd day after the 1st blood NEHO session with 0.06% GN solution. Group 1 = achEPo × 12.5 + achL1 day. × 4.36 + achL3 days. × 1.1-7.5. Group 2 = achEPo × 2.37 + achL1 day. × 1.64 + achL3 days. × (-0.014) -2.77.

Group 1 = 0.32 × 12.5 + 2.13 × 4.36 + 2.97 × 1.1-7.5 = 9.1

Group 2 = 0.32 × 2.37 + 2.13 × 1.64 + 2.97 × (-0.014) -2.77 = 1.45

The patient belongs to the 1st group of patients, since the classification value for group 1 is greater than the similar value for group 2. Therefore, on the 3rd day after the first NEHO blood test, the patient had a favorable prognosis of the outcome of the infectious-inflammatory disease.

07/11/2012, the internal stent on the right was removed. The postoperative period was uneventful.

The final forecasting was carried out on the 7th day after the NEHO blood test with a 0.06% solution of GN. 07/12/2012 classification functions were as follows. Group 1 = achEDo × 3.8 + achL7 days. × 7.26-7.1. Group 2 = achEDo × 0.02 + achL7 days. × 2.1-2.72.

Group 1 = 0.18 × 3.8 + 2.48 × 7.26-7.1 = 11.58

Group 2 = 0.18 × 0.02 + 2.48 × 2.1-2.72 = 2.48

The patient belongs to the 1st group of patients, since the classification value for group 1 is more than the same value for group 2. Therefore, on the 7th day after the NEHO blood test, the prognosis of the outcome of the infectious and inflammatory disease in the patient remained favorable.

In satisfactory condition with a nephrostomy on the right, the patient was discharged to continue treatment under the supervision of a polyclinic urologist.

Example 3. Patient I, 77 years old, medical history No. 1851, was admitted to a urological hospital on 05/11/1996 with complaints of a prolonged painful erection for 12 hours, difficulty urinating. In connection with a non-stopping erection, he was hospitalized in a urological hospital.

From the anamnesis it was found that in 1990 the patient suffered an acute myocardial infarction.

The skin is pale, skin turgor is reduced. No swelling. In the lungs, harsh breathing, wheezing in the lower sections is determined. Heart sounds are muffled, the rhythm of cardiac activity is correct. Blood pressure - 160/90 mm Hg, heart rate - 90 strokes in 1 min. The abdomen is soft, painless on palpation. Pasternatsky’s symptom is negative left and right. Body temperature at admission is 37.0 ° C. The bladder is not detected percussion. Per rectum. The prostate gland is round in shape, with a tight-elastic consistency, painless; increased in size by approximately 1.5 times. Thrombosis of hemorrhoids.

Diuresis 400 ml per day.

Ultrasound 05/12/1996, the Kidneys are not structurally changed. No expansion of the pyelocaliceal system. The volume of the prostate gland is 60 cm ³ . Adenoma node - 50 cm ³ . In the bladder, residual urine is determined in a volume of 120 ml.

Ultrasound 05/15/1996, the right kidney is reduced in size. The volume of the prostate gland is 60 cm ³ . Adenoma node - 50 cm ³ . Residual urine in a volume of 600 ml is determined in the bladder.

Radiography of the lungs 05/12/1996, In the lower part of the right pulmonary field there is a darkening of the lung tissue due to infiltration, merging with the shadow of the diaphragm. The left lung tissue is emphysema. Pneumosclerosis Conclusion X-ray picture of right-sided lower lobe pneumonia.

Laboratory data. Clinical blood test: hemoglobin - 92.0 g / l, leukocytes - 9.0 × 10 ⁹ / l, s / I neutrophils - 10%, s / I neutrophils - 64%, eosinophils - 0, basophils - 0, lymphocytes - 3%, monocytes - 4%, ESR - 38 mm / hour. Biochemical analysis of blood: urea - 32.6 mmol / L, creatinine - 0.46 mmol / L, potassium - 5.4 mmol / L.

Based on the patient’s complaints, medical history, objective examination data, laboratory and instrumental examination methods, the patient was diagnosed with prostate adenoma. Priapism. Chronic hemorrhoids. Thrombosis of hemorrhoids. Chronic pyelonephritis. Chronic renal failure, terminal stage. GFR = 11 ml / min. General atherosclerosis. Postinfarction cardiosclerosis.

11.05. and 12.05. puncture of the cavernous bodies and washing of the cavernous bodies with a 5% solution of novocaine were performed twice. 05/15. A trocar cystostomy was performed.

From antibacterial drugs, the patient received ampiox, cefazolin. From 13.05. In order to detoxify the patient, blood NECHO sessions with a 0.06% solution of GN were prescribed.

Intravenous infusion of a 0.06% sodium hypochlorite solution was performed through a catheter in the subclavian vein. We performed 4 sessions of electrochemical detoxification: 13.05, 14.05, 16.05 and 20.05. The total volume of a 0.06% GN solution was 1 liter of 400 ml.

In order to predict the outcome of an infectious and inflammatory disease in a patient, the dynamics of the absolute number of peripheral blood eosinophils and lymphocytes before and after the start of NEHO blood sessions was studied, table 3.

Table 3. Absolute values of eosinophils and blood lymphocytes before and after the start of NEHO blood sessions. Indicator Up to 1 session of NEHO blood After 1 session of NEHO blood After 1 day of the beginning of NEHO blood After 3 days of the beginning of NEHO blood After 7 days of the beginning of NEHO blood The absolute value of eosinophils, × 10 ⁹ / l 0 0.18 - - - The absolute value of lymphocytes, × 10 ⁹ / l - - 0.85 0.27 0.45 * - the table shows only those values that are necessary to predict the outcome of the disease.

Preliminary forecasting was performed on the 3rd day after the 1st blood NEHO session with 0.06% GN solution. Group 1 = achEPo × 12.5 + achL1 day. × 4.36 + achL3 days. × 1.1-7.5. Group 2 = achEPo × 2.37 + accl1 days. × 1.64 + achL3 days. × (-0.014) -2.77.

Group 1 = 0.18 × 12.5 + 0.85 × 4.36 + 0.27 × 1.1-7.5 = -1.2

Group 2 = 0.18 × 2.37 + 0.85 × 1.64 + 0.27 × (-0.014) -2.77 = -0.95

The patient belongs to group 2 of patients, since the classification value for group 2 is greater than the same value for group 1. Therefore, on 05.16.1996, on the 3rd day after the first NEHO blood test with GN solution, the patient had an unfavorable prognosis of the outcome of the infectious-inflammatory disease ( fatal outcome).

The final forecasting was carried out on the 7th day after the first NEHO blood test with a 0.06% GN solution. Group 1 = achEDo × 3.8 + achL7 days. × 7.26-7.1. Group 2 = achEDo × 0.02 + achL7 days. × 2.1-2.72.

Group 1 = 0 × 3.8 + 0.45 × 7.26-7.1 = -3.8

Group 2 = 0 × 0.02 + 0.45 × 2.1-2.72 = -1.8

The patient belongs to group 2, since the classification value for group 2 is greater than the same value for group 1. Therefore, on 05/18/1996, on the 7th day after the start of the NEHO blood test with GN solution, the patient maintained an unfavorable prognosis of the outcome of the infectious-inflammatory disease.

The course of the disease was complicated by sepsis, increasing endogenous intoxication, multiple organ failure. The patient died on May 26, 1996.

Example 4. Patient I., 72 years old, medical history No. 3875, was admitted to a urological hospital on November 27, 1995 with complaints of pain in the penis, purulent discharge from the urethra, and enlargement of the scrotum.

11/14. the patient underwent hernia repair for an inguinal hernia in a multidisciplinary hospital in Moscow. An urethral catheter is installed. From concomitant diseases: IHD. Angina pectoris, functional class 3.

Ultrasound of the kidneys. Multiple cysts in both kidneys are determined up to 4.2 cm in size. The pyelocaliceal system is not expanded.

Ultrasound of the scrotum. The left testicle is enlarged. 2 hypoechoic lesions are determined.

Laboratory data. Clinical blood test: hemoglobin - 70.0 g / l, erythrocytes - 3.0 × 10 ¹² / l, white blood cells - 15.2 × 10 ⁹ / l, s / I neutrophils - 15%, s / I neutrophils - 62% , eosinophils - 3, lymphocytes - 12%, monocytes - 6%, ESR - 65 mm / hour. Biochemical blood test: urea - 30.0 mmol / L, creatinine - 0.5 mmol / L, potassium - 4.2 mmol / L. GFR = 11.6 ml / min.

Diagnosis on admission. Hematoma of the right half of the scrotum. Purulent urethritis. Priapism. Cavernith. Orheoepididymitis on the left. Chronic renal failure. Uremic intoxication.

11/28. Urethral catheter removed. Performed a trocar cystostomy, an orcofuniculectomy on the left.

For the purpose of renal replacement therapy and detoxification, the patient underwent 3 hemodialysis sessions and 2 hemosorption.

12/19. Clinical blood test: hemoglobin - 55.0 g / l, erythrocytes - 1.2 × 10 ¹² / l, white blood cells - 5.2 × 10 ⁹ / l, s / I neutrophils - 9%, s / I neutrophils - 64% , eosinophils - 1, lymphocytes - 17%, monocytes - 9%, ESR - 80 mm / hour. Biochemical blood test: urea - 36.8 mmol / L, creatinine - 0.43 mmol / L, potassium - 3.6 mmol / L. GFR = 13.5 ml / min.

November 19, 1995, for the purpose of detoxification, the patient was prescribed a course of indirect electrochemical oxidation of blood with a 0.06% solution of sodium hypochlorite. Intravenous infusion of sodium hypochlorite was carried out through a catheter in the subclavian vein. 6 daily electrochemical detoxification sessions were performed. The total volume of injected 0.06% GN solution was 1 liter of 450 ml.

In order to predict the outcome of an infectious and inflammatory disease in a patient, the dynamics of the absolute number of peripheral blood eosinophils and lymphocytes before and after the start of NEHO blood sessions was studied, table 4.

Table 4. Absolute values of eosinophils and blood lymphocytes before and after the start of NEHO blood sessions. Indicator Up to 1 session of NEHO blood After 1 session of NEHO blood After 1 day of the beginning of NEHO blood After 3 days of the beginning of NEHO blood After 7 days of the beginning of NEHO blood The absolute value of eosinophils, × 10 ⁹ / l 0.05 0.05 - - - The absolute value of lymphocytes, × 10 ⁹ / l - - 0.88 0.47 1.34 * - the table shows only those values that are necessary to predict the outcome of the disease.

Preliminary forecasting was performed on the 3rd day after the first NEHO blood test with a 0.06% GN solution. Group 1 = achEPo × 12.5 + achL1 day. × 4.36 + achL3 days. × 1.1-7.5. Group 2 = achEPo × 2.37 + achL1 day. × 1.64 + achL3 days. × (-0.014) -2.77.

Group 1 = 0.05 × 12.5 + 0.88 × 4.36 + 0.47 × 1.1-7.5 = -2.49

Group 2 = 0.18 × 2.37 + 0.85 × 1.64 + 0.27 × (-0.014) -2.77 = -1.2

The patient belongs to group 2 of patients, since the classification value for group 2 is greater than the same value for group 1. Therefore, on December 22, 1995, on the 3rd day after the start of NEHO blood sessions with a 0.06% solution of GN, the patient had an unfavorable prognosis of the outcome of the infectious -inflammatory disease.

The final forecasting was carried out on the 7th day after the first NEHO blood test with a 0.06% GN solution. Group 1 = achEDo × 3.8 + achL7 days. × 7.26-7.1. Group 2 = achEDo × 0.02 + achL7 days. × 2.1-2.72.

Group 1 = 0.5 × 3.8 + 1.34 × 7.26-7.1 = 2.8

Group 2 = 0.5 × 0.02 + 1.34 × 2.1-2.72 = 0.095

The patient belongs to group 1, since the classification value for group 1 is greater than the similar value for group 2. Therefore, on December 26, 1995, on the 7th day after the start of NEHO blood sessions, the patient had a favorable prognosis of the outcome of the infectious-inflammatory disease.

12/25/1995, a biochemical blood test: urea - 30 mmol / l, creatinine - 0.3 mmol / l, potassium - 3.9 mmol / l. GFR = 19.4 ml / min.

December 27, 1995, against the background of positive dynamics, improvement in the patient’s condition, was discharged for outpatient aftercare after the supervision of a polyclinic urologist.

To clarify the mechanism of action of blood NEHO, a 0.06% solution of GN in patients with infectious and inflammatory diseases of the urinary system conducted a clinical study. We studied the dynamics of hormones in the pituitary-adrenal system and catecholamines in response to intravenous infusions of sodium hypochlorite in patients with acute pyelonephritis.

Materials and methods. We studied 10 patients with urolithiasis and with prostate adenoma, who developed acute pyelonephritis in the early postoperative period. All patients received antibacterial and infusion therapy. Patients in the control group No. 1 - 5 people - intravenously, drip was injected with saline in a volume of 150 ml, patients in the study group No. 2 - 5 people - intravenously, drip through a catheter in the subclavian vein was administered 0.06% sodium hypochlorite solution in a volume of 60-110 ml in a dose of 0.6-0.7 mg / kg. We studied the level of adrenocorticotropic hormone (ACTH), cortisol, aldosterone, adrenaline, norepinephrine, dopamine, serotonin. Blood was taken before the intravenous administration of saline or 0.06% GN solution, after 20 minutes of exposure, immediately after the session, after 2 hours, after 1 day and on the 4-5th day of treatment. Statistical data processing was performed in the program "Statistics 6" with the calculation of reliability by the nonparametric U-criterion Mann-Whitney.

Results. The level of hormones of the pituitary-adrenal system and catecholamines in the control and experimental groups of patients with infectious and inflammatory diseases of the urinary system are presented in table 4.

Table 4. The level of hormones in the pituitary-adrenal system and catecholamines in the control and experimental groups of patients (M = m ± σ). Normal performance Before the session In 2 hours After 1 day After 4-5 days Gr. 1 Gr.2 Gr. 1 Gr.2 Gr. 1 Gr.2 Gr. 1 Gr.2 Cortisol 138-690 nmol / l 347 ± 128 670 ± 274 319 ± 124 284 ± 56 ^* 355 ± 57 262 ± 201 ^* 335 ± 58 336 ± 59 ^* ACTH less than 46 pg / ml 14 ± 8 34 ± 35 16 ± 5 9 ± 8 ^* 17 ± 6 15 ± 9 17 ± 5 16 ± 5 Aldosterone 15-50 pg / ml 222 ± 155 153 ± 108 215 ± 106 119 ± 134 266 ± 94 74 ± 88 264 ± 85 68 ± 74 ^* Adrenalin 10-110 pg / ml 82 ± 45 106 ± 27 87 ± 5 59 ± 4 ^* 76 ± 8 111 ± 49 79 ± 3 78 ± 10 ^* Norepinephrine 95-750 pg / ml 571 ± 60 557 ± 63 499 ± 68 401 ± 52 505 ± 92 542 ± 147 478 ± 53 471 ± 79 Dopamine less than 80 pg / ml 31 ± 9 42 ± 19 29 ± 2 37 ± 20 27 ± 4 40 ± 21 26 ± 2 46 ± 24 Serotonin 0.49-0.71 ng / ml 0.66 ± 0.12 0.62 ± 0.14 0.66 ± 0.12 0.58 ± 0.11 0.62 ± 0.11 0.59 ± 0.13 0.62 ± 0.1 0.59 ± 0.12 * - the difference is significant compared with the initial data in the same observation group.

Significant changes were found only in patients of the study group. 2 hours after a session of indirect electrochemical oxidation of blood with a 0.06% solution of GN, the level of ACTH, cortisol, adrenaline significantly decreased. On day 1 of the observation, a decrease in cortisol remained significant, on day 4-5 of the observation, a significant decrease in cortisol, aldosterone and adrenaline was found compared with the data before the introduction of saline and GN. In the control group of patients, significant changes in hormonal status were not found.

Conclusion Intravenous infusions of a 0.06% GN solution at a dose of 0.6-0.7 mg / kg have an adaptogenic effect on the body in patients with acute pyelonephritis, stopping the catabolic stress reaction.

Apparently, NECHO blood 0.06% solution of GN, blocking the catabolic phase of the stress reaction, reduces the degradation of the immune system and reduces the suppressive effect of glucocorticoid hormones on eosinophils. A strong negative correlation between the concentration of cortisol and the relative content of lymphocytes (r = -0.75; p <0.001) has been proved (Tereshchenko O.A. et al. Effect of sodium hypochlorite on the state of the systemic inflammatory reaction and hormonal metabolism in the treatment of biliary peritonitis // Kuban Scientific Medical Bulletin No. 9 (123). 2010. S.149-152). All this affects the dynamics of eosinophils and lymphocytes after one or more sessions of intravenous infusion of GN and activates the protective and adaptive mechanisms of a patient with an infectious and inflammatory disease. Positive dynamics, expressed in an increase in the absolute number of eosinophils and lymphocytes within 3-7 days, allows us to make a favorable prognosis of the outcome of the disease. Negative dynamics, i.e. a further progressive decrease in the absolute number of eosinophils and lymphocytes within 3-7 days indicates the depletion of the patient's vital forces, the continuation of destructive changes due to the ongoing severe pathological process, which predicts a fatal outcome.

Thus, predicting a favorable or fatal outcome of an infectious and inflammatory disease of the urinary system will make it possible to more rationally use the available resources for providing medical care to patients receiving treatment in a urological hospital and make the best efforts to treat a group of patients with an unfavorable prognosis.

Claims (1)

A method for predicting the likelihood of a favorable or fatal outcome in patients with infectious and inflammatory diseases of the urinary system, characterized in that they conduct laboratory and clinical studies of eosinophils and blood lymphocytes, determine the absolute value of eosinophils before the first session of indirect electrochemical oxidation (NEHO) of blood 0.06% a solution of sodium hypochlorite (AChEDo) and the absolute value of eosinophils after the first session of NEHO blood 0.06% solution of sodium hypochlorite (achEPo), as well as the absolute values blood lymphocytes 1 day after the first session of NECHO blood (achL1 days), 3 days after the first session of NECHO blood (achL3 days), 7 days after the first session of NECHO blood (achL7 days) 0.06% hypochlorite solution sodium, the results obtained include the discriminant functions of the preliminary forecast for 3 days after the NEHO blood test:
Group 1 (favorable outcome) = achEPo × 12.5 + achL1 day. × 4.36 + achL3 days. × 1.1-7.5;
Group 2 (fatal outcome) = achEPO × 2.37 + achL1 day. × 1.64 + achL3 days. × (-0.014) -2.77 and the final forecast for 7 days after the NEHO blood test:
Group 1 (favorable outcome) = achEDo × 3.8 + achL7 days. × 7.26-7.1;
Group 2 (fatal outcome) = achEDo × 0.02 + achL7 days. × 2.1-2.72, while the patient belongs to the group for which the classification value of the function is maximum.