RU2565837C1 - Method for visual measurement of intraperitoneal blood loss - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: abdominal cavity is visually inspected intraoperatively to determine a blood amount therein. If the blood occurs to accumulate locally in one anatomical region of the abdominal cavity, the blood loss amount is estimated at less than 200 ml. If the blood accumulates in two anatomical regions, the blood loss amount appears to fall within the range of 200 to 500 ml. The blood accumulated in three anatomical regions makes observing the blood loss amount ranging from 500 to 1000 ml. The blood loss amount from 1000 to 1500 ml is stated if the blood accumulates in four anatomical regions. Provided the blood accumulates throughout the abdominal cavity, the blood loss amount is estimated at 1500 ml.

EFFECT: reducing the length of blood loss measurement procedure that is of prime importance in an urgent situation requiring lost blood replacement.

5 ex

Description

The present invention relates to medicine, namely to abdominal surgery, and can be used in patients and patients with intra-abdominal bleeding.

State of the art

A known method for determining the amount of blood loss, including the passage of blood through the measuring chamber, exposure to it with ultrasound, followed by registration of the value of the absorption index of blood ultrasound and calculation of the amount of blood loss from the calibration curve [patent RU 2024873, 1994].

A known method for determining the degree of blood loss of more than 0.5 l, which consists in taking a certain amount of the studied peripheral whole blood, recording changes in blood characteristics and calculating the hematocrit value based on experimental data, moreover, blood sampling is carried out in an amount of 80-100 μl, placed in measuring chamber, an electric current is passed through it, changes in the specific resistance of blood are recorded, the calculation of the hematocrit value is carried out according to the formula

where R _K is the specific resistance of the studied peripheral blood;

R _P - a constant average value of the resistivity of a healthy person's plasma;

k = 1.02-1.04 is a calibration coefficient that takes into account the influence of resistance of shaped elements, and when the hematocrit is reduced to 30%, a slight degree of blood loss is determined, up to 25% - medium and below 25% - severe degree of blood loss. The method is implemented using a device for determining the amount of blood loss, comprising a resistance measurement unit, which further comprises interconnected unit of an analog-computing device, a control and switching circuit unit, an analog-to-digital converter unit, a display and a plasma resistance regulator unit, and the resistance measurement unit its output is connected to the first input of the analog-computing device and the first input of the control and switching circuit block; the block of the analog-computing device with its output is connected to the second input of the block of the control and switching circuit, the block of the control and switching circuit of the first output is connected to the input of the block of resistance measurement and the block of the plasma resistance regulator, as well as with the second input of the block of the analog-computing device, the second output is the block control and switching circuits are connected to the input of the analog-to-digital converter unit, the analog-to-digital converter unit is connected with its outputs to the display inputs, the resistor control unit The plasma phenomenon is connected with its output to the third input of the analog-to-digital device unit and the third input of the control and switching circuit unit, while the resistance measuring unit contains a positive current polarity stabilizer, a first analog switch, a measuring chamber, a second analog switch, and a current amplifier with a second input of the first analog key, a current stabilizer of negative polarity, and the control inputs of the first and second analog keys are connected to the generator output and the clock control unit and the switching circuit [patent RU 2197729, 2003 g.].

A known method for determining blood loss, including taking a patient’s blood sample, determining the electrical conductivity of the blood and calculating the amount of blood loss by the formula:

where KP - the amount of blood loss; Bcc - the proper volume of circulating blood; UEP - electrical conductivity of a patient’s blood sample in a dimension of 1 / Ohm · cm [patent RU 2238670, 2004].

The prototype of the invention is a method for estimating the amount of blood loss, including blood sampling from the abdominal cavity during laparotomic access and calculating the amount of intra-abdominal blood loss using a fixed volume scoop [Blood reinfusion with combined trauma [Electronic resource]. Access Mode: http://meduniver.com/Medical/Xirurgia/258.html MedUniver http://meduniver.com/Medical/Xirurgia/258.html Date of appeal: 02/07/2014].

The objective of the invention is to develop a method for rapid visual assessment of the value of intra-abdominal blood loss, which can be carried out both with laparotomy and laparoscopy.

The technical result when using the invention is to reduce time and simplify the method.

The specified technical result is achieved by the fact that in the method for estimating the amount of intra-abdominal blood loss, including intraoperative determination of the volume of blood located in the abdominal cavity, according to the invention, a visual examination is carried out, with a local accumulation of blood in one anatomical region of the abdominal cavity, a blood loss of less than 200 ml is estimated; with blood accumulation in two anatomical areas, the volume of blood loss from 200 to 500 ml is estimated; with blood accumulation in three anatomical regions, the blood loss volume from 500 to 1000 ml is estimated; with blood accumulation in four anatomical regions, the volume of blood loss from 1000 to 1500 ml is estimated; with blood accumulation in all parts of the abdominal cavity, a blood loss of more than 1500 ml is estimated.

Based on the experience of treating patients with intra-abdominal bleeding experimentally (after evacuating blood from the abdominal cavity and calculating its volume), we developed the following visual assessment criteria corresponding to one or another value of intra-abdominal blood loss:

1. Local accumulation of blood in one anatomical region of the abdominal cavity corresponds to blood loss of less than 200 ml.

2. The accumulation of blood in the two anatomical regions of the abdominal cavity corresponds to a blood loss of 200 to 500 ml.

3. The accumulation of blood in the three anatomical regions of the abdominal cavity corresponds to a blood loss of 500 to 1000 ml.

4. The accumulation of blood in the four anatomical areas corresponds to blood loss of a volume of 1000 to 1500 ml.

5. Blood accumulation in all parts of the abdominal cavity corresponds to blood loss of more than 1,500 ml.

The invention is illustrated by the following clinical examples.

Example 1

Patient A., 37 years old, was admitted to the clinic 1 hour after receiving a stab wound to the abdomen. Upon admission, the patient's condition is relatively satisfactory, clear consciousness, heart rate of 80 beats per minute, blood pressure 120/90 mm RT. Art., the wound was located in the left iliac region. The patient underwent primary surgical treatment of the wound, during which the penetrating nature of the wound in the abdominal cavity was revealed. Further, the patient under intubation anesthesia urgently performed

diagnostic laparoscopy, in which blood with clots was detected in the pelvis, which corresponded to less than 200 ml blood loss according to the criteria developed. No other damage to the internal organs was detected. The source of bleeding was a wound of the anterior abdominal wall. Then, with suction, blood with clots was evacuated, its volume was 140 ml. Hemostasis is achieved by electrocoagulation of the wound of the anterior abdominal wall from the side of the abdominal cavity. The operation was completed by draining the small pelvis with 2-lumen polyvinyl chloride drainage through a separate incision in the anterior abdominal wall. Sutures from the wound were removed to the patient on the 7th day after the operation. On the 7th day the patient was discharged with recovery in satisfactory condition.

Example 2

Patient 3., 25 years old, was admitted to the clinic 1.5 hours after receiving a stab wound to the abdomen. Upon admission, the patient was intoxicated with alcohol, the patient's condition was moderate, heart rate 80 beats per minute, blood pressure 110/90 mm Hg, the wound was located in the epigastric region. The patient underwent primary surgical treatment of the wound, during which the penetrating nature of the wound in the abdominal cavity was revealed. Then, a patient under intubation anesthesia underwent emergency diagnostic laparoscopy, in which blood with clots was detected in the subhepatic space and interlobularly in the umbilical region, which corresponded to blood loss from 200 to 500 ml according to the criteria developed. On the diaphragmatic surface of the liver revealed stab-wound 15 × 5 mm with low intensity bleeding. No other damage to the internal organs was detected. Further, with suction, blood with clots was evacuated, its volume was 250 ml. Hemostasis was achieved by electrocoagulation of the wound of the liver and the anterior abdominal wall from the side of the abdominal cavity. The operation was completed by draining the subhepatic space and the pelvis with 2-lumen polyvinyl chloride drainages through separate incisions on the anterior abdominal wall. Sutures from the wound were removed to the patient on the 8th day after the operation. On the 10th day the patient was discharged with recovery in satisfactory condition.

Example 3

Patient X., 21 years old, was admitted to the hospital 2 hours after a traffic accident with complaints of abdominal pain. On admission, the patient’s condition of moderate severity, clear consciousness, heart rate of 90 beats per minute, blood pressure 110/70 mm Hg The patient underwent an ultrasound examination of the abdomen, in which free fluid was revealed in the abdominal cavity. Next, a patient under intubation anesthesia underwent emergency diagnostic laparoscopy, in which blood was detected in the left subphrenic space, left lateral canal and pelvis, which corresponded to blood loss from 500 to 1000 ml according to the criteria developed. A gap of 10 × 8 mm with active bleeding was revealed in the area of the gate of the spleen. Then performed median laparotomy, splenectomy. Blood from the abdominal cavity was evacuated by a scoop into a container with Glyugitsir, after which the Cell Saver was returned to the bloodstream. The volume of evacuated blood was 900 ml. The operation was completed by drainage of the pelvis and left subphrenic space with 2-lumen polyvinyl chloride drainages through separate incisions on the anterior abdominal wall. The sutures from the wound were removed to the patient on the 12th day after the operation. On day 13, the patient was discharged with recovery in satisfactory condition.

Example 4

Patient G., 59 years old, was admitted to the hospital 3 hours after receiving an intentional injury (received a blow to the abdomen with an unknown person). On admission, the patient’s condition of moderate severity, consciousness is stunned, heart rate 96 beats per minute, blood pressure 100/60 mm Hg The patient underwent an ultrasound examination of the abdomen, in which free fluid was revealed in the abdominal cavity. Further, a patient under intubation anesthesia underwent emergency diagnostic laparoscopy, in which blood was detected in the right lateral canal, right subhepatic space and subphrenic space and in the pelvis, which corresponded to blood loss from 1000 to 1500 ml according to the criteria developed. Then, through a 5 mm manipulation trocar, a sterile tube with a diameter of 4 mm and a length of 60 cm was introduced into the abdominal cavity from the intravenous infusion system, the free end of which was sequentially directed to the above-described places of blood accumulation using a laparoscopic clamp installed from another 5 mm trocar access. Due to the presence of pneumoperitoneum (14 mm Hg), blood with a volume of 1400 ml was freely evacuated without gravity by gravity into a container with Glyugitsir, after which it was returned to the bloodstream with the Cell Saver. The source of bleeding was a superficial rupture of 6 segments of the liver along the diaphragmatic surface of 40 × 5 mm, with bleeding of low intensity at the time of surgery. Hemostasis is achieved by electrocoagulation of the rupture area. The operation was completed by draining the small pelvis and the right lateral canal with 2-lumen polyvinyl chloride drainages through separate incisions on the anterior abdominal wall. Sutures from the wound were removed to the patient on the 7th day after the operation. On day 12, the patient was discharged with recovery in satisfactory condition.

Example 5

Patient I., 32 years old, was admitted to the hospital 2.5 hours after a traffic accident (collision of two cars, the patient was sitting in the passenger seat). Upon admission, the patient’s condition is severe, consciousness is stunned, heart rate in beats per minute, blood pressure 80/30 mm Hg Given the presence of signs of shock, the presence of peritoneal symptoms, the patient was taken for surgery. Under intubation anesthesia, an emergency laparotomy was performed, in which blood was detected in all parts of the abdominal cavity, which corresponded to more than 1500 ml blood loss according to the criteria developed. Blood was evacuated by a scoop, its volume was 2300 ml. The source of bleeding was a rupture in the area of the portal of the spleen 25 × 5 mm and a rupture of the wall of the intraperitoneal part of the bladder. Then performed splenectomy, closure of rupture of the bladder, epicystostomy. Due to the suspicion of hemolysis of the blood (during centrifugation) and the presence of concomitant rupture of the bladder, blood reinfusion was not performed. The operation was completed by draining the pelvis and left subphrenic space with 2-lumen polyvinyl chloride drainages through separate incisions on the anterior abdominal wall. The patient was 5 days in the intensive care unit in critical condition. On day 13, the sutures from the wound to the patient were removed, on day 18 the patient was discharged with recovery in satisfactory condition.

Claims (1)

A method for assessing the value of intra-abdominal blood loss, including intraoperative determination of the volume of blood located in the abdominal cavity, characterized in that a visual examination is carried out, with a local accumulation of blood in one anatomical region of the abdominal cavity, a blood loss volume of less than 200 ml is estimated; with blood accumulation in two anatomical areas, the volume of blood loss from 200 to 500 ml is estimated; with blood accumulation in three anatomical regions, the blood loss volume from 500 to 1000 ml is estimated; with blood accumulation in four anatomical areas, the volume of blood loss from 1000 to 1500 ml is estimated; with blood accumulation in all parts of the abdominal cavity, a blood loss of more than 1500 ml is estimated.