SU825079A1 - Method of treating acute myocardial infarction - Google Patents

Description

(54) METHOD OF TREATING ACUTE MYOCARDIAL INFARCTION In the lymphatic vessel, the pressure is artificially increased to a level equal to the pressure in the superior vena cava. Lymph flow 1-2 drops per minute, pulse 70 beats. in min, HELL 60/40 mm Hg In the lymphatic vessel, the pressure is artificially reduced to atmospheric pressure. Lymph flow 50 drops per minute, pulse 140 beats. in HELL 150/10 mm Hg When reproducing acute myocardial infarction, difficulty in lymphatic drainage from the myocardium worsens the functioning of the heart. The reproducibility of the results of the experiment p 0.01. Example 2. A healthy dog after sedation with a 2 ° / o-solution of promedol and the introduction of 5% anesthesia with a 10% solution of hexenal is intubated and ether-oxygen anesthesia is started. Drain the thoracic lymphatic duct (HLP). Register HELL (in the femoral artery) and make an electrocardiogram (ECG). Lymph flow 6 drops per minute, pulse 166 per minute; after 6 .min Lymph drainage 8 drops per minute; later VO min HELL 190/110 mm Hg, LIMPOTTOK 7 drops per min; 4 minutes later, a thoracotomy was performed, a blood pressure of 195/125 mm Hg. Next, a luteur is inserted under the anterior interventricular branch of the left coronary artery (PMVLVA), BP 130/50 mm Hg, pulse 106 per minute, LYMPHOTTOK 12 drops per minute. Pinch PMVLVA (model of acute myocardial infarction). After 3 min HELL 150/60 mm Hg, pulse 108 per minute sinus rhythm. Lymph drainage 19-20 drops per minute. After 10 minutes HELL 160/80 mm Hg, pulse 115 per minute, LYMPHOTTOK 19-20 drops per minute. After 11 minutes HELL 80/40 mm Hg, pulse 100 per minute, LYMPHOTTOK 16 drops per minute. After 9 min. HELL 70/35 mmHg, pulse 100 min, LYMPHOTTOK 16 drops in min. After 8 min. HELL 55/30 mm Hg, pulse 108 per minute, sinus rhythm. Sharply marked coronary changes stabilize on the ECG. After 43 min. HELL 45/25 mm Hg, pulse 100 beats. per minute, sinus arrhythmia. On the ECG, severe coronary changes. Lymph flow 18 drops per minute. An isotonic solution of sodium chloride at a rate of 15 ml / kg was administered intravenously and immediately after that 0.2 mg / kg of ergotamine. After 13 minutes of blood pressure of 165/90 mm Hg, puls 136 per minute, improved ECG, lymph flow 144 drops per minute. After 9 min HELL 165/95 mm Hg, pulse 136 per minute, sinus r. M. Significant stable ECG improvement. Lymphatic drainage 140 drops per minute. After 47 minutes HELL 160/100 mm Hg, pulse 126 per minute, sinus rhythm, LYMPHOTTOK 60-64 drops per minute. Thus, it can be seen that the normalization of ECG and blood supply indices during the implementation of the water load and the introduction of ergotamine are interrelated with increased lymph outflow from the thoracic duct. Similar data are obtained in other experiments of the same type, as well as with the use of other drugs of lymphogonic action: troposan 0.02 g; alupent 0.2 mg / kg; manitol 10 g / kg; ergotoxin 0.2 mg / kg. Example 3. A patient, 46 years old, was admitted to hospital with an attack of chest pains. Based on clinical and electrocardiographic data, a two-thirds septum, anterior wall, apex, and an hour of the lateral wall of the left ventricle was diagnosed with anterior two-thirds of the septum, the right, 60 beats. in minutes Duration of the interval Р-Q 0.18 s, P-wave 0.10 s. In standard and limb-reinforced ST spacing on contour lines. The T wave is positive in 1, 2 and aVL, biphasic (h) in 3 and aVF, negative in aVR leads. The width of the QRS complex is 0.06 s. In the right chest leads, a complex of type Rs. ST above contour 1 mm. In the left chest leads, the complex type Rs, ST is 0.5 mm higher than the isoline, the T wave is positive, high symmetrical. In the transition zone, the QS, ST type complex is 6 mm higher than the isoline, the T wave is high positive. Conclusion: myocardial infarction of the anterior wall of the left ventricle with the spread to the apex, the anterior lateral wall and the anterior part of the interventricular septum. Data 35 precordial leads compiled in the form of cartograms. The sum of informative leads is 20, the sum of ST (ZST) rises is 61 mm, the average ST (NST) value is 3.05 mm. Treatment was carried out: intravenous infusion of 5 ° /% glucose solution 200.0; insulin 6 units, 10% potassium chloride 15.0; Heparin 10,000 units. in / in, and then in / m; fentanyl 2.0; droperidol 2.0; 5 ° / o-ny glucose solution of 20.0; nonahlazine. 0; 03 2 tablets 3 times a day. After 3 h 10 min after admission to the ECG. these 35 precordial leads, the sum of informative leads 20, the sum of ST (JST) elevations 72.5 mm, NST 3.625 mm. Example 4. A 40-year-old patient, with sharp lateral pains, was taken to hospital. According to the clinical picture and electrocardiographically diagnosed transmural infarction of the anterior two-thirds of the septum, the anterior wall of the apex and part of the side wall of the left ventricle. On the ECG sinus rhythm correct, 120 beats. in minutes Low-voltage QRS complexes in standard and reinforced leads. The duration of the PQ interval is 0.16 s, the duration of a tooth is 0.10 s. The width of the QRS complex in the standard 0.08 s, the ST interval is higher than the isoline in 1 standard and aVL by 0.5 mm, in 2, 3 and aVF on the isoline. The T wave is positive in standard, negative in aVR, smoothed in aVL and two-phase (a) in aVF leads. In the right chest leads, the complex of type rS, ST is higher than the isoline. T tooth high, positive. In the left chest leads, the QS, ST type complex is higher than the isoline, the T wave is high positive. In the transition zone, the complex is of the QS, ST type above the isoline, the T wave is high positive.

According to 35 precordial leads, the sum of informative leads is 25, the sum of ST (EST) 67 rises, the average NST is 2.68.

Diagnosis after complete clinical examination: fresh transmural infarction of the anterior two-thirds of the septum, anterior wall, apex, and part of the side wall of the left ventricle. Acute aneurysm of the anterior wall of the left ventricle in the anteroparticular region. Rare ventricular extrasystoles. Circulatory failure I st. Ischemic heart disease, atherosclerosis of coronary vessels. Angina pressure and rest.

Intravenous infusion of 500 ml of physiological saline and 500 ml of U / o mannitol solution was carried out with the usual treatment, carried out analogously to Example 3.

On. ECG recorded 4 hours after admission, there is a decrease in the ST segment compared to the previous ECG in 35 precordial leads: the sum of informative leads 18, the sum of ST elevations of the segment 29 mm, NST 1.5 mm.

Example 5. A patient, 54 years old, was admitted to hospital with acute pains in the heart area, was diagnosed with a transmural myocardial infarction of the anterior two-thirds of the septum, anterior wall, apex, and part of the lateral wall of the left ventricle.

ECG - sinus rhythm, correct, 100 beats per minute. PQ interval 0.18 s. The ST segment is isolated in standard and reinforced limb leads, the T wave is flattened in 1 standard lead, positive in 2 and 3, negative in aVR, weakly positive in aVL and aVF leads. Right chest leads are presented. complex QS, ST in the form of a multiphase curve, 12 mm higher than the isoline. Left chest leads are represented by the QS, ST complex above the isoline by 5 mm. The transition zone is represented by the QS, ST complex in the form of a multiphase curve, 12 mm above the isoline.

According to the data of 35 precordial leads, the sum of informative leads is 25, the sum of ST lifts is 125 mm. NST 5 mm.

 Along with the usual treatment (Example 3), 500 ml of saline and 500 ml of 10% mannitol solution were transferred intravenously to the patient within 3 hours after the intake. On an ECG recorded after this, the sum of informative leads is 24, the sum of ST elevations is 125 mm NST 5.2 mm.

Diagnosis after complete clinical examination: fresh transmural myocardial infarction of the anterior two-thirds of the septum, anterior wall, apex and part of the lateral wall of the left ventricle. Ischemic heart disease. Atherosclerosis of the aorta, coronary arteries. Angina pressure and rest. Circulatory failure I st. Ulcerative disease of the duodenum with urinary exacerbations.

Thus, example 3 shows the typical dynamics of ST segment elevation on the first day of myocardial infarction, KOTOpak is usually maintained up to 3-7 days with a gradual decrease in the ST segment to an isoline. In example 4, with a rapid jet injection of saline and mannitol, the pronounced positive dynamics of the ST segment decrease to the isoline is shown, which indicates the positive effect of the method on reducing the peri-infarction zone and reducing the total amplitude, ST rise. In example 5, with a slow drip of mannitol in the background of conventional treatment, the dynamics of ST elevation are reflected, similar to that in Example 3.

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Exercising effects that increase lymphatic drainage and lymph formation is accompanied by an improvement in heart and hemodynamic performance. The use of stimulation of lymph formation and lymphatic drainage in patients in the acute stage of myocardial infarction contributes to a more rapid positive dynamics of electrocardiographic signs and, in particular, a more rapid decrease in the peri-infarction zone, a reduction in the incidence of complications of infarction in the form of arrhythmias and acute heart failure, and their presence - terms of stopping.

The present invention opens up a new way to treat myocardial infarction through

5 effects on the lymphatic system. It is harmless and does not deny the use of other methods of treatment of this disease; at the same time, it can supplement them by acting on that link (lymphatic system), which until now has remained outside the sphere of purposeful influence.:

Claims (1)

Invention Formula 55 A method of treating acute myocardial infarction by administering drugs. 7 825079а stabilizing hemodynamic properties, stimulating lymph formation and The gateway is characterized in that, in order to limit the drainage. relieve swelling of the heart muscle by ud-sources of information, laziness of necrotic products from the outbreak of war-taken into account during the examination songs, intravenously sequentially injected-1. Basics of resuscitation. Ed. Ned t isotonic solution of sodium chloride VA A., M., “Medicine, 1977, p. 488- in the amount of 0.3-0.8 liters and medicinal environments-489.