UA140352U - METHOD OF CORRECTION OF IRON LEVEL IN PATIENTS WITH ACQUIRED MITRAL HEART DEFECTS BY BLOOD SAVING TECHNOLOGY IN THE PREOPERATIVE PERIOD - Google Patents

Abstract

The method of correction of iron levels in patients with acquired mitral heart disease by the technology of blood preservation in the preoperative period, according to which intravenous iron is administered intravenously, up to 7 mg / kg body weight. The total estimated dose of the iron preparation is divided into 3 parts: 1 part is administered 5 days before the operation, 2 part is administered 3 days before the operation, 3 part is administered the day before the operation.

Description

The proposed technical solution belongs to medicine, namely to cardiac surgery, anesthesiology, resuscitation, and can be used in the surgical treatment of patients with acquired heart defects.

Traditionally, surgical treatment of patients with acquired mitral heart defects is accompanied by transfusion of donor blood components. Transfusion of donor blood components is, in fact, transplantation of foreign tissue, it is associated with the risk of developing various post-transfusion reactions and complications of an immune and non-immune nature. At the same time, there is a danger of infection with infectious and viral diseases (hepatitis, AIDS, cytomegalovirus, syphilis, transfusion mononucleosis, malaria, etc.), the number of which is constantly increasing. The immunosuppressive effect of allogeneic blood transfusions on the recipient's body is proven. Recently, clinicians increasingly have to face ethical and legal problems related to the refusal of patients from allogeneic blood transfusions due to doubts about the safety of donor blood components and due to religious beliefs. It should also be pointed out the low functional efficiency of the donor erythrocyte mass in connection with the sequestration of 25-30 96 overflow erythrocytes and their reduced content of 2,3-diphosphoglycerate. In this regard, hemoglobin, although it attaches oxygen, but does not give it to the tissues actively enough. Therefore, the effect of transfused donor blood is less than the costs incurred, and complications occur especially often after transfusion.

One of the problems faced by doctors during surgical operations on patients with mitral acquired heart defects is anemia, which is accompanied by a low level of hemoglobin. The level of iron in these patients is reduced in most cases.

There is a need to create a method of iron level correction in patients with acquired mitral heart defects in the preoperative period using the technology of blood conservation in conditions of artificial blood circulation, which would stabilize the patient's oxygen exchange during surgery and in the postoperative period.

There are many ways to increase the level of iron in hemoglobin in patients with anemia. However, in the surgical treatment of heart pathologies, the use of oral liquid or solid dosage forms of iron preparations before the operation is not appropriate in terms of time, since in order to increase the level of iron with the help of oral forms, oral forms of iron should be taken for several months.

The author suggests rapid saturation of hemoglobin with iron in patients with acquired mitral heart defects with varying degrees of anemia.

When conducting scheduled, and especially urgent operations, the only method of increasing the iron level is the intravenous use of iron preparations.

For example, the well-known drug "Sufer" (see "Instructions for the medical use of the drug Sufer"; approved by the Order of the Ministry of Health of Ukraine on 04.10.2013; Mo 860 Registration certificate Mo OA/13269/01/01; amended by the Order of the Ministry of Health of Ukraine dated November 27, 2015 Mo 789), intended for intravenous administration, which is a hydroxide-sucrose complex of iron (I), 1 ml of which solution contains 20 mg of iron.

The task of the useful model is to create a new method of iron level correction in patients with acquired mitral heart defects in the preoperative period using blood conservation technology, which allows to reduce the need for hemotransfusion of donor blood, reduce the level of postoperative complications and improve the quality of life of patients.

The task is solved by a new method of iron level correction in patients with acquired mitral heart defects using the technology of blood conservation in the preoperative period, according to which an iron preparation is administered intravenously, up to 7 mg/kg of body weight maximum for 5 days. The total calculated dose of the iron preparation is divided into 3 parts: 1 part is injected 5 days before the operation, 2 part is injected 3 days before the operation, 3 part is injected the day before the operation.

The technical result, according to the proposed technical solution, is achieved due to the set of new essential features outlined in the formula.

The division of the total dose of the iron preparation into 5, 3 and 1 day before the operation is due to preventive care in case of possible complications of the introduction of the preparation and the possibility of adaptation of the body to the introduction of a concentrated solution.

According to the calculation tables of the hemoglobin level (for this, the instructions for the use of the iron preparation are used), the iron preparation is administered intravenously up to a maximum of 7 mg/kg of body weight.

The introduction of iron was not accompanied by allergic reactions, was not accompanied by changes in the cardiovascular, respiratory and urinary systems.

The proposed method was called the method of iron level correction in patients with acquired mitral heart defects using blood conservation technology in the preoperative period.

The safety of administration of the iron preparation (according to the instructions) is determined by: a) the criteria and doses of the administration of the preparation, which are based on the developed "Instructions for the medical use of the Sufer preparation" (approved by the Order

Ministry of Health of Ukraine 04.10.2013; Mo 860 Registration certificate Me OA/ 3269/01/01; changes were made by the Order of the Ministry of Health of Ukraine dated November 27, 2015 Mo 789); b) conducting constant supervision and visual control over the drip administration of the drug and control over the probable occurrence of allergic reactions during and after the infusion; c) carrying out biochemical control of the level of iron, transferrin, ferritin and the iron-binding function of erythrocytes.

The effect of separate administration of the iron preparation on the 5th, 3rd and 1st days before the operation is due to: a) the need for a minimal effect of transfusion of hypertonic iron solutions on the hemodynamics of patients; b) observation and prevention of possible complications, both on the day of iron transfusion and on the 2nd day after transfusion.

The effect of iron saturation in hemoglobin is achieved in the fastest way, which is very important in the preoperative period. It is accompanied by: 1 - the need for maximum hemoglobin level support, 2 - the efficiency of the blood's oxygen capacity (according to the erythrocyte buffer).

Before carrying out iron correction, a control determination of its level is carried out with the help of laboratory tests.

According to the table (according to the instructions), the level of hemoglobin is found, according to the weight of the patient, the amount of iron in mg or ml, which should be transfused to the patient, is calculated.

Correction of the patient's iron level is carried out in the 3rd stage.

5 days before the operation, the first dose of the iron preparation of 500 mg is administered, which is calculated according to the instructions for the preparation, and dissolved in 0.9 95 physiological solution in the proportion:

From 100 mg of iron in 100 ml of physiological solution. The solution is administered within 4 hours. The second dose (500 mg of the drug) is administered three days before the operation. The third dose is added to the total calculated dose according to the above method.

Monitors the level of iron, ferritin, transferrin, iron-binding function of the erythrocyte, the amount of diuresis, the level of hemoglobin (HB) and hematocrit (NI), the level of leukocytes, reticulocytes.

The proposed preoperative correction of the iron level increases the hemoglobin level in patients with acquired heart defects: mitral heart defects, aortic heart defects, and mitral-aortic heart defects

The claimed method is implemented as follows.

An example of clinical application of the method.

Example 1.

Patient V., 72 kg. Diagnosis: Mitral-aortic acquired heart disease. Coronary heart disease,

The indicated operation: Prosthesis of mitral and aortic defects of the heart. Aorto-coronary shunting using the technology of blood conservation in conditions of artificial blood circulation. Preoperative intravenous drip administration of an iron preparation was carried out. The drug was administered in the following mode according to the method proposed by this technical solution: 500 mg of iron was transfused 5 days before the operation, another 500 mg of iron was transfused 3 days before the operation, and 420 mg of the calculated dose was transfused the day before the operation. In total, 1420 mg of iron was infused intravenously, which corresponded to the calculated dose. The infusion period was uneventful and without complications. Biochemical indicators of patient V., 72 years old, before iron transfusion and after transfusion of the calculated dose are given in the Table.

Table

Transferritin 3.61 g/l 2.07 g/l 82.31 mmol/l 61.56 mmol/l 44.99 ng/ml 334.65 ng/ml 23.9 mmol/l 57.0 mmol/l

Iron saturation of transferrin 25.82 90 82.33 90

Hemoglobin (NEW 104 g/l 124 g/l

Erythrocytes (ABS 4.337 10 mmol/l 3.7 "10 mmol/l

NT (NST) 36.8 96

Platelets (RIHT 247" 103 mmol/l 2227 103 mmol/l 8.3 103 mmol/l 4.67 109 mmol/l 31 mm/h. 32 mm/h.

Average concentration of hemoglobin in erythrocytes (MCHS) 30.6 g/dL 32.5 g/dL

Average volume of erythrocytes (MSU 83.1 femtoliter 83.2 femtoliter anterior hemoglobin content in erythrocyte 25.4 picograms

The distribution width of erythrocytes (VOMU SM 14.1 95 15.3 95

The average volume of platelets (MRU 11.5 femtoliter 11.4 femtoliter

Anisocytosis of erythrocytes

Hypochromia of erythrocytes

The proposed method can be applied for use in medical institutions.

The proposed method is adequate anatomically and clinically. It should be understood that the examples and embodiments described above are only illustrative and various modifications and changes are suggested to those skilled in the art, which are covered by the essence of this application and the scope of the technical solution formula.

It should be understood that the above information in no way limits the scope of the rights under the application.

Claims (2)

- USEFUL MODEL FORMULA 1. The method of iron level correction in patients with acquired mitral heart defects using blood conservation technology in the preoperative period, according to which an iron preparation is administered intravenously, maximum up to 7 mg/kg of body weight, the total estimated dose of the iron preparation is divided into 3 parts: 1 part is administered 5 days before the operation, the 2nd part is administered 3 days before the operation, the 3rd part is administered the day before the operation. 2. The method according to claim 1, which differs in that the iron preparation is administered intravenously within no more than 5 days.