RU2230562C2 - Method for preoperational preparing in cardiosurgical patients - Google Patents

Abstract

FIELD: medicine, cardiosurgery.

SUBSTANCE: before operation patient's autoblood should be stored, moreover, additionally, before autoblood sampling one should carry out simultaneous course of nutritive support for 2-3 wk and that of adaptation hypoxytherapy. The present innovation enables to decrease the number of postoperative complications due to increased quantity and quality of autoblood stored for further injection in postoperative period that, in its turn, leads to increased patient's body resistance to blood loss and posthemorrhagic anemia, enhanced hemopoiesis and higher blood hemoglobin and protein concentration.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to cardiac surgery, to the comprehensive preparation of patients for open heart surgery associated with large volumes of blood loss and a significant need for blood replacement therapy.

A known method of preoperative preparation of patients, which consists in the procurement of autologous blood before surgery. Preoperative autologous blood preparation is a single exfusion and canning of 5-10% of the patient’s blood a few days before the operation, canned autologous blood is transfused during or after surgery (Rumyantsev A.G., Agranenko V.A. Clinical transfusiology. - M .: GEOTAR MEDICINE, 1997 .-- 575 p.).

This method is the closest to the claimed technical essence and the achieved result and is selected as a prototype.

The disadvantage of this method is the ability to harvest a limited amount of autologous blood.

The aim of the invention is to reduce postoperative complications by improving the functional state of organs and systems of the patient’s body, increasing hematopoiesis and increasing the concentration of hemoglobin and blood proteins, improving the quality of regulation of protective and adaptive reactions of the body of cardiosurgical patients in the preoperative period, increasing the quality and quantity of harvested autoblood, increasing stability the body of patients to blood loss and posthemorrhagic anemia.

This goal is achieved by the fact that the preparation of autologous blood is preceded by a simultaneous 2-3-week course of nutritional support and the course of adaptive hypoxic therapy, which allows to increase the quantity and quality of harvested autologous blood, to increase the patient's body resistance to blood loss.

New in the proposed method is that before harvesting autologous blood an additional simultaneous conduction of a 2-3-week course of nutritional support and a course of adaptive hypoxic therapy makes it possible to completely abandon the transfusion of blood and its preparations during uncomplicated cardiac surgery, including in children. Such preoperative preparation of patients is a necessary component of a whole range of blood preservation methods, used as an alternative to transfusion of blood and its preparations. An integrated approach is fundamental, since when combined, different methods complement and enhance the effect.

Nutritional support includes the appointment of drugs, in particular nutrison and nutridrink, which provide effective correction of protein-energy deficiency. At the same time, the concentration of blood proteins increases, anabolic processes increase. Adaptation hypoxic therapy leads to an increase in hematopoiesis and an increase in the concentration of hemoglobin in the blood, an increase in the quality of regulation of protective and adaptive reactions of the body, and an improvement in the tolerance of hypoxia. Their simultaneous appointment allows you to achieve your goal in the shortest possible time. Our study showed that in children the effect is achieved after 2 weeks, and in adult patients - after 3 weeks from the start of preparation.

These signs showed in the inventive combination of new properties. No identical population was found in the known solutions of a similar problem. The claimed solution can be considered relevant criteria "novelty", "significant differences" and "inventive step".

The invention will be clear from the following description.

2-3 weeks before the proposed cardiac surgery, patients started simultaneously with a course of nutritional support and a course of adaptive hypoxic therapy.

To ensure adequate nutritional support, we recommend using the standard protocol, which involves taking the drug NUTRIDRINK in addition to the main diet.

Adaptation hypoxic therapy is carried out on the basis of the recommendations of the Ministry of Health of the USSR No. 10-11 / 119. The methodology of adaptive hypoxytherapy consists of sessions of inhalation of a hypoxic gas mixture for patients in cycles in which a 5-minute inhalation of the mixture alternates with a 5-minute breath of atmospheric air. The session consists of 5-10 cycles daily for one to three weeks (Strelkov RB, Belykh A.G., Sobolev A.A. Normobaric hypoxytherapy: Methodical recommendations of the Ministry of Health of the USSR No. 10-11 / 119. - M. , 1988. - 12 p.).

After completing the courses of nutritional support and adaptive hypoxytherapy, the level of proteins and indicators of the red blood of patients are determined, based on which the volume of harvested autologous blood is calculated. Autoblood is harvested.

Example. Patient B., 3 g. Ib No. 1538. Height 91 cm, weight 10 kg.

The main diagnosis. Congenital heart disease, bicuspid aortic valve, valvular aortic stenosis. NK-1.

Accompanying illnesses. Delayed physical development. The consequences of central nervous system PP, myotonic syndrome. Residual effects of rickets. Atopic dermatitis. Curvature of the nasal septum on the right.

Laboratory indicators: hemoglobin 110 g / l, hematocrit 34%, red blood cells 3.5 T / l, reticulocytes 1 ‰, protein 60 g / l.

Two weeks before surgery, in addition to the main diet, the patient took nutridrink according to the standard protocol. The patient also underwent a course of adaptive hypoxic therapy. After the preoperative preparation, laboratory indicators were obtained: hemoglobin 128 g / l, hematocrit 39%, erythrocytes 3.7 T / l, reticulocytes 9 ‰, protein 66 g / l. Harvesting autologous blood in the amount of 13% of the BCC was carried out 1 day before the operation. After taking the blood, laboratory parameters did not change.

An operation was performed - an open commissurotomy of the aortic valve under IR conditions.

Indicators of red blood (hemoglobin / hematocrit): the beginning of the operation - 125/38, during the IC - 72/21, at the end of the operation after ultrafiltration - 102/30. During the operation, 100 ml of albumin was transfused. Ultrafiltrate 650 ml, blood loss 30 ml. The duration of the operation was 4 hours. Harvested autologous blood was transfused after the operation. The duration of mechanical ventilation is 15 hours. 60 ml of discharge was discharged on the drainage in the first day after the operation. Canned blood and its preparations in the postoperative period were not transfused. Laboratory indicators on the first day after surgery: hemoglobin 104 g / l, hematocrit 30%, reticulocytes 6 ‰, protein 56 g / l. A week later, the patient was transferred to a general ward.

The method proposed by the authors was tested in 32 patients, which allows to reduce the number of postoperative complications, improve the results of cardiac surgery, and reduce financial costs.

Claims (1)

The method of preoperative preparation of cardiac surgical patients, which consists in the fact that autologous blood is harvested before the operation within the framework of blood-preserving technologies in patients, characterized in that, in addition to taking autologous blood, a course of nutritional support and a course of adaptive hypoxic therapy are carried out simultaneously for 2-3 weeks.