SU1673979A1 - Method for prognosis of insult course - Google Patents

Abstract

This invention relates to the field of medicine and relates to methods for predicting the course of a stroke. The aim of the invention is to earlier predict and improve accuracy. To achieve this goal, the concentration of medium molecules in the blood plasma of patients is determined and, at a value of this indicator, 0.4 conv. units and more predict an unfavorable course of stroke. Prediction accuracy reaches 92.3%.

Description

This invention relates to medicine, in fairness, to methods for predicting the course of a stroke.

The purpose of the invention is to increase the informativity of the method due to earlier prediction and increase in accuracy.

The method is carried out as follows.

On the 1-3 day after the stroke, the patient takes blood from a vein, and plasma is obtained. To determine the level of medium molecules, 0.5 ml of 10% grichloroacetic acid is added to 1.0 ml of plasma, stirred, centrifuged at 3000 rpm for 30 minutes. The supernatant liquid in an amount of 0.5 ml is transferred to a tube containing 4.5 ml of water, and the contents of the tube are mixed. The extinction of the solution is determined using a spectrophotometer at a wavelength of 254 nm in a cuvette with a thickness of 10 mm. When the concentration of medium molecules in the plasma is 0.4 uel units. and more, predict an unfavorable course of stroke.

Example 1. Patient G., 48 years old, drank 2 days after acute cerebrovascular accident. On admission, the patient is ill. Lies with his eyes closed, opens them to appeal. The pupils are symmetrical, 3 mm in diameter. Swallows water, do not puff. Right-sided hemiplegi. Tendon jerks live, without a clear difference of the parties. Pathological foot reflexes from 2 sides. Respiratory rate 20 in 1 min., Rhythmic, is conducted to all parts of the lungs. Pulse 72 beats./min, rhythmic HELL 140/90 mm Hg Heart sounds are loud. A computed tomography (CT) scan revealed a massive heart attack in the left hemisphere of the brain. The patient's condition continued to deteriorate. After 36 hours after admission (on the 4th day of the disease), the patient developed a comatose state. No longer responding to painful irritation, ophthalmoplegia was noted, lack of photoreaction diffuse muscular hypotonia with low sukhozhipI t

About vj

SA sQ h o

I

reflexes. HELL 110/70 mm Hg, pulse 98 beats / min, rhythmic. In the lungs breathing was carried out in all departments. Heart sounds are sleepy. The level of medium molecules, measured during this period of time was equal to 0.40 conv. Units, the osmolarity of blood plasma was 311 my / kg, which indicated a complicated course of stroke.

Example 2. Patient K., 47 years old, was taken to the intensive care unit on the 3rd day after an acute violation of cerebral circulation. On admission, the patient's condition is severely conscious, complaining of a headache. In neurological status: stiff neck, Kernig and Brudzinsky symptoms. Right pupil 4 mm in diameter, left 3 mm in diameter. Coarse paresis of gaze is the difference of the eye block vertically. The movements in the arms and legs are preserved, the left leg is rotated outwards, its moderate weakness is noted. Tendon reflexes high with extended zones, symmetrical. Bilateral reflexes Babinsky and Oppenheim. Respiratory rate 22 at 2 min, HELL 220-160 mm Hg, pulse 96 beats / min, rhythmic. The heart is enlarged to the left, the tones are clear. In the lower sections of the left lung, a small number of moist rales are heard.

With KG of the brain, hemorrhagic infarction in the left hemisphere of the cerebellum with pressure on the trunk and the beginning of occlusive hydrocephalus is revealed.

The level of medium molecules, measured during this time period, was 0.442 conv. Units, osmolarity 297 washes / kg,

After a few hours, the patient's condition deteriorated sharply — he stopped following instructions, responding to external stimuli, and talking. The level of medium molecules increased to 0.700 sr. units, osmolarity - up to 304.5 my / kg. In connection with a decrease in the level of wakefulness and CT data, the patient underwent a ventricular drainage operation in the right lateral ventricle of the brain and nasotracheal tracheal intubation with a conversion to artificial ventilation of the lungs.

In spite of intensive therapy, the patient's condition continued to deteriorate, coma developed, and in parallel there was a further increase in the level of medium molecules up to 2.0 conv. units with osmolarity of blood plasma, 311.5 wash / kg. The established level of middle molecules made it possible to predict the complicated course of a stroke.

Example 3. Patient P., 57 years old, was admitted 3 hours after an acute violation of cerebral circulation, On admission

the condition of the patient is severe. Coma. The response to pain irritation is absent. The right pupil is wider than the left. Ophthalmoplegia. Corns and conjunctival reflexes are absent on both sides. There are no active movements in the limbs. Distoni. Decerebral cramps in the hands are periodically noted. Tendon and peri-other reflexes on the hands of live, higher

on the right, the knee jerk is higher on the left, the Achilles reflexes are symmetrical, There are no pathological foot reflexes, there are no protective reflexes. Respiratory rate 24-28 in 1 min, breath bubbling, rhythmic,

Auscultation is carried out in all parts of the lungs, weakened in the posterior-lower parts on both sides. HELL 130/80 mm Hg, pulse 140 beats./min. Heart sounds are somewhat muffled. Clinical diagnosis: total

ischemia of the brain. In connection with an increase in respiratory failure, transnasal trachea intubation was performed and the patient was transferred to artificial lung ventilation.

During the period of stay

the patient in the hospital was used to determine the values of the average molecules and the osmolarity in the blood plasma: already on admission the level of the average was raised to 0.418 sr.

units with an osmolarity of 302 my / kg, 24 hours after the onset of the disease, a further increase in the average molecules in the blood plasma to 0.573 conv. with a constant osmolarity, after another day the size of the average molecules was at the level of 0.532 services. units, osmolarity increased to 343 my / kg, the level of medium molecules testified to a complicated course of stroke.

Thus, the proposed method for predicting the outcome of strokes by determining the level of medium molecules in the blood plasma provides more: earlier and more accurate prediction than the known one. The prediction accuracy when using the proposed method reaches 92.3%.

Claims (1)

Claim method for predicting the course of stroke by clinical and laboratory examination, characterized in that, in order to increase the informativity of the method due to earlier prediction and increase accuracy, the concentration of medium molecules in the blood plasma is additionally determined 4 conventional units more predict a complicated course of stroke.