SU1636770A1 - Method of estimation the severity of traumatic shock in children - Google Patents

Abstract

This invention relates to medicine and can be used to determine the severity of traumatic shock in children. The aim of the invention is to improve the accuracy of determination. In order to achieve the goal, the activity of kallikrein in the serum and the volume of the circulating blood are also determined, and with the activity of kallikrein equal to 42-58 honey / ml. and a decrease in circulating blood volume by 0-8% determines the average degree of traumatic shock, with kallikrein activity values of 59 honey / ml and above and a decrease in circulating blood volume by 9-26%, a severe degree of traumatic shock is determined and in the absence of changes in activity Kallikrein and a decrease in circulating blood volume by 27% and more determine the extremely severe degree of traumatic shock. The method allows to significantly improve the accuracy of determining the degree of traumatic shock in children. (Oh (L

Description

This invention relates to medicine and can be used to determine the severity of traumatic shock in children.

The aim of the invention is to improve the accuracy.

The method is carried out as follows.

After a clinical and laboratory examination of the patient, the serum kallikrein activity and the circulating blood volume are additionally determined. To determine the activity of kallikrein, 3 ml of blood is taken from a patient from a vein, serum is obtained, 0.75 ml of 0.02 M and phosphate buffer, pH 7.0 are added to 0.25 ml of serum, 2.5 ml of Sephadex A suspension are added. 50 in the same buffer solution (1: 3 ratio), the mixture is stirred for 10 minutes with a glass rod, 3.0 ml of 0.02 M phosphate buffer, pH 7.0, containing 0.05 M NaCl is added, stirred within 2 min. Transfer the suspension to a glass filter (DG-29), wash the filter 3 times with 5 ml of 0.02 M phosphate buffer, and make the filtrate volume to 5 ml with 0.02 M phosphate buffer.

To 1.0 ml of the filtrate are added 1.0 ml of 0.1 M Tris buffer pH 8.0 and 1.0 ml of 1.5 ml-10 3 10 M solution of EAEA in the same buffer. B control sample taken 2.0 ml of 0.1 M Tris buffer pH 8.0 and 1.0 ml 1, solution BAEE. Samples are poured into spec.

SE

one

-h

trophotometer and measure the increase in optical density at a wavelength of 253 nm and 25 ° C for 15 MHHJ readings are made every 5 minutes. the potency of kallikrein is calculated by the formula

Ak-on

d E sample-1 3 5

1000

WapT- 15-0,25-1

3636,

where a is the activity of kallikrein in the serum, honey / ml;

 proc

 standard

the extinction of the test sample for 15 min at a wavelength of 253 nm;

extinction 1 µm of N-benzoyl-α-L-arginine from BAEE in 1 ml at a wavelength of 253 nm; 3 - sample volume in a cuvette, ml; 5 - volume of non-adsorbed fry

tion, ml, 0,25 - the amount of serum,

taken for analysis, ml. To determine the circulating blood volume, 0.5% solution of Evans blue dye was injected intravenously at a rate of 0.2 mg / kg body weight. After 10-15 minutes, 5 ml of blood is taken from the vein, centrifuged at 3000 rpm for 30 minutes at an angular centrifuge of TsUM-1. Serum is sucked off and re-centrifuged for 5-7 minutes at a speed of 6-7 thousand rpm. Prepare a standard dye solution using serum from healthy donors. The hematocrit value in the blood taken from the finger is determined separately. The extinction of the test sample and the control sample is determined on a spectrophotometer at a wavelength of 253 nm in a 1 cm cuvette. The concentration of the dye is determined by the formula

 with D

D,;

with -

B 1c

 one

D

S., - dye concentration in the sample;

the dye concentration in the standard sample,

- standard density (optical),

t) Ј is the optical density of the sample. volume of circulating blood is calculated by the formula

OP

Vk

 100%

100 -0.96-G Vk - circulating blood volume, ml,

0

five

0

five

0

five

40

45

50

55

G - hematocrit value,%.

The volume of circulating blood for a given age, body weight, sex (rate) is calculated in a known manner.

With the values of kallikrein activity equal to 42-58 honey / ml, and reducing the volume of circulating blood to 8%, the average degree of traumatic shock is determined, with values of kallikrein activity equal to 59 honey / ml and above, and a decrease in circulating blood volume by 9 -26% determines the severe degree of traumatic so far and in the absence of changes in the activity of kallikrea; By reducing the volume of circulating blood by 27% or more, an extremely severe degree of traumatic shock is determined.

Example 1. Patient A., 14 years. He was admitted with a diagnosis: closed fracture of the left ischial bone, left kidney contusion. When a blood pressure is 130/80 mm Hg, the pulse is 100 beats per minute of satisfactory filling and voltage. Consciousness is clear, answers questions correctly. The skin and visible mucous membranes of normal color, warm to the touch, no cyanosis. Complete blood and urine without pathology. A study of acid-base balance and blood gas composition showed subcompensated changes.

In order to determine the degree of severity of the patient's condition, the activity of kallikrein in the blood serum and the volume of the circulating blood was determined. The activity of kallikrein 2 hours after the injury was 42.0 honey / ml, the volume of circulating blood decreased by 1% compared with the normal level for this age and body weight, which indicated an average degree of traumatic shock. When carrying out anti-shock therapy, which included the introduction of polyglucine, reopolyglucine, 5-10% glucose solutions, potassium preparations, the patient's condition improved and on the 49th day he was discharged in a satisfactory condition.

Example 2. Patient V., 7 years old, was admitted with a diagnosis of a fracture of the radial and ulnar bones of both forearms, and the moderate degree of brain damage. Clinical and laboratory data: BP 110 / / 70 mm Hg, pulse 96 beats per 1 min, CVP 40 cm water. Complete blood count - reducing the number of red blood cells to 3.5 minutes. The remaining figures are unchanged.

In order to determine the degree of severity of the patient's condition, the activity of kallikrein and the volume of circulating blood were determined. The activity of kallikrein 1.5 hours after injury was 58.9 honey / ml, the volume of circulating blood decreased by 8% compared with the control indicators for a given age and body weight, indicating a moderate degree of traumatic shock.

Refinement of the diagnosis required a change in the volume of anti-shock intensive care. The patient was expanded with infusion-transfusion therapy by administering gelatinol, reopolyglucine, a lactosol solution, 5-15% glucose solutions with potassium and insulin.

After the treatment, the patient's condition improved. Discharged on the 27th day in a satisfactory condition.

Example 3. Patient S., 13 le arrived with a diagnosis: closed fracture of the left hip with displacement, fracture of the pubic bone. Clinical and laboratory examination data: BP 120/90 mm Hg, pulse 102 beats per minute, CVP 20 cm water. Total protein 60 g / l, acid-base balance and blood gas composition were changed to subcompensated state. Complete blood count - expressed anemia, erythrocytes 2.8 million.

In order to determine the degree of severity of the condition, the patient determined the serum kallikrein activity and the circulating blood volume. The activity of kallikrein 3 h after injury was equal to 59.0 honey / ml, the volume of circulating blood decreased by 9% compared with the norm for a given age and body weight, which indicated a severe degree of traumatic shock.

The specification of the diagnosis required a reimbursement of the volume of circulating blood: the patient was additionally injected with 400.0 RBC, 300.0 ml of polyglucidine, 200.0 ml of reopolyglucin. For 5 days, the child received potassium and insulin preparations in the form of a polarizing mixture.

ten

6367706

Conducting intensive therapy improved the patient's condition and on the 32nd day after the injury he was discharged in a satisfactory condition.

Example 4. Patient 0., 6 years old, was admitted with a diagnosis: fracture of the right ischial bone, pubic claws, rupture of the symphysis. Clinical and laboratory data: changes in the acid-base and gas state of the blood to a subcompensated level were detected.

In order to determine the degree of severity of the condition, the patient determined the serum kallikrein activity and the circulating blood volume. The activity of kallikrein was equal to 92.0 honey / ml, the volume of circulating blood decreased by 26% compared with the norm for a given age and body weight, indicating a severe degree of traumatic shock.

During therapy (polyglucin, polypher, reopolyglucin, gelatin, blood preparations, potassium, insulin)

15

20

25

0

five

0

five

0

five

ling, hormonal substances, painkillers, etc.) the patient's condition improved, on the 42nd day he was discharged in a satisfactory condition.

Example 5. Patient L., 5 years old, was admitted with a diagnosis: fracture of the base of the skull, closed fracture of both femoral bones, injury of the abdominal organs.

Data of clinical and laboratory examination: HELL 90/60 mm Hg, pulse 140 beats per minute, CVP 20 cm. Water. The skin and visible mucous membranes of pale color are warm to the touch, there is no cyanosis, in the general analysis of the blood there is anemia, 3 million, of erythrocytes. Acid-base state at decompensation level. Total protein 55 g / l. In order to determine the degree of severity of the condition, the patient determined the serum kallikrein activity and the circulating blood volume. The activity of kallikrein at 3 hours after injury was 31.0 honey / ml. The volume of circulating blood decreased by 27% compared with the norm for a given age and body weight, indicating an extremely severe degree of traumatic shock. Refinement of the diagnosis required a change in the volume of anti-shock therapy: an increase in the intravenous administration of blood and its components (erythrocyte

mass, plasma, thrombovzvesi), as well as polyglgokine, polypher, reopolyglukina, gelatinol, glucose solution, salt solutions. The child received insulin potassium in the form of a polarizing mixture, hormones for 9 days.

Adequate intensive therapy led to an improvement in the patient's well-being and on the 52nd day after the injury the child was discharged in a satisfactory condition.

Example 6. Patient E., 12 years old, was admitted with a diagnosis of a closed fracture of the temporal bone with a transition to the base, a brain contusion with a degree. Multiple fractures of the tepal bones, closed by fracture of the upper third of the left thigh with displacement,

In order to determine the degree of severity of the patient's condition, the kineticity of serum kallikrein and the volume of circulating blood were determined. The activity of kallikrein after 3 h after trauma was 41.9 honey / ml, the volume of circulating blood decreased by 50% compared with the norm for this age and body weight, indicating an extremely severe degree of traumatic shock.

Refinement of the diagnosis required a change in the volume of infusion-transfusion therapy, which was increased by 1,800 ml. The child received complex posyndromic intensive therapy (IVD, HBO, painkillers, a polarizing mixture, vitamins, hormones).

The condition of the child has improved as a result of anti-shock therapy. Discharged after 48 days in satisfactory condition.

five

0

five

0

five

0

blood. The activity of kallikrein 4 hours after injury 31.0 honey / ml. The volume of circulating blood did not change compared with the norm for a given age and body weight. The findings suggest that the condition of the patient was satisfactory. After therapy (pain relief, skeletal stretching) on day 28, he was discharged with recovery.

Example 8. Patient N., 4 years old, was admitted with a diagnosis: a closed fracture of both bones of the right forearm with a significant displacement.

Clinical and laboratory data: HELL 90/60 mm Hg, pulse 92 beats per minute. Skin and visible mucous regular color, warm to the touch. Blood and urine tests without pathology.

To assess the degree of severity of the patient's condition, the activity of kallikrein and the volume of circulating blood were determined. The activity of kallikrein 3 h after injury was 41.9 honey / ml, the volume of circulating blood was within the control values for a given age and body weight. The obtained data indicated a satisfactory condition of the patient. Discharged on the 12th day.

Compared with the known method, the proposed method allows to increase the accuracy of determining the degree of traumatic shock by increasing the number of detectable indicators | And their greater informativeness, which allows determining the degree of traumatic shock in children with a high degree of accuracy, despite On some technical difficulties of the method.

Claims (1)

Example 7. Patient K., 7 years old, 45 claims He arrived with a diagnosis of a closed fracture of the middle third of the left thigh without displacement. Clinical and laboratory examination data: BP 110/70 mm Hg, pulse 92 beats per minute, satisfactory filling and tension, skin and visible mucous membranes of normal color, without cyanosis. Biochemical parameters without changes. In order to determine the degree of severity of the condition, the patient determined the activity of kallikrein in the blood serum and the volume of circulating 0 five A method for determining the degree of traumatic shock in children by clinical and laboratory examination, characterized in that, in order to increase accuracy, the serum kallikrein activity and circulating blood volume are determined at kallikrein activity values 42-58 honey ml, and a decrease in circulating blood volume by 0-8% determines the average degree of traumatic shock, with values of kallikrein activity 9 .163677010 59 honey / ml and above and reducing the bulk of the caplicreaia and reducing the volume circulating blood by 9–26% of the detected circulating blood by 27% and a severe degree of a traumatic more severely determine an extremely heavy sieve, and in the absence of changes ak-stump of traumatic shock.