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INVENTION
Patent of the Russian Federation RU2199742
METHOD FOR PREDICTING LUMBER BLEEDING
In patients with duodenal ulcer disease
The name of the inventor: Kokuyeva OV; Kolinko B.Yu .; Stepanova LL; Novoselya NV; Safonov AV; Yakovenko MS; Proshin D.E.
The name of the patent holder: Kokueva Olga Vasilievna; Kolinko Bela Yuryevna; Stepanova Larisa Leonidovna; Novoselya Natalya Vasilyevna; Safonov Aleksey Valerevich; Yakovenko Maria Sergeevna; Proshin Dmitry Evgenevich
Address for correspondence: 350063, Krasnodar, ul. Gray, 4, KGMA, T.A. Dronina
Date of commencement of the patent: 2000.10.27
The invention relates to medicine, namely to gastroenterology, and can find application in the choice of treatment tactics for patients with duodenal ulcer (YB PDC). In a complex reveal certain criteria for assessing the functional state of the liver and pancreas, secretory and motor-evacuation activity of the gastroduodenal complex, calculate the total coefficient of criteria, the increase of which is proportional to the risk of duodenal bleeding. The technical result: the method allows to reduce the number of ulcer bleeding, leading to disability and mortality of patients with YaD KDP.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, namely to gastroenterology, and can find application in the choice of treatment tactics for patients with duodenal ulcer (YB PDC).
Ulcer disease is one of the most common diseases of internal organs [1]. Throughout the world, it suffers about 10% of the population [2].
In some patients, peptic ulcer has a progressive, often recurrent course, which leads to various complications, which are the cause of mortality and disability of patients with this pathology.
One of the most formidable complications of YaP PDC is ulcer bleeding, observed in 15-20% of cases [1, 3]. Postoperative lethality for this complication varies according to various estimates from 14 to 38.6% and does not tend to decrease, regardless of the method of treatment [1, 3, 4].
To prevent ulcers bleeding is possible with its timely prediction.
The solution of the task is largely complicated by the heterogeneity of the disease, which is determined by the combination of many etiological and pathogenetic factors with a single anatomical and clinical manifestation, that is, the presence of a duodenal ulcer [5, 6, 7].
Known methods for predicting ulcerative bleeding are typical. So, for example, there is a method for predicting the development of bleeding from duodenal ulcers [8], which consists of the following: the patient's parameters are determined, including male gender, ulcer localization on the posterior wall of the duodenal bulb, hereditary burden, negative atropine test value , HLA-phenotype - B35, A2AZ, A2AX .. The listed criteria are suggested by the author to take into account for bleeding prognosis in the case of NDB DP.
The disadvantage of the above method of prediction is that the biochemical, morphological and functional examination data of the patient were not taken into account, reflecting the concomitant lesion of the liver and pancreas, the state of which changes the course of the YaD PDK. This causes the inaccuracy of the proposed method and the reduction of its socio-economic efficiency.
PURPOSE - to increase the accuracy of forecasting the development of ulcerous bleeding in patients with YaD PDK.
TASKS:
1. An increase in the reliability of the prognosis of ulcerous duodenal bleeding in order to obtain an earlier and accurate conclusion about the state of the patient YaB PDK.
2. Reducing the risk of ulcerative duodenal bleeding and reducing the mortality of patients with YaD PDK.
3. Decrease in the number of emergency surgical interventions for ulcerous bleeding.
SUMMARY OF THE INVENTION
To establish the risk of duodenal hemorrhage in the complex, certain criteria for assessing the functional state of the liver and pancreas, the secretory and motor-evacuation activity of the gastroduodenal complex are revealed. Calculate the total coefficient of criteria, the increase of which is proportional to the risk of duodenal bleeding.
To determine the prognostic criteria of ulcer bleeding in patients with YaD PDC, a sequential Wald analysis is used, based on probabilistic methods of comparing the frequency of each of the analyzed indicators in the studied states-the presence or absence of a history of ulcerative bleeding [9].
A history of the disease and formalized observation maps of 108 patients with YaD PDK were prospectively analyzed. Ulcer bleeding in the anamnesis was observed in 33 patients, in 75 this symptom was absent. 165 signs were included in the comparative analysis, including indicators of the motor-evacuation function of the gastroduodenal complex and the morpho-functional state of the liver and pancreas, secretory and motor-evacuation activity of the gastroduodenal complex, and for each of the signs the value of the confidence interval was calculated.
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Then, the signs were significantly differentiated in the frequency of occurrence in groups with ulcer bleeding and without them (the confidence interval value is less than 0.05). Such signs turned out to be 26 (tab.1). For each of them sensitivity, specificity and efficiency were calculated [9, 10].
For prediction, it is possible to use all the signs, but after the screening criteria were selected (Table 2), which have the greatest predictive informativeness, sensitivity, specificity and efficiency. There are 19 such signs.
The method is carried out as follows
To determine the prognosis of ulcer bleeding in patients with YaD, PDK takes into account more significant prognostic signs with the corresponding sign "+" or "-". With a pre-set allowable error of ± 5%, in the case of a sum of symptoms of +6 or more, one should speak of a high risk of ulcer bleeding, +4 to +5 - moderate, +1 to +2 - minimal.
We give examples of predicting the risk of ulcer bleeding in patients.
Example 1 . Tab. 3. Patient P., 28 years old, I / B 485 entered the Republican Center for Functional Surgical Gastroenterology on 10.03.00 for emergency indications with signs of gastrointestinal bleeding: complaints of weakness, "black" stool for two days, pain in Abdomen, pallor of the skin, tachycardia, A / D reduction, reduction of red blood cells to 2.8 xl0 12 / l, hemoglobin 75 g / l, hematocrit 0.26, ESR 45 mm / h.
When interviewing the patient it was found out that he suffers from peptic ulcer of the duodenum for about 4 years. The exacerbations did not have a clear seasonal character, the pain syndrome was not pronounced. Two years ago, I underwent a checkup at RCEFC, which resulted in a high risk of ulcer bleeding.
From the proposed surgical treatment in the volume of selective proximal vagotonia (antacid surgery), the patient refused. As an alternative, the patient was prescribed eradication of H. pylori followed by antisecretory therapy. However, the doctor's recommendations were not met.
At the moment of admission, when an emergency examination was carried out on EGDS, it was established that the source of bleeding is the bulb of the duodenum. The patient's condition served as the basis for conducting an emergency operation, which was performed in the volume of bridge duodenoplasty and removal of the duodenum from under the mesentery root. After a recovery period lasting 6 weeks, an antisecretory operation was performed - selective proximal vagotomy.
Example 2 . Tab. 4. Patient A., 59 years old, I / B 645, was on examination in the republican center of functional surgical gastroenterology since 12.05.98.
The patient had a low risk of ulcer bleeding. Surgical treatment of cicatrical and ulcerative stenosis was postponed indefinitely due to concomitant cardiac pathology. Nevertheless, the patient continued to be outpatient. For more than 2 years of follow-up, the patient had no signs of gastrointestinal bleeding.
Approbation of this method was performed in 56 patients, the prognosis was proved in 48 (85.7%) patients for 2.5-3 years, which proves the high accuracy of the method.
Isolation of 3 groups of prognosis for ulcerative bleeding allows to optimize and individualize the treatment regimens of patients with JD KDP. Patients who are predicted to have a high degree of risk, are indicated surgical treatment with antacid operations or constant maintenance therapy with antisecretory drugs.
The proposed differentiated approach to the tactics of treatment and management of patients with YaD KDP has undoubted medico-social effectiveness, since it allows to reduce the number of ulcerous bleedings leading to disability and mortality of patients with YaD KDP.
USED BOOKS
1. Guide to gastroenterology: in three volumes / Under the general editorship of F.I. Komarova and A.L. Grebenev. T.2. Diseases of the liver and biliary system / AL Grebenev, A.I. Khazanov, S.D. Podymova et al .: ed. F.I. Komarova, A.L. Grebeneva, A.I. Khazanov. - Moscow: Medicine, 1995.-528 p.
2. Zimmerman Ya.S. Essays on clinical gastroenterology. - Perm, 1992.-336p.
3. Lomachenko Yu. I., Grachev A.M. Profuse gastroduodenal ulcer bleeding. // Proceedings of the 26th Conference, May 21-22, 2000. Ed. Prof. EI Zaitsevoy. -Smolensk, 1998.- P. 232-236.
4. Onopriyev V. Etudes of functional surgery of peptic ulcer. - Krasnodar: Publishing and printing production leased enterprise, 1995.-296s.
5. Frost F.3. Use of atropine test in patients with duodenal ulcer. // Medical work. - 1997, 5. P. 29-31.
6. Rotter JI, Rimoin DI // Gastroenterology. - 1977. - Vol. 73, 3. - P. 626-632.
7. Vasilenko V.Kh., Grebenev A.L., Sheptulin A.A. Ulcer disease: modern concepts of pathogenesis, diagnosis, treatment. - M., -1987. -288s.
8. Potashov LV, Morozov VP, Savransky IP, Kudrevatykh IP, Did-Zurabova Ye. S., Kimkov A.V. Predicting the development of bleeding from duodenal ulcers. // Surgery. Journal of them. N.I. Pirogova, 1998, 7. - P. 4-6.
9. Gubler EV Informatics in pathology, clinical medicine and pediatrics. -L .: Medicine, 1990.-176 p.
10. Dvoyrin VV, Klimenko AA The method of controlled clinical trials. - Moscow: Medicine, 1985.-142 p.
CLAIM
The method for predicting ulcer bleeding in patients with duodenal ulcer, characterized by the fact that in order to establish the risk of duodenal hemorrhage in the complex, significant criteria for assessing the functional state of the liver and pancreas, secretory and motor-evacuation activity of the gastroduodenal complex, determine the overall coefficient of criteria, increase Which is proportional to the increased risk of duodenal bleeding.
print version
Date of publication 29.03.2007gg
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