| Start of section
Production, amateur Radio amateurs Aircraft model, rocket-model Useful, entertaining |
Stealth Master
Electronics Physics Technologies Inventions |
Secrets of the cosmos
Secrets of the Earth Secrets of the Ocean Tricks Map of section |
  |
| Use of the site materials is allowed subject to the link (for websites - hyperlinks) | |||
Navigation: => |
Home / Patent catalog / Catalog section / Back / |
|
INVENTION
Patent of the Russian Federation RU2021747
METHOD FOR PREDICTING THE OUTPUT OF OPERATIONAL INTERVENTION IN ACUTE CHOLECYSTITE IN PATIENTS WITH AGED AND SENIOR AGE
The name of the inventor: Ulyanov Yu.N.
The name of the patent holder: Ulyanov Yuri Nikolayevich
Address for correspondence:
Date of commencement of the patent: 1991.06.14
(EN) The invention relates to medicine, in particular, to the prediction of the outcome of surgical treatment of acute cholecystitis in elderly and senile patients. The essence of the invention is that in order to quantify and improve the accuracy of the prognosis of surgical treatment while providing the most acceptable and shoddy methods of research, as well as assessing the dynamics of the degree of operational risk in the preoperative preparation process, the activity of the cardiovascular and respiratory systems is determined with the help of alcohol and Rheograms before and after carrying out the loading test. The degree of operational risk is calculated by the developed formula, which includes the most informative functional indicators. Advantages of the method: the most acceptable and safe method of loading was used in determining the functional state of the cardiovascular and respiratory systems. On the basis of mathematical analysis, a formula for calculating the degree of operational risk was developed, which made it possible to improve the accuracy of the forecast, dynamic control over the functional state of the systems under investigation and the degree of operational Risk in the preoperative preparation process.
DESCRIPTION OF THE INVENTION
(EN) The invention relates to medicine, in particular, to the prediction of the outcome of surgical treatment of acute cholecystitis in elderly and senile patients in terms of the functional status of the cardiovascular and respiratory systems.
There are schemes in which the degree of operational risk is determined by the sum of the scores that characterize the severity of the most significant prognostic factors-age, the presence of concomitant diseases, the form of the inflammatory process, the nature of the operation (Malinovsky NN et al. Degree of Operational Risk .-- Surgery, 1973, N 10, pp. 32-36).
The drawbacks of the predictive tables are the schematic, lack of individual characteristics and changes in the state during the preoperative preparation of patients.
To improve the objectivity and accuracy of the forecast, it is assessed by the functional state of the main homeostasis systems.
Load cells are used to identify hidden disorders of the function of the cardiovascular and respiratory systems, and assess their reserve capabilities (Panfilov BK Biliary-cardial syndrome in calculous cholecystitis - Surgery, 1981, N 1, pp. 57-61).
The closest to the proposed method is a method for assessing the functional state of the cardiovascular and respiratory systems in surgical patients using spiro and rheograms using a stress test (Buravtsov, VI, Prognostic significance of functional methods for the study of respiration and circulation in lung cancer surgery.) - Journal of Surgery , 1986, No. 12, pp. 7-11). The disadvantage of the prototype is that physical exercises are used as a load (a tenfold rise from the lying position to the sitting position). For many elderly and senile patients this burden is unacceptable, since they can not rise in bed without assistance, many of them have disrupted coordination. In addition, any physical load for patients with acute surgical diseases of the abdominal cavity is contraindicated because of a sharp pain syndrome, the danger of spreading the inflammatory process, the threat of complications, etc. The second drawback of the method chosen as a prototype is a qualitative assessment of changes in hemodynamics and respiration in the absence of a total quantitative determination of the degree of operational risk.
The aim of the invention is to improve the accuracy of the prognosis of surgical treatment and to quantify the degree of operational risk in acute cholecystitis in elderly and senile patients.
The goal is achieved as follows. With the help of spiro- and rheography determine the volume of breathing, the vital capacity of the lungs, the shock volume of the heart. Then the patient is offered to inhale the gas mixture with an increased CO 2 content and depleted O 2 for 1 minute, after which the parameters of the cardiovascular and respiratory systems are again measured and the recovery time of the indicators to the initial values. The degree of operational risk is determined by the formula:
COP = 
- 8.2 where COR is the degree of operational risk, cond. Units;
В - age (more than 60 years);
T is the recovery time of functional indicators to the initial values, s;
DO - respiratory volume, ml;
LIVED - vital capacity of the lungs, ml;
VO is the stroke volume of the heart, ml;
At values of the GRA less than 30 conventional units. Predict a favorable, and with values of the GRA more than 30 conv. Units - an unfavorable outcome of surgical intervention. The allocated prognostic groups of patients are characterized by the indicators given in the table.
Checking the differences in prognostic groups by the number of complications and lethality by the method of nonparametric criteria showed their reliability (the K 2 index is 12 and 9, respectively).
Clinical example: Patient K., 69 years old (ib.N. 1705), entered the NIISP on 16.10.86 with a diagnosis of acute cholecystitis. Suffers hypertensive disease III st., Postinfarction cardiosclerosis, atrial fibrillation, pulmonary emphysema, pulmonary heart disease III st. A functional study of the cardiovascular and respiratory systems was carried out, a high degree of operational risk was established (105 conventional units). Seven days after the arrest of acute cholecystitis and targeted therapy including antibiotics, antispasmodics, cardiac, vasodilating, diuretics, intravenous glucose solution with insulin, a functional study was re-conducted. It was found that a high degree of operational risk persists (82.8 conventional units), therefore it was decided to abstain from surgical treatment in the cold period. The stones are removed through the laparoscopic cholecystostomy. Recovery.
Patient S., 79 years old, (ib.N. 835), entered the NIISP on 22.07.86 with the diagnosis of acute cholecystitis, peritonitis. In connection with severe cardiopulmonary insufficiency, the degree of operational risk was determined, which was 189 conv. Units (High). Within 6 hours intensive detoxification and antibacterial therapy, forced diuresis was carried out. The patient's condition improved, the degree of operational risk decreased to 28.4 conventional units. An emergency operation was performed. Gangrenous calculous cholecystitis, local peritonitis was revealed. Produced cholecystectomy. In the postoperative period, he suffered a right-sided pneumonia. Recovery.
The proposed method of loading is the most acceptable and safe in determining the functional state of the cardiovascular and respiratory systems, a formula for calculating the degree of operational risk has been developed, which has made it possible to improve the accuracy of the prognosis of surgical treatment of acute cholecystitis in elderly and senile patients. In addition, the method allows dynamic monitoring of the functional state of the cardiovascular and respiratory systems, a change in the prognosis of surgical treatment during preoperative preparation, thereby correcting the intensity of therapy and treatment tactics.
CLAIM
METHOD FOR PREDICTING THE OUTPUT OF OPERATIONAL INTERVENTION IN ACUTE CHOLECYSTITIS IN PATIENTS WITH AGING AND SENIOR AGE, including the evaluation of the activity of the cardiovascular and respiratory systems by spiro and rheography before and after carrying out the loading test, characterized in that, in order to improve the accuracy of the method while providing sparing Methods of investigation, determine the volume of breathing, the vital capacity of the lungs, the shock volume of the heart, then offer the patient for 1 min to inhale the gas mixture with an increased content of CO 2 and depleted O 2 , and then again measure the cardiovascular and respiratory systems and the recovery time of their Up to the initial values, the degree of operational risk of COP is determined by the formula
COP = = 8.2, standard units /
Where B is the age;
T is the recovery time of functional indicators to the initial values, s;
DO - respiratory volume, ml;
LIVED - vital capacity of the lungs, ml;
VO - impact volume, ml;
With values of the GRA less than 30U.s. Predict a favorable, and at values of the GRA more than 30 units. - an unfavorable outcome of surgical treatment.
print version
Date of publication 28.01.2007gg
Comments
When commenting on, remember that the content and tone of your message can hurt the feelings of real people, show respect and tolerance to your interlocutors even if you do not share their opinion, your behavior in the conditions of freedom of expression and anonymity provided by the Internet, changes Not only virtual, but also the real world. All comments are hidden from the index, spam is controlled.