RU2012128236A

RU2012128236A - METHOD FOR EVALUATING THE CONDITION OF A BLOOD COOLING SYSTEM IN PATIENTS IN CRITICAL CONDITION

Info

Publication number: RU2012128236A
Application number: RU2012128236/15A
Authority: RU
Inventors: Вячеслав Сергеевич Афончиков
Priority date: 2012-07-03
Filing date: 2012-07-03
Publication date: 2014-01-20
Also published as: RU2517116C2

Abstract

Способ оценки состояния свертывающей системы крови у пациентов, находящихся в критическом состоянии, заключающийся в том, что проводят оценку механических свойств пробы крови по мере формирования сгустка в реальном масштабе времени с помощью тромбоэластографа, отличающийся тем, что одновременно исследуют цельную кровь и обедненную тромбоцитами плазму, определяют разницу между показателями R, К, Angle, MA, G и LY30 в пробах с цельной кровью и обедненной плазмой, соответственно, и при величине R, находящейся в пределах нормы, a ΔR более 9 мин диагностируют дефицит гуморальных факторов свертывания крови (II, V, VIII, IX, X, XII) или избыточную активацию антитромбина III, при повышении показателя Rи ΔR менее 9 мин диагностируют недостаточность тромбоцитарного звена коагуляции, при увеличении показателя ΔK более 4 мин диагностируют дефицит факторов I и II или наличие высокой активности естественных или лекарственных антикоагулянтов прямого действия, при повышении ΔAngle более 32° также диагностируют дефицит факторов I и II, при нормальных показателях MAи G, сопровождающихся увеличением показателей ΔМА и ΔG выше 26 мм и 6 КДин/см, соответственно, диагностируют дефицит фибриногена (фактор I) или нарушение процессов его полимеризации и гидратации (дилюция синтетическими коллоидными плазмозаменителями, дефицит XIII фактора свертывания), при увеличении показателя LY30более 8% одновременно с увеличением показателя LY30диагностируют активацию плазмин-зависимого фибринолиза, а при увеличении показателя LY30более 8% при нормальных показателях LY30диагностируют повышенную ретракцию кровяного сгустка (гиперактивность тромбоцитов), где:R- время начала образоA method for assessing the state of the blood coagulation system in critically ill patients, which consists in assessing the mechanical properties of the blood sample as a clot forms in real time using a thromboelastograph, characterized in that both whole blood and platelet-poor plasma are examined, determine the difference between the indicators R, K, Angle, MA, G and LY30 in samples with whole blood and depleted plasma, respectively, and when R is within normal limits, and ΔR is more than 9 min, the diagnosis deficiency of humoral coagulation factors (II, V, VIII, IX, X, XII) or excessive activation of antithrombin III are diagnosed, with an increase in R and ΔR less than 9 min, platelet coagulation deficiency is diagnosed, with an increase in ΔK more than 4 min, factor I deficiency is diagnosed and II or the presence of a high activity of natural or medicinal anticoagulants of direct action, with an increase in ΔAngle of more than 32 °, a deficiency of factors I and II is also diagnosed, with normal MA and G, accompanied by an increase in ΔMA and ΔG above 26 mm and 6 KDin / cm, respectively, diagnose fibrinogen deficiency (factor I) or a violation of its polymerization and hydration processes (dilution with synthetic colloidal plasma substitutes, coagulation factor deficiency XIII), with an increase in LY30 of more than 8% simultaneously with an increase in LY30, diagnose activation plasmin-dependent fibrinolysis, and with an increase in LY30 more than 8% at normal LY30 values, an increased retraction of a blood clot (platelet hyperactivity) is diagnosed, where: R is the time of the onset of the image

Claims

A method for assessing the state of the blood coagulation system in critically ill patients, which consists in assessing the mechanical properties of the blood sample as a clot forms in real time using a thromboelastograph, characterized in that both whole blood and platelet-poor plasma are examined, determining the difference between the indices of R, K, Angle, MA, G and LY30 in samples from whole blood and depleted of plasma, respectively, and when the value of R _1, being in the normal range, a ΔR over 9 min diagn styryl deficit humoral blood coagulation factors (II, V, VIII, IX , X, XII) or excessive activation of antithrombin III, with increasing index R ₁ and ΔR less than 9 min diagnosed failure platelet coagulation level, with increasing index ΔK over 4 min diagnose deficiency factors I and II, or the presence of a high activity of natural anticoagulants, or medicines direct action, at higher than 32 ° ΔAngle also diagnose deficiency factors I and II, with normal values MA ₁ and G _1, accompanied by an increase in the exponent ΔMA and ΔG above 26 mm and 6 kdyně / cm ^2, respectively, diagnose deficiency of fibrinogen (factor I), or disturbance in its polymerization and hydration (dilution synthetic colloidal plasma substitutes deficit XIII clotting factor), with increasing index LY30 ₁ to 8% while with an increase in LY30 _{2, the} activation of plasmin-dependent fibrinolysis is diagnosed, and with an increase in LY30 ₁ more than 8%, with normal LY30 _2, an increased blood clot retraction (platelet hyperactivity) is diagnosed, where:

R ₁ - time of onset of clot formation in a sample with whole blood,

ΔR is the difference between R and the onset of clot formation in platelet-poor plasma;

ΔK is the time difference between reaching the amplitude of the thromboelastogram 20 mm between samples with whole blood and plasma depleted in platelets;

ΔAngle - the difference in the angles of inclination of the amplitude of the thromboelastogram between samples with whole blood and plasma depleted in platelets;

MA ₁ - the maximum amplitude in the sample with whole blood;

ΔMA - the difference in the maximum amplitudes of the thromboelastogram between samples with whole blood and platelet-poor plasma;

G ₁ - the elasticity of the clot in the sample with whole blood;

ΔG is the difference in the elasticity of the clot between samples with whole blood and plasma depleted in platelets;

LY30 ₁ - lysis of a clot in a sample with whole blood in 30 min;

LY30 ₂ - clot lysis in a sample with platelet-depleted plasma in 30 min.