肝硬化患者心血管系统共向病变的检测发病机制;特点与特点;临床指标及其预后价值;修改处理的理据及有效性(第二次公告)

M. Farmaha, M. Abrahamovych, O. Abrahamovych, O. Fayura, V. Chemes
{"title":"肝硬化患者心血管系统共向病变的检测发病机制;特点与特点;临床指标及其预后价值;修改处理的理据及有效性(第二次公告)","authors":"M. Farmaha, M. Abrahamovych, O. Abrahamovych, O. Fayura, V. Chemes","doi":"10.25040/lkv2020.04.008","DOIUrl":null,"url":null,"abstract":"Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis (LC), although often fatal, are poorly studied. The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with LC, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment. Materials and methods. We processed medical records of 603 patients with LC and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy (CCMP), and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of LC. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with LC and syntropic cardiovascular lesions as well as to assess its effectiveness. Results. The presence of the combination of such complaints as nausea, jaundice of the skin and sclera in patients with LC and the absence of the “jellyfish head” symptom lets us think with 97.09 % sensitivity, 98.02 % specificity and 97.70 % accuracy about syntropic secondary CCMP. In the presence of the combination of such complaints as pain and heaviness in the right side of the abdomen, ascites, hepato-, splenomegaly and telangiectasia lets us think with 85.39 % sensitivity, 98.61 % specificity and 94.75 % accuracy about syntropic persistent hypotension. Improvement of the comprehensive treatment of patients with LC, syntropic secondary CCMP and persistent hypotension, taking into account the peculiarities of their pathogenesis and clinical course, can improve the quality of life of patients by 44.95 % and 40.39 %, respectively, and significantly increase the effectiveness of treatment. Conclusions. Clinical symptom complexes that indicate the presence of syntropic lesions of the circulatory system – a combination of complaints of nausea, jaundice and sclera in the absence of symptoms of “jellyfish head” indicates CCMP, and a combination of complaints of pain and heaviness in the right hypochondrium, ascites, hepato- and splenomegaly and telangiectasia indicate persistent hypotension. Improvement of the comprehensive treatment of patients with LC and CCMP by adding a β-blocker with α-blocking properties of carvedilol (1 tablet (3.125 mg) twice a day), cardio- and hepatoprotector thiotriazoline (in patients with LC and CCMP of the 1st degree of severity (100.0 mg) three times a day, patients with LC and CCMP II and III degrees of severity – intramuscularly 2.0 ml of 2.5 % solution (50.0 mg) three times a day for five days, then 1 tablet (100.0 mg) three times a day), and improvement of the comprehensive treatment of patients with LC and persistent hypotension of I and II degrees of severity by adding ivabradine (1 tablet (5.0 mg) in the morning after meals), patients for hypotension of III degree of severity – intravenous albumin solution (at the rate of 1.5 g/kg for at least 10 days), as well as α-lipoic acid (1 capsule (600.0 mg) in the morning after meals), in the presence of ascites and edema syndrome – spironolactone (in the dosage, which is provided by the severity of the complication, of us a blunt transition to a maintenance dose of 1 tablet (50.0 mg) in the morning after a meal) enhanced the quality of life by 44.95 % and 40.39 %, respectively, and significantly increased the effectiveness of treatment.","PeriodicalId":279640,"journal":{"name":"Lviv clinical bulletin","volume":"8 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Syntropic Lesions of the Cardiovascular System in Patients with Liver Cirrhosis: their Determination; Selected Pathogenetic Mechanisms; Characteristics and Specifics; Clinical Markers, Their Prognostic Value; Justification and Effectiveness of Modified Treatment (Second Notice)\",\"authors\":\"M. Farmaha, M. Abrahamovych, O. Abrahamovych, O. Fayura, V. Chemes\",\"doi\":\"10.25040/lkv2020.04.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis (LC), although often fatal, are poorly studied. The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with LC, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment. Materials and methods. We processed medical records of 603 patients with LC and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy (CCMP), and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of LC. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with LC and syntropic cardiovascular lesions as well as to assess its effectiveness. Results. The presence of the combination of such complaints as nausea, jaundice of the skin and sclera in patients with LC and the absence of the “jellyfish head” symptom lets us think with 97.09 % sensitivity, 98.02 % specificity and 97.70 % accuracy about syntropic secondary CCMP. In the presence of the combination of such complaints as pain and heaviness in the right side of the abdomen, ascites, hepato-, splenomegaly and telangiectasia lets us think with 85.39 % sensitivity, 98.61 % specificity and 94.75 % accuracy about syntropic persistent hypotension. Improvement of the comprehensive treatment of patients with LC, syntropic secondary CCMP and persistent hypotension, taking into account the peculiarities of their pathogenesis and clinical course, can improve the quality of life of patients by 44.95 % and 40.39 %, respectively, and significantly increase the effectiveness of treatment. Conclusions. Clinical symptom complexes that indicate the presence of syntropic lesions of the circulatory system – a combination of complaints of nausea, jaundice and sclera in the absence of symptoms of “jellyfish head” indicates CCMP, and a combination of complaints of pain and heaviness in the right hypochondrium, ascites, hepato- and splenomegaly and telangiectasia indicate persistent hypotension. Improvement of the comprehensive treatment of patients with LC and CCMP by adding a β-blocker with α-blocking properties of carvedilol (1 tablet (3.125 mg) twice a day), cardio- and hepatoprotector thiotriazoline (in patients with LC and CCMP of the 1st degree of severity (100.0 mg) three times a day, patients with LC and CCMP II and III degrees of severity – intramuscularly 2.0 ml of 2.5 % solution (50.0 mg) three times a day for five days, then 1 tablet (100.0 mg) three times a day), and improvement of the comprehensive treatment of patients with LC and persistent hypotension of I and II degrees of severity by adding ivabradine (1 tablet (5.0 mg) in the morning after meals), patients for hypotension of III degree of severity – intravenous albumin solution (at the rate of 1.5 g/kg for at least 10 days), as well as α-lipoic acid (1 capsule (600.0 mg) in the morning after meals), in the presence of ascites and edema syndrome – spironolactone (in the dosage, which is provided by the severity of the complication, of us a blunt transition to a maintenance dose of 1 tablet (50.0 mg) in the morning after a meal) enhanced the quality of life by 44.95 % and 40.39 %, respectively, and significantly increased the effectiveness of treatment.\",\"PeriodicalId\":279640,\"journal\":{\"name\":\"Lviv clinical bulletin\",\"volume\":\"8 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-10-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lviv clinical bulletin\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.25040/lkv2020.04.008\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lviv clinical bulletin","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.25040/lkv2020.04.008","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

介绍。肝硬化(LC)患者的循环系统共病性病变,虽然通常是致命的,但研究很少。研究的目的。目的:鉴别LC患者的心血管系统共向病变,确定其发病机制、性质和特征,确定具有预后价值的临床标志物,论证和评价其改良治疗的有效性。材料和方法。我们处理了603例LC患者的医疗记录,并检测了490例患者的循环系统病变。其中一些只有一种类型的病变(研究组):103例患者被诊断为肝硬化心肌病(CCMP), 89例患者被诊断为动脉低血压。无循环系统病变患者(113例)作为对照组。研究第一步的目的是确定循环系统的共病病变。第二步的目的是研究它们形成的一些发病机制。第三步的目的是表征这些病变,对其进行分类,并确定其与LC严重程度相关的具体特征。第四步的目的是确定他们的临床标志。第五步的目的是为LC和向性心血管病变患者的改良治疗方案辩护,并评估其有效性。结果。LC患者合并恶心、皮肤、巩膜黄疸等主诉,且无“海蜇头”症状,使我们对伴向性继发CCMP的敏感性为97.09%,特异性为98.02%,准确率为97.70%。结合右腹疼痛、沉重、腹水、肝、脾肿大、毛细血管扩张等主诉,对同向性持续性低血压的诊断敏感性为85.39%,特异性为98.61%,准确率为94.75%。考虑到LC、向右性继发CCMP和持续性低血压的发病机制和临床病程的特殊性,加强对患者的综合治疗,可使患者的生活质量分别提高44.95%和40.39%,显著提高治疗效果。结论。临床症状复合表明存在循环系统的同向性病变——在没有“水母头”症状的情况下出现恶心、黄疸和巩膜的症状表明CCMP,而在右侧胁肋部出现疼痛和沉重、腹水、肝、脾肿大和毛细血管扩张的症状表明持续低血压。改善患者的综合治疗CCMP的LC,通过添加β-受体阻滞药与α利用卡维地洛的属性(1片(3.125毫克)一天两次),有氧运动,hepatoprotector thiotriazoline (LC患者和资助的第一学位的严重性(100.0毫克)一天三次,LC患者和严重性CCMP II和III度——肌内2.0毫升的2.5%解决方案(50.0毫克)为五天,一天三次1片(100.0毫克)一天三次),和改善患者的综合治疗LC和持续低血压I和II度的严重性增加ivabradine(1片(5.0毫克)早上饭后),患者的低血压三世程度的严重性——静脉注射白蛋白溶液(1.5克/公斤的速度至少10天),以及α-酸(1胶囊(600.0毫克)早上饭后),在腹水和水肿综合征-螺内酯(剂量,由并发症的严重程度提供,我们钝化过渡到维持剂量1片(50.0 mg,早上饭后),分别提高了44.95%和40.39%的生活质量,显著提高了治疗的有效性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Syntropic Lesions of the Cardiovascular System in Patients with Liver Cirrhosis: their Determination; Selected Pathogenetic Mechanisms; Characteristics and Specifics; Clinical Markers, Their Prognostic Value; Justification and Effectiveness of Modified Treatment (Second Notice)
Introduction. Comorbid syntropic lesions of the circulatory system in patients with liver cirrhosis (LC), although often fatal, are poorly studied. The aim of the study. To distinguish syntropic lesions of the cardiovascular system in patients with LC, to determine some of their pathogenetic mechanisms, nature, and characteristics, to determine clinical markers with prognostic value, to justify and evaluate the effectiveness of their modified treatment. Materials and methods. We processed medical records of 603 patients with LC and detected circulatory system lesions in 490 patients. Some of them had only one type of lesions (study groups): 103 patients were diagnosed with cirrhotic cardiomyopathy (CCMP), and 89 patients were diagnosed with arterial hypotension. Patients without the circulatory system lesions (113 patients) formed a comparison group. The purpose of the first step of the study was to determine syntropic comorbid lesions of the circulatory system. The purpose of the second step was to study some pathogenetic mechanisms of their formation. The purpose of the third step was to characterize these lesions, classify them, and determine their specific characteristics related to the severity of LC. The purpose of the fourth step was to determine their clinical markers. The purpose of the fifth step was to justify a modified course of treatment for patients with LC and syntropic cardiovascular lesions as well as to assess its effectiveness. Results. The presence of the combination of such complaints as nausea, jaundice of the skin and sclera in patients with LC and the absence of the “jellyfish head” symptom lets us think with 97.09 % sensitivity, 98.02 % specificity and 97.70 % accuracy about syntropic secondary CCMP. In the presence of the combination of such complaints as pain and heaviness in the right side of the abdomen, ascites, hepato-, splenomegaly and telangiectasia lets us think with 85.39 % sensitivity, 98.61 % specificity and 94.75 % accuracy about syntropic persistent hypotension. Improvement of the comprehensive treatment of patients with LC, syntropic secondary CCMP and persistent hypotension, taking into account the peculiarities of their pathogenesis and clinical course, can improve the quality of life of patients by 44.95 % and 40.39 %, respectively, and significantly increase the effectiveness of treatment. Conclusions. Clinical symptom complexes that indicate the presence of syntropic lesions of the circulatory system – a combination of complaints of nausea, jaundice and sclera in the absence of symptoms of “jellyfish head” indicates CCMP, and a combination of complaints of pain and heaviness in the right hypochondrium, ascites, hepato- and splenomegaly and telangiectasia indicate persistent hypotension. Improvement of the comprehensive treatment of patients with LC and CCMP by adding a β-blocker with α-blocking properties of carvedilol (1 tablet (3.125 mg) twice a day), cardio- and hepatoprotector thiotriazoline (in patients with LC and CCMP of the 1st degree of severity (100.0 mg) three times a day, patients with LC and CCMP II and III degrees of severity – intramuscularly 2.0 ml of 2.5 % solution (50.0 mg) three times a day for five days, then 1 tablet (100.0 mg) three times a day), and improvement of the comprehensive treatment of patients with LC and persistent hypotension of I and II degrees of severity by adding ivabradine (1 tablet (5.0 mg) in the morning after meals), patients for hypotension of III degree of severity – intravenous albumin solution (at the rate of 1.5 g/kg for at least 10 days), as well as α-lipoic acid (1 capsule (600.0 mg) in the morning after meals), in the presence of ascites and edema syndrome – spironolactone (in the dosage, which is provided by the severity of the complication, of us a blunt transition to a maintenance dose of 1 tablet (50.0 mg) in the morning after a meal) enhanced the quality of life by 44.95 % and 40.39 %, respectively, and significantly increased the effectiveness of treatment.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Infection with klebsiella and pseudomonas in mine-blast wounds: frequency of their isolation at the third stage of evacuation; spectrum of their resistance; sensitivity to antimicrobial drugs; general rules of military medical care Endothelin-1 indices in patients with leptospirosis of various severity degrees and their changes under the influence of seven-day treatment Characteristics of the affective sphere in patients with negative symptoms in schizophrenia The effectiveness of magnesium compounds in the complex treatment of patients with arterial hypertension with concomitant chronic obstructive pulmonary disease Contemporary perspectives on vitamin D provision in children and adolescents with obesity: a literature review and clinical case description
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1