| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention concerns medicine, namely to abdominal surgery and can be used in diagnostics of a strangulated form of acute enteric obstruction. At the patient with a clinical picture of acute enteric obstruction following indicators are estimated: term from the disease beginning; quantity of operations in the anamnesis; character, intensity and pain localisation; a muscular strain of a forward abdominal wall; quantity of leucocytes; pH of blood and partial pressure of a carbon dioxide of blood; diametre of a small bowel roentgenologically. Thus arrival term is estimated as follows: at arrival of the patient less than in 12 hours from the disease beginning, the given indicator is estimated in 1.5 points, at arrival from 13 to 24 hours from the disease beginning - "-1 point", at arrival over 25 hours from the disease beginning - "-2 points"; the quantity of operations in the anamnesis is estimated as follows: in the absence of operations - "3.5 points", in the presence of one operation - "1 point", in the presence of two operations - "-1.5 points", in the presence of three operations - "-2 points", more than four operations - "-3 points"; character of a pain is estimated as follows: in the presence of pain - "-2.5 points", at constant pains - "4.5 points"; intensity of a pain is estimated as follows: at the expressed pains - "3.5 points", at moderate pains - "-1 point"; pain localisation is estimated as follows: at pains in the whole stomach - "-1.5 points", at the localised pains - "1.5 points"; Presence of a muscular strain is estimated in 5 points; absence of a muscular strain is estimated in 0 points; leucocytes of blood less 5ù109/l are estimated in "-4.5 points" leucocytes of blood from 5ù109 to 7ù109 "-2.5 points", from 8ù109 to 10ù109 - "-3 a point", leucocytes of blood from 11ù109 to 13ù109 - "1,5 points", leucocytes of blood from 14ù109 and above - "5 points". pH of blood is estimated as follows: pH less than 7.3 - "3 points", pH from 7.3 to 7.39 - "1 point", pH from 7.4 and above - "-2 points". The partial strain pressure of a carbon dioxide of blood is estimated as follows: size of the given indicator less than 30 mm of a mercurial column - "-6 points", from 30 to 43 mm of a mercurial column - "0 points", over 44 mm of a mercurial column - "1.5 points". Diametre of a small bowel is estimated as follows: diametre to 45 mm - "0 points", from 46 mm to 80 mm - "-1 point", more than 80 mm - "8 points". Further points of all ten estimated indicators are summarised and the obturation form of acute enteric obstruction if the score makes less "-3" and the strangulated form of acute enteric obstruction if the score makes more than 3 points is determined. At a score from "-3" to 3, determination of a score at the patient as shown above in 4-6 hours after initial research and carrying out of a complex of the conservative actions referred on the permission of acute enteric impassability is repeated. At again certain score less than 3 the form of acute enteric obstruction is established obturation form, at a score more than 3 - the strangulated form, and at a score from "-3" to 3 the risk of development of a strangulation is established and indications to carrying out of a diagnostic laparoscopy are determined. At a score from "-3" to 3, additional ultrasonic examination with determination of an intestinal blood flow is carried out and at the maximum systolic rate of a blood flow to 9 cm/sec the form of acute strangulated intestinal obstruction is diagnosed, and at the maximum rate of a blood flow from 9 to 18 cm/sec the form of acute obturation intestinal obstruction is diagnosed. ^ EFFECT: way raises accuracy of determination of strangulated form of enteric obstruction against simplification and larger availability of diagnostics. ^ 4 cl, 1 tbl, 1 dwg, 4 ex |
