Львівський клінічний вісник (Dec 2019)
Substantiation of Principles and Effectiveness of Advanced Complex Differentiated Treatment of Circulatory System Organs Affections in Patients With Liver Cirrhosis
Abstract
Introduction. Liver cirrhosis is one of the most important and complex problems of modern hepatology. Comorbid syntrophic affections of liver cirrhosis are also relevant, including circulatory system affection – syntropic cirrhotic cardiomyopathy and persistent arterial hypotension, which are widespread and considered to be the key in the multiorgan failure occurrence and main factors that cause death. For now, specific recommendations for the treatment of syntropic cardiovascular affections in patients with liver cirrhosis have not been developed, so the treatment complex needs to be optimized. The aim of the study. To substantiate the principles and to find out the effectiveness of the syntropic affections advanced complex differentiated treatment of the circulatory system in patients with liver cirrhosis. Materials and methods. In a randomized way and with the preliminary stratification for the presence of liver cirrhosis 603 patients (164/439 – women/men, age 18-83) who were treated within the period of 2010–2015 at the Lviv Regional Hepatology Center were involved in the research. Among them, 490 (81.3 %) patients with liver cirrhotic extrahepatic affections of the circulatory system were singled out and were stratified into three subgroups: only with syntropic cirrhotic cardiomyopathy (103 patients), only with syntropic arterial hypotension (89 patients) and other (306 patients). To compare the treatment effectiveness of patients with cirrhotic cardiomyopathy and arterial hypotension, they were divided in a randomized way into two groups: experimental, treated with the help of our modified method, and control one, treated with the standard method. The evaluation of treatment effectiveness included a “subjective” evaluation (quality of life survey – MOS 36-Item Short-Form Health Survey) and an “objective” (assessment by the patients clinical, laboratory and instrumental indicators). The factual material was processed on a personal computer with the help of EViews (Quantitative Micro Software) and Excel (Microsoft) software programs, using descriptive statistics, ANOVA analysis of variance, z-criteria for two-particles comparisons. Results. Summarizing our own clinical experience and information from the latest literature sources, we modified the conventional treatment complex for patients with liver cirrhosis with syntropic affections of the circulatory system in the following way. One should add to the treatment of patients with liver cirrhosis and syntropic secondary cirrhotic cardiomyopathy the complex β-adrenoblocker with α-blocking properties of carvedilol (in case there are other conditions, requiring the appointment of β-adrenoblockers, in the maximum tolerated dosage, and in case of their non-tolerance – 1 tablet (3.125 mg) in the morning and evening during the meal), cardio and hepatoprotection thiotriazoline: in patients with liver cirrhosis and cardiomyopathy with I degree of severity – 1 tablet (100.0 mg) three times a day, patients with liver cirrhosis and cardiomyopathy with II and III degrees of severity – intramuscular injection of 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. The results of our “subjective” and “objective” evaluations of the complex treatment effects on patients with liver cirrhosis with syntropic cirrhotic cardiomyopathy prove that the use of our proposed modified treatment complex can improve the quality of patients’ life in 44.95 % and enhance the effectiveness of treatment. One should add to the standard therapeutic complex for patients with liver cirrhosis and syntropic arterial hypotension with I and II degrees of severity 1 tablet (5.0 mg) of ivabradine in the morning after having the meal, patients with liver cirrhosis and syntropic arterial hypotension with III degree severity – intravenous albumin liquid per 1.5 g/kg for at least 10 days. Also, alpha-lipoic acid 1 capsule (600.0 mg) in the morning after having a meal, and in case there are ascites and edema syndrome – spironolactone in a dose which is predicted by the severity of the complication, followed by a maintenance dose of 1 tablet (50.0 mg) in the morning after having a meal should be prescribed to all patients. The obtained results indicate significantly high efficiency of proposed modified treatment complex for following-up the patient with syntropic arterial hypotension, which is also proved by the life quality evaluation survey, the overall score of which increased by 40.39 %, and by the doctors-researchers’ complex evaluation of the treatment results. Conclusions. Improved medical complexes for the following-up patients with liver cirrhosis with syntropic cirrhotic cardiomyopathy and persistent arterial hypotension, taking into account the features of their pathogenesis and clinical progression, allow to improve significantly the patients’ life quality and boost the effectiveness of their treatment.
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