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GASTROENTEROLOGY

INVENTION
Patent of the Russian Federation RU2039557

METHOD FOR TREATING PURULENT INFLAMMATORY DISEASES OF THE ABDOMINAL CAVITY

METHOD FOR TREATING PURULENT INFLAMMATORY DISEASES OF THE ABDOMINAL CAVITY

The name of the inventor: Vasiliev IT; Kolesova OE; L. Smirnov; Dumayev KM; Lebkova NP; Alekseeva L.M.
Name of patent holder: Russian Medical Academy of Postgraduate Education
Address for correspondence:
Date of commencement of the patent: 1993.05.27

The invention relates to medicine and relates to the treatment of purulent-inflammatory diseases of the abdominal cavity. The essence of the invention consists in the fact that the patient undergoes antibacterial, detoxification therapy and additionally during the treatment intravenously, mexidol is administered at a dose of 100 200 mg / ml 3 4 times a day for 3 4 days. The method allows to reduce the dose of injected antibiotics and thus prevent complications associated with it, is highly effective in the treatment of peritonitis, acute pancreatitis, cholecystitis and other purulent-septic diseases. It can be used to prevent purulent-septic complications in the postoperative period.

DESCRIPTION OF THE INVENTION

The invention relates to medicine, namely to methods of treating inflammatory and purulent-inflammatory diseases of the abdominal cavity.

Methods are known including antibiotic therapy. The duration of administration of antibiotics is determined by the nature of the inflammatory process and is 5-7 days (Strukov AI Petrov VI Paukova V. E. Acute diffuse peritonitis, M. 1987, pp. 228-229). In the preoperative and postoperative period, infusion therapy is used in conjunction with antibiotic therapy.

The negative side of antibiotic therapy is an increase in the number of antibiotic-resistant strains of some pathogenic microorganisms, a decrease in nonspecific resistance and immunity factors.

Known and the method of treatment of purulent inflammatory diseases of the abdominal cavity, which includes active detoxification of the body by extracorporeal lympho- and hemosorption, which is performed against the background of hemodilution and forced diuresis (Dotsenko AP Sipovets AA Hemosorption in the treatment of the syndrome of endogenous intoxication in patients with Diffuse peritonitis., Clinical Surgery, 1985, issue 1, pp. 46-48).

However, in the treatment with this method, a significant loss of total protein and electrolytes occurs.

In order to increase the general resistance of the organism in purulent-inflammatory complications of the abdominal cavity in the postoperative period, extracorporeal irradiation of the patient's blood with ultraviolet rays is used (Popov VA Peritonit, L. 1985, p. 218).

However, UFK enhances the bactericidal properties of blood, which is accompanied by the simultaneous disintegration of a large number of microbial bodies and the release of biologically active products leading to hypotensive and pyrogenic effects, and transistor release of fibrinogen, which leads to an increase in the coagulation system of blood. In this regard, the use of ultraviolet radiation in the early period of purulent-inflammatory complications is not recommended.

As a prototype, a method of treating purulent-inflammatory complications in patients in the postoperative period is adopted, including antibacterial therapy using various antibiotics and sulfonamides against the background of antifungal agents. At the same time, detoxification therapy is carried out, including the introduction of water-salt (trisol, quartz, acetol, etc.) and colloidal solutions (polyglucin, reopolyglucin, gemodez, etc.).

Prescribe such vitamins and conduct a wide range of general strengthening therapy.

However, the introduction of a large number of antibiotics leads to an increase in the number of strains of microorganisms resistant to their action. In this case, in the exudate of the abdominal cavity with peritonitis, microbial associations are more often detected.

Destructive processes in the abdominal cavity lead to the development of pathogenic microflora. This requires intensive infusion therapy aimed at stabilizing indicators, improving microcirculation, compensating for water-electrolyte, protein and energy losses. The side effect of such therapy is intestinal paresis and intestinal obstruction.

Treatment time in a known way is 10 days or more. Mortality reaches 20%

The object of the invention is to provide an effective method for treating purulent-inflammatory diseases, which allows to reduce the lethality and shorten the duration of treatment.

The essence of the invention is that in the method for treating purulent-inflammatory diseases, including antibacterial and detoxification therapy, mexidol is administered intravenously intravenously with a dose of 100-200 mg / ml 3-4 times a day for 3-4 days.

Use as an anti-inflammatory drug mexidol allows you to quickly remove intoxication, normalize body temperature, improve the rheological properties of blood, stimulate energy processes, stabilize LPO, stimulate humoral nonspecific protection system, correct antioxidant defense, which significantly improves treatment outcomes, reduces lethality and decreases Treatment time is 3-5 times.

The method allows to reduce the dose of antibiotics to be administered and thereby prevent allergic and other complications associated with them. The method is highly effective in the treatment of peritonitis, acute pancreatitis, cholecystitis and other purulent-septic diseases. It can be used to prevent purulent-septic complications in the postoperative period.

The technical result is achieved due to the fact that the anti-inflammatory effect of mexidol was established, which was used as a psychotropic drug. Its ability to inhibit trypsin, chymotrypsin, and leucin aminopeptidase has been experimentally established.

The method is carried out as follows.

After establishing a clinical diagnosis and surgical removal of the source of peritonitis, the patient is sanitized with an abdominal cavity and prescribed antibacterial therapy taking into account the sensitivity of the isolated microorganisms to the prescribed remedies.

Simultaneously with antibacterial therapy, detoxification therapy is carried out, including intravenous administration of water-salt (tresol, quartrel, acesol, etc.) and one of the colloidal solutions (homodesis, polyglucin, reopolyglucin, etc.). Introduce solutions for parenteral nutrition (glucose, fructose, balanced amino acid solutions, fat solutions).

Additionally, during the treatment intravenously, mexidol is administered at a daily dose of 100-200 mg / ml 3-4 times a day for 3-4 days.

Example 1 . Patient K-in, 19 years old (case history N 4807) entered the clinic on 21.11.91. About 8 hours ago, the patient suddenly had a sharp pain in the upper abdomen, which gradually spread to other parts of the abdominal cavity. The patient had no ulcerative anamnesis. At admission, the patient is of moderate severity. Pulse 104 beats per minute, rhythmic, satisfactory filling, blood pressure 110/70 mm, tongue coated white, dry. The belly does not participate in the act of breathing, it is exaggerated, it is expressed by palpation muscle tension especially in the right half, with deeper palpation, soreness is more pronounced to the right. Positive symptom of Schetkina-Blumberg in all departments. Intestinal noises are almost not listened to. Blood test HB-145, leukocytes 7.7 thousand sticks 4, segments 78, lymphocytes 13, monocytes 5. Urinalysis: rel. Density 1011, protein, sugar, the reaction is acidic. With the survey radiography of the abdominal cavity, the presence of free gas was not detected. The patient has a clinical picture of diffuse peritonitis, but the source of peritonitis is not entirely clear. In connection with this, the patient underwent urgent laparoscopy: in the abdominal cavity a turbid effusion with fibrin flakes is greater along the right lateral canal and in the subhepatic space. The parietal and visceral peritoneum are swollen, hyperemic. In the right ileal region, an inflammatory infiltrate.

Conclusion: diffuse fibrinous-purulent peritonitis. Urgent operation. Lower-middle larynotomy. The appendix is ​​edematous, hyperemic. Appendectomy was performed. When draining the abdominal cavity, a purulent exudate was admitted with an admixture of mucus and bile from the upper floor of the abdominal cavity. The incision is extended upward. With further revision, a kalez ulcer of the anterolateral wall of the pyloric wall was found penetrating into the hepatoduodenal ligament. The site of the perforation is covered by the gallbladder and the lower surface of the liver. Perforation aperture 1.0 x 0.5 of the edge of the ulcer is dense, ulceration of the ulcer according to Polikarpov. Sanitation of the abdominal cavity with an isotonic solution of sodium chloride and chlorhexidine was carried out. Drainage and subhepatic space and cavity of the small pelvis are established. Histological examination: fibrinous periapendicitis. Bacteriological study of the contents of the abdominal cavity: fungi of the Sanoloa type.

In the postoperative period, the patient was prescribed complex therapy, including parenteral administration of ampicillin, saline solutions (chlolol, quartrel), reopolyglucin.

In addition, mexidol was administered, which was administered intravenously for 3 days at a dose of 200 mg / ml three times a day.

The postoperative period in the patient passed without complications. Drainage from the abdominal cavity was removed on the 4th day. On the third day after the operation, intestinal noises began to be heard, and another day later there was an independent chair. The wound healed by primary tension. An. Blood from 28.11: urea 6.3 g / l, bilirubin 7 μm / l, cholesterol 3.5 mmol / l; Society. Protein 67 g / l, sugar 5.1 mmol / l, ALT 23 units; AST 35 units, APF 14 mmol / l. 06.11. The patient in a satisfactory condition was transferred to separate gastroenterology for further antiulcer treatment.

Example 2 . MA-A, 72 years old (clinical disease No. 26013) was admitted to the clinic on 17.10.91. I got sick three days ago. There were pains in the epigastric region, which then spread throughout the abdomen, twice was vomiting, there was a delay in stool and gases.

On examination, the patient's condition is severe. Pulse 108 beats. In minutes. Rhythmic, satisfactory filling, blood pressure 140/80 mm Well, the tongue is dry, the stomach is slightly inflated. With superficial palpation, the maximum muscle tension of the anterior abdominal wall. With deep palpation, the abdomen is painful in all parts, but a greater soreness is expressed in the right lateral hypochondrium. Positive symptom of Schetkina-Blumberg. Intestinal noises are not heard. Diagnosis: acute appendicitis. Spilled peritonitis. Urgent operation: medium-median laparotomy. In the abdominal cavity a significant amount of turbid effusion with fibrin. The peritoneum is edematic, hyperemic, the loops of the intestine swollen, in many places with fibrinous overlap. The appendix is ​​retrotic, black with perforation in the apex. Appendectomy, blockade of the root of the mesentery with 1/4 solution of novocaine (100 ml) was performed. The abdominal cavity is drained, if possible, fibrinous overlays are removed, washed with a solution of furacillin and chlorhexidine, drained. The postoperative period was very difficult. Antibiotic therapy was prescribed (ampicillin, kanamycin, gentamicin), and etazol, meromidazole.

Massive infusion therapy was performed, including saline solutions (acesol, chlossol, lactosol), rheopolyglucin. Additionally, intravenously, mexidol was administered at a dose of 100 mg 4 times a day for 4 days.

Gradually, the patient's condition began to improve, on the 4th day there were intestinal noises and gases began to flow away. The phenomena of endotoxicosis a week later declined. A week later, an. Blood: HB 138, leukocytes 5.2, FALL 1, ESR 2.

Biochemical blood tests without special features.

Exod 3 days 7 days DK 1.2 0.52 0.75 Cf. Mol. 0.78 0.51 0.29 TF 6.2 9.2 14.2 OSH 5.2 4.9 2.5

The patient was discharged from the hospital for 5 days.

CLAIM

A METHOD FOR TREATMENT OF PULMONARY INFLAMMATORY DISEASES OF THE ABDOMINAL CAVITY, including antibacterial and detoxification therapy, characterized in that additionally intravenous mexidol is administered at a dose of 100 200 mg / ml 3 4 times a day for 3 4 days.

print version
Date of publication 28.01.2007gg