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INVENTION
Patent of the Russian Federation RU2286780
METHOD OF TREATMENT OF PURIFIED RAS
The name of the inventor: Geinits Alexander Vladimirovich (RU); Tolstykh Peter Ivanovich (RU); Ashmarov Vyacheslav Vladimirovich (RU); Baum Rudolf Filippovich (RU); Petrin Sergey Alexandrovich (RU); Derbenev Valentin Arkadevich (RU); Tolstykh Mikhail Petrovich (RU); Guseynov Ali Israfilovich (RU); Gulmuradova Nargis Tashpulatovna (RU); Tamrazova Olga Borisovna (RU)
The name of the patent holder: State Scientific Center of Laser Medicine of the Ministry of Health of the Russian Federation (RU); Limited Liability Company "Veta Grand" (RU)
Address for correspondence: 119602, Moscow, ul. Acad. Anokhin, 12, к.2, кв.6, Т.Д. Martins
Date of commencement of the patent: 2004.09.30
The invention relates to medicine, namely surgical methods of treatment, and can be used to treat extensive purulent soft tissue diseases. For this purpose, a gel-photosensitizer containing 0.5-1.5% glucamine salt of chlorin E6 is injected into the wound and a subsequent laser irradiation is carried out in a continuous mode at a wavelength of 660 nm, the density of energy supplied to the wound is 30-40 J / cm 2 And a power density of 0.8-1.0 W / cm 2 . The method provides simplification, acceleration and increase of treatment efficiency due to the use of the optimal radiation power density.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, specifically to surgical methods for treating extensive purulent soft tissue diseases.
A surgical method for the treatment of purulent soft tissue diseases is known, which consists in performing an autopsy of the purulent focus and wound toilet, then applying a bandage with antiseptic solutions or ointments followed by daily dressings. In doing so, the wound toilet is performed using antiseptic solutions (The Great Medical Encyclopedia, M., Publishing House "Soviet Encyclopedia", 1985, vol. 1, pp. 20-21).
Treatment with traditional dressings has a long, protracted nature, dressings are painful because of the drying of the bandage to the wound.
There is a known method for treating purulent soft tissue lesions, consisting in placing a wipe with an immobilized proteolytic enzyme, Dalcex-trypsin, through which a semiconductor low-energy laser is irradiated daily (USSR USSR No. 1598269, MKI A 61 N 5/06, Published 1988).
Epithelization during treatment in a known way is observed on the 9-12th day.
Known closest to the claimed method of treatment of purulent wounds of soft tissues is that a wipe based on dialdehyde cellulose is applied to the wound, containing photosensitizer "Photosens" based on aluminum phthalocyanine as a biologically active drug, and after keeping the wiper on the wound for 24 hours Irradiate the wound with red light emitted by a solid-state laser on yttrium aluminate, with a doubled frequency and wavelength of 670 nm, or a non-laser light source with a wide emission band of 600-700 nm and a wavelength of 670 nm (RF patent No. 2144427, MKI No. 61 N 5 / 067, published on 27.03.2001).
The disadvantages of the known method include the complexity of the procedure - the need for the use of napkins of a certain type (based on dialdehyde cellulose), the duration of keeping the wiper on the wound, the inability to localize the photosensitizer within the wound surface.
The invention solves the problem of simplifying, accelerating and increasing the effectiveness of treatment of extensive purulent wounds of soft tissues.
The task is achieved due to the fact that in the method of treatment of purulent wounds of soft tissues, including the introduction into the wound of the photosensitizer and subsequent irradiation with a laser, a photosidazine gel containing 0.5-1.5% glucamine salt of chlorine E6 is used as a photosensitizer, And laser irradiation is carried out in a continuous mode at a wavelength of 660 nm, the density of the energy supplied to the wound is 30-40 J / cm 2 and the power density is 0.8-1.0 W / cm 2 .
Gel based on the chloramphenic acid glycine salt E6 "Photoditazine" (TU 64-19-162-92) complies with sanitary regulations SanPiN 1.2.681-97.
THE METHOD IS PROVIDED AS FOLLOWS:
After entering the patient in a hospital, surgical treatment of purulent foci with excision of necrotic tissues, elimination of purulent swelling and treatment of the wound with solutions of antiseptics is performed. After the wound toilet with a solution of hydrogen peroxide, a photosensitizer is applied with a spatula using the spatula - gel "Photoditazine" (manufactured by Vetra-Grand), with a concentration of active substance in the preparation of 0.5-1.5%. Exposure of the photosensitizer on the wound is 2 hours. With less time, the gel "Photoditazine" does not manage to penetrate into the tissues of the wound, and the increase in the exposure time is not advisable, because For the accumulation of gel in the wound is enough 2 hours. Then laser irradiation of the wound is carried out at a wavelength of 660 nm, the density of the energy supplied to the wound is 30-40 J / cm 2 and the power density is 0.8-1.0 W / cm 2 with the ATKUS-2 apparatus (ZAO Semiconductor Devices ", St. Petersburg). The irradiation time is determined depending on the area of the wound surface.
At an energy density of less than 30 J / cm 2, a weak clinical effect is observed, and at an energy density of more than 40 J / cm 2, necrotic tissue of healthy tissues is necrotic.
When treating with the proposed method, a rapid (within 2-3 days) cleansing of the wound from purulent necrotic masses, the appearance of granulations on the 4th-5th day, and marginal epithelization on the 6-7th day are noted. Treatment terms are reduced to 8-9 days, the treatment process is more sparing and does not require the use of special dressings.
Allergic reactions to the photosensitizer - gel "Photoditazine", not noted.
The cytological examination of wound exudate of purulent wounds before the beginning of treatment indicates that the wounds are characterized by a pronounced infection with microbial associations, inhibition of phagocytosis, increased disintegration and dystrophic changes in neutrophils. After a photodynamic therapy session, the level of microbial contamination is sharply reduced. Later, in patients who received a session of photodynamic therapy, the cytograms are characterized by increased phagocytosis, a sharp decrease in the content of detritus and destroyed neutrophils.
The invention is illustrated by examples.
Example 1
Patient K., 56 years old, entered the hospital with a directing diagnosis: festering hematoma of the right tibia. In the anamnesis - a bruise of soft tissues in the region of the right leg 7 days ago. At admission - an infiltration up to 10 × 7 cm in the area of the anterior surface of the right tibia in the middle third with the presence of fluctuations above it. Around determined pronounced edema and hyperemia of the tissues. In urgent order, the primary surgical treatment of a purulent focus was performed. Under intravenous general anesthesia in aseptic conditions, a purulent focus was revealed by a linear incision up to 8 cm. Up to 70 ml of pus with clots of blood was isolated, the wound was washed with a solution of hydrogen peroxide, hemostasis was performed. The wound is placated with a napkin with a 1% solution of iodopyrone, an aseptic dressing is applied. The next day after the operation in the area of the bottom and edges of the wound, there were isolated necrosis, a copious purulent discharge from the wound. Moderately expressed perifocal inflammatory changes persisted. After the toilet, the gel "Photoditazine" is applied to the wound surface at a concentration of active substance of 0.5%, held for 2 hours and a photodynamic therapy session is performed by laser irradiation of the wound at a wavelength of 660 nm, the density of the wound energy of 35 J / cm 2 at a density of Power 0.8 W / cm 2 for 8 minutes. In the future, daily dressings with solutions of antiseptics, symptomatic therapy. Complete cleansing of the wound was observed on the 2nd day, to the 4th there were single granulations in the absence of perifocal inflammation. Secondary sutures are applied to the wound. The patient was discharged on the 9th day after the operation.
Example 2
Patient P., 65 years old, entered the hospital with a diagnosis: postinjection abscess of the left gluteal region. It is sick for 2 weeks after a / m injection of magnesium sulfate about the exacerbation of hypertension.
Of the concomitant diseases in a patient with IHD, hypertension II stage, postinfarction cardiosclerosis. The patient was urgently treated with a primary surgical treatment of a purulent focus. The surgical incision is 10 cm along the length of the purulent focus, the purulent contents were evacuated, hemostasis was performed and the wound was washed with hydrogen peroxide solution, a tamponade with 1% iodopyrone solution. The next day after the toilet is done, the gel "Photoditazine" is applied to the wound surface, held for 2 hours and photodynamic therapy is performed by laser irradiation of the wound at a wavelength of 660 nm and the density of the wound energy of 30 J / cm 2 at a power density of 1.0 W / Cm 2 .
In the future, daily dressings with solutions of antiseptics, symptomatic therapy. Complete cleansing of the wound was noted on the 3rd day, later the edges of the wound were compared with strips of medical adhesive plaster. Inflammatory changes in the region of the edges of the wound quickly regressed, the purulent discharge was not observed. In the postoperative period, antibiotics were not necessary. The patient was discharged on the 8th day after the operation.
Example 3
Patient T., 23 years old, entered the hospital with a diagnosis: purulent bruised wound of the left leg, mesh lymphangitis. He was sick for 2 days, when he received a bruised shin wound up to 3 × 1.5 cm. Later he noted the appearance of edema and pronounced hyperemia in the wound area, increased pain. He asked for medical help and was hospitalized. Antibiotic therapy was started in the department. After doing the toilet, the gel "Photoditazine" is applied to the wound surface, held for 2 hours and photodynamic therapy is performed by laser irradiation of the wound at a wavelength of 660 nm and the density of the wound energy of 40 J / cm 2 at a power density of 1.0 W / cm 2 For 3 minutes, then apply a bandage with 1% solution of iodopyrone on the wound area. In the future, daily dressings are carried out with solutions of antiseptics. The next day, the bruised wound is characterized by a virtually complete absence of necrosis and fibrin deposits in the area of its bottom and margins. Local edema and hyperemia persist for 4 days. Six days after the start of treatment, active edge epithelialization of the wound was noted, which made it possible not to attempt to operatively close the wound defect. The patient was discharged on the 9th day after the start of treatment.
CLAIM
A method for treating purulent wounds of soft tissues, comprising administering a photosensitizer to the wound and subsequently irradiating it with a laser, characterized in that a gel containing 0.5-1.5% glucamine salt of chlorin E6 is used as a photosensitizer, and laser irradiation is carried out continuously in a A wavelength of 660 nm, a density of energy supplied to the wound of 30-40 J / cm 2 and a power density of 0.8-1.0 W / cm 2 .
print version
Date of publication 06.01.2007gg
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