RU2519102C1 - Method of treating superficial thermal burns - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: affected areas of skin are coated with dressings impregnated with therapeutic preparations containing 1.0-2.0% hypromellose, an antiseptic specified in a group: 4% boric acid, 0.05% chlorhexidine, 1% iodopyron and 2% lidocaine hydrochloride. At the stage of wound exudation on the second or third post-injury day, the dressings impregnated with 2.0% hypromellose, the antiseptic specified in the group: 4% boric acid, 0.05% chlorhexidine, 1% iodopyron, and 2% lidocaine hydrochloride are used and changed once a day. At the stage of proliferation, the dressings impregnated with 1.0% hypromellose and the antiseptic specified in the group: 4% boric acid, 0.05% chlorhexidine, 1% iodopyron are used and changed every 2 days. At the stage of epithelisation, the dressings impregnated with 1.0% hypromellose and the antiseptic specified in the group: 4% boric acid, 0.05% chlorhexidine, 1% iodopyron are used and changed every 3 days until the wound surface is completely epithelised.

EFFECT: invention provides the humid environment on the burn wound surface which stimulates wound epithelisation and prevents the infectious complications.

1 ex

Description

The invention relates to medicine, namely to surgery, traumatology, combustiology and can be used to treat superficial thermal burns.

Among all types of injuries, burns account for more than 5%. In the Russian Federation, the annual number of patients registered in medical institutions with thermal injury is more than 450 thousand people. In recent years, there has been a tendency to increase the proportion of victims with deep and extensive burns due to an increase in the number of natural and man-made disasters, which leads to the massive influx of patients with thermal injury (V.V. Azolov, V.A. Zhigalov, M.A. Ponomareva, 2002). Almost all victims with deep burns undergo surgical treatment, which needs up to half of patients (A.A. Alekseev, V.A. Lavrov, 2008).

Among all operations performed by patients with thermal burns, the main one is autodermoplasty with split skin grafts, which makes up 56.3 to 90% of all surgical interventions in burn departments and centers (B.S. Vikhriev, V.M. Burmistrov, 1986; A .A. Alekseev, V.A. Lavrov, 2008).

Clinical manifestations of burns. For burns of the first degree, manifested in the form of hyperemia, it is enough to cool the damaged skin and apply any ointment with anesthetic properties. Clinical manifestations pass from several hours to two days.

With second-degree burns, bladder care is performed, they are emptied by puncture or an incision at the base, then the dome of the bladder will lie on the wound, forming a natural dressing for 2-3 days. When infected, they make toilet wounds, remove necrotic tissues, dressing with solutions of antiseptics, it is possible to add antibiotics. In the phase of cleansing the wound before the start of epithelialization, ointments on a water-soluble basis are used. As with the open method with the beginning of epithelialization, ointments based on vaseline or fat are used. If the dressings are dry and clean, and are tightly attached to the underlying tissues, then they are not removed, but treated with ointments, adding aseptic dressings.

With burns of the IIIA degree, the clinical manifestations will be edema, hyperemia, large confluent vesicles with serous or jelly-like contents. When the epidermis of the wound is knocked down, it is pale pink or red with scanty discharge, when it is pressed on the wound, it turns pale. First aid is provided, as with burns of I and II degrees, in the future, with adequate treatment, a superficial scab forms, under which self-epithelization occurs on day 14-20. With suppuration or inadequate therapy, a “deepening” of the burn occurs with the formation of a granulating wound.

Burns of the IIIB degree arise with prolonged exposure to a thermal agent. The formation of the primary scab of varying density and color (from pale gray to black) occurs. At the same time, thrombosed vessels are clearly distinguishable and do not disappear when pressed. On the periphery of the burn scab, pronounced swelling and hyperemia, the appearance of secondary trophic blisters is possible. Pain sensitivity is reduced or absent due to the death of nerve endings. Dressings are carried out with solutions of antiseptics to prevent suppuration (solutions of iodopiron, chlorohexedine, boric acid, etc.). Subsequently, the scab is removed with the formation of a granulating wound and autodermaplasty.

With burns of the IV degree, the same measures are carried out as with burns of the IIIB degree. When carbonization is performed, emergency amputation or early necrectomy is performed, followed by autodermaplasty.

New methods of treating burnt fundamentally differ from the methods that were adopted 10-15 years ago. Modern treatment tactics for burns are aimed at preventing possible infectious complications.

There is a method of local treatment of burns, characterized in that before dressing a suspension is prepared (a mixture of skin and placenta) at the rate of 1 g of tissue per 8-9 ml of physiological saline or Ringer's solution, treatment is carried out during dressings, starting from 1-3 days from the moment injuries to complete epithelization of burn wounds, and after a normal toilet, sterile wipes impregnated with a suspension of human fetal tissues with different skin and placenta ratios from 1: 9 to 9: 1, respectively, are applied to the burn wound, depending on the stage of the course wound healing process, ligation is carried out every day or every other day (patent RU 2122416, 1998).

A known method of treating infected wounds, which can be used in the treatment of burns, which consists in the surgical and mechanical treatment of the wound, drainage and washing, conducting reconstructive surgery, local drug therapy. Rinsing is carried out once with an aqueous solution of pilastine (cholerogen-toxoid or cholera vaccine) at a concentration of 0.25-0.8 person-doses / ml for 3-5 days, local drug therapy is carried out by applying a dressing with an aqueous solution of pylastine of the same concentration on the wound for 24-48 hours for 5-8 days (patent RU 2128518, 1999).

There is a method of complex antibacterial treatment of a generalized burn infection by local and parenteral exposure to antiseptics and antibiotics in patients with deep and superficial burns, which consists in applying Butol solution in the form of moist-drying dressings for 1-3 days, for 4- 10 days later, ointment Butolol ointment is applied to the wound every other day, followed by Butolan ointment, with superficial burns until complete epithelization, and with deep burns after surgery, necrectomy, to prepare wounds to autodermoplasty; simultaneously with local treatment, ceftriaxone is administered intravenously, 2 g per day, from day 1 to 12, and galavit, intramuscularly, 200 mg on the first day, and 100 mg per day from day 2 to 12 (patent RU 2302859, 2007).

A known method of local treatment of burn wounds, characterized in that they use antiseptic solutions: 1% solution of iodopyron, iodovinol and ointment - levosin, levomycol, 5% dnoxidine, dioxole, iodopyrone. To prepare wounds for autodermoplasty - Algimaf. Antibiotics are used parenterally: pefloxacin, cipronol, zanolin, and an immunocorrector - sandoglobulin (Alekseev A.A. Burn sepsis: diagnosis, prevention, treatment, abstract of dissertation, doctor of medical sciences, M., 1993.).

The closest in technical essence and the achieved result is a method of treating burn wounds, which consists in applying topical dressings with antiseptic solutions during exudation, ointments during proliferation and epithelization (Paramonov B.A. et al. Burns: A Guide for Doctors.St. Petersburg: SpetsLit, 2000. - 480 p.). The disadvantage of this method is the lack of the effect of treating burn wounds in a "wet environment" using antiseptic solutions and ointments, which slows down the epithelization process, and in the process of treating burn wounds, the choice of means for local exposure is wide and requires a constant change of drugs.

The objective of the invention is to develop a method of local treatment of patients with thermal lesions, creating optimal conditions for epithelialization and accelerate the healing of superficial burn wounds.

The technical result achieved by the claimed invention is to create a moist environment on the surface of burn wounds, contributing to the stimulation of epithelization of burn wounds while maintaining high treatment efficiency, as well as the prevention of infectious complications.

To achieve the specified technical result in a method of treating superficial thermal burns, including applying dressings with impregnated drugs to the affected areas, according to the invention, 1.0-2.0% hypromellose solution, antiseptic are used as impregnations for dressings applied to the wound surface selected from the group: 4% solution of boric acid, 0.05% solution of chlorhexidine, 1% solution of iodopyron, and 2% solution of lidocaine hydrochloride, and in the stage of exudation of the wound process and on the second, third day after the injury, dressings are used that are saturated with a 2.0% solution of hypromellose, an antiseptic selected from the group: 4% solution of boric acid, 0.05% solution of chlorhexidine, 1% solution of iodopyrone, and 2% solution of lidocaine hydrochloride, and dressings are changed 1 time per day, in the proliferation stage, dressings are used that are saturated with a 1.0% hypromellose solution and an antiseptic selected from the group: 4% boric acid solution, 0.05% chlorhexidine solution, 1% iodopiron solution, and a dressing change spend 1 time in 2 days, in the epithelialization stage using comfort bandage soaked with a solution of 1.0% hypromellose and antiseptic selected from the group: 4% solution of boric acid, 0.05% chlorhexidine solution, 1% yodopiron solution and replace dressings performed 1 every 3 days until complete epithelialization of the wound surface.

With burns of the first degree, indications for the use of the claimed method for the treatment of thermal burns have not been established. For burns of the II-IIIA degree after the termination of severe exudation from the surface of the wounds on the second, third day after thermal damage during treatment of the wound surface, dressings are applied with 1.0-2.0% hypromellose solution, an antiseptic selected from the group: 4% boric solution acid, 0.05% chlorhexidine solution, 1% iodopyron solution and local anesthetic 2.0% lidocaine hydrochloride solution.

In the stage of exudation of the wound healing process, dressings are changed once with these solutions once a day. In the stage of proliferation, dressings of burn wounds of the II-IIIA degree are performed with dressings with 1% hypromellose solution and the indicated antiseptics 1 time in 2 days; in the stage of epithelization, dressings are performed with dressings with 1% hypromellose solution and the indicated antiseptics 1 time in 3 days until the wound surface is completely epithelized. .

The analysis of the prior art by the applicants, including a search by patent and scientific and technical sources of information, and the identification of sources containing information about analogues of the claimed method, allowed us to establish that the applicants did not find an analogue characterized by features identical (identical) to all the essential features of the claimed method.

Therefore, the claimed combination drug meets the criterion of ″ novelty ″.

To verify the conformity of the claimed method to the prior art, the applicants conducted an additional search for known solutions in order to identify signs that match the distinctive features of the claimed invention from the prototype.

The search results showed that the claimed invention does not follow explicitly from the prior art as determined by the applicants for the specialist, the influence of the transformations provided for by the essential features of the claimed method on the achievement of the technical result is not revealed.

Therefore, the claimed invention meets the criterion of ″ inventive step ″.

The studies of the authors proved that the proposed method for the treatment of superficial thermal burns, including dressings by applying dressings with a 2.0% solution of hypromellose, an antiseptic and local anesthetic in the exudation stage 1 time per day, in the proliferation stage of dressings with a 1% solution of hypromellose and an antiseptic 1 time in 2 days, at the stage of epithelization with dressings with 1% hypromellose solution and antiseptic once every 3 days, creates a moist environment on the surface of burn wounds to stimulate epithelization of burn wounds, provides acceleration of healing the occurrence of superficial burn wounds while maintaining high treatment efficiency, as well as the prevention of infectious complications.

Therefore, the claimed invention meets the criterion of ″ industrial applicability ″.

The claimed method was treated 7 patients with superficial burns in MBUZ GKB No. 18 of Ufa. In all cases, the specified technical result was achieved.

The invention is illustrated by the following example.

Patient G. was admitted to the burn department of MBUZ GKB No. 18 of Ufa with a diagnosis of a burn of II - IIIA degree of the right lower limb 12%. After the termination of severe exudation from the surface of the wounds on the second, third day after the injury, the dressings were applied with the treatment of the wound surface with: 2.0% hypromellose solution, an antiseptic selected from the group: 4% boric acid solution, 0.05% chlorhexidine solution, 1 % solution of iodopyron, and a local anesthetic - 2.0% solution of lidocaine hydrochloride.

In the stage of exudation of the wound process, dressings were changed with these solutions once a day. At the stage of proliferation, dressings for burn wounds of the II-IIIA degree were replaced with dressings soaked in 1% hypromellose solution and indicated antiseptics once every 2 days; in the epithelialization stage, dressings were changed by dressings soaked in 1% hypromellose and antiseptic products once every 3 days before complete epithelialization of wounds.

The proposed method is easily reproducible in a hospital environment and when it is used, the indicated technical result is achieved, which consists in creating a moist environment on the surface of burn wounds, which helps to stimulate epithelization of burn wounds while maintaining high treatment efficiency, as well as in the prevention of infectious complications.

Claims (1)

A method of treating superficial thermal burns, including applying dressings with impregnated drugs to the affected areas, characterized in that 1.0-2.0% hypromellose solution, an antiseptic selected from the group, are used as drugs for impregnating dressings applied to the wound surface 4% solution of boric acid, 0.05% solution of chlorhexidine, 1% solution of iodopyron, and 2% solution of lidocaine hydrochloride, and in the stage of exudation of the wound process on the second, third day after the injury, they use Ki soaked in 2.0% hypromellose solution, an antiseptic selected from the group: 4% boric acid solution, 0.05% chlorhexidine solution, 1% iodopiron solution, and 2% lidocaine hydrochloride solution, and dressings are changed once a day, in the proliferation stage, dressings are used that are saturated with a 1.0% hypromellose solution and an antiseptic selected from the group: 4% boric acid solution, 0.05% chlorhexidine solution, 1% iodopyrone solution, and dressings are changed once every 2 days, in the stage epithelization use dressings soaked in a 1.0% solution of hypromellose and ntiseptic selected from the group: 4% solution of boric acid, 0.05% chlorhexidine solution, 1% iodopiron solution, and dressings are changed once every 3 days until the wound surface is completely epithelized.