EA007768B1 - Method for treating of severe craniocerebral injury - Google Patents

Abstract

The invention relates to medicine, namely, to resuscitation and intensive care, and in particular, to the influence upon patient blood suffering from craniocerebral injury complicated by factors of secondary cerebral fault by A.C. low-frequency electromagnetic field against a background of administration of neuroprotective preparations. The method is characterized in that a magnetic blood treatment is effected during the intensive patient care by using A.C. magnetic field noninvasively upon arterial blood which directly provides the blood supply of cerebral hemisphere with focuses of traumatic injury.

Description

The invention relates to medicine, namely to intensive care and intensive care.

Severe craniocerebral trauma (BMI) is a traumatic brain injury that causes a violation of the patient’s level of consciousness from 3 to 8 points on the Glasgow coma scale when it is evaluated no less than 6 hours after the injury in the correction of arterial hypotension, hypoxia and the absence of any or intoxication and hypothermia [Potapov A., Likhterman L., Moscow. 2003 // Evidence-based neurotraumatology // I.A., Onoprienko G.A., Amcheslavsky V.G., B.A. Filimonov // Algorithms for the treatment of severe traumatic brain injury in the acute period].

In 50% of cases, PMTCT is combined with a systemic injury of varying severity. Currently, in the CIS countries, mortality with combined PMTCT reaches 80%, and among survivors - up to 75% remain with severe neurological deficit, which is consistent with statistics from Western European countries more than 10 years ago. It is estimated that in the USA, a head injury (TBI) occurs with a frequency of 200 cases per 100,000 population per year. In Germany, the annual CNS injury is approximately 10,000. In Western Europe, as well as in the USA, it has declined slightly in recent years thanks to such preventive measures as helmets, seat belts, air bags, and speed limits. However, the number of penetrating gunshot head injuries is growing in the United States. Traumatic brain injuries remain the leading cause of death for young men in developed countries. For survivors, this is often significant personal suffering, problems for the family and a significant increase in social costs for society [Apbget 1.K. Maak, Magk Beatbepp, Etaiso 8etuabe1, Νίηο 8! Ossye !! 1 apb Apbgeak unnegde // Siggep! Kesoshepbayopk cat No.ig! Gaisha. Sigg Ορίη Stu Sage 2000.6: 281- 292 Yrshsoy Abyashk & APksh, 1ps.].

Each year, approximately 500,000 people receive moderate to severe head injuries, of which 450,000 are hospitalized and 50,000 die before hospitalization. Among the 450,000 patients who are referred to the hospital, approximately 100,000 people per year experience significant disability. TBI is most often found in young people aged 15 to 24 years. According to statistics, men receive this type of injury two to three times more often than women in all age groups [Aibge A. Vepbo, M. B. Akkos1a! Rgokekkog. / ApekSheys Chapadeshep! ok ra! 1ep! to \ νίΐ1ι forges with yourselves! haishak // Beraishep! ok apek! yekyuodu, 8! a! e Ishuegku ok № \ ν Watk // NeaIy 8s1epse Sep1et a! Vgook1up, Vgook1up, Watk 11203,2002].

The main mechanisms of neurotrauma are determined not only by the primary effect at the time of the injury, but also by the action of various damaging factors over the next hours and days, the so-called factors of secondary brain damage (VPM). If the severity of primary brain damage determines the outcome at the pre-hospital stage of PMTCT, then the clinical prognosis and outcome of the acute and long-term PMTCT depends on the development and action of VPM.

Clinical studies have shown the importance of ischemic lesions in the pathophysiology of neurotrauma and have shown a significant effect of secondary ischemia on outcome [Apbget 1.K. Maak, Magk Beatbepp, Etapso 8etuabe1, No. 8! Kesoshepbayopk kog Noito! Gaisha. Ssht Orsh St Sage 2000, 6: 281-292 Irshsoy AyNash & Aykshk, 1ps.]. Cerebral vasospasm is one of the most serious complications in patients with TBI, leading to disability or death of the patient.

Literature review on post-traumatic vasospasm

For the first time, arterial spasm in patients with PMTCT was described in 1936. In 1963, almost simultaneously, articles appeared detailing post-traumatic vasospasm. Ете1бепке1! and 8ipbq! nausea described 5 cases of vasospasm in patients with head injury. Co1ishpe11a detected vasospasm in 10% of cases and divided it into two groups: generalized and local vasospasm of the cerebral vessels. In 1972, 8ietapteaa studied 350 cases of head injury and revealed a narrowing of one or more vessels in 18.6% of cases. The authors divided post-traumatic vasospasm into 4 types: local narrowing of the large cerebral arteries at the base of the skull (1%); local narrowing of the branches of the cerebral arteries on the side of the brain contusion (9.5%); diffuse narrowing of the cerebral arteries (3.4%); and spasm associated with penetrating damage to the cerebral arteries.

In a study at the University of Mississippi, 68.7% of patients with post-traumatic vasospasm had a TBI accompanied by subarachnoid hemorrhage (SAH), while 31.3% of patients with SAA were not visualized on computed tomography. Other studies have shown that post-traumatic vasospasm is associated with SAH in 90% of cases. Maish demonstrated that three types of pathology detected on computed tomograms: SAH, subdural hematoma, intracerebral hematoma, are independent factors predicting the development of vasospasm of the middle cerebral artery. Vasospasm developed in 14% of cases, in the presence of one of the factors; if two factors were present, then the probability of occurrence of vasospasm became equal to 65-78%. It was found that epidural and subdural hematomas are more common in patients with post-traumatic vasospasm. It is possible that a greater number of pathologies detected simply indicates a more severe head injury in patients with post-traumatic vasospasm. One of the alleged factors responsible for the occurrence of posthemorrhagic vasospasm is the inflammatory process in the meninges. Cases of vasospasm in patients with meningitis are described. Important

- 1 007768 the inflammatory process during the development of cerebral vasospasm was revealed during studies that showed a high level of interleukins in the cerebrospinal fluid of patients with SAH, a large amount of collagen in the walls of arteries, and also some effectiveness of anti-inflammatory drugs to slow the development of experimental vasospasm. Inflammatory complications of TBI are well known, and can also contribute to post-traumatic vasospasm. According to the literature, vasospasm may be one of the factors determining the outcome of head injury. Masrejzop and Ohioat found vasospasm in angiograms in 41% of patients who died due to head injury. Vasospasm can be detected in patients with a head injury 12 hours to 4 days after injury, and its duration is from 12 hours to 14 days. 8aieg showed that vasospasm occurs between 3 and 5 days after the injury, although dopplerography can be detected on the second day. So in the studies conducted in 20.8% of patients, vasospasm occurred in the first three days. At the same time, the duration of vasospasm in 58.3% was more than 3 days. Aeb also showed that the blood flow velocity according to transcranial dopplerography (TCD) increased after 48 hours and reached maximum values between the fifth and seventh days. Several authors have studied vasospasm in the vertebrobasilar basin. Magzyay (1978) described 6 cases of vasospasm in the vertebrobasilar basin and indicated that vasospasm is primarily responsible for impaired brain stem function. Using TCD, Magyi (1995) found that a third of patients with vasospasm in the anterior cerebral artery pool also had vasospasm in the vertebrobasilar basin. All patients with vasospasm in the vertebrobasilar basin had an unfavorable outcome. Nyap1 found basilar artery vasospasm in 70% of patients with CCI and in 40% of cases with moderate TBI. 90% of patients with vasospasm in the vertebrobasilar basin died [2 & bkou Α.Υ., Riktsop A.8., Vetapke Ό.Η., Rageš Α.Ό., ηιηηβ 1.// Rosaigaytis sesbaga1 uazorazrat: 1. No. 1 gait. 1999; 16: 763-770. // May1sa1 seSheg I am looking for an ok 81a1e Myzirg 1akgop, and 8A].

Many authors conclude that severe PMTCTs are accompanied by gross disorders of the function of the neuroendocrine system as a result of commotion. At the same time, the immune response acquires features that directly depend on the degree of damage to the central nervous system [A.N. Khlunovsky, A.A. Starchenko // Damaged brain, concept of the disease. P. 253]. The distinctive ability of the immune response directly depends on the degree of damage to the central nervous system.

One of the causes in the etiology of PA is a systemic inflammatory response syndrome, when an adaptive systemic reaction of the body to aggressive irritation (damage) occurs and sanogenetic mechanisms are switched on [A.N. Khlunovsky, A.A. Starchenko // Damaged brain, concept of the disease, p .253]. At the focal and organismal level, they include:

1. The reaction of local blood circulation (spasm, blood stasis and thrombosis of damaged vessels, as a measure of spontaneous stop of bleeding).

2. Organization of a zone of local cerebral edema that provokes uncontrolled infiltration (delimitation) of the area of damage by immunocompetent cells (macrophages, lymphocytes) and delivery of immunoglobulins as natural antibodies directly to the site of concentration of generated antigens.

3. Hyperlicvorea in order to reduce the toxic concentration of decay products of irreversibly injured tissues.

4. Potentiation of a neuroendocrine stimulus to include a systemic adaptive response, namely a systemic immune response, aimed at removing antigenic material from the body.

All these processes are appropriate sanogenetic, in conditions of a closed cavity of the skull, upon reaching a strictly defined and individual degree of development, they turn into effective pathogenesis factors that are secondary [A.N. Khlunovsky, A.A. Starchenko // Damaged brain, concept of the disease. p.253].

The leading pathological process causing brain damage is local circulatory hypoxia.

The occurrence of zones of local cerebral edema (single and multiple), a violation of cerebrospinal fluid dynamics associated with the development of intracranial hypertension (ICH), which causes brain ischemia, leads to metabolic disorders in the intact areas of the central nervous system.

Neuro-endocrine imbalance in the presence of ICH arises and is maintained due to circulatory disorders in the system of portal pituitary vessels, due to obstruction of the cerebrospinal fluid and as a result of overstrain of hormone-producing systems that occur in the first hours after PMI or in the early postoperative period [V.A. Khilko / / Hypothetical model of the systemic pathological process of the post-aggressive reaction of the body to traumatic brain damage. Materials to the head contractor on the topic С.09 No. 39 - в5.Л., 1990].

Thus, dislocation, cerebral edema, post-traumatic vasospasm, ischemia and hypoxia of neurons, inflammation in the membranes of the brain, aspiration pneumonia due to regurgitation, present in more than 50% of neurotraumatic patients arriving in a state of coma II and higher, even with timely intensive care, timely and uncomplicated surgical intervention lead to a worsening of the course of the disease, long-lasting and progressing

- 2 007768 neurological symptoms (cerebral symptoms, focal neurological deficit, convulsive syndrome, diencephalic crises, etc.), an increase in the length of hospital stay of patients, disability and social maladaptation.

The central doctrine of intensive care for PMTCT is the prevention and treatment of secondary ischemic attacks [S.V. Tsarenko, Research Institute of Emergency Medicine. Sklifosovsky, M., // Modern approaches to intensive therapy of severe head injury // Anesthesiology and intensive care.-2003, No. 2 .- p. 45-49].

A good effect was observed when using drugs that have been widely used in recent years from the groups: antioxidants, antihypoxants, alpha-blockers, calcium tubule blockers, phosphodiesterase inhibitors (gliatilin, emoksipin, diavitol, actovegin, mexidol, ubiquinone, nicobergoline, nicergoline, pentoxifylline) on the background of intensive care in the intensive care unit, including, if necessary, respiratory support, osmodiuresis, infusion therapy to correct the water-electrolyte balance and acid-base of state, osmolarity, osmolality, parenteral nutrition.

The negative aspects of this approach, based on the use of high doses of neuroprotective drugs in the complex during the acute period of BMI, which increase mental activity, include neurological and psychiatric disorders noted in the long term by neurologists and psychiatrists, manifested in the form of excitement, insomnia, suicidal thoughts, and intellectual and nonnestic disorders. It should also be noted the high cost of treatment. Therefore, it is promising to search for additional opportunities to increase the effectiveness of treatment, reduce the dosage of neuroprotective drugs, reduce disability and social maladaptation of neurotraumatic patients.

This made it necessary to look for not only pharmacological, but also efferent methods of influencing the body of critically ill patients hospitalized in the intensive care and neurosurgery departments, which stimulate recovery processes in damaged brain tissue during PMI.

Based on the known data on the treatment of various diseases using a low-frequency variable electromagnetic field (NPEMP), including arterial hypertension with cerebral insufficiency [Lenchin V.N. Clinical and pathophysiological analysis of the effectiveness of magnetotherapy for arterial hypertension with cerebrovascular insufficiency: Author's abstract. Cand. dis. honey. sciences. - Kharkov, 1985 - 16 pp.], Cerebral atherosclerosis [Vasilevskaya L.F. The use of combined magnetotherapy in the complex treatment of cerebral atherosclerosis // Thesis. doc. 1st congress of gerontologists and geriatricians of Ukraine, Kiev, 1998 - Kiev, 1998. - p. 34 35.], ischemic strokes [Clinical efficacy of extracorporeal autohemomagnetotherapy in the complex treatment of chronic coronary heart disease and ischemic brain disease / V.A. Ostapenko, R.M. Vasilenko, N.G. Kruchinsky // In the book: Efferent and physicochemical methods of therapy: Mater. 3rd Belarussian Scientific Pract. conf. / Ed. V.A. Ostapenko. - Mogilev, 1998 .-- p. 199-203] since March 2004, in the intensive care unit 5 of the City Clinical Hospital in Minsk, scientific and experimental work has been carried out on the topic: Treatment of patients with severe traumatic brain injury using low-pulse alternating electromagnetic exposure. Appropriate equipment for exposure to blood was provided by ΙΝΊΈΡδΙΝΊΈΡ: apparatus υ δΡΟΚ with IAMV-7 and IAMV-4 gearboxes.

The following methods of treating PMTCT using PEMP are known.

A method for the treatment of head injury by electrical stimulation of the brain stem. One of the electrodes is installed in the anterior horn of the uncompromised lateral ventricle of the brain, and the second is inserted epidurally between the lower edge of the occipital bone and the posterior arch of the C1 vertebra or into the large occipital cistern [Kasumov RD, Davydov EA, 2003 119277 A 61 N1 / 04].

The disadvantage of this method is its invasiveness, a high risk of septic complications.

A known method of treating wounds with combined radiation injuries using combined high-frequency therapy (EHF-therapy). Using an improved technique for ultrasound examination of postoperative wounds, it was found that millimeter radiation with direct irradiation of the area of the postoperative wound has a stimulating effect on the course of regenerative processes not only in the skin, but also in the underlying tissues. It has been established that the optimal parameter for EHF-therapy of postoperative wounds when using the domestic AMFIT apparatus with a standard radiation power of this apparatus is 1.0 μW is local irradiation of the area of the postoperative wound for 20-30 minutes. The safety of the use of millimeter-wave waves with a noise spectrum for patients and medical personnel is shown [76.02.2003.296 04200206296 Loginov V.I. Treatment of postoperative wounds with low-intensity broadband electromagnetic radiation of the EHF range: Dis. Cand. honey. Sciences // Nizhny Novgorod State Medical Academy (NGMA). - Protected on 2002.04.19. UDC 616-089.129 s: 19 tab., 44 ill. - Bibliography: 237 titles.].

The method is not effective enough, the improvement of the rheological properties of blood and a pronounced anti-inflammatory effect are not proven, there is no positive dynamics in the clinic with central nervous system damage, and there is also a narrow range of application.

A method for the treatment of traumatic brain disease, including exposure to the brain

- 3 007768 the brain with an alternating electromagnetic field, characterized in that, in addition to treatment and after treatment, the patient's EEG, REG and ECG are recorded, the condition of the studied systems is evaluated and the amplitude-frequency modulated low-intensity magnetic field with a frequency of not more than 3 Hz with a modulation depth of up to 40% is applied and with an energy of not more than 1 mT on the parietal region of the skull sequentially left and right for 3 minutes, then they are affected by amplitude-frequency modulated electric waves with a frequency of not more than 3 Hz and a modulation depth of up to 50 %, current no more than 100 μA to the area of the mastoid processes bipolar for 30 minutes, the course of treatment 15 sessions [Butukhanov V.V., Sorokovikov V.A. KI2003123465A 2003.07.23. Α61Ν5 / 06].

The disadvantage of this method is the little-studied effect of the variable electromagnetic field on the brain, changes in the psychiatric and neurological status, low parameters of electromagnetic effects, the absence of significant positive effects on the oxygen transport function of the blood, immunomodulating effect and low clinical efficacy.

These methods of treatment are relatively widely used in the practice of resuscitation and intensive care, but most often they are ineffective.

Known closest to the proposed technical essence and the achieved positive effect is a method of treating PMTCT using PEMP after the introduction of drugs into the body, which served as a prototype.

Medicines are injected into the body and act on PEMP. PEMP is formed by a sinusoidal signal with a carrier frequency in the range of 200-1000 kHz with amplitude-modulated voltage with a frequency in the range of 10-100 Hz using the device. The method and device can improve the effectiveness of the treatment of head injury.

The disadvantages of the method are the uncontrolled effect of PEMP on the most important centers of the brain due to high parameters of the carrier frequency and the possibility of potentiation of hyperthermia, insignificant positive dynamics in the psychiatric and neurological status, the absence of pronounced positive effects on the oxygen transport function of the blood, and the safety of use for patients and medical personnel is not shown.

The objective of the invention is to prevent the development and action of secondary damaging factors (dislocation, cerebral edema, post-traumatic vasospasm, ischemia and hypoxia of neurons, the inflammatory process in the membranes of the brain) by exposure to a low-frequency pulsed alternating magnetic field on arterial blood flowing inside the body.

The problem is solved by the action of NPEMP on the blood of patients with PMTCT complicated by VPM factors, and the distinctive point is that the effect of an i-pulse alternating magnetic field when using neuroprotective drugs is not on the brain, but non-invasively on the arterial blood, which directly supplies blood to the cerebral hemisphere brain with existing foci of traumatic injury, to improve its rheological properties, increase oxygen transport function, immunomodulator guide influence and reducing the inflammatory response.

For IOC, a common carotid artery was selected for the following reasons: the angle of departure of the right common carotid artery from the brachiocephalic trunk, according to V.V. Kovanova, ranging from 25 to 750, and the left common carotid artery from the aortic arch from 85 to 1100, most often the angles for the right vessels was 45-500, for the left 100-1100. In the common carotid artery, both in the right and left, it is customary to distinguish three departments: from the sternoclavicular joint to the lower edge of the upper abdomen of the scapular-hyoid muscle, from the lower edge of the scapular-hyoid muscle to the site of the division of the common carotid artery into the external carotid artery and the internal carotid artery, the actual site of bifurcation of the common carotid artery. The length of the trunk of the common carotid artery varies depending on the location of the aortic arch and the brachiocephalic trunk. The diameter of the common carotid artery, according to I.V. Golubeva and V.V. Kovanova, in children of different ages ranges from 3 to 6 mm, in adults - from 9 to 14 mm. B.V. Petrovsky presented his own data, according to which the diameter of the common carotid artery at the bifurcation site is from 1 to 1.5 cm. G.V. Barbachuk found that the diameter of the carotid arteries increases with age. The internal carotid artery is the main artery carrying blood to the intracranial regions of the skull and supplying the brain with blood.

An artery begins with bifurcation of the common carotid artery and does not have branches before entering the skull [Bragin L.K. // Compensatory capabilities of the Wilizian circle in the pathology of the main arteries of the head // In the book: Vascular pathology of the brain. M, 1966 27s Bragina L.K. // Features of extra- and intracranial circulation with occlusive lesions of the arteries that feed the brain. // Dis. Doct. 1974 Vereshchagin N.V., Musatova R.A. // Regional cerebral blood flow in patients with EICMA with ICA occlusion. // In the book: Actual issues of neurology and neurosurgery. Tallinn, 1984, v. 1, p. 25. Koltover A.N., Vereshchagin N.V., Lyudkovskaya I.G., Morgunov V.A. // Pathological anatomy of cerebrovascular accident. // M., 1975, 253 p. Ikyeg S.M. // ТНе С1ге1е о £ \ У11Нк: ApaYu1shsa1 uapa Boi.//Uaxi1ag b1k., 1965, ν.2, # 2 ,. p. 99-102. Nakk ν.Κ., Ie1bk \ ¥ .5. e! A1. // 1 from 1 to! ibu o £ ex! gasgash1 ag1epa1 oss1ikui.// 1АМА, 1968, ν.203, p.961-968. Kappe1 ν.Β. e! A1 .// Bepait., 1978, ν.33, p. 71-83. Thyotrkoy GE. e! A1 .// Sagoyb eibaPegesUtu.// AtBigd., 1976, ν.184, # 1, p.1-15].

- 4 007768

In experimental studies, it was found that for normal functioning of the brain, its blood flow should provide 60-100 ml of blood per 100 g of its mass. With a decrease in blood flow to 55 ml per 100 g in 1 min (the first critical level), anaerobic glycolysis occurs, in which only 2 ATP molecules are formed from one glucose molecule instead of 38 (with aerobic glycolysis). The first reaction occurs in the form of inhibition of protein synthesis in nerve cells. A decrease in cerebral blood flow to 35 ml per 100 g per 1 min (second critical level) is accompanied by further activation of anaerobic glycolysis. When ischemia reaches 20 ml per 100 g in 1 min. (the third critical level), energy deficiency forms and, as a result, cessation of cell protein synthesis and dysfunction of active ion transport channels, which leads to destabilization of cell membranes and excessive release of neurotransmitters. In the ischemic area, pericellular edema develops. Potassium leaves the brain cell, and sodium and calcium rush into the cell, which leads to intracellular edema and their destruction. Complete anoxic depolarization of cell membranes and their death occurs when the level of cerebral blood flow decreases below 10 ml per 100 g in 1 min. Anaerobic glycolysis leads to energy deficiency and lactic acidosis. They trigger pathological biochemical reactions in the entire cellular mass of the central nervous system and cause neuronal dysfunction, astrocytosis, microglial activation and dysfunction of trophic factors. [Dambinova S.A., Kamenskaya S.A., Ashmarini I.P., Stukanov P.V. Neurochemistry. M. 1996, 246295. A81cr 1., 81e5) about V., 8shop I. // 81 current 1981. N 12.-p. 530-535. Vagop 1.S., Bgaskoizak K..8.T, Netyok K. e! a1. // 1. NETWORK. B1ob Noi Me1aB. -1989. N 9. - p. 723-742].

The proposed method for the treatment of PMTCT is aimed at preventing the development and action of secondary damaging factors: dislocation, cerebral edema, post-traumatic vasospasm, ischemia and hypoxia of neurons, inflammatory process in the membranes of the brain. The dynamics of the neurological status, the increase in oxygen-transport function, and a change in the blood formula are used to judge the effectiveness of the procedure. Evaluation and comparison of the course of PMTCT, outcome, changes in laboratory and clinical parameters in the experimental group of patients (EG) treated with NPEMP was carried out with a control group of patients (CG) who received only medication in accordance with current trends in intensive care for this pathology , with similar diagnoses and the same severity of the condition and prognosis, determined on a scale 8AP8 II. Data analysis was carried out in patients admitted to the intensive care and resuscitation department (ICU) with indicators of at least 23-56 points and a mortality prediction of at least 6-62%.

The method is as follows.

The clinical diagnosis of PMTCT upon admission of a patient to the intensive care unit was based on the criteria formulated at the Institute of Neurosurgery. NN Burdenko of the Russian Academy of Medical Sciences, Moscow, 1994, and later supplemented Evidence-based neurotraumatology Potapov A., Likhterman L., Moscow. 2003.

The diagnosis of PMTCT was made on the basis of an assessment of the following parameters:

1) assessment of consciousness (deep stunning, stupor, coma);

2) the state of vital functions (impaired by 1-2 indicators); the state of focal neurological functions a.stemal - moderately expressed (anisocoria, decreased pupillary reactions, etc.); hemispheric and craniobasal - are clearly expressed both in the form of irritation symptoms (epileptic seizures) and prolapse symptoms (motor disturbances, which can reach a degree plegia). Identification of violations of vital functions by 2 or more indicators, despite the severity of depression of consciousness, is sufficient to qualify the condition as serious;

3) radiography of the skull;

4) data from computer tomography or magnetic resonance imaging;

5) lumbar puncture (cerebrospinal fluid pressure, analysis of cerebrospinal fluid).

If there are indications for surgery, based on the dynamics of the condition, CT data, laboratory and clinical examinations by the duty neurosurgeons, surgical interventions were performed, followed by transfer of patients to the intensive care unit.

Intensive therapy included the following measures: 1) inhalation of moistened oxygen through nasal catheters, if necessary - auxiliary respiratory support with special modes, taking into account the following standards: normoventilation, in the absence of signs of intracranial hypertension, avoid prolonged hyperventilation Ra <25 ssNd (during the first 5 days), preventive hyperventilation (Ra <35 bshNd) was also avoided due to the risk of worsening cerebral perfusion in the presence of a decrease in cerebral blood flow, briefly meline hyperventilation only used an acute neurological deficit or for a longer time while maintaining the intracranial hypertension do not respond to medication or neurosurgical manipulation; 2) normalization and maintenance of blood pressure, mean blood pressure was maintained> 90 ssNd throughout the course of intensive care in order to maintain cerebral perfusion pressure> 70 ssnd; 3) the prevention and relief of intracranial hypertension: elevated head position, the fight against hypothermia, the elimination of motor excitement, seizures using sedatives or muscle relaxants, maintaining adequate oxygenation, eliminating

- 5 007768 hypercapnia; correction of intracranial pressure when exceeding a threshold of 20-25 ttNd using mannitol 0.25-1 g / kg; 4) infusion-transfusion therapy in the form of solutions of colloids and crystalloids in order to maintain normovolemia, maintaining blood plasma osmolarity <320 mosm / l in order to avoid the development of renal failure; 5) antibiotic therapy; 6) a complex of vitamins of group B: B1, B6, B12; Vitamin E 7) antioxidants, antihypoxants: gliatilin, emoksipin; 5) vasodilator: aminophylline; 7) if necessary, parenteral nutrition; 8) magnetic blood treatment (IOC) with an ϋΝΙδΡΟΚ apparatus with an IAMV-7 reducer (Interspok LLC, Belarus).

Prior to the start of the IOC, the parameters of the blood gas transport function of the blood are studied on a Kab1oteEeg oxygen generator (Sorepkadep): arterial blood oxygen saturation (8aO2), arterial blood carbon dioxide partial tension (paCO2), arterial blood oxygen partial pressure (paO2); the following parameters of blood samples punctured from the bulb of the internal jugular vein on the side of brain damage manifested by contusion, epidural, subdural or intracerebral hematomas: saturation of venous blood with oxygen (8νΟ2), partial tension of carbon dioxide of venous blood (pνСΟ2), partial tension of venous oxygen blood (ρνΟ2); as well as the level of hemoglobin (Hb), the number of leukocytes in peripheral blood, the blood formula.

Based on the data obtained, the calculations were performed according to the following formulas [Raaf G. // Secrets of physiology].

The content of O2 in arterial blood (CaO2):

8aO2

CaO2 = (Hb) 1D4 + (PaO2 · 0.0031);

100 O2 content in venous blood (CaO2):

8νΟ2

002 = (Hb) · 134 + (ΡνΟ2 · 0.0031);

where 1.34 means the amount of oxygen associated with 1 g of hemoglobin.

The arteriovenous difference (C (a ^) O2) ml / dl was calculated: C (a-t) O2 = CaO2 - OO2; Oxygen Extraction Coefficient (OEC)%:

CaO2 - 002

KIO2 ---- 100%,

CaO2 and the dynamics of changes in the parameters of the blood formula upon admission, in case of surgical intervention (decompression trepanation, emptying of the hematoma) after surgery on the first, third, seventh days after admission and in the long-term period, the IOC is carried out with an E% '18 ROCK apparatus with an IAMB-7 inductor according to the following method: the head end of the bed was raised to 25 °, the exposure to the electromagnetic field was carried out in the projection of the external carotid artery (A. sagoyz e \ !.), on the side of the damaged hemisphere of the brain, the head was turned 45 ° against opolozhnuyu side. The pulse wave in the region of the carotid triangle (Eldopit sagoisitis) is determined by palpation, its maximum value. Inductor IAMB-7 is firmly fixed clearly in this projection, in the case of constitutional features of the patient (short, thick neck), the reference point is used: to retreat 1.5-2 cm from the lower edge of the lower jaw at the front edge of the sternocleidomastoid muscle. Patients from the experimental group underwent 10 EPEMV procedures. The following parameters of the pulsed alternating magnetic field are set to 110% (70 ± 20 mT) according to the following scheme: immediately after surgery in the OITAR, the magnetic treatment time is 35 minutes, after 4 hours 110% (70 ± 20 mT) - 35 minutes, after 8 h after surgery 110% (70 ± 20 mT) - 35 min, 12 hours after surgery 110% (70 ± 20 mT) - 35 min, then 1 time per day 110% (70 ± 20 mT) - 25 min .

The most important condition for the successful use of EPEMW is the correct execution of the manipulation - this is the exact differentiation of the zone and direction of action, the maximum fit of the inductor to the artery wall (carrier frequency 100 Hz, modulation frequency 10-20 Hz). With increased patient irritability due to uncoordinated movements, the IAMB-7 inductor can be removed or displaced, so it is necessary to control the correct fixation of the inductor in the projection of bifurcation of the common carotid artery during the entire procedure.

Impact characteristics of the IAMB-7 inductor: on the surface - 60 mT, at 4 cm -1.5 mT, at 3 cm - 2.5 mT, at 2 cm - 6.7-8 mT, at 1 cm - 15 mT, carrier frequency 100 Hz, modulation frequency 10-20 Hz. With this method, the IEM for bifurcation of the common carotid artery is transmitted PEMV with induction of 15-60 MT.

Thus, the proposed technique allows you to process a large amount of arterial blood, which is directly delivered to the intracranial sections and supplies the brain on the side of the traumatic lesion, bypassing other sectors of the circulatory system. The above therapy with the use of IOC according to the above methodology was carried out in 14 patients with BMI. Statistical processing of the results was carried out using the program Ε.ΧΕΕ (M1gozoy OEys ΧΡ 8ΧΡ3), and “81izys”. The results were considered reliable by Student's ΐ-criterion of less than 5%. Compare groups

- 6 007768 of the same type, the difference in assessing the severity of the condition on the BARB II scale is statistically insignificant. Changes in the parameters characterizing the oxygen transport function and blood formula during treatment with the help of the IOC are presented in table. one.

Table 1. Dynamics of changes in oxygen transport function and blood formula during treatment with magnetic blood treatment in patients with TBI (and = 28)

Index On admission After surgery (compared indicators in the CG and the EG are equivalent) One day after surgery 3 days after surgery 7 days after surgery kg eg KG EG kg EG KG EG 8aO2% 96.3 ± 1.9 96.3 ± 1.4 97.0 ± 0.4 * £ 96.8 ± 13 97.65 ± 1.7 * £ 98.45 ± 0.5 μ 97.5 ± 0.45 * £ 97.65 ± 0.55 97.95 ± 0.15 * £ 8νΟ2% 78.9 ± 183 78.9 ± 183 70.1 ± 10.6 * £ 56.4 ± 15.4 μ 68,4 ± 1,8 * £ 61, Ι5 ± 16.5 μ 6435 ± 1.75 * £ 72.5 ± 2.5 μ 693 ± 1,1 * £ paO2 ΜΜ, ρτ.οτ. 90.5 ± 21.45 90.5 ± 21.56 92.3 ± 3.1 * £ μ 106, Ι ± 27.45 μ 92.9 ± 3.75 * £ 96.7 ± 173 μ 913 ± 4.9 * £ 903 ± 0.2 μ 87.55 ± 6.65 * £ ρνΟ2 mm, Hg 62.4 ± 25.2 62.4 ± 25.1 59.45 ± 27.65 μ 34.65 ± 0.75 μ 48.9 ± 2.1 * £ 32.75 ± 1.25 34.6 ± 4.2 * £ 35.65 ± 1.55 μ 40.65 ± 0.55 * £ paCO2mm, Hg 20.15 ± 11.75 20.15 ± 10.85 23.15 ± 735 * £ 21.2 5 ± 1.15μ 26.8 ± 4.75 * £ 21.55 ± 0.85 μ 29.95 ± 1.65 * £ 21.4 ± 1.1μ 29.35 ± 3.05 * £ rusO2mm, rt.st 13.35 ± 10.15 33.35 ± 10.07 31.6 ± 8.4μ 35.8 ± 2.8 μ 41.6 ± 0.55 * £ 43.4 ± 4.8 36.45 ± 735 * £ 42.4 ± 33 μ 21.95 ± 5.6 * £ C (ay) O2ml / dl 2.99 ± 331 2.99 ± 3.17 436 ± 1.47 * £ μ 6, Ι4 ± 3.11 μ 4.66 ± 0.14 * £ 6.65 ± 2.52 μ 5.67 ± 0.63 £ 4.04 ± 0.62 μ 5.19 ± 032 * £ H, g / l 122 ± 8.5 122 ± 83 1223 ± 9.1 * £ 1223 ± 4.1 μ 1173 ± 7.5 * £ 1213 ± 14.1 μ 1163 ± 14.1 * £ 1183 ± 2.1 μ 1333 ± 3.1 * £ KEC,% 26.41 ± 10 ^ 6 26.41 ± 10.14 28.27 ± 11.04 163 ± 5,4 C. 2934 ± 1.83 * £ 38.55 ± 15.8 μ 39.57 ± 3.17 * £ 2637 ± 2.83 μ 29.9 ± 1.18 * £ White blood cells, 10 ’/ l 8.45 ± 2.55 8.45 ± 2.43 11.8 ± 4.9 * £ 935 ± 035 μ 63 ± 13 * 9.95 ± 0.35 6.05 ± 0.95 * £ 9.55 ± 1.45 μ 7.6 ± 03 * £ Neutrophils: young,% 1 ± 1 1 ± 1 2 ± 1 2 ± 1 0 0 0 0 0 stab core,% 9.5 ± 5.5 9.5 ± 5.3 18 ± 13 * £ μ 14 ± 4μ 6 ± 1 * £ 12 ± 7μ 4 ± 1 * 6 ± 5μ 5* basophils,% 0 0 0 0 0 0 0 0 0 eosinophils,% 1 ± 1 1 ± 1 one 1 ± 1 0 1 ± 1 0 one 2 * monocytes,% 5 ± 4 5 ± E 6 ± 3 7 ± 5 1 ± 1 3 ± 1 0 5 ± 2 5 ± 1 segmented% 75 ± 2 75 ± 1 67 ± 9μ 61 ± 9 μ 68 ± 4 72 ± 16 μ 56 ± 2 * £ 74 ± 2μ 53 ± 1 * £ miepocigi,% 0 0 0 0 0 0 0 0 0 Lymphocytes,% 11 ± 1 11 ± 1 13 ± 7 * £ c 12 ± 5 μ 23 ± 3 * 10 ± 7μ 24 ± 1 * £ 15 ± 6μ 23 ± 1 * £ ESR mm / hour 17 ± 14 17 ± 11 15 ± 10 μ 42 ± 15μ 11 ± 5 * £ 43 ± 16 9 ± 3 * £ 44 ± 9 μ 8 ± 5 * £

* - the significance of differences in the indicator of the experimental group in comparison with the control group; p <0,05 £ - the significance of differences in indicators in the experimental group in comparison with the original; p <0.05 μ - the significance of differences in indicators in the control group compared with the original; p <0.05

Compared with the control group, the following C (ay) O2 and KEK changes were observed in patients who underwent EPEMV for blood: indicators closer to the lower limit of the norm one day after admission, increase in oxygen transport and utilization by almost 34.5% by third day, by 15-20% on the seventh day, stabilization of indicators within normal limits in the future. In 6 patients from the control group, one day and three days after admission and after surgery, the indicator C (ay) O2 increased and reached a value of more than 9 ml 02/100 ml of blood, which indicates the development of global ischemia [normal value C ( a-u) O2 is 4.5-6 ml 02/100 ml of blood], which was not observed in patients from the experimental group, the latter showed a dynamic and uniform improvement in performance. Three patients from the experimental group who arrived in a coma due to regurgitation had aspiration pneumonia, the course of which did not worsen when using only one antibacterial drug with a wide spectrum of activity, in contrast to patients from the control group in four of whom the course of the underlying disease was complicated by pneumonia, increasing the length of stay in the hospital is up to 23 bed days. Three of them were transferred to the pulmonary department with a concomitant diagnosis: Bilateral lower lobe pneumonia. This is confirmed by changes in the general analysis of blood in patients of the control group: accelerated ESR (from 12 to 57 mm / h one day after admission, up to 59 mm / h on the 3rd day), leukocytosis (increased white blood cells from 6.9x109 / l to 9.6x109 / l in a day, up to 11.6x109 / l on the 3rd day), an increase in the number of stab and segmented neutrophils, a shift of the leukocyte formula to the left.

Three patients from the experimental group who received aspiration of the upper respiratory tract received antibiotic therapy similar to the control group, but within a day from the moment of receipt after 3 EPEMV procedures in patients, ESR decreased from 25 to 16 mm / h, by 3- and a day - up to 12 mm / h, and from 30 mm / h ESR decreased to 3 mm / h (this value remained), a decrease in leukocytosis a day after receipt from 16.8 x 109 / l to 8 x 109 / l, by 3- and a day to 6x109 / l, there was a decrease in stab neutrophils from 16.8 to 7% in a day to 8% on the 3rd day and.

Seven patients from the experimental group showed a pronounced positive intellectual-mnestic effect, which manifested itself in the complete restoration in memory of the events preceding the injury and the circumstances of the injury, although the severity of the condition upon admission according to the BARB II scale was estimated at 48-50 points, the level of consciousness was coma II . On the 9th day after receipt of the aforementioned patients were discharged home in satisfactory condition.

Example 1

Patient L., 45 years old, was admitted to the intensive care unit with a diagnosis of Severe traumatic brain injury. A severe brain contusion. Subacute subdural hematoma on the right. Traumatic subarachnoid hemorrhage.

Upon admission to the hospital, the condition was rated on the BARB II scale at 48 points, mortality at

-7007768 this degree of severity 41%, level of consciousness coma II.

The patient was taken from the operating room, where he was performed: resection trepanation, emptying of the subdural hematoma.

After surgery: level of consciousness - stupor, focal neurological symptoms - moderate paresis of the left hand. Breathing is independent, effective. BH = 28 per min.

Heart sounds are muffled, rhythmic, tachycardia up to 105 beats per minute. Pulse of weak filling and tension. Blood pressure 140/75 mm Hg The abdomen is soft, painless on palpation. Liver +0.5 cm from the costal arch.

Intensive therapy has been started according to the above scheme, including infusion therapy under the control of CVP, VEB, CBS correction, antibacterial, neuroprotective therapy using drugs from the antioxidant groups, antihypoxants; procedures for magnetic blood treatment with the Unispock apparatus according to the above method. The IOC procedures were performed immediately after the operation (10 minutes), 4 hours, 8 hours after the operation, then 1 time per day, which amounted to a total of 10 sessions. The nature of the change in oxygen transport function and blood counts are presented in table. 2.

table 2

Index On admission After operation One day after surgery 3 days after surgery 7 days after surgery Remote period> 14 days 8aO2% 96.5 97.0 98.5 97.1 97.8 On the 9th Day 8νΟ2% 97.4 68,2 68,2 66.0 70 paO2 mmHg 78.7 90.1 90.1 86.9 80.9 ρνΟ2 mm, Hg 87.6 87.1 47.1 30,4 40,0 paCO2 mmHg 21.1 22.6 25.3 28.3 26.3 rubCO2 mmHg 23,2 23,2 26,4 28.6 27.6 C (ay) O2 ml / dl -0.22 3.83 4.6 6.23 4.97 Ng / l 122 99 110 110 130 KEC% 29.13 31.08 42.75 28.75 Leukocytes x 10 ^9/1 5.9 7.5 6.4 6.1 6.1 Neutrophils: Young,% 2 3 one 0 0 stab core,% 6 7 6 6 6 basophils,% 0 0 0 0 0 eosinophils,% 2 one 2 2 2 monocytes,% 4 8 6 6 5 segmented% 76 62 56 fifty fifty myelocytes,% 0 0 0 0 0 Lymphocytes,% 12 twenty 26 25 23 ESR mm / hour 25 25 sixteen 12 8

As can be seen from the table, there is a pronounced positive dynamics of the parameters characterizing the oxygen transport function of the blood. This is clearly noted after three IOC procedures performed within 12 hours after surgery. Fast and uniform normalization of indicators C (ay) O2, KEK, their approximation to the upper limit of the norm, indicates the absence of ischemia and the threat of its development on a total scale. The increase in ECC after 3 days is 1.5-2 times compared with patients receiving standard drug therapy from the control group, indicating a marked improvement in tissue respiration of damaged areas of the brain after three IOC procedures.

The indicators characterizing the phenomenon of inflammation in the blood underwent significant positive changes already after 2 IOC procedures using only 1 broad-spectrum antibiotic (oxamp 2.0 i / m 4 times a day), and a full normalization of the blood formula a day after receipts.

The above dynamics of the indicators confirmed the observed clinical effect: a day after the patient arrived in clear consciousness, a moderate paresis of the left arm was built up to 3 days.

The effect of a quick regression of retrograde amnesia is also noted: the patient remembers in detail the place, time and circumstances of the injury (car accident), although upon admission the level of consciousness is coma II.

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The severity of the patient's condition at the time of transfer to the specialized department on a scale of 8AR8 II 32 points, bed-day in OITAR-3.

On the 9th day he was discharged from the hospital in satisfactory condition.

The given example clearly demonstrates a positive increase in the oxygen transport function of the blood, faster normalization of the inflammatory response in the general blood test (leukocytes, leukocyte formula, ESR) and the speedy recovery of neurological deficit after applying the above therapy and magnetic blood treatment.

Example 2

Patient K., 44 years old, was admitted to the intensive care unit in serious condition with a diagnosis of Severe traumatic brain injury. A severe brain contusion. Acute subdural hematoma over the right hemisphere of the brain. Convulsive syndrome. Upon admission to the hospital, the condition was assessed on a 8AR8 II scale at 48 points, mortality at such a severity level of 41%, and coma Sh. neuroprotective therapy using drugs from the groups of antioxidants, antihypoxants; procedures for magnetic blood treatment with the Unispock apparatus according to the above method. IOC was performed immediately after surgery (10 minutes), 4 hours, 8 hours after surgery, then 1 time per day, which amounted to a total of 10 procedures. The nature of the change in oxygen transport function and blood counts are presented in table. 3.

Table 3

Index On admission After operation One day after surgery 3 days after surgery 7 days after surgery Remote period> 14 days 8aO2% 95.1 96.8 96.8 97.8 98.1 At 10- ~ day discharged 8νΟ2% 60,4 80.0 70.6 62.6 68 paO2 mmHg 83.6 89.2 89.2 96.2 94.2 ρνΟ2 mm, Hg 35,2 46.8 46.8 38.8 41 paCO2 mmHg 31.9 30,4 31.6 31.6 38,4 rubCO2 mmHg 41.0 40,0 42.0 44.3 16.3 C (ay) O2 ml / dl 6.2 2.89 4,52 6.31 5.41 G / l 130 127 125 130 130 KEC% 36.8 17.23 27.41 36,4 31.12 White blood cells · 10 ^U / L 14.5 16.8 10.0 8.0 7.6 Neutrophils: young,% 2 0 0 0 0 stabs % 26 31 12 5 4 basophils,% 0 0 0 0 0 eosinophils,% 2 3 2 2 2 monocytes,% 4 8 7 7 5 segmented % 58 56 60 62 56 myelocytes,% 0 0 0 0 0 Lymphocytes,% 6 5 23 26 26 ESR mm / hour 5 6 5 5 5

As can be seen from the table, pronounced positive dynamics in this patient is observed with parameters characterizing the oxygen-transporting function of the blood. This is noted after three procedures within 12 hours after surgery. Fast and uniform normalization of indicators C (ay) O2, KEK, their approximation to the upper limit of the norm indicates the absence of ischemia and the threat of its development. The increase in KEK after 3 days is 1.5 times greater compared with patients receiving standard drug therapy from the control group, indicating a marked improvement in tissue respiration of damaged areas of the brain after 4 IOC procedures.

The indicators characterizing the phenomenon of inflammation in the blood underwent significant positive changes already after 2 sessions of IOC when using only 1 antibiotic of a wide spectrum of action of oxamp 2.0 v / m 4 times a day, and the blood formula was completely normalized one day after admission.

-9007768

The above dynamics of indicators confirmed the observed clinical effect: 3 days after the patient’s admission in clear consciousness, moderate, upper, left-sided hemiparesis was rebuilt by 4 days. The effect of the quick elimination of retrograde amnesia is also noted: the patient remembers in detail the place, time and circumstances of the injury (fight), although the level of consciousness of coma Sh is on admission. The severity of the patient's condition at the time of transfer to the specialized department on a scale of 8AP8 II 34 points, bed-day in OITAR-5. On the 10th day he was discharged from the hospital in satisfactory condition.

The given example clearly demonstrates the stabilization of the oxygen transport function of the blood, the faster normalization of the parameters of the inflammatory reaction of the blood (leukocytes, leukocyte formula, ESR), the speedy recovery of neurological deficit after applying the above therapy and magnetic blood treatment.

Example 3. Patient L., 54 years old, was admitted to the intensive care unit with a diagnosis of Severe traumatic brain injury. A severe brain contusion. Acute intracerebral hematoma in the left hemisphere of the brain. Upon admission to the hospital, the condition was rated on a scale of 8АР8 II at 57 points, lethality with such a severity of 62%, level of consciousness coma II.

The patient was delivered from the operating room, where she underwent surgery: resection trepanation, emptying of the intracerebral hematoma. After the operation, the level of consciousness is stupor, focal neurological deficit (moderate left upper paresis), independent breathing, effective. Heart sounds are muffled, rhythmic, tachycardia up to 105 beats per minute. Pulse of weak filling and tension. Blood pressure 140/75 mm Hg The abdomen is swollen, soft, participates in the act of breathing, ascites. Liver +4.5 cm from the costal arch.

Intensive therapy has been started according to the above scheme, including infusion therapy under the control of CVP, VEB, CBS correction, antibacterial, neuroprotective therapy using drugs from the antioxidant groups, antihypoxants; procedures for magnetic blood treatment with the Unispock apparatus according to the above method. IOC was performed immediately after surgery (10 minutes), 4 hours, 8 hours after surgery, then 1 time per day, which amounted to a total of 10 sessions. The nature of the change in oxygen transport function and blood counts are presented in table. 4.

Table 4

Index On admission After operation One day after surgery 3 days after surgery 7 days after surgery Remote period 14 days 8aO2% 96.7 98.2 97.6 98 98.3 Died on the 9th day from profuse bleeding from varicose veins of the esophagus. Concomitant diagnosis: cirrhosis 8νΟ2% 94.3 74.1 70.7 62.5 65.5 paO2 mmHg 77.6 52,4 96.7 96.7 97.7 ρνΟ2 mm, Hg 86.7 41.6 50.8 36.7 36.8 paCO2 mmHg 22.3 27.8 22.0 21.3 21,4 ρνΟΟ2 mm, Hg 24.6 43.3 41.1 38.3 39.2 C (ay) O2ml / dl 0.3 4.83 4,56 5.04 5.90 G / l 103 132 119 102 130 KEC% 2.23 27.53 27.94 36.79 33.87 White blood cells10 ⁹ / L 10.3 13.1 11.5 7.4 8.2 Neutrophils: young,% one 0 0 0 0 stabs % 12 14 7 5 4 basophils,% 0 0 0 0 0 eosinophils,% one one 2 3 2 monocytes,% 4 4 3 4 4 segmented % 73 74 82 62 54 myelocytes,% 0 0 0 0 0 Lymphocytes,% nine 7 8 23 27 ESR mm / hour eighteen 12 thirty eleven 10

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As can be seen from the table, pronounced positive dynamics are observed with parameters characterizing the oxygen-transporting function of the blood. This is noted after 3 IOC procedures according to the above method. The indicators characterizing the phenomenon of inflammation in the blood underwent significant positive changes also after 3 IOC procedures.

The complex of measures taken allowed to normalize the indicators. On day 2, the patient regained consciousness, focal neurological symptoms remained, moderate paresis of the left arm.

This allowed us to reduce the severity of the condition on a scale of 8-8 II to 35 points.

Despite the ongoing medical measures, the patient's condition worsened due to the development of profuse bleeding from varicose veins of the esophagus (cirrhosis) on the 9th day, as a result of which the patient died.

This clinical case also convincingly demonstrates the stabilization of the oxygen transport function and the approximation of the blood count to normal, recovery of consciousness, after using the IOC. The complication that developed in the patient was not associated with the underlying disease and arose against the background of stabilization of the studied parameters.

In the table. 5 shows the data of the analysis of the condition of patients from the experimental and control groups, made in order to determine the degree of social maladaptation on the Rankin scale in the long term.

Table 5 The assessment of the degree of social maladaptation according to the Rankin scale in the long-term period in patients who underwent BMI, in whose treatment IOC was used compared with the control group (n = 25)

Patient groups Ikala Rankin (points) 0 one 2 3 4 5 experimental η = 13 3 4 3 2 one - control n = 12 - - 4 3 3 2 -

In the experimental group, in 7 patients (53.8%) after the treatment, there were no symptoms or minimal disabilities (0 or 1 point according to Rankin).

In the control group, the corresponding indices were observed only in 4 patients (33.3%), and none of them showed a complete regression of clinical symptoms, in contrast to the experimental group (3 people).

In the experimental group, 1 patient died, in the control group 2 patients died.

Advantages over prototype

The method of treating patients according to the proposed method in comparison with the prototype excludes the effect of PEMP directly on the brain. The exposure parameters (carrier frequency of 100 Hz, modulation frequency of 10-20 Hz, magnetic induction is 15-60 mT) are completely safe for patients and medical staff. The proposed application of magnetic processing of blood allows non-invasive effect on arterial blood, improving its rheological properties directly in the projection of a large artery (a.satoshch eottishk) that feeds the cerebral hemisphere with foci of traumatic injury, bypassing other sectors of the circulatory system.

The use in combination with pharmacotherapy allows for a short time to eliminate cerebral energy deficiency and lactic acidosis, to stabilize the oxygen-transport function. This leads to the restoration of metabolic processes, the passage of edema, a rapid decrease in ischemic damage in the foci of injured brain tissue and the risk of total ischemia. Normalization of the inflammatory response in a general blood test (white blood cells, white blood cell count, ESR) indicates an immunomodulatory effect of IOC. A positive change in the above parameters confirms the observed clinical effects: early recovery of consciousness, the passage of retrograde amnesia, the absence of early post-traumatic epilepsy, a dynamic detuning of focal neurological symptoms.

Application of the above technique reduces and in most cases prevents the development and action of secondary damaging factors (dislocation, cerebral edema, post-traumatic vasospasm, ischemia and hypoxia of neurons, inflammatory process in the meninges), which determines the clinical prognosis and outcome of acute and long-term periods after PMI.

An analysis of the condition of patients during treatment in the intensive care unit and an assessment according to the Rankin scale in the long-term period showed that the most pronounced effect of the treatment, the least disability and social maladaptation are observed in patients who underwent PMTCT, the treatment of which was carried out according to the proposed method using magnetic treatment blood.

Claims (10)

CLAIM 1. A method of treating severe traumatic brain injury, including an effect on the blood of patients with severe traumatic brain injury complicated by factors of secondary brain damage, low-frequency alternating electromagnetic field against the background of the use of neuroprotective drugs, characterized by magnetic treatment of blood during intensive therapy by acting with a pulsed alternating magnetic field, non-invasively on arterial blood, which directly provides the blood supply to the hemisphere hectares with the existing centers of traumatic injury. 2. The method according to claim 1, characterized in that the carotid artery is selected for the magnetic treatment of blood. 3. The method according to PP.1, 2, characterized in that the magnetic processing of blood is carried out using a low-frequency pulsed magnetic therapy device and a local inductor of a pulsed alternating magnetic field. 4. The method according to PP.1-3, characterized in that the magnetic processing of blood is carried out according to the method, including, but not limited to the following steps: the head end of the bed is raised to 25 °, the influence of the electromagnetic field is carried out in the projection of the external carotid artery ex !.) on the side of the damaged hemisphere of the brain, observe a 45 ° turn of the head in the opposite direction; palpation determine the pulse wave in the region of the carotid triangle (Tsdopit eatoyeit), its maximum value; the inductor is firmly fixed clearly in this projection, and the exact differentiation of the zone and direction of the impact and maximum adherence of the inductor to the artery wall are observed. 5. The method according to claims 1-4, characterized in that the following parameters of a pulsed alternating magnetic field are set to -110% (70 ± 20 mT). 6. The method according to PP.1-5, characterized in that the impact of a pulsed alternating magnetic field is carried out according to the following scheme: immediately after surgery, the time of magnetic treatment is set to 35 minutes, after 4 hours 110% (70 ± 20 mT) - 35 min, 8 hours after surgery 110% (70 ± 20 mT) - 35 minutes, 12 hours after surgery 110% (70 ± 20 mT) - 35 min, then 1 time per day 110% (70 ± 20 mT ) - 25 min. 7. The method according to claims 1-6, characterized in that the carrier frequency is set near 100 Hz, and the modulation frequency is 10-20 Hz. 8. The method according to PP.1-7, characterized in that they set the following characteristics of the impact of a pulsed alternating magnetic field by the inductor: on the surface - 60 mT, 4 cm -1.5 mT, 3 cm - 2.5 mT, 2 cm - 6.7-8 mT, 1 cm - 15 mT, carrier frequency 100 Hz, modulation frequency 10-20 Hz. 9. The method according to claims 1-8, characterized in that the magnetic processing of blood in the area of the common carotid artery bifurcation is carried out by a low-frequency alternating electromagnetic field with an induction of 15-60 mT. 10. The method according to PP.1-9, characterized in that the number of procedures for exposure to low-frequency alternating electromagnetic field is from 8 to 15, with 10 procedures for exposure to low-frequency alternating electromagnetic field is the optimal number.