MD1560Z - Method for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis - Google Patents

Method for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis Download PDF

Info

Publication number
MD1560Z
MD1560Z MDS20210014A MDS20210014A MD1560Z MD 1560 Z MD1560 Z MD 1560Z MD S20210014 A MDS20210014 A MD S20210014A MD S20210014 A MDS20210014 A MD S20210014A MD 1560 Z MD1560 Z MD 1560Z
Authority
MD
Moldova
Prior art keywords
nacl solution
dissolved
ascites
peritonitis
patients
Prior art date
Application number
MDS20210014A
Other languages
Romanian (ro)
Russian (ru)
Inventor
Георге АНГЕЛИЧ
Сергей ПИСАРЕНКО
Олег КРУДУ
Татьяна ЗУГРАВ
Георге ЛУПУ
Original Assignee
Оу Государственный Университет Университет Медицины И Фармации "Nicolae Testemitanu" Республики Молдова
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Оу Государственный Университет Университет Медицины И Фармации "Nicolae Testemitanu" Республики Молдова filed Critical Оу Государственный Университет Университет Медицины И Фармации "Nicolae Testemitanu" Республики Молдова
Priority to MDS20210014A priority Critical patent/MD1560Z/en
Publication of MD1560Y publication Critical patent/MD1560Y/en
Publication of MD1560Z publication Critical patent/MD1560Z/en

Links

Landscapes

  • Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)

Abstract

The invention relates to medicine, in particular to hepatology, and can be used for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis.Summary of the invention consists in that infusion therapy is carried out with parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological and antiplatelet drugs, diuretics, and simultaneously, under local anesthesia, puncture approaches are performed in the region of the left and right iliac fossa and under the right costal arch, the ascitic fluid is evacuated, then through the same approaches, a mixture is injected into each region, which contains 4…8 mg of dexamethasone, dissolved in 50…100 ml of 0.9% NaCl solution, hyaluronidase 124…248 IU, dissolved in 100…200 mL of 0.9% NaCl solution, an antibiotic from the cephalosporin group, dissolved in 50…100 mL of 0.9% NaCl solution and an antimicrobial drug from the nitroimidazole group, in a dose of 5…10 mg/mL and in a volume of 25…75 ml, daily, for 3…5 days.

Description

Invenţia se referă la medicină, în special la hepatologie şi poate fi utilizată pentru tratamentul miniinvaziv al ascit-peritonitei spontane bacteriene la pacienţii cu ciroză hepatică decompensată. The invention relates to medicine, in particular to hepatology and can be used for the minimally invasive treatment of spontaneous bacterial ascites-peritonitis in patients with decompensated liver cirrhosis.

Este cunoscută metoda de tratament al ascit-peritonitei spontane bacteriene, care constă în efectuarea laparocentezei de volum cu evacuarea lichidului ascitic contaminat şi administrarea i/v a antibioticelor şi anume a preparatelor din grupa cefalosporinelor de generaţia III (ceftriaxonă câte 1 g de 2 ori, timp de 5...7 zile) şi administrarea preparatelor hepatoprotectoare, diureticelor, aminoacizilor cu catenă ramificată [1]. The method of treatment of spontaneous bacterial ascites-peritonitis is known, which consists of performing volume laparocentesis with evacuation of contaminated ascitic fluid and i/v administration of antibiotics, namely preparations from the group of cephalosporins of the third generation (ceftriaxone 1 g 2 times, for 5...7 days) and the administration of hepatoprotective preparations, diuretics, branched-chain amino acids [1].

Dezavantajul metodei date constă în eficacitatea redusă şi procentul înalt de mortalitate în rezultatul progresării procesului septic intraabdominal şi insuficienţei hepato-renale. The disadvantage of this method is its low effectiveness and high mortality rate as a result of the progression of the intra-abdominal septic process and hepatorenal insufficiency.

Mai este cunoscută metoda de tratament al ascit-peritonitei spontane bacteriene, care constă în aceea că se efectuează terapia intensivă cu administrarea parenterală a antibioticelor, hepatoprotectoarelor, plasmei, aminoacizilor, preparatelor reologice şi dezagregante, diureticelor, iar adăugător se efectuează laparocenteza cu evacuarea a 3...5 L de lichid ascitic contaminat. Apoi prin abord laparoscopic, după evacuarea suplimentară a lichidului ascitic din etajul abdominal superior sub controlul vizual se instalează un tub de drenaj în etajul abdominal inferior, prin care se insuflă CO2 în cantitate de 3000...5000 cm3, care se barbotează prin lichidul ascitic restant, timp de 3…5 min, după care gazul se evacuează prin troacarul superior. Apoi prin drenul menţionat se insuflă O2 în cantitate de 1000...3000 cm3, care se barbotează prin lichidul ascitic, timp de 2…3 min, după care se evacuează tot lichidul ascitic restant. Apoi prin drenul menţionat se introduce consecutiv sol. lidocaină de 2% în cantitate de 20...30 ml, dexametazon 8…16 mg, în 100...200 ml sol. NaCl 0,9 %, lidază 370…640 un. cu sol. NaCl 0,9 % în cantitate de 200…500 ml, un antibiotic din grupa cefalosporinelor şi antimicrobiene din grupa fluorchinolonelor, fiecare din ele cu sol. NaCl 0,9 % în cantitate de 200…500 ml. Procedura de introducere a preparatelor menţionate prin drenul instalat se efectuează zilnic, timp de 3...5 zile [2]. There is also a known method of treating spontaneous bacterial ascites-peritonitis, which consists in performing intensive therapy with parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological and disaggregating preparations, diuretics, and additionally performing laparocentesis with evacuation of 3...5 L of contaminated ascitic fluid. Then, through a laparoscopic approach, after additional evacuation of ascitic fluid from the upper abdominal floor under visual control, a drainage tube is installed in the lower abdominal floor, through which CO2 is insufflated in an amount of 3000...5000 cm3, which is bubbled through the remaining ascitic fluid, for 3...5 min, after which the gas is evacuated through the upper trocar. Then through the mentioned drain O2 is insufflated in an amount of 1000...3000 cm3, which is bubbled through the ascitic fluid, for 2...3 min, after which all the remaining ascitic fluid is evacuated. Then through the mentioned drain 2% lidocaine solution is consecutively introduced in an amount of 20...30 ml, dexamethasone 8...16 mg, in 100...200 ml 0.9% NaCl solution, lidase 370...640 units with 0.9% NaCl solution in an amount of 200...500 ml, an antibiotic from the cephalosporin group and antimicrobials from the fluoroquinolone group, each of them with 0.9% NaCl solution in an amount of 200...500 ml. The procedure for introducing the mentioned preparations through the installed drain is performed daily, for 3...5 days [2].

Dezavantajul metodei date constă în aceea că pentru efectuarea metodei este necesară anestezia generală, care poate agrava starea pacientului cirotic decompensat, care poate conduce uneori la progresarea encefalopatiei cu trecere în comă hepatică ireversibilă. The disadvantage of this method is that general anesthesia is required to perform the method, which can worsen the condition of the decompensated cirrhotic patient, which can sometimes lead to the progression of encephalopathy with irreversible hepatic coma.

Problema pe care o rezolvă invenţia constă în elaborarea unei metode de tratament minim-invaziv al ascit-peritonitei spontane bacteriene, care constă în asanarea cavităţii abdominale prin accese multiple puncţionale atraumatice cu scop de a minimiza trauma fizică şi psihologică a pacientului şi reducerea cheltuielilor şi duratei de spitalizare. The problem solved by the invention consists in developing a minimally invasive treatment method for spontaneous bacterial ascites-peritonitis, which consists in cleaning the abdominal cavity through multiple atraumatic puncture accesses with the aim of minimizing the patient's physical and psychological trauma and reducing expenses and duration of hospitalization.

Esenţa invenţiei constă în aceea că se efectuează terapia infuzională cu administrarea parenterală a antibioticelor, hepatoprotectorilor, plasmei, aminoacizilor, preparatelor reologice şi dezagregante, diureticelor, şi concomitent, sub anestezie locală, se efectuează accese puncţionale în regiunea fosei iliace stângi şi drepte şi sub rebordul costal drept, se evacuează lichidul ascitic, apoi prin aceleaşi accese, în fiecare regiune se introduce câte un amestec, care conţine 4...8 mg de dexametazonă dizolvată în 50...100 ml de soluţie de NaCl 0,9 %, hialuronidază 124...248 UI dizolvată în 100...200 ml de soluţie de NaCl 0,9 %, un antibiotic din grupa cefalosporinelor dizolvat în 50...100 ml de soluţie de NaCl 0,9 % şi un preparat antimicrobian din grupa nitroimidazolilor, în doză de 5...10 mg/ml şi în volum de 25...75 ml, zilnic, timp de 3...5 zile. The essence of the invention consists in performing infusion therapy with parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological and disaggregating preparations, diuretics, and simultaneously, under local anesthesia, puncture accesses are made in the region of the left and right iliac fossa and under the right costal margin, the ascitic fluid is evacuated, then through the same accesses, a mixture is introduced into each region, which contains 4...8 mg of dexamethasone dissolved in 50...100 ml of 0.9% NaCl solution, hyaluronidase 124...248 IU dissolved in 100...200 ml of 0.9% NaCl solution, an antibiotic from the cephalosporin group dissolved in 50...100 ml of 0.9% NaCl solution and an antimicrobial preparation from the nitroimidazole group, in a dose of 5...10 mg/ml and in a volume of 25...75 ml, daily, for 3...5 days.

Rezultatul invenţiei constă în ameliorarea stării pacientilor prin accese multiple puncţionale atraumatice pentru atenuarea procesului inflamator septic intraabdominal, ameliorarea proceselor de resorbţie peritoneală a lichidului ascitic cu scop de redresare a funcţiei hepatice, corecţia sindromului ascitic, totodată are loc minimizarea traumei fizice şi psihologice a pacientului cu reducerea cheltuielilor şi duratei de spitalizare. The result of the invention consists in improving the condition of patients through multiple atraumatic puncture accesses to alleviate the intra-abdominal septic inflammatory process, improving the peritoneal resorption processes of ascitic fluid with the aim of restoring liver function, correcting ascitic syndrome, while minimizing the patient's physical and psychological trauma with a reduction in expenses and duration of hospitalization.

Metoda se efectuează în modul următor. După pregătirea necesară a pacientului se efectuează terapia infuzională cu administrarea parenterală a antibioticelor, hepatoprotectorilor, plasmei, aminoacizilor, preparatelor reologice şi dezagregante, diureticelor, şi concomitent, sub anestezie locală, se efectuează accese puncţionale în regiunea fosei iliace stângi şi drepte şi sub rebordul costal drept, se evacuează lichidul ascitic, apoi prin aceleaşi accese, în fiecare regiune se introduce câte un amestec, care conţine 4...8 mg de dexametazonă dizolvată în 50...100 ml de soluţie de NaCl 0,9 %, hialuronidază 124...248 UI dizolvată în 100...200 ml de soluţie de NaCl 0,9 %, un antibiotic din grupa cefalosporinelor dizolvat în 50...100 ml de soluţie de NaCl 0,9 % şi un preparat antimicrobian din grupa nitroimidazolilor, în doză de 5...10 mg/ml şi în volum de 25...75 ml, zilnic, timp de 3...5 zile. The method is performed in the following way. After the necessary preparation of the patient, infusion therapy is performed with parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological and disaggregating preparations, diuretics, and simultaneously, under local anesthesia, puncture accesses are performed in the region of the left and right iliac fossa and under the right costal margin, the ascitic fluid is evacuated, then through the same accesses, a mixture is introduced into each region, which contains 4...8 mg of dexamethasone dissolved in 50...100 ml of 0.9% NaCl solution, hyaluronidase 124...248 IU dissolved in 100...200 ml of 0.9% NaCl solution, an antibiotic from the cephalosporin group dissolved in 50...100 ml of 0.9% NaCl solution and an antimicrobial preparation from the nitroimidazole group, in a dose of 5...10 mg/ml and in a volume of 25...75 ml, daily, for 3...5 days.

Metoda revendicată a fost utilizată pentru tratamentul a 21 de pacienţi. The claimed method was used for the treatment of 21 patients.

Exemplu Example

Pacientul D., 52 ani a fost internat în secţia chirurgie septică cu diagnosticul de ciroză hepatică decompensată HCV, Child “C”(11), hipertensiune portală, ascit-peritonită spontană bacteriană tensionată. Prezenta febră 37,8°C, dureri abdominale, meteorism, oligurie. S-a efectuat terapia infuzională detoxifiantă, reologică, hepatoprotectorie, transfuzii de plasmă, albumină, diureză forţată. S-a efectuat puncţia cavităţii abdominale cu examinarea lichidului ascitic la prezenţa de neutrofile polimorfonucleare (NPN), care s-a stabilit la nivelul de 320 mm3, ce a confirmat diagnosticul de peritonită spontană bacteriană. S-a efectuat terapia infuzională cu administrarea parenterală a antibioticelor, hepatoprotectoarelor, plasmei, aminoacizilor, preparatelor reologice şi dezagregante, diureticelor, iar concomitent sub anestezie locală s-au efectuat accese puncţionale în regiunea fosei iliace stângi şi drepte şi sub rebordul costal drept, s-a evacuat lichidul ascitic, apoi prin aceleaşi accese în fiecare regiune s-au introdus câte 6 mg de dexametazonă în 100 ml sol. NaCl 0,9 %, hialuronidază 248 UI cu sol. NaCl 0,9 % în cantitate de 200 ml, ceftriaxon 1,0 g cu sol. NaCl 0,9 % în cantitate de 50 ml şi antimicrobiene din grupa nitroimidazolului 10 mg/ml în volum de 75 ml, care s-a efectuat zilnic, timp de 5 zile. După 72 de ore starea generală s-a ameliorat, a dispărut febra, s-a restabilit diureza, ascita s-a micşorat, probele funcţionale hepatice s-au ameliorat. Pacientul a fost externat la tratament ambulatoriu peste 7 zile. Patient D., 52 years old, was admitted to the septic surgery department with a diagnosis of decompensated HCV liver cirrhosis, Child “C” (11), portal hypertension, tense spontaneous bacterial peritonitis-ascites. He had fever of 37.8°C, abdominal pain, flatulence, oliguria. Infusional detoxification, rheological, hepatoprotective therapy, plasma transfusions, albumin, forced diuresis were performed. Abdominal puncture was performed with examination of the ascitic fluid for the presence of polymorphonuclear neutrophils (PNF), which was established at the level of 320 mm3, which confirmed the diagnosis of spontaneous bacterial peritonitis. Infusion therapy was performed with parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological and disaggregant preparations, diuretics, and simultaneously under local anesthesia, puncture accesses were performed in the region of the left and right iliac fossa and under the right costal margin, the ascitic fluid was evacuated, then through the same accesses in each region, 6 mg of dexamethasone in 100 ml of 0.9% NaCl solution, 248 IU of hyaluronidase with 0.9% NaCl solution in an amount of 200 ml, 1.0 g of ceftriaxone with 0.9% NaCl solution in an amount of 50 ml and antimicrobials from the nitroimidazole group 10 mg/ml in a volume of 75 ml, which was performed daily for 5 days. After 72 hours, the general condition improved, the fever disappeared, diuresis was restored, ascites decreased, liver function tests improved. The patient was discharged for outpatient treatment after 7 days.

1. Хохлов А.В. Хирургическое лечение резистентного асцита у больных циррозом печени. Автореферат дисс. докт.мед.наук.,Санкт-Петербург, 2002, 184 с. 1. Khokhlov A.V. Surgical treatment of resistant ascites in patients with liver cirrhosis. Dissertation abstract. докт.мед.наук., Санкт-Петербург, 2002, 184 с.

2. MD 926 Y 2015.07.31 2. MD 926 Y 2015.07.31

Claims (1)

Metodă de tratament miniinvaziv al ascit-peritonitei spontane bacteriene la pacienţii cu ciroză hepatică decompensată, care constă în aceea că se efectuează terapia infuzională cu administrarea parenterală a antibioticelor, hepatoprotectorilor, plasmei, aminoacizilor, preparatelor reologice şi dezagregante, diureticelor, şi concomitent, sub anestezie locală, se efectuează accese puncţionale în regiunea fosei iliace stângi şi drepte şi sub rebordul costal drept, se evacuează lichidul ascitic, apoi prin aceleaşi accese, în fiecare regiune se introduce câte un amestec, care conţine 4...8 mg de dexametazonă dizolvată în 50...100 ml de soluţie de NaCl 0,9 %, hialuronidază 124...248 UI dizolvată în 100...200 ml de soluţie de NaCl 0,9 %, un antibiotic din grupa cefalosporinelor dizolvat în 50...100 ml de soluţie de NaCl 0,9 % şi un preparat antimicrobian din grupa nitroimidazolilor, în doză de 5...10 mg/ml şi în volum de 25...75 ml, zilnic, timp de 3...5 zile.A method of minimally invasive treatment of spontaneous bacterial ascites-peritonitis in patients with decompensated liver cirrhosis, which consists in performing infusion therapy with parenteral administration of antibiotics, hepatoprotectors, plasma, amino acids, rheological and disaggregating preparations, diuretics, and simultaneously, under local anesthesia, puncture accesses are made in the region of the left and right iliac fossa and under the right costal margin, the ascitic fluid is evacuated, then through the same accesses, a mixture is introduced into each region, which contains 4...8 mg of dexamethasone dissolved in 50...100 ml of 0.9% NaCl solution, hyaluronidase 124...248 IU dissolved in 100...200 ml of 0.9% NaCl solution, an antibiotic from the cephalosporin group dissolved in 50...100 ml of 0.9% NaCl solution and an antimicrobial preparation from the group nitroimidazoles, in a dose of 5...10 mg/ml and in a volume of 25...75 ml, daily, for 3...5 days.
MDS20210014A 2021-02-25 2021-02-25 Method for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis MD1560Z (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
MDS20210014A MD1560Z (en) 2021-02-25 2021-02-25 Method for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
MDS20210014A MD1560Z (en) 2021-02-25 2021-02-25 Method for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis

Publications (2)

Publication Number Publication Date
MD1560Y MD1560Y (en) 2021-08-31
MD1560Z true MD1560Z (en) 2022-03-31

Family

ID=77635755

Family Applications (1)

Application Number Title Priority Date Filing Date
MDS20210014A MD1560Z (en) 2021-02-25 2021-02-25 Method for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis

Country Status (1)

Country Link
MD (1) MD1560Z (en)

Also Published As

Publication number Publication date
MD1560Y (en) 2021-08-31

Similar Documents

Publication Publication Date Title
US3232836A (en) Facilitating healing of body surface wounds by intravenous administration of n-acetyl glucosamine, glucosamine, or pharmaceutically acceptable acid salts of glucosamine
Koch et al. Bile-blood fistula: a complication of percutaneous transhepatic cholangiography
US6720011B1 (en) Injectable composition for cancer treatment
Lawson et al. NAC and antibiotics in cystic fibrosis
JP2704546B2 (en) ATLL therapeutic inhalant
MD1560Z (en) Method for minimally invasive treatment of bacterial spontaneous ascites-peritonitis in patients with decompensated liver cirrhosis
Bennett-Jones et al. A comparison of intraperitoneal and intravenous/oral antibiotics in CAPD peritonitis
Bortolussi et al. Treatment of Candida peritonitis by peritoneal lavage with amphotericin B
MD926Z (en) Method of laparoscopic treatment of spontaneous bacterial ascites-peritonitis in decompensated liver cirrhosis
Daimon et al. Efficacy of extracorporeal ultrafiltration of ascitic fluid as a treatment of refractory ascites.
RU2203667C2 (en) Method for treating lymphoproliferative diseases
RU96122812A (en) METHOD FOR CORRECTION OF FUNCTIONAL STATE OF THE ORGANISM
Yol et al. Whole gut washout ameliorates the progression of acute experimental pancreatitis
CN105769849B (en) A kind of pharmaceutical composition for treating oophoroma
Offerman et al. Influence of captopril on cis-diamminedichloroplatinum-induced renal toxicity
Woods Susceptibility to experimental pyelonephritis when hormonal hypertension is prevented by hypotensive drugs
JPH0560813B2 (en)
MD927Z (en) Method for treatment of anaerobic spontaneous peritonitis in decompensated hepatocirrhosis with hepato-renal syndrome
Golper et al. Incomplete activation of intraperitoneal clindamycin phosphate during peritoneal dialysis
MD1593Z (en) Method for improving liver microcirculation in decompensated and ascites-peritonitis complicated liver cirrhosis
Rattner et al. Bacteremia and shock in urology
BORCSTRÖM et al. Healing of colon anastomoses: an experimental study in the rabbit
Berio et al. PROPHYLAXIA OF CYSTINE CALCULOSIS BY α-MERCAPTOPROPIONYLGLYCINE ADMINISTERED CONTINUOUSLY OR EVERY OTHER DAY
RU2071773C1 (en) Medicinal agent for treatment of acquired immunodeficiency syndromes, among them hiv-depended
RU2266738C2 (en) Method for treating endotoxicosis cases accompanying pyoseptic small pelvis diseases

Legal Events

Date Code Title Description
FG9Y Short term patent issued