RU1814561C - Method for management of cerebrospinal pathologic state - Google Patents

Abstract

The invention relates to medicine, namely to neurology, neurosurgery, resuscitation, and can be used to treat cerebrospinal pathology, for example, meningitis, meningoencephalitis, osteochondrosis. The method improves the recovery of central nervous system functions. For this, lumbar punctures are performed at two levels, liquor pressures at the inlet and outlet are determined and the direction of liquor sorption is determined by their values, then liquorosorption is performed to the liquor osmolarity level below 270 mosmol-l, then stop sorption and alignment of osmolarity of the cerebrospinal fluid throughout the cerebrospinal fluid space, which leads to a change in the water-salt balance, alignment of intracranial and spinal cord volumes, and this in turn leads to an improvement in neurological symptoms. 1 ill. w 6

Description

The invention relates to medicine, namely to neurology, neurosurgery, resuscitation and can be used to treat cerebrospinal pathology, for example, meningitis, meningoencephalitis. osteochondrosis.

The aim of the proposed method is to increase the effectiveness of treatment due to a more complete regression of neurological symptoms.

The drawing shows a device that implements the proposed method.

The device consists of lumbar needles 1 to which liquor pressure gauges, a mass exchanger, and an infusomat are connected through a system of silicone tubes.

The method is carried out as follows.

A lumbar puncture is performed. The cerebrospinal fluid pressure, cell composition, and biochemical and spectral analyzes of cerebrospinal fluid are determined; its osmolarity.

After obtaining rapid analyzes, a lumbar puncture is performed at the 2nd level after 1-2 vertebrae, cerebrospinal fluid pressure is measured and the direction of cerebrospinal fluid absorption (from larger to smaller) is determined.

A liquor absorption system is being assembled, which includes liquor pressure gauges at the inlet and outlet, lines of silicone tubes of 0 4 mm, a mass exchanger developed by VNI-BMI with a volume of 20 mm with a sorbent, for example, Aktilen-1 and infusomat with the speed of liquor from 0 to 1.5 ml / min.

00

ft

ABOUT

 With

The assembled system is connected to the needles for spinal puncture and the sorption process begins. At certain time intervals of 15-30 minutes, control biochemical analyzes of the cerebrospinal fluid and its osmolarity are carried out. The cerebrospinal fluid in the area between the two points is cleaned up to an osmolarity level of at least 270 mosmol / l.

In order to improve the oxidative process before the cerebrospinal fluid returns to the body, it can be heated to the temperature of the patient’s internal environment.

Then the sorption system is turned off.

As a result of changes in osmolarity, measurement of the concentration gradient of toxic metabolites in the cerebrospinal fluid after sorption, the concentrations in the entire cerebrospinal fluid are equalized, cerebrospinal fluid cysts, intracerebral hematomas, etc. are released, which leads to an improvement in neurological symptoms.

Example. The patient was in the neurosurgical department LNIITO them. R.R.Vredena from 06.26.91. Received complaints of pain in the lumbar spine, lower limbs, range of motion.

When viewed in neurological status; smoothness of lumbar lordosis, pain on palpation of the region L-4-5, L-5-1, positive symptoms of tension on both sides. Hypesthesia in the area L-5-C-1 on the left. Decreased knee and Achilles reflex on the left.

On R-grams sacralization L-5, scoliotic deformity along the lumbar spine, signs of osteochondrosis. Diagnosis at admission: osteochondrosis of the lumbosacral spine. Cicatricial commissural epiduritis. Radicular syndrome.

He considers himself a patient for about 3 years. In December 1989, he was operated on to remove hernia of the intervertebral disc L-4-5 on the left. After surgery, the pain decreased, but did not pass. After a few months, the pain resumed. The neurological status was determined: hypesthesia in the L-5-C-1 zone on the left, a positive symptom of Lesia on both sides, a decrease in the knee and achilles reflex on the left, limitation of the range of movements in the lumbar spine and lower extremities.

During her stay in the hospital she received vascular, sedative, analgesic, general strengthening therapy, rheological and

anabolic drugs, physiotherapeutic treatment (magnetotherapy, laser therapy, physiotherapy, hydromassage, electrophoresis), paravertebral and epidural blocks with trimecaine. The effect of conservative therapy was not received, the pain did not decrease.

After evaluating the clinical data, the neurological status, a lumbar puncture was made, the following results were obtained: Protein 0.33 g / l, cytosis Zb / 3, Pandy + reaction, colorless transparent, urea 4.41 mmol / l, glucose 1.0 mmol / l, chlorides 161 mmol / l, osmolarity 286 mosmol / l. After evaluating the rapid analysis, we decide on the need for liquororption. We produce the second lumbar puncture, determine the liquor pressure on each lumbar needle with a manometer and determine the direction of sorption. We carry out sorption every 15 minutes, making an express analysis of liquor for osmolarity. After 45 minutes, we obtain an osmolarity of 273 mosmol / L, and we turn off the system. After sorption, the results of laboratory liquor data were: protein 0.165, cytoe 6/3, Pandy + reaction, colorless transparent, urea 2.5 mmol / L, glucose 0.25 mmol / L, chlorides 77 mmol / L. osmolarity 273 mosmol / l.

As a result of the performed cerebrospinal fluid sorption, an improvement in neurological symptoms was noted: restoration of sensitivity in the L-5 dermatome on the left, tension symptoms regressed, pain decreased.

After 7 days /26.04/ in connection with a good analgesic effect after liquorosorption, it was decided to repeat it. Under local anesthesia, a lumbar puncture was performed at the level of L-4-5. The following results were obtained: protein 0.33 g / l, cytosis 42/3, Pandy reaction +, colorless transparent, urea 6.66 mmol / l, glucose f, 5 mmol / l, chlorides 114 mmol / l, osmolarity 290 mosmol / l. After evaluating the rapid analysis, it was decided to repeat liquororption. We produce the second lumbar puncture at the level of L-3-4, determine the liquor pressure on each lumbar needle with a manometer and determine the direction of liquorosorption. We perform sorption by determining laboratory liquor data and osmolarity every 15 minutes. After 30 min, we obtain an osmolarity of 276 mosmol / L, and we turn off the system. After sorption, the results

laboratory data were: protein 0.099 g / l, cytosis 2/3, Pandy - reaction, colorless transparent, urea 3.2 mmol / l, glucose 0.25 mmol / l, chlorides 105 mmol / l, osmolarity 276 mosmol / l

As a result of liquororption, the patient notes improvement, walks without crutches. Neurologically: restoration of sensitivity in L-4-5 dermatomes on the left, tension symptoms regression / cm Lassega negative /, pain decreased. In satisfactory condition, was discharged under the supervision of a neurologist.

0

5

Claims (2)

1. A method of treating a cerebrospinal pathological condition by sorption of cerebrospinal fluid in a gradual closed-cycle mode, characterized in that, in order to increase the effectiveness of treatment due to a more complete regression of neurological symptoms, lumbar puncture is performed at two levels, and sorption is performed before osmosis liquor level not lower than 270 mosmol / l. 2. The method of claim 1, wherein the cerebrospinal fluid is heated to the temperature of the internal environment of the body for reinfusion.