RU1827239C - Method for treating infected wounds - Google Patents

Abstract

The invention relates to medicine, in particular to a method for treating infected wounds. Using the proposed method allows to create an increase in the concentration of specific highly active chemicals in the volume of the wound cavity, to carry out the selective effect of low-frequency ultrasound and gas components on various groups of pathogenic microorganisms, prevent the development of severe purulent-septic complications and reduce the treatment time to 7-8 days. This is achieved by combined exposure to the wound surface through an intermediate drug solution with low-frequency ultrasound in combination with gas components (oxygen, nitrogen) with the latter feeding into the zone of the cavitation region adjacent to the radiating end of the waveguide tool, 1 sfp. WITH 3

Description

The invention relates to medicine, namely to surgery, and relates to the treatment of infected wounds.

The purpose of the invention is to reduce the treatment time due to the targeted exposure to pathogenic microflora with various types of respiration by a complex of factors initiated in the wound cavity by low-frequency ultrasound and gas components.

The goal is achieved in that in the method of treating infected wounds by exposure to the wound surface with low-frequency ultrasound through an intermediate drug solution, they are additionally exposed to the gas component and supplied to the zone of the causal region adjacent to the emitting end of the waveguide-multiplex. In this case, gaseous oxygen and nitrogen are used as gas components.

In FIG. 1 is a flow chart of a method for treating an infected wound with a gas component and supplying it to the cavitation area; in FIG. 2 is a cross section of the working part of the waveguide tool and its radiating end with the gas component flowing out through the axial channel.

A device for implementing a method for treating infected wounds comprises an acoustic unit 1 with an attached waveguide tool 2, provided with an internal axial channel 3, the working part of the waveguide tool 2 is made in the form of a developed emitting end 4 s

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reverse taper to increase the radiating surface of the end and create a delimited zone of a developed cavitation region (reaction zone).

. In the axial channel 3 of the waveguide-tool 2, a fluoroplastic supply tube 5 is installed for supplying the gas component b directly to the developed cavitation region adjacent to the radiating end 4. The fluoroplastic is selected from the condition that heat exchange of the gas component b fed through the tube 5 with the heating due to internal friction forces during ultrasonic vibrations of the waveguide tool 2, as well as draining of ultrasonic vibrations to the supply tube 5, while one end of the tube 5 communicates with the gas supply system component and the other end of the tube 5 is installed in the upper base of the cone of the radiating end 4 of the waveguide tool 2. As a source of low-frequency ultrasonic vibrations, a commercially available ultrasonic generator for surgical purposes such as URSK-7N-18 (not shown) is used.

The method is based on taking into account the selective effect of the corresponding gas components on various groups of pathogenic microorganisms characterized by different types of respiration, as well as on the creation of elevated concentrations of specific highly active chemicals in the volume of the wound cavity that can cause significant disturbances in the structure of the bacterial cell. At the same time, the saturation of the wound cavity volume with highly active chemicals is caused by the formation of a large number of highly active primary and secondary products of sound chemical reactions in the reaction zone — the zone of the caamation region, which represents the cating gas-liquid phase (liquid drug solution), than in the case of initiation of sound chemical reactions only in the liquid phase of the drug.

The proposed treatment method is as follows. At the preliminary stage, the patient undergoes general clinical research methods. Immediately before the start of treatment, a wound is removed for cytological, morphological, bacteriological and gas chromatographic methods, and the pH of the wound is determined using a pH-millivoltmeter pH-150. For rapid diagnosis of anaerobic non-clostridial infection (ANI) in the clinical material, it is possible to use gas chromatographic vapor-phase analysis of volatile fatty acids (VFA) with the gas chromatographic part of the analysis performed on a CHROM 5 chromatograph.

After obtaining the results of gas chromatographic analysis and determining the type of pathogenic microflora, a gas component is selected that has a bactericidal effect on a particular type of microorganism. After that, the waveguide instrument is immersed in a wound cavity filled with a medicinal solution (furatsilin 1: 5000) to a depth that excludes mechanical destruction of nearby tissues of the wall of the wound cavity. The source of low-frequency ultrasonic vibrations is turned on and, moving the waveguide-insturmeitis. The wound cavity is processed under the following parameters of the process of biological tissue tissue involvement:

-frequency of ultrasonic vibrations - 26.5 kHz;

the amplitude of oscillations of the radiating end of the waveguide tool is 55-60 microns:

-exposure of ultrasonic exposure - 5 e / cm of the wound surface;

- the distance between the radiating end of the waveguide tool and the wall of the wound cavity is at least 5 mm;

- gas component consumption - 80 ml / min.

At the same time, with the inclusion of ultrasonic vibrations, a gas component supply system is switched on, which, through a fluoroplastic supply tube installed in the axial channel of the tool waveguide, is brought to the developed cavitation region zone, which is formed in the ultrasonic field near the radiating end of the waveguide tool.

The resulting physicochemical processes initiated by cavitation, acoustic currents and variable sound pressure, as well as other physical factors, cause the gas component introduced into the voiced drug solution to mix and dissolve to achieve a metastable system - gas dispersion in the liquid. At the same time, in the developed cavitation zone in the vapor-gas phase of the oscillating quasi-cavities due to electrical breakdown, excited and ionized molecules of the vapors of the aode and the gas component present, as well as secondary products of their reaction, are formed, which then pass to the dispersion medium surrounding the developed cavitation of the drug solution. By acoustic currents and variable sound pressure creating intense mass transfer, these highly active primary and secondary products of sound-chemical reactions are distributed throughout the entire volume of the wound cavity being treated, and are also deposited in the surface layers of the wound; the main mass of pathogenic microorganisms is known to accumulate. At the same time, due to the inverse ultrasonic capillary effect, extraction of pathological contents and flame-induced microflora from

a capillary-porous system of the wound surface into the volume of the wound cavity, filled with a medicinal solution saturated with specific highly active chemical groups of substances.

These highly active substances are the products of sound chemical reactions (Н, Н +, На, ОН, Н202. О, 02, N. N2. N0, СО, СО, etc.) formed in the ultrasonic field depending on the composition of the initial gas-liquid cocktail arising during the bubbling and ultrasonic mixing of the gas component and the drug solution in the volume of the reaction zone - the developed cavitation zone, manifesting their biocatalytic properties, specifically affect the shells of microorganisms, destroying them, disrupting or stopping the redox processes in ikrobnyh cells causing their death. The studies conducted on the BMMS Mk 2 microanalyzer of acid-base equilibrium of the Radiometer (Dani) company indicate a high partial voltage of the dissolved gas components in the ultrasonic field as compared to simple bzbogging and that the gas solubility in the ultrasonic field is much higher than the equilibrium.

The presence of one or more VFAs in the test material is an indication for use as the gaseous component of oxygen supplied to the zone of the cavitation region. If there is no VFA in the gas chromatographic analysis, gaseous nitrogen or carbon dioxide is used as the gaseous component. Sounding is also carried out with the above parameters.

At the end of the treatment of the infected wound, the ultrasound is turned off, the wound contents are collected and bacteriological, chromatographic and morphological methods of investigation are taken, the pH of the wound is determined

separable as well as visual inspection. Based on the results of the control, a conclusion is drawn on the appropriateness of the further use of one or another gas component, as well as the extension or termination of the treatment process. The number of treatment sessions for infected wounds by the proposed method is determined in each case depending on the 10 degree of infection, depth, area, configuration and dynamics of reparative processes. The total number of sessions per treatment course is not more than 7-8, carried out daily.

5 The combined use of low-frequency ultrasound and gas components was used in 94 patients with purulent wounds of soft tissues of various localization.

0 L r memer 1. Sick K., 47 years old. Diagnosis: postinjection abscess of the annual region. Under aseptic conditions, with the help of a needle and syringe tf, dense rubber rings of the piston are produced

5 point purulent foci for bacteriological examination and rapid diagnosis of anaerobic infection. In the analysis obtained after 25 minutes, a large amount of VFA is present in the pathological material. Under mask anesthesia, a wide dissection of the purulent focus is performed, characterized by the presence of profuse

5 purulent-putrid exudate of dark color. odorless. The combination of clinical and chromatographic data made it possible to establish early and confidently,

0 that in this case a non-clostridial anaerobic infection develops. We excise necrotic tissue, rinse the wound with a solution of hydrogen peroxide and perform ultrasonic cavitation using the URSK-7N-18 unit with the supply of an oxygen cavitation zone in accordance with the parameters described above. The wound is drained by the traditional method. In the following days, ultrasound

0 cavitation according to the proposed technique. On the 3rd day, the wound cleared of necrotic tissues, then a pronounced granulation tissue appeared, and there were no VFAs in the chromatograms. This allowed on the 4th day

5 to perform initially deferred seams. Last shots on the 8th day. Primary healing.

Example 2. Sick L., 23 years old, was admitted to the hospital with a diagnosis of acute purulent lactational mastitis. Under aseptic conditions, an abscess was punctured in compliance with the conditions of anaerobiosis. Received thick pus. Gas chromatographic

the study revealed the presence of only a peak of acetic acid in the test material, which indicates the presence of staphylococcal infection.

Under mask anesthesia with a radial incision, the skin and subcutaneous tissue were dissected. Stand out up to 80 ml of thick pus odorless. Pus was taken for bacteriological examination, the wound was filled with an antiseptic solution. Ultrasonic cavitation of the wound was made with the supply of nitrogen gas to the cavitation zone. Prior to suturing, wound treatment using the proposed method significantly reduces bacterial contamination, which is confirmed microbiologically (sterile cultures). The wound is drained by the insertion of two perforated drainage tubes through separate punctures of healthy skin. The wound is sutured through all layers. In the postoperative period, the wound was washed through drainage with antiseptic solutions. Drainages were removed on the 5th day, and sutures were removed on the 7th day.

Summarizing the data obtained, we can say that the developed method of treatment gives better results in the treatment of patients in comparison with the known:

- treatment time is reduced from 8-10 to 7-8 days;

-express diagnosis of non-clostridial anaerobic infection allows

timely select treatment tactics, in connection with which to prevent the development of severe purulent-septic complications;

- taking into account the presently increased polymorphism of the microbial flora of infected wounds, it allows the selective action of HCI and the corresponding gas components on various groups of pathogenic microorganisms, as well as the creation of increased concentrations of specific highly active chemicals in the volume of the wound cavity that can cause significant disturbances in the structure of the bacterial cell ;

-possible widespread use of this method in outpatient settings;

Satisfactory treatment results are provided.

Claims (2)

1. A method of treating infected wounds by exposure to the wound surface with low-frequency ultrasound through an intermediate drug solution, characterized in that, in order to reduce the treatment time, the wound surface is treated with low-frequency ultrasound with the simultaneous supply of gas components to the zone of the cavitation region. 2. A method according to claim 1, characterized in that gaseous oxygen is used as the gas component in anaerobic non-clostridial infection, and gaseous nitrogen in the aerobic flora.