RU2000825C1 - Method of woman perineum wound treating after birth delivery - Google Patents

Abstract

The proposed method is used in obstetrics and gynecology in the treatment of postpartum perineal wounds. The essence of the method: through an annular ferrite magnet with a magnetic field strength of 25 - 35 mT, they are exposed to infrared semiconductor continuous Laser radiation, a wavelength of 0.81 μm, a density l of radiation power of 18-22 mW / cm daily for 4 - 5 days, an exposure of 1 - 4 min at an angle of 80 - 85 ° C depending on the size of the wound Technical result: the method has a pronounced anti-inflammatory effect, thereby increasing the effectiveness of the prevention of joint divergence with a decrease in the percentage of purulent-inflammatory complications neniy. 1 tab.

Description

The invention relates to medicine, namely to obstetrics and gynecology in the treatment of postpartum perineal wounds.

Wounds of the soft tissues of the birth canal are the most common form of postpartum diseases. A similar disease occurs up to 25%. The healing of perineal wounds has its own differences, due to the anatomical and physiological features of this area - it is the impossibility of creating an obstruction due to tonic and volitional contractions of the muscles of the anal pulp and perineum, permanent bacterial contamination of the wound with lochia, functional changes in the tissue of the birth channel. They often lead to serious complications, in particular postpartum inflammatory diseases, healing by secondary tension, lowering of the walls of the vagina and uterus, the formation of wide, rough scars, and dysfunction of sexual function.

For the treatment of perineal wounds healing by primary intention, the existing methods can be divided into medical and physiotherapeutic ones. The requirements for the treatment of such wounds are as follows: prevention of infection of the wound, acceleration of regenerative processes, prevention of the formation of wide gross scars.

Medicinal methods of treatment consist in daily treatment of sutures with 3% hydrogen peroxide, potassium with 3% perm anatom, furatsillin 1: 5000, 3% alcohol solution of iodine, levomesol. Physiotherapeutic include UHF therapy, quartz, a helium-neon laser. The application of these methods does not produce tangible results due to the long healing of the perineal wound and a large percentage of the divergence of sutures with wound healing by secondary tension. In this case, the occurrence of inflammatory processes of the internal genital organs, the formation of wide, rough scars, the prolapse of the walls of the vagina and uterus, and the violation of sexual function.

The prototype is a method of physiotherapeutic treatment of perineal ruptures with an LG-75 helium-neon laser. The essence of the method lies in the fact that irradiation of the perineal gap is carried out with an LG-75 helium-neon laser from the 2nd day of the postpartum period. Irradiation is carried out by sliding movements of the laser beam along the wound, exposure 10 minutes. In 94.7% of women, primary wound healing was performed by tension, in 5.3 - secondary.

The disadvantage of this method is the exposure time of up to 10 min, the incomplete treatment effect - only 94% heal by primary intention, a large percentage

differences in sutures with wound healing by secondary tension - 6%.

The aim of the invention is to increase efficiency by reducing exposure, shortening treatment time and

reducing the percentage of wound healing by secondary tension with the formation of a gentle scar.

The goal is achieved by the fact that every day for 4-5 days is carried out

5 at an angle of 80-85 ° magnetic laser therapy of perineal wounds in the postpartum period for 1-4 minutes, depending on the size of the gap ALLD-04 semiconductor infrared laser, combined with

0 ring magnet.

The method is carried out using an ALLD-04 semiconductor infrared laser physiotherapeutic apparatus with an output power of 35 mW / cm2, which

5 is determined by the device available in the physiotherapeutic laser apparatus, a wavelength of 0.81 microns, a continuous mode of operation. At the exit point of the laser beam, a ring medical

0 magnet MN-1, magnetic field strength 25-35 mT. After treating the wounds with antiseptic solutions, they are exposed to a magnetic laser at an angle of 80-85 ° with a distance of 1.0-1.5 cm for 1-4 minutes depending on the size of the wound, daily for 4-5 days,

Magnetic laser therapy of perineal wounds was performed in 100 puerperas: the full healing effect in 98%, partial discrepancy in 2 cases. The most optimal exposure was 1 min, the power density was 20 mW / cm, depending on the length of the wound, irradiation was carried out in 1-2-3 half m. Exposure was carried out for 30 s per

5 field, the result is insignificant, the effect was achieved with an exposure of 1 min, an increase in exposure to 2 min did not give an improvement in the effect of wound healing.

PRI me R 1. Sick A., 20 years old, in childbirth

0 there was a rupture of the perineum I degree. The length of the wound is 2.5 cm. The wound is sutured.

Objectively: the general condition is satisfactory. HELL 140/75 mm Hg, pulse 74 beats / min, satisfactory quality. Analyzes before treatment: commonly. blood test: er. 3200000, Hb 12.0 g / l: CP 0.9: white blood cells 10100: E 2: P 3: L 28: C 60; M 7. ESR 37 mm / h. Examination of the perineal wound There is a tear of the perineum of the 1st degree, which is stitched. The wound is swollen, hygermic.

Diagnosed with urgent delivery, 1st. The postpartum period is 1 day. Rupture of the perineum I degree.

From the first day of the postpartum period, a course of magneto-laser therapy of the perineal wound at an angle of 80 ° was started. The laser beam power density at the irradiated object is 18 mW / cm2, the wavelength is 0.81 μm, the mode is continuous, the constant magnetic field strength is 30-35 mT, the exposure time is 1 min. Improvement was noted on the second day, which was manifested in a decrease in edema of the wound surface, pain, hyperemia decreased. By the end of treatment with a magneto-laser (daily for 4 days), the perineal wound healed by primary intention with the formation of a delicate scar; no complaints. Sn stitches. Discharged home on the 5th day of the postpartum period. Assays after treatment: commonly. an. blood: er. 3,300,000; Hb 12.5 g / l; CPU 1.0; white blood cells 8300; E 1; P 2; C 65; M 5: L 27; ESR 15 mm / h.

At follow-up after six months, no complaints.

PRI me R 2. Sick B., 25 years old, in childbirth there was a rupture of the perineum of the II degree. The length of the wound is 5 cm. Sutures are laid.

Objectively: the general condition is satisfactory, blood pressure 115/80 mm Hg, pulse 75 beats / min, satisfactory qualities, blood lochy, moderate. Analysis before treatment: commonly. an. blood: er. 2,950,000; Hb 11.2 g / l; CPU 0.8; white blood cells 11000; E 2, P 4; L 27; C 58; M 9; ESR 34 mm / h. Inspection of the perineal wound; there is a gap of the perineum of the II degree, on which stitches are applied. The wound is swollen, hyperemic.

Diagnosed with Urgent Delivery, 2nd. Postpartum period, 1 day. Rupture of the perineum II tbsp.

A course of magneto-laser therapy of the perineal wound at an angle of 85 ° has begun. The laser beam power density at the irradiated object is 20 mW / cm, the wavelength is 0.81 μm, the magnetic field strength is 25-35 mT, the exposure time is 1 min per field, and the total exposure time is 2 min. Improvement was noted on the second day, which was manifested in a decrease in edema of the wound surface, pain, hyperemia decreased. Toward the end of the magneto-laser treatment (daily for 5 days), the perineal wound healed by primary intention. Sn stitches. She was discharged home in satisfactory condition at the 5th postpartum CVT. Assays after treatment: commonly. an. blood: er. 3,300,000; Hb 12.4 g / l; CPU 0.9; white blood cells 9000: E 0; P 1; C 69: M 5; L 25: ESR 16 mm / h.

At the follow-up examination after 6 months, there were no complaints; a tender scar formed on the wound.

PRI me R 3. Sick In ,, 22 years old, in childbirth 5 produced episiotomy. The length of the wound is 8 cm. Sutures are laid.

Objectively: the general condition is satisfactory: HELL 115/75 mm Hg, pulse 74 beats / min, satisfactory qualities. At

0 examination of the birth canal: episiotomy, wound 8 cm long. Tests before treatment: total. blood test: er. 3,100,000; H 11.5 g /%, CP 0.9: white blood cells 9300; E 1; P 3; L 26; C 65; M 5; ESR 29 mm / h.

5 Diagnosed with urgent delivery II, Postpartum period, 1 day. Episiotomy, wound length 8 cm. Sutures were laid on the wound, A course of magneto-laser therapy of the episiotomy wound was started, Laser power density at the irradiated object 22 mW / cm2, wavelength 0.81 μm, magnetic field strength 25-30 mTl, exposure 1 min to 4 floors, total exposure 4 min. Improvement was noted in the second days, which was manifested in a decrease in edema of the wound surface, pain and hyperemia decreased. By the end of treatment with a magnetic laser (daily for 5 days), healing of the perineal wound with primary

0 tension. Sn stitches. Discharged home on the 6th day of the postpartum period in satisfactory condition. Assays after treatment: total. blood: er 3400000; Hb 12.8 g /%; CPU 1.0; white blood cells 8000; E 1; P 3; S 63:

5 L 28; M5; ESR 14 mm / h.

At follow-up after 6 months there were no complaints; a tender scar was formed on the zpisiotomic wound.

All patients received conventional

0 treatment, treatment of perineal wounds with antiseptic solutions, vitamin therapy.

The use of this method allows one to achieve an advantage over known methods due to the use of a combined magneto-laser action on the perineal wound at an angle of 80-85 °. This helps to increase the effectiveness of treatment by shortening the treatment time, reducing the percentage of complications, diverging sutures with healing by secondary tension, and the function of the muscles of the pelvic floor is restored. By reducing exposure to 1-4 minutes instead

5 5-10 minutes time is freed up for the medical staff to work.

The ALLD-04 physiotherapeutic laser apparatus with an output power of 35 mW / cm2, which is determined by the device, was used as a laser source.

available in the physiotherapy apparatus, wavelength 0.81 microns. The power density of the laser radiation is 18-22 mW / cm2 at the irradiated object. An annular medical magnet MN-1 with a magnetic field strength of 25-35 mT was used as a magnet. After treatment of the wound with antiseptic solutions, it is exposed to a mznito laser at an angle of 80-85 ° with a distance of 1.0-1.5 cm for 1-4 minutes, depending on the size of the wound daily for 4-5 days. With a decrease in the power density of the laser beam at the irradiated object less than 18 mW / cm2 and a decrease in exposure to 30 s per field, the treatment effect worsens. With an increase in exposure to 2 minutes and an increase in power density above 22 mW / cm2, no improvement in treatment effect is noted.

As a result of the studies, the optimal parameters of the impact of the perineal wound on the perineum by the magneto-laser were selected for puerperas with a power density of 18-22 mW / cm2 and magnetic field strength of 25-35 mT. Exposure 1-4 minutes.

The table provides comparative data on the effectiveness of treatment by known and proposed methods.

The optimal exposure parameters are within the parameters that have a stimulating effect on the healing of inflammatory processes (see A.K. Polonsky. Laser and magneto-laser therapy. 1985; Materials of the international symposium Lasers in surgery and medicine. M: 1988) .

A study of the known data showed that the effect of treating perineal wounds with magnetic laser irradiation is a new treatment for this pathology and has the character of an immunomodelling effect on the pathological focus and the body of puerperas with an increase in metabolism in tissues, under the conditions of a whole organism it has an antibacterial effect . Thus, the proposed Method for the treatment of perineal wounds in puerperas is a new effective means of treatment in the treatment of perineal wounds. This leads to an increase in the effectiveness of treatment due to the persistent healing effect, shortening the treatment time, reducing the severity of the disease, reducing the percentage of complications, wound healing occurs by primary intention with the formation of a gentle scar.

(56) Akulich T.N., Gerasimovich G.I. The use of laser radiation in obstetric and gynecological practice. XIV Congress of Obstetricians and Gynecologists. M., 1983, p. 620.

Comparison chart of the effectiveness of treatment of postpartum wounds of the perineum

at puerperas