RU2002463C1 - Method for improving efficiency of endolymphatic therapy - Google Patents

Abstract

The invention relates to medicine and can be used in surgery and intensive care. The purpose of the invention is to reduce treatment time by increasing the effectiveness of endopimphatic therapy by stimulating the reverse flow of lymph. 20% mannitol is used in an amount of 100-120 ml with the addition of a therapeutic dose of finoltin. The resulting drug solution is administered at a rate of 5-6 ml h for 20-24 hours 3 tablets.

Description

The invention relates to medicine and can be used in surgery and intensive care to improve the results of endolymphatic drug therapy, especially in diseases of the abdominal organs.

Closest to the claimed and accepted as the prototype is a method of increasing the effectiveness of endolymphatic therapy by prolonging the main drug with an auxiliary solution. According to this method, 0.5% novocaine with the addition of 5000 units, heparin in 2 ml of isotonic sodium chloride solution and 100000 units are used as an auxiliary solution. contrikala. The resulting mixture (main drug plus auxiliary solution) is administered at a rate of 0.1 ml / min for 4-20 hours daily or every other day 3-5 times.

The main disadvantage of the prototype is primarily low efficiency in diseases of the abdominal organs, since the mixture, according to the prototype method, accelerates lymph flow from the abdominal organs, improves lymphatic drainage. As a result, a significant portion of the drug is discharged together with lymph into the thoracic lymphatic duct, and from there into the subclavian vein. Thus, the phenomenon of backflow of lymph is promoted, which facilitates the delivery of drugs to the pathological focus.

The purpose of the invention is to reduce the duration of treatment for spores by increasing the effectiveness of endolymphatic therapy by stimulating the reverse flow of lymph.

The goal is achieved in that in a method of increasing the efficiency of endolymphatic therapy, including prolonging the main preparation with an auxiliary solution, 20% mannitol in an amount of 100-120 ml with the addition of a therapeutic dose of phinoptin is used as an auxiliary solution. The drug is administered by infusion at a rate of 5-6 ml / h for 20-24 hours.

The idea of administering mannitol is that the latter, due to the high osmotic pressure, draws a large amount of tissue fluid into the lymph vessels. The conditions for relative overfilling of the lymphatic channel are created and the main drug introduced against this background spreads evenly throughout the lymphatic channel, including retrograde distribution from the center to the periphery, i.e. targeted to the pathological focus.

Finoptin, as a calcium antagonist, helps to stabilize cell and methochondrial membranes, rupture the vicious circle characteristic of ischemic and toxic damage to various organs and systems,

Thus, the destruction of lymphoid and other tissues in the area of the pathological focus is prevented, leveled

0 negative e, the effect of lymphohypertension.

The proposed dose and mode of administration of mannitol is due to the need for a smooth, gradual increase in endolymphatic pressure and prolonged

5 maintaining relative lymphohypertension. This is a necessary condition for gentle stimulation of lymphatic backflow, adequate intake and long-term maintenance of the therapeutic concentration of the main drug in the pathological focus,

A decrease in the rate of infusion and a decrease in the duration of administration will not allow achieving the indicated effect, and exceeding the dose and rate of administration of mannitol will lead to significant lymphohypertension, severe peripheral lymphostasis with the effects of destruction of lymphoid tissue.

0 The used dose of finolptna is selected based on the recommendations of the Pharmacopoeia.

Clinical observations in the treatment of patients with the proposed method fully confirm the above provisions,

Cnocofi is carried out as follows. Under local anesthesia, novocaine under aseptic conditions catheterizes the subcutaneous lymph vessel of the thigh. WITH

0 using an automatic injector, a prolonged endolymphatic infusion of O solution containing the main drug in the required dose, 20% mscnitol in an amount of 100-120ml is made

5 and finoptin in a therapeutic dose. The infusion rate is set at 5-6 ml / h for a duration of 20-24 hours. After the end of the infusion, 4-5 ml of heparinized isotonic is introduced into the lumen of the catheter

0 sodium chloride solution and a plug is installed. 8 further infusions are repeated in the same mode. The frequency of infusion and the duration of the course depends on the pharmacodynamics of the main drug and

5 from the characteristics of a particular clinical situation. After completion of the course, the catheter is removed from the lymphatic vessel.

PRI me R. Sick N-na, 53 years old, and / b N 4386 delivered with a diagnosis of subhepatic abscess. The clinical picture was dominated by the effects of hyperthermia, intoxication, yellowness of the skin and mucous membranes, leukocytosis, hyperbilirubinemia with a predominance of the direct fraction, an increase in the leukocyte intoxication index to 4.8. Spontaneous esterase blood activity 19.3 mmol / h-ml. One of the components of the complex intensive care and preoperative preparation was the endolymphatic administration of gentamicin. For this purpose, a subcutaneous lymphatic vessel in the upper third of the right thigh is catheterized under local anesthesia with a 0.5% novocaine solution. On the same day, a prolonged lymphatic infusion of gentamicin at a dose of 80 mg, dissolved B with 100 ml of a 0.5% solution of novocaine with the addition of 5000 units was started. heparin and 10,000 units. contrikala. The infusion was performed using an automatic Lineomat mat injector (GDR). The infusion rate was 5 m / h, the duration was 20 hours. However, despite the measures taken, there was no positive clinical and laboratory dynamics. To clarify the diagnosis, a laparoscopy and puncture biopsy of the liver were performed, which made it possible to confirm the diagnosis of a hepatic abscess and additionally reveal an abscess of the left lobe of the liver. The concentrations of gentamicin in exudate and in liver biopsy were 34 μg / ml and 60 μg / r, respectively. Spontaneous esterase blood activity continued to increase and amounted to 19.6 mmol / h-ml.

A day before the planned operation, a second znolidymphatic infusion was carried out with the following components: gentamicin 80 mg; 20% mannitol 100 ml; 2% finoptin 2 ml at a rate of 5 ml / h for 20 hours. A day later, laparotomy was performed, drainage of the abscess of the left lobe of the liver and subhepatic abscess, drainage of the abdominal cavity. During the operation, a second biopsy of the liver was carried out, samples of exudate from the abdominal cavity were taken. The concentration of gentamicin in liver exudate and biopsy was 560 μg / ml and 575 μg / g, respectively. Stabilization of the spontaneous extraserase activity of the blood was also noted, which amounted to 19.2 mmol / h ml. In the postoperative period, the endolymphatic infusion of the mixture of gentamicin, mannitol and finoptin in the previous doses and in the same mode is repeated four more times with an interval of a day. Positive clinical and laboratory dynamics, a gradual decrease in spontaneous exterrase blood activity, which on the 10th day after surgery reached 13.77 mmol / h, were noted

ml The catheter from the lymphatic vessel is removed. After 24 days of inpatient treatment, the patient was discharged in satisfactory condition.

According to the proposed method of leakage, 6 patients are 8 years old from 39 to 61 years. The average age was 52.1 ± 8.2 years. A detailed list of patients and the results of the measures are presented in table. 1.

For comparative analysis, a group of 6 patients aged 42 to 62 years was examined. The average age is 52.5 ± 8.5. A detailed list of patients, parameters and results of the measures are presented in table. 2.

Gentamicin was used as the main drug in these groups. The effectiveness of endolymphatic therapy was judged on the basis of measuring the concentration of gentamicin in the drainage and tissue biopsy specimens separated from the selective (conducted directly to the pathological focus). obtained during preoperative diagnostic biopsy and during surgery. As can be seen from the tables when using the prototype method, a small part of the drug fell into the pathological focus, since the concentration of gentamicin in the separated from the selective drains and in the tissue biopsy did not exceed 6.0 μg-ml and 5.8 μg / g, respectively. At the same time, when using the claimed method, gentamicin was retained in larger numbers and longer in lesions. Evidence of this is a higher concentration of the antibiotic in the separable from selective drainages and in tissue biopsies.

The proof of the feasibility and effectiveness of the use of finoptin is the results of a comparative study of the spontaneous extraserase blood activity of the studied patients, are given in table. 3.

As can be seen from the table. 3, the use of fino ptina contributed to a significant decrease in the spontaneous extraserase activity of the blood, thus inhibiting destructive processes in the affected organs and tissues.

The achieved use of the claimed method, the more effective penetration of gentamicin into the lesion sites, was also reflected in the final results of the treatment of the ballroom (see Tables 1 and 2) .If there were no complications in the first group of patients (the claimed method), then one of the patients treated according to the prototype method, there was a development of purulent cholengitis with a transition to chronic hepatitis. The average duration of the patient's stay in bed when using

The claimed method was 23.6 ± 3.2 days. When using the prototype method, this indicator was equal to 36.1 ± 7A days.

(56) Clinical lymphologists. The First All-Union Conference October 24-25, 1985 Moscow-Podolsk. 1985.S. 150-151.

List of patients treated by the claimed method

Table 1

Continuation of Table 1.

The list of patients treated by the prototype method

Continuation of Table 1.

table 2

The average values of spontaneous exterrase activity of blood depending on the method of treatment

Claims (1)

The claims ; METHOD FOR INCREASING THE EFFECTIVENESS OF ENDOLYMPHATIC THERAPY by prolonging the main drug with an auxiliary solution, characterized in that, in order to shorten the treatment time by stimulating Continuation of Table 2. Table 3 direct lymph flow for intensive inflow of the main drug to the pathology center, 20% mannitol with the addition of finoptin in therapeutic doses j, which is administered at a rate of 5 ml / h for 20-24 hours, is used as an auxiliary solution.