RU2005489C1 - Method for treating acute sepsis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves determining percentage of inclusions in blood leukocytes. If content of inclusions in monocytes exceeds 10 % and is over 3 % in lymphocytes, interlock inhalations are given in a dose of 420-900 thousand mass units. Lethality rate decreases from 89 to 11% . EFFECT: lethality is decreased due to intensified therapeutic treatment.

Description

 The invention relates to medicine, namely to methods of non-specific immunotherapy of diseases that occur with a decrease in antiviral cell resistance.

 Known methods for the complex treatment of acute sepsis, including sanitation of septic foci (antibacterial, detoxification, immunostimulating, hemocomponent, cardiotonizing), correction of water-electrolyte balance and acid-base state, antihistomic, anticoagulant, hemorheological active drugs, hypogenergic regenerators, stimulants, anti-inflammatory drugs etc.

 The prototype of the invention is a method for the treatment of purulent-septic diseases by additional intravenous administration of 300-500 ml of freshly prepared donor white suspension. The disadvantages of the prototype are the inappropriateness of the use of immune leukemia in non-staphylococcal sepsis, high lethality, the long duration of treatment due to the lack of a highly effective antiviral component, the impossibility of long-term (more than 2 days) storage of leukocytes, the risk of infection with AIDS and viral hepatitis, the possibility of adverse blood transfusion reactions, high laboriousness for harvesting white blood cells, the impossibility of implementation in the absence of suitable donors, high cost out of.

 The purpose of the invention is to reduce the lethality.

 The method is as follows. In the complex of therapeutic measures (antibacterial, detoxification, immunocorrecting, blood component and other methods of treatment), 420-900 thousand IU of the drug alpha-interferon (Interloka) are used.

 Immediately before inhalation of the drug, to improve its absorption, a drainage gymnastics session was performed or trypsin and aminophylline were inhaled in usual therapeutic doses, or nasotracheal lavage, or therapeutic bronchoscopy, or stimulation of cough activity. Interlock was used in the form of inhalations of 30,000 IU 2-3 times a day. Inhalations were performed using an ultrasonic inhaler (TNR-Ii GDR). A 0.9% sodium chloride solution was used as the Interlock solvent. The amount of inhalation per procedure was 20-30 ml, its duration was 15-20 minutes. The duration of treatment was 7-10 days. Good tolerability of the drug and the absence of complications associated with its administration were noted. Interlock was used in the treatment of 36 patients with severe forms of acute surgical sepsis. Among them were 27 men and 9 women. The age of patients ranged from 18 to 52 years. In all patients, sepsis arose as a result of suppurative diseases or complications after elective surgery. In 7 patients, the initial phase of sepsis was diagnosed, in 18 septicemia, in 11 septicopyemia. 19 patients had various pulmonary-pleural complications of sepsis. In 24 patients, sepsis was caused by pathological strains of staphylococcus, in 4 - streptococcus, in 4 - E. coli and in 2 - enterobacteria. As a concomitant pathology, 7 patients of the main group had atherosclerosis and hypertension, 4 had chronic alcoholism, and 3 had diabetes mellitus. All patients received complex treatment.

 The prototype group consisted of 24 other patients with severe forms of acute surgical sepsis.

 The content of therapeutic measures in this group was absolutely similar to those in the previous group, except that patients in the prototype group were additionally injected with 300-500 ml of a suspension of donors previously immunized with an antistaphylococcal toxoid for 7-17 days. However, interlock was not prescribed for these patients. In terms of gender, age, nature of the main and concomitant pathology, its severity, and the content of the basic treatment, the patients of both groups did not practically differ and were quite comparable.

 Before and after completion of treatment in patients of both groups according to the method of L. V. Filev et al. examined the number of blood monocytes and lymphocytes containing viral inclusions. Normally, viral inclusions contain 10% or less of monocytes and 3% or less of peripheral blood lymphocytes.

 As a result of the study, it was found that at the beginning of the course of treatment, the number of monocytes and blood lymphocytes infected with viruses in patients with sepsis is significantly (p <0.01) higher than normal (see table. 1). After a course of treatment with interloc, the percentage of affected cells decreased statistically significantly (p <0.01), significantly exceeding in its rate that in the prototype.

 In the table. Figure 1 shows the change in the percentage (M ± m) of blood cells containing viral inclusions during treatment with Interloc.

 Of the 36 patients receiving interlock, despite the ongoing comprehensive treatment, only 4 (11.1%) died. Of the 24 patients with sepsis of staphylococcal etiology, only 1 (4.2%) died, while of 24 patients with staphylococcal sepsis of the prototype group, 5 (20.8%) died.

 From the data table. 2 shows that the proposed method is superior to the prototype and when used for the treatment of sepsis of a different etiology, it can significantly reduce the total duration of treatment.

 In the table. 2 gives a comparative assessment of the results of treatment of sepsis using the proposed method and prototype.

PRI me R 1. Patient P., 21 years old, medical history N 53238, 15.2.89 g transferred to the hospital surgery clinic of the Medical Academy named after S. M. Kirov for acute staphylococcal sepsis, septic abscessed pneumonia of the upper lobe of the left and right lungs, cachexia, septicopyemia. Upon admission to the clinic, the general condition is extremely serious, due to the phenomena of severe pulmonary heart failure and purulent intoxication. Body temperature in the evening 39.5 ^about C. The pulse rate of 124 beats. / min, respiration 33 per min. HELL 105/70 mm RT. Art. When radiography in the upper lobe of the right lung is determined by the destruction cavity with a diameter of 6 cm, in the upper lobe of the left lung, many small cavities of destruction. When fibrobronchoscopy revealed pronounced purulent endobronchitis. On the ECG there were phenomena of myocardial hypoxia in the region of the anterior wall. During this period, significant changes were detected in the peripheral blood: the number of red blood cells 3.6 x 10 ¹² / l; hemoglobin 102 g / l; white blood cells 15 x 10 ⁹ / l with a shift of the leukocyte formula to the left; LII 9.62 units. ; monocytes 20%; lymphocytes 13%; hypoglobulinemia 27.3 g / l. Staphylococcus aureus, sensitive to methicillin and oleandomycin, was seeded from venous blood and sputum. Virus-containing monocytes 69.9%, lymphocytes 7.1%. The patient was prescribed complex antiseptic treatment with sanitation of the tracheobronchial tree, massive infusion therapy: 1.5 l of a 20% polyionic solution with insulin, 400 ml of hemodesis, 400 ml of hepasteril; erythrocyte mass of 250 ml of N 5, native donor plasma of 300 ml of N 7, methicillin 12 g / day, kefzol 7 g / day, metrogil 200 ml / day, heparin 10,000 units. 3 times a day, vitamin therapy, carrying out general hyperbaric oxygenation, physiotherapy exercises. Immediately before interlock inhalation, tracheobronchial tree was sanitized by postural drainage, nasotracheal washes, and twice sanitation bronchoscopy, as well as by the use of generally accepted doses of trypsin and aminophylline. Interlock was used at a dose of 30,000 IU three times a day for 10 days after it was diluted in 20 ml of physiological saline. Inhalations were performed using a TIR-Ii ultrasonic inhaler (GDR) for 20 minutes. The course dose was 900,000 IU. Upon completion of the course of complex treatment in combination with interlock, the patient’s well-being and general condition improved significantly. Body temperature dropped to 37.1 ^{° C,} sputum disappeared, appetite. Pulse 80 beats. / min, respiratory rate of 21 per min. When radiography in the left lung disappeared cavity destruction and infiltration, in the right - the destruction cavity decreased to 3.5 cm in diameter. On the ECG, signs of myocardial hypoxia in the anterior wall were leveled. The number of red blood cells in peripheral blood increased to 4.0 x 10 ¹² / l, hemoglobin to 128 g / l, the number of leukocytes decreased to 7.4 x 10 ⁹ / l, LII 1.24 units. , the number of monocytes increased to 6% and lymphocytes to 28%. A significant decrease in the percentage of virus-containing blood monocytes to 17.8% and lymphocytes to 3.9% was noted. Bacteremia disappeared. After two weeks, the patient was discharged in satisfactory condition for outpatient treatment. When viewed after 3 months no complaints. X-ray - in the right lung there is a "dry" cavity with a diameter of 3 cm, in the left lung there is slight pneumofibrosis. (56) B.M. Kostyuchenok et al. Surgical sepsis. In the book. : Wounds and wound infection. M. Medicine. 1981, p. 535-627.

Claims (1)

 METHOD FOR TREATING ACUTE SEPSIS, including traditional therapy, characterized in that, in order to reduce mortality by enhancing the effect of therapy, the percentage of viral inclusions in blood leukocytes and when their content in monocytes is more than 10%, and in lymphocytes more than 3%, interlock is additionally administered inhaled in a dose of 420 - 900 thousand IU per course.

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