RU2016553C1 - Method of treating postpartum and postabortion endometrites - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: essence of this method resides in that two-channeled catheter provided with electrode is inserted into uterus cavity which is consecutively washed with chilled solutions of antiseptics, biological adsorbents and multi-purpose antibiotics with simultaneously treating focus of inflammation and surrounding tissues by direct electric current. EFFECT: shorter curing period and positive prevention of complications. 1 dwg

Description

 The method relates to medicine, namely to gynecology, and can be used to treat postpartum and postabortion endometritis.

 Closest to the proposed is a method of prolonged washing of the uterine cavity with a cooled solution of furatsilin. This method is aimed at sanitizing the focus of inflammation, preventing generalization of infection and restoring the function of the affected organ, but the limited use of this method, which is essentially additional in the complex treatment of endometritis, makes us look for new methods of treatment for this disease.

 The aim of the invention is to reduce the treatment of postpartum and postabortion endometritis, the prevention of complications of endometritis.

The goal is achieved by the fact that in the proposed method produced uterine cavity drainage catheter with a dual-channel electrode and consecutive long washing the uterine cavity cooled to 0-4 ^{° C} solution of drug substances: 1 - antiseptic solutions, e.g. furatsilina, chlorhexidine bigluconate, dioksidina, Baliz; 2 - solutions of biological adsorbents, for example gelatin, hemodesis; 3 - solutions of broad-spectrum antibiotics, for example, groups of aminoglycosides, semisynthetic penicillins, cephalosporins with simultaneously produced direct electric current (P.E.T.) on the uterus and adjacent pelvic organs.

 The inventive method consists in actively evacuating the inflammatory exudate from the uterine cavity by prolonged flushing of the uterus, the anti-inflammatory, anesthetic, uterine-contracting effect of local hypotherapy, which is carried out by washing the uterine cavity with chilled solutions of medicinal substances, adsorbing exudate toxins by washing the uterine cavity with solutions of biological adsorbents combined action of P.E.T.; in addition, in removing metabolic products from the pathological focus, the anesthetic effect of P.E.T., creating a high concentration of antibiotics and depositing them in the focus of inflammation and adjacent tissues due to the electrophoretic effect of P.E.T., increasing the content of free corticosteroids in the tissues having anti-inflammatory effect, increasing the penetration of antibacterial drugs to the source of infection, which helps to reduce the doses of antibiotics, improve regional blood circulation and regeneration no tissue.

 Comparative analysis with the prototype allows you to recognize this technical solution meets the criterion of "Novelty."

 When comparing the proposed method with the prototype and with other technical solutions, no solutions were found that have similar characteristics, which allows us to conclude that this technical solution meets the criterion of "Significant differences".

 The drawing shows a diagram of the pelvic organs, section.

 The body of the uterus 1, into the cavity 2 of the uterus through the cervical canal 3 introduced a two-channel catheter 4, with a diameter of 6-7 mm, length 350-400 mm. The catheter is fixed in the vagina 5 by a vaginal fixator 6. An electrode 9 made of copper or silver wire with a diameter of 0.15-0.2 mm is inserted into the small channel 7 of the catheter 4 (small channel 7 has a diameter of 1.0-1.5 mm and not reaching the outlet 8 of the channel by 5-10 mm, the needle channel 10, intended for the introduction of a solution of a medicinal substance.

 A terminal clamp 11 of the P.E.T. source is connected to the catheter electrode 9. 14 (the Potok-1 apparatus or others having similar technical characteristics can be used), an infusion system 13 filled with a drug solution is connected to the needle 10. The plate electrode 12 is fixed on the lumbar or supral region of the patient. The outflow of contents from the uterine cavity is carried out through the holes 15 of the channel 16 of the catheter (channel diameter 3-4 mm).

 The method is as follows: after processing the external genitalia and the vagina with a disinfectant solution, the cervix is exposed in the mirrors and fixed with bullet forceps. The uterine cavity is probed to clarify its size. A two-channel catheter 4 is inserted into the uterine cavity 2 through the cervical canal 3 with an electrode 9 located in the small canal 7 of the catheter, through which the drug solutions are fed into the uterine cavity through the needle 10 from the infusion system 13. The catheter electrode 9 does not reach the outlet 8 of the small channel 7 of the catheter by 5-10 mm to prevent damage to the uterine wall by the electrode and irritation of the uterine mucosa by direct contact with the electrode. After insertion of the catheter 4 into the uterine cavity, bullet forceps are removed from the cervix, and the catheter 4 is fixed in the vagina 5 by the vaginal retainer 6, which does not adversely affect the walls of the vagina and does not prevent the outflow of contents from the vagina, since there are holes in it (in case of absence vaginal fixator catheter can be fixed on the inner thigh with a band-aid).

 A source of P.E.T. is connected to the catheter electrode 9 and the plate electrode 12. 14, wherein the electrode inserted into the uterine cavity is the cathode, and the plate electrode is the anode.

Uterine cavity lavage performed alternately chilled to 0-4 ^{° C} with solutions of medicinal substances with simultaneous exposure P.E.T.

First of all, the uterine cavity is washed with antiseptic solutions, for example, furatsilin 1: 500, chlorhexidine bigluconate 0.1%, an aqueous solution of dioxidine 1%, baliz 0.8%, rinsing is performed first by jet (without creating additional pressure in the infusion system), then drip to obtain a clear transparent discharge from the uterine cavity in a volume of 400-800 ml. After this, the uterine cavity is washed with solutions of biological adsorbents, for example, gelatin, hemodesis, the solution is injected dropwise in a volume of up to 400 ml, then a solution of broad-spectrum antibiotics is injected into the uterine cavity with a isotonic 0.9% sodium chloride solution. During the introduction of the antibiotic solution, the pole of the P.E.T. source corresponding to the polarity of the antibiotic is connected to the electrode catheter, and the opposite pole of the P.E.T. The current supplied to the electrodes is set depending on the patient's individual electro-sensitivity and can be 0.2-5 mA / cm ² . Duration of exposure P.E.T. depends on the individual tolerance of the patient.

 After the procedure is completed, the source of P.E.T.T. is disconnected, the infusion system is disconnected from the catheter, the catheter is removed from the uterine cavity. The procedure is performed 1-2 times a day in compliance with safety regulations. In severe cases of the disease, the procedure can be performed around the clock.

 Upon reaching subjective and objective data on the cure of the disease, the patient is discharged from the hospital without the need for further outpatient treatment.

An example of a specific implementation: patient V., 30 years old, case history No. 1774, was admitted to the gynecological department of hospital No. 1 of Belgorod on 08/01/90 with a diagnosis of endometritis after cesarean section. Doubling of the vagina. On admission he complained of pain in the lower abdomen and lumbar region, increase in body temperature above 38 ^{° C} for 4 days, heavy pussy-sukrovichnye separation of the genital tract with an unpleasant odor. Objectively: a condition of moderate severity, body temperature 38.2 ^{° C,} uterine body is increased to 15-16 weeks of pregnancy, softening sharply painful when viewed appendages are not detected in the cervix stage of formation, separation suppurative sukrovichnye.

Examined: general blood test HB 109 g / l, red blood cells 3.3 ˙ 10 ¹² / l, CP - 0.9; leukocytes 5.7 ˙ 10 ⁹ / l, P - 4, C - 64, L - 22, M - 7, ESR - 35 mm / h, PB N 221 - negative, smear from the cervical canal - leukocytes densely cover the field of view, erythrocytes 4-5-6 in the field of view, gonococci and Trichomonas were not found, the flora is mixed.

 Tank. inoculation from cervical canal N 331 - epidermal staphylococcus and Escherichia coli isolated, sensitive to monomycin, gentamicin, oxacillin.

08/01/90, uterine cavity was washed - furatsilin 1: 500 - 800 ml, kanamycin - 1.0: 500 isotonic sodium chloride solution, I = 0.4 mA / cm ² , t = 25 min. Other treatments have not been used.

08/02/90, notes the cessation of pain in the lower back and lower abdomen, a significant improvement in well-being. Body temperature = 37.1-37.3 ^o C. With an objective examination - the uterus is enlarged to 12 weeks of pregnancy, painful when examined, softened. The uterine cavity was washed - furatsilin 1: 500 - 400 ml, hemodesis - 400 ml, kanamycin 1.0: 500 ml of isotonic sodium chloride solution, I = 0.4 mA / cm ² , t = 40 min.

08/03/90, there are no complaints. The body temperature is normal. The uterus is enlarged to 10-11 weeks of pregnancy, moderately painful, dense. The uterine cavity was washed: furatsilin 1: 500 - 400 ml, kanamycin 1.0: 500 ml of isotonic sodium chloride solution, I = 1.0-1.8 mA / cm ² , t = 40 min.

08/04/90. There are no complaints. Body temperature is normal, the uterus is increased to 7-8 weeks of pregnancy, dense, painless. The uterine cavity was washed: isotonic sodium chloride solution - 800 ml, kanamycin 1.0: 500 ml isotonic sodium chloride solution, I = 2.2-2.8 mA / cm ² , t = 240 min.

 Breastfeeding is allowed.

08/05/90, there are no complaints. The body temperature is normal. The uterus is enlarged to 6-7 weeks of pregnancy, dense, painless. The uterine cavity was washed: an isotonic sodium chloride solution - 1500 sludge, I = 3.2-3.6 mA / cm ² , t = 240 min.

 08/06/90, there are no complaints. The body temperature is normal. A blood test without pathology. The uterus is enlarged to 5-6 weeks of pregnancy, dense, painless. Discharged home in satisfactory condition.

 08/07/2010 - 08/10/90 g - control examinations. There are no complaints. The body temperature is normal. The uterus is enlarged to 5-6 weeks of pregnancy, dense, painless.

 Thus, the course of treatment consisted of 5 procedures, during which the patient was administered kanamycin 4.0 g, furatsilina - 1,600 ml, hemodesis - 400.0; saline solution - 3800 ml. After 5 procedures without any other treatment methods, the patient was discharged in satisfactory condition.

 The proposed method for the treatment of postpartum and postabortion endometritis is simple, economical, since it does not involve the use of expensive and scarce drugs and medical equipment, reduces the length of hospital stay for patients to 7-9 days (in the prototype method, the treatment course is 19 days according to the clinical database tests), is available for use in all obstetric and gynecological hospitals, does not require additional enteral or parenteral administration of drugs, stimulates own defenses, does not cause complications in the treatment, due to the direct influence of the therapeutic factors to the affected organ. The application of the proposed method involves the prevention of complications of endometritis.

Claims (1)

METHOD FOR TREATMENT OF POST-FERTILITY AND POST-ABORTION ENDOMETRITIS, including washing the uterine cavity with a cooled solution of furatsilin, characterized in that, in order to reduce treatment time and prevent complications, the uterine cavity is washed through a two-channel catheter with an electrode additionally and sequentially cooled with a wide range of biological adsorbent and antibiotic action solutions with simultaneous exposure to the focus of inflammation and surrounding tissue with a constant electric current of 0.2 - 5.0 mA / cm ² .

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