RU2019209C1 - Method for treatment of prolonged compression syndrome - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: patient is affected within 15-20 min by pulse electromagnetic field having induction 2.5-1.2 MT and frequency 0.8-2.5 Hz. Then this procedure takes place within 25-35 min at induction 3.0-4.0 MT and frequency 2.2-3.0 Hz. Proposed method is carried out together with intense therapy to reduce kidney functioning. With in whole the procedure ratio of increasing and decreasing pulses is 50± 10%. Treatment course has 10-30 procedures. EFFECT: decreases lethality, decreases quantity of amputations, decreases treatment time.

Description

 The invention relates to medicine, in particular to disaster medicine and field surgery, to methods of treating patients with injuries of soft tissue structures of the extremities that occur during prolonged compression.

 Currently, prolonged compression syndrome should be designated as traumatic toxicosis and refer it to the pathological processes of the early period of severe traumatic disease.

 There are various methods of treating prolonged limb compression syndrome based on: 1) transfusion therapy, 2) hemodialysis, 3) hemosorption, 4) lymphodialysis, 5) hyperbaric oxygenation, 6) antibacterial therapy and 7) surgical aids.

 The vast majority of the above therapeutic measures are aimed at 1) removing from the body of the affected person the unoxidized metabolic products entering the bloodstream from the affected limb immediately after releasing it from compression, 2) eliminating the toxic effect of the unoxidized metabolic products on the cells of the parenchymatous organs, 3) normalizing microcirculation.

 The aim of the invention is to reduce the treatment time for patients with crash syndrome, reduce mortality, reduce the number of amputations.

 The goal is achieved by non-contact exposure to an induced electric field with an induction amplitude of 2.5-3.0 mT, a frequency of 0.8-1.2 Hz for 15-20 minutes, then the manipulation is carried out at an amplitude of 3.0-4.0 mT, a frequency of 2.2-3.0 Hz for 25-35 min, and the ratio of the rise and fall fronts of current pulses in the solenoid system is 50 ± 10% during the entire procedure with a total number of sessions from 10 to 30 per treatment course.

 New in the proposed method is the use of a pulsed electromagnetic field with bio-adequate parameters for the treatment of patients with long-term compression syndromes.

 It is proved that in order to normalize regional blood circulation in the pathology zone, it is advisable to apply successively different amplitude, frequency and temporal characteristics of the field to relieve spasm of arterial vessels and normalize the tone of the vein walls.

 The choice of frequency intervals is due to the following clinical observations. Over the course of treatment of patients with soft tissue contractures, the field intensity, its frequency and the shape of the current pulse in the solenoid system were varied; at the same time, impedance rhepletismogram (RPG) from segments of the affected and symmetric intact limbs was recorded in patients. RPG treatment was performed with the release of arterial and venous phases.

 It was found that with an increase in the frequency of the pulsed field from 0.1 to 5.0 Hz, a monotonic increase occurs, followed by a spasm of blood supply to the segment due to dilatation of arterial vessels, and the frequency interval of the maximum blood supply corresponds to 0.8-1.2 Hz. In this range, there is a characteristic dependence on the amplitude of the magnetic field induction with a maximum in the range of 2.5-3.0 mT.

 Similar studies on the reaction of venous vessels gave optimal values of frequencies and magnitude of magnetic field induction in the range of 2.2-3.0 Hz and 3.0-4.0 mT, respectively. Moreover, arterial dilatation occurred and was expressed during the first 15-20 minutes of exposure to the field, and venous - during 25-35 minutes.

 Special studies on the choice of the pulse shape showed that the most pronounced response of both arterial and venous vessels within the indicated frequency and amplitude field parameters corresponds to a symmetric (close to triangular) exponential current pulse in the system of solenoids with a ratio of rise and fall edges of current pulses of 50 ± 10%.

 The invention is illustrated by the following clinical examples.

 PRI me R 1. Ghazaryan Rosa, 6 years.

 The child was under the rubble of the building for 8 hours. For 12 hours from the time of the blockage did not receive medical care. Delivered on the 7th day after the earthquake in Armenia.

 Clinical diagnosis: syndrome of prolonged compression of the lower extremities, acute renal failure.

 At admission: general condition is serious, in consciousness; the skin is pale; breathing is heard on both sides, wheezing is not detected; heart sounds are muffled, tachycardia up to 140 beats per minute. The abdomen is soft, painless. Urine does not excrete.

 Locally: the right lower extremity is swollen, tissues are tense; the skin is pale pink with red spots in the lower leg, foot and fingers, in the area of the I-th toe - a dark spot; on the back and side surface of the lower leg - blue-violet skin; in the region of the Achilles tendon, a focus of skin necrosis, 2.0 cm in diameter. The left lower limb is swollen, the skin is pale.

 Immediately after the child's admission, intensive intravenous infusion therapy was started, aimed at normalizing homeostasis and dehydrating the body. A course of hyperbarotherapy has been started (daily for one session for an hour).

 On the day the child arrived at the clinic, a radioisotope study of the blood flow of the lower extremities was performed with s / s - 99t-pertechnitate; marked decrease in blood flow in both lower extremities: on the right - in the area of the toes and surface layers of soft tissues of the lower third of the leg; on the left - in the heel and lower third of the tibia.

 During the first days of treatment, the child in his general state of improvement was not noted, did not urinate. Anemia, toxicosis are expressed.

 12/13/88. an operation was performed - hemosorption, after which pastility and tension of the soft tissues of the left lower limb decreased. The area of hyperemia and swelling of the right lower limb are preserved.

 12/13/88. a repeated radioisotope study of the blood flow of the lower extremities was performed: an increase in the zone of reduced blood supply to soft tissues in the region of the lower thirds of both limbs was revealed.

 14 and 12.15.88. Hemodialysis sessions were repeated; On their own, the child isolated 7-10 ml of urine the color of meat slops. The right leg remained edematous, its tissues were tense; the area of hyperemia, cyanosis of the lower leg and foot did not decrease.

 12/15/88. (3rd day of stay) the general condition of the child is very serious, intoxication persists, anemia is expressed (HB - 46 g / l); vomiting 7.0 urine of a rusty color was allocated per day.

 12/15/88. skin thermometry was performed (Tables 2 and 3); registered rheovasograms from the right and left lower extremities; diagnosed with a pronounced decrease in the intensity of arterial blood supply, especially from the hips and on the right lower leg; slowing down the venous outflow of blood and peripheral vasodilation on the left leg; peripheral vasoconstriction on the right lower limb; the average rate of blood supply is reduced and the relative elasticity of the vascular wall is increased (Tables 4 and 5).

 Immediately after recording the rheovasogram, the first session of electromagnetic action on the right thigh and upper third of the right lower leg was performed using the Cascade apparatus. The electromagnetic wave session consisted of three cycles: cycle 1 — exposure time — 15 minutes, amplitude of electromagnetic field induction — 3.0 mT, frequency — 0.8 Hz; cycle 2 - exposure time - 25 min, the induction amplitude is 4.0 mT, frequency 2.2 Hz; cycle 3 - the parameters of cycle 1 were repeated; during all three cycles, the ratio of rise and fall fronts of current pulses in the system of solenoids is 50 ± 10%.

 Immediately after the computer session N 1, repeated thermometry of the skin and rheovasography was performed: no noticeable change in skin temperature was noted (table 2); there was an increase in the intensity of arterial blood flow and an average rate of blood supply (table 3), an improvement in venous outflow, and a decrease in vascular spasm.

 12.16.88. the general condition of the child remains severe, but without deterioration. Swelling of the soft tissues in the chest, trunk and extremities has not increased. A child excreted 80.0 ml of urine per day.

 12.16.88. EMV session N 2t was performed (exposure parameters are similar to session 1) on the right leg with rheovasogram and skin thermometry records.

 After a repeated session of electromagnetic exposure according to rheovasography, there was a tendency to increase blood flow intensity and decrease spasm of arterial vessels (table 3).

 12.16.88. the child also had regular sessions of HBO and hemodialysis.

 12/17/88. the third session of electromagnetic exposure was performed (exposure parameters are similar to those of session 1); Cascade solenoids are superimposed on the right thigh and upper third of the right tibia. During the EMV session, the child was sleeping soundly. There was a slight decrease in swelling of the right lower limb, although the boundaries of skin hyperemia remained the same.

 For a day, the child first allocated 125.0 ml of yellow urine.

 12/18/88. a marked improvement in the state of the left lower limb was noted (there is no tension in the soft tissues, the leg is warm; the skin is naturally colored). In the region of the right limb, the sensitivity zone spread down to the level of the lower third of the leg.

 12/18/88. held regular sessions of hemodialysis, HBO.

 12.19.88. the child’s health improved a bit. 130.0 ml of yellow urine was released per day. Swelling in the left thigh, left lower leg increased. A decrease in the area of hyperemia zone and intensity of hyperemia in the region of the right tibia was noted. The area of hyperemia in the right foot also decreased. The next EMV session (session No. 4) was performed on the zone of the right lower leg and right foot. Conducted regular sessions of hemodialysis and HBO.

 12.20.88. the child’s well-being continues to improve. 250.0 ml of urine were released per day. The swelling of the soft tissues in the lower extremities has clearly decreased. The area of hyperemia in the region of the right lower leg and foot continues to decrease.

 An EMV session was performed on the right lower leg and foot No. 5 (the exposure parameters were not changed). During a session of electromagnetic exposure, the child was sleeping soundly. Over the next 3 days, neither in the general condition of the child, nor locally, on the shin and foot side, significant changes occurred. Continued sessions of HBO, hemodialysis, plasmapheresis.

 In order to clarify the condition of the soft tissues of the right lower leg and right foot 12.24.88. diagnostic fasciotomy was performed: a skin incision was 4.0 cm long in the middle third of the right lower leg along its outer surface. It was found that all tissues, including subcutaneous tissue, muscles, and the tibia, are viable and not tense. There are no signs of necrosis and inflammation. The wound was sutured in layers of silk stitches.

 K 12/26/88. the daily amount of urine increased to 1,500 ml with normal indicators of its color and transparency. Swelling on the legs became softer.

 Transferred from intensive care to the general ward. On January 4 and 6, 1989 under mask anesthesia, both knee joints were straightened to a physiological position, plaster casts were applied to the left foot and right leg.

 On January 11, 1989, a repeated study of the blood flow of the soft tissues of the lower extremities was performed: a positive trend was confirmed; a certain decrease in blood circulation of the left foot and toes of the right foot is preserved.

 Plaster casts removed after 7 days.

 In order to prevent fibrous muscle degeneration, a child underwent a course of electrophoresis with lidase on the lower legs (15 procedures). This treatment was combined with water procedures and exposure to a low-frequency alternating magnetic field (30 mT).

 The general condition of the child continued to improve; the skin in the region of the lower extremities acquired a normal color, the swelling disappeared, and on March 2, 1989 the child, accompanied by relatives, was sent for aftercare in America.

 Thus, according to the objective monitoring of blood flow in the lower extremities, a marked decrease in the intensity of blood pressure was observed in the outcome, especially from the hips and on the right lower leg, proceeding with the phenomena of slowing down the venous outflow of blood, peripheral vasorelaxation - on the left, peripheral vasoconstruction - on the right. Along with this, the average rate of blood supply was reduced and the relative indicator of elasticity of the vascular wall was increased.

 The most pronounced positive effect of electromagnetic stimulation was noted after the 3rd session of EMW, when the intensity of arterial blood flow and the average blood speed increased significantly, and disorders of vascular tone decreased. It should be noted that at this stage of treatment there were practically no differences in peripheral blood circulation both on the right and on the left.

 It is considered necessary to note that despite the late arrival of the child to our clinic (on the seventh day after removal from the obstruction) and the delayed provision of first aid (only twelve hours after extraction from the obstruction), bioavailable electromagnetic stimulation improved blood circulation in the lower extremities and to save the right lower leg of the child from amputation. This observation proved the possibility of a successful combination of all modern methods of treatment of traumatic toxicosis (transfusion therapy, hemodialysis, plasmapheresis, hyperbarotherapy, antibacterial therapy) and bio-adequate non-contact electromagnetic stimulation.

Claims (1)

 METHOD FOR TREATING LONG-PRESSURE SYNDROME, including intensive therapy aimed at restoring kidney function, characterized in that, in order to reduce mortality, reduce the number of amputations and shorten treatment time, they additionally affect the affected part of the patient’s body with a pulsed electromagnetic field, induction 2.5 - 1.2 mT, frequency 0.8 - 2.5 Hz for 15 to 20 minutes, then by induction 3.0 - 4.0 mT, frequency 2.2 - 3.0 Hz for 25 - 35 minutes, and the ratio of rise and fall fronts of pulses is 50 ± 10% in t the entire procedure with a total number of sessions from 10 to 30 per treatment course.

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