RU2036658C1 - Method of treating infected wound - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: this method is effective for treating such purulent-nonnecrotic diseases as purulent wounds, trophic ulcers, suppurative fistulas, phlegmons, and thermal burns. In the first phase of development of wound process (hydration phase), this method prescribes treating affected areas with use of proteolytic complex prepared from pancreatic tissue of hydrobionts having activity of 0.1 to 0.5 PU in 1 mg of medicinal preparation to be administered in the form of dusting powder which should be applied to wound surface. In the second phase (dehydration), this method prescribes treating affected areas with low-molecular DNA preparation (content of desoxyribonucleic acid: 46 to 85 %) to be used either separately or in combination with proteolytic complex (1:1) - (1:3). EFFECT: excellent remedy. 1 tbl

Description

 The invention relates to medicine and can be used to treat diseases of a purulent-necrotic nature, including purulent wounds, trophic ulcers, purulent fistulas, phlegmon, thermal burns.

 A known method of treating purulent wounds with the microbial preparation terrilithin by external use in the form of an aqueous or novocaine solution containing 40-50 PE in 1 ml. The napkin is moistened with a solution, applied to the wound and covered with a waterproof dressing. The dressing is changed 1 time per day. With deep burns, the drug is used in the form of powder.

 A known method of treating purulent wounds with hygrolitin. Apply in the form of a solution or powder. The napkin is moistened with a solution, 1 ml of which contains 20-50 PE, applied to the wound and covered with a waterproof dressing.

 The closest to the achieved result is a method of treating purulent wounds with trypsin. Its use in medical practice is based on its ability to split necrotic tissues and fibrinous formations under local influence. Treatment of purulent wounds and pressure sores is carried out by applying a dressing soaked in trypsin solution in a 25% solution of novocaine or isotonic sodium chloride solution.

 The problem solved by the invention is the expansion of the arsenal of drugs for the treatment of infected wounds, increasing the effectiveness of treatment.

 The essence of the method is as follows: in the first phase of the wound healing process, the hydration phase is applied to a proteolytic complex from marine organisms (PC) in the form of powders for daily dressings with fixation on the wound surface using aseptic dressings or with ointment preparations, in a dose of 4-6 mg per one square centimeter of the treated surface with the activity of the drug 0.1-0.5 PE in 1 mg of the drug. Then, after the wound is completely cleansed, in the second phase of the development of the wound process, the dehydration phase uses the preparation of low molecular weight deoxyribonucleic acid (DNA) from salmon milk. DNA is applied in the form of powders in a dose of 6-10 mg per square centimeter of the treated surface in pure form or mixed with PC at a ratio of (1: 1) (1: 3) in a dose of 10-12 mg. Treatment is carried out until the wound is completely healed.

 The proteolytic complex (PC) is obtained from the internal organs of aquatic organisms, for example, pyloric appendages of salmon or crab hepatopancreas. The method for producing PC consists in grinding the raw material, extracting it with 1 mM calcium chloride solution, adding 0.2% detergent and the following operations: separation, supercentrifugation, microfiltration and ultrafiltration on membranes with pore size 15000-20000 (Yes), drying the final product.

The resulting preparation is an amorphous brown powder, soluble in water. Contains acidic, neutral and alkaline proteases: trypsin, chymotrypsin, collagenase. The activity of alkaline proteases is 50-500 U / g of mass under the following conditions: pH 8.0; t 30 ^about C; substrate 2% casein.

Low molecular weight deoxyribonucleic acid (DNA) is obtained from overripe salmon milk. The production method is based on the extraction and standard hydrolysis of DNA with 0.5 M perchloric acid to soluble fragments under control by measuring ultraviolet absorption at 170-290 nm. The final product is dried in air at a temperature of 20-24 ^about C.

 The DNA preparation is an amorphous powder of light cream color, with a characteristic, specific odor, soluble in water, 0.5 M perchloric acid, alkali when heated.

 The drug contains 45-86% DNA and 10-12% protein and is a complex of protein and nucleoprotein DNA.

 PRI me R 1. Patient A. 54 years old, diagnosis: decompensated type II diabetes mellitus, diabetic angiopathy of the vessels of the lower extremities, wet gangrene of the left foot.

On October 22, 1990, the upper third of the leg was amputated for wet gangrene. The postoperative period was complicated by suppuration of the wound of the stump with the development of deep phlegmon of the lower leg. A bacteriological study of culture was performed, in which a white plasmocoagulating staphylococcus, insensitive to antibiotics, was detected. The use of traditional topical treatment of antibiotics, reparants, antiseptics, proteolytic enzymes from the pancreas of cattle (trypsin and chymotrypsin) gave only an insignificant effect. Necrosis of the underlying tissues within 18 days progressed with profuse purulent separation. On the 19th day, a proteolytic complex from pancreatic organs of aquatic organisms (PC) was used with an activity of 0.2 PE in 1 mg of the drug. PC was used in the form of powders daily at a dose of 4-6 mg per 1 cm ^{2 of the} wound surface. Aseptic dressings were applied to the wound. The treatment was carried out for 10 days until the wound was completely cleansed, there was a complete rejection of necrotic tissue and the exudation was completed. In the second phase of the wound healing process from the 30th day after the operation, a DNA preparation was used (the content of the main component 55%) in the form of powders in a dose of 6-10 mg per 1 cm ² surface daily. This made it possible to reduce the dehydration phase. As a result, two wounds with a total area of 35 cm ² healed completely by secondary intention on the 42nd day after surgery.

 PRI me R 2. Patient M, 33 years old, was operated on for deep phlegmon of the thigh, after the opening of which a long-term non-healing wound was formed.

 On September 10, 1991, phlegmon was opened and drained. The hydration phase lasted about a month with a constant significant purulent separation. Despite the use of methods of active evacuation, aspiration, drainage, and other methods, exudation continued.

With a decrease in purulent exudation, PCs with an activity of 0.2 PE in 1 mg and DNA (60%) were used in an equal ratio of / 1: 1 /. The drug was applied to the wound in powder form daily at a dose of 10-12 mg per 1 cm ² surface, which sharply stimulated the regeneration processes. The exudation was completely completed on the 11th day after the use of drugs. The wound healed completely on the 19th day from the start of treatment by the proposed method.

 PRI me R 3. Patient B. 62 years old, the diagnosis of venous insufficiency, chronic thrombophlebitis of deep veins of both legs, trophic ulcers of the left leg.

 The patient was admitted for planned conservative treatment on November 3, 1991. He suffers from this disease for several years. On admission, a trophic ulcer of 6 x 7 cm with uneven, saped edges in the area of the medial ankle, with moderate purulent separation was determined. The patient daily, from the first day of treatment, PK (0.25 PE) was applied in the form of a concentrated aqueous emulsion. On the 7th day from the start of treatment, the wound cleansed of necrotic tissue, exudation decreased. On November 11, autodermoplasty was performed according to Yanovich-Chaynsky. 1 day before the operation, a DNA preparation (60%) was applied to the ulcer surface in the form of a powder, and in the postoperative period, ligation was performed with concentrated aqueous DNA solution daily, which increased the marginal epithelization of the transplanted skin areas. The ulcer is completely epithelized on the 19th day after surgery.

 PRI me R 4. Patient Z. 32 years old was admitted to the surgical department on an emergency basis for a knife penetrating wound of the chest on the left, damage to the subclavian artery, hemorrhagic shock of the III degree, the postoperative period was complicated by suppuration of the postoperative wound, general and local treatment was performed , including traditional preparations of proteolytic enzymes. On the 18th day he was discharged for outpatient treatment with a diagnosis of a granulating wound. In the clinic on the 19th day, treatment of PC with an activity of 0.2 PE / mg in combination with DNA (1: 3) daily was started. The exudation was completed on the 3rd day, and a secondary scar formed on the 9th day from the start of treatment.

 The advantages of the proposed method compared to the well-known, taken as a prototype, were distinguished by the total duration of treatment, as well as the timing of completion of the individual phases of the wound process. The results are presented in the table.

 Using the proposed method for the treatment of infected wounds can significantly increase the specific focus of treatment and accelerate the healing time of wounds.

Claims (1)

METHOD FOR TREATING INFECTED RAS by external use of preparations containing proteolytic enzymes, characterized in that at the stage of development of the wound process in the hydration phase, treatment is carried out with a proteolytic complex from pancreatic organs of aquatic organisms with an activity of 0.1 0.5 PE in 1 mg of the drug in a dose of 4 6 mg per 1 cm ² of wound surface and the dehydration treatment in step is carried out with low molecular DNA preparation DNA content of 45 86% in pure form or in admixture with 1 1 3 proteolytic complex in a dose of 10 12 mg per 1 cm ² of the wound n surface.

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