RU2039555C1 - Method of treating burn shock - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: essence of this method resides in administering Ringer's solution, polyglucin, diphenylhydramine hydrochloride, analginum, pyridoxine solution, glucose solution, procaine hydrochloride, ascorbic acid, strophanthin, hemodese, euphylline, plasma, contrical, and heparin. Disclosed method is distinguished from prior art in that it prescribes additionally administering mildronate, clofelin, thrental and rhelanium, administering about 300 to 500 ml Ringer's solution, about 300 to 500 ml polyglucin, 1 to 3 ml 1-percent solution of diphenylhydramine hydrochloride, 1 to 3 ml 50-percent solution of analginum, 1 to 3 ml 2.5-percent solution of pyridoxine, 300 to 500 ml 5-percent solution of glucose with 75 to 125 ths units of contrical, 300 to 500 ml of rheopolyglucin with 3 to 5 ml thrental, and 4 to 6 ml 10-percent solution of mildronate, slowly dropwise carrying out infusion of about 300 to 500 ml of glucose into patient's central vein, at the same time slowly dropwise infusing about 300 to 500 ml of 5-percent glucose solution and about 0.5 to 1.5 ml of 0.01-percent of clofelin into peripheral vein after positive central vein pressure has been attained, at the same time infusing about 300 to 500 ml 10-percent glucose solution, 12 units of insulin, about 4 to 6 ml of 5-percent solution of ascorbic acid, 150 to 250 ml of 5-percent glucose solution, about 150 to 250 ml of 0.25-percent procaine hydrochloride, 10 to 15 ml of 2.4-percent euphylline solution, about 0.5 to 1.0 ml of 0.05-percent strophanthin solution, about 1 to 2 ml of 0.5-percent rhelanium solution, about 300 to 500 ml hemodese solution, about 750 to 850 ml of plasma, and about 30 to 40 ths units per day of heparin into central vein during 4 to 6 h, and after patient's going out of shock, intramuscularly administering about 0.5 to 1.5 ml of clofelin three times a day during 72 to 120 h and intravenously administering about 4 to 6 ml of mildronate during fourteen days. EFFECT: greater intensity of therapy of burn disease and lower rate of side effects.

Description

 The invention relates to medicine, namely to anesthesiology-resuscitation and combustiology, can be used in the treatment of burn patients.

 A known method of stopping the pain response in burn shock with narcotic analgesics. However, the use of narcotic analgesics with high toxicity can also cause side effects such as muscle stiffness, respiratory distress, cardio depression, paresis of the gastrointestinal tract, and vasodilation.

 The use of antipsychotics in the treatment of a burn disease in order to prevent an excessive stress response often does not have the desired result, reducing to some extent the hyperergic reaction associated with the psychoemotional reaction; these drugs do not block other channels of stress development.

 The use of glucocorticosteroids in burn patients in the acute phase of suffering can reduce the inflammatory response, protect intracellular structures, reduce the permeability of the walls of the capillaries, and prevent the development of adrenal insufficiency. An increase in the concentration of glucocorticosteroids often leads to a breakdown in adaptation, inhibition of immunity, and contributes to the spread of infection.

 An integral part of the treatment of patients with burn injury is infusion-transfusion therapy. The scheme for the appointment of infusion media and plasma preparations has been sufficiently developed.

A known method of treating patients with burn shock, including intravenous administration of painkillers, antihistamines, cardiac drugs and antipsychotics: analgin, diphenhydramine, promedol, droperidol, strophanthin (corglucon), ATP. During the first day, the patient receives 3-6 liters of fluid. Polyglucin, reopoliglukin, glucose, lactosol, Ringer, mannitol, novocaine, hemodesis, ascorbic acid, vitamins B ₁ , B ₆ , B ₁₂ , prednisolone, euphilin, trasilol, heparin are administered dropwise during the day. Transfuse plasma and blood. However, conventional therapy does not always give positive results.

 The aim of the invention is to increase the effectiveness of intensive care of a burn disease, to reduce the side effects of conventional treatment.

This is achieved by the fact that according to the method of treating burn shock, comprising administering Ringer's solution, polyglucin, diphenhydramine, analgin, vitamin B ₆ solution, glucose solution, reopoliglukin, novocaine, insulin, ascorbic acid, strophanthin, homodez, euphilin, plasma, contrical and heparin , the patient is injected with mildronate, clonidine, trental, relanium, and first, Ringer's solution of 300-500 ml, polyglucin 300-500 ml, diphenhydramine 1% 1-3 ml, analgin 50% 1-3 ml are injected into the central vein , vitamin B ₆ solution 2.5% 03.01 ml glucose solution 5% 300-500 l with kontrikalom 75-125 thousand U, reopoligljukin trentalom with 300-500 ml 3-5 ml mildronat 10% 4-6 ml; after the CVP reaches positive numbers, infusion of a glucose solution of 5% 300-500 ml with clonidine 0.01% 0.5-1.5 ml was slowly dripped into the peripheral vein, then a 10% glucose solution was poured into the central vein 300-500 ml with insulin 12 U and ascorbic acid 5% 4-6 ml, glucose solution 5% 150-250 with novocaine 0.25% 150-250 ml, strofantine solution 0.05% 0.5-1 ml, eufilin solution 2.4% 10-15 ml, Relanium solution 0.5% 1-2 ml, homodez solution 300-500 ml, plasma 750-850 ml, heparin 30-40 thousand units / day moreover, after emergence from shock, clonidine is administered intramuscularly for 3-5 days, 0.5-1.5 ml 3 times a day, Mildronate is administered intravenously 4-6 ml until 14 days.

 The proposed method is characterized in that the patient is administered mildronate, clonidine, trental and relanium, and drugs known by the prototype are administered in modified doses.

 The use of clonidine helps to reduce the functional load on the heart and oxygen requirements of tissues, reduce lactic acidosis and increase the concentration of glucose in brain tissues with a reduced level of insulin, improves the energy supply of brain metabolism, and causes a pronounced sedative and analgesic effect. The use of mildronate eliminates vasospasm, has a cardioprotective, antiarrhythmic effect, immunocorrective properties. Mildronate is well combined with antianginal agents, anticoagulants, antiplatelet agents, etc.

 Trental stimulates the formation of ATP in red blood cells, increases their elasticity and thus reduces blood viscosity, reduces vascular resistance, increases stroke volume of the heart, and inhibits platelet aggregation.

 Relanium has a calming, hypnotic, anticonvulsant, muscle relaxant effect.

 The method is as follows.

Ringer’s solution of 300-500 ml, polyglucin 300-500 ml, diphenhydramine 1% 1-3 ml, dipyrone 50% 1-3 ml, vitamin B ₆ solution 2.5% 1- 3 ml, glucose solution 5% 300-500 ml with contracal 75-125 thousand units, reopoliglyukin 300-500 ml with trental 3-5 ml, mildronate 10% 4-6 ml; after the CVP reached positive numbers, a glucose solution of 5% 300-500 ml with clonidine 0.01% 0.5-1.5 ml was slowly dripped over a peripheral vein for 4-6 hours; at the same time, a 10% 300-500 ml glucose solution with 12 U insulin and 5-6% ascorbic acid 5% glucose solution, 150-250 ml glucose solution with 0.25% novocaine was poured into the central vein 150-250 ml, eufilin solution 2.4% 10-15 ml, Relanium solution 0.5% 1-2 ml, hemodesis solution 300-500 ml, plasma 750-850 ml, heparin 30-40 thousand units / day, and after exiting the shock, clonidine is administered intramuscularly for 3-5 days, 0.5-1.5 ml 3 times a day, Mildronate is administered intravenously 4-6 ml up to 14 days.

PRI me R 1. Patient A., 19 years old, received thermal burns on an electric train car. Diagnosis at admission: burn disease, shock III tbsp. thermal burn II-III art; burn surface area 80% The state of admission is difficult, consciousness is inhibited, intact skin and visible mucous membranes are pale, T 35.5 ^о С, symptom of a pale spot more than 3 s. Vesicular breathing, no wheezing, NPV = 24 in 1 min. Heart tones are deaf single extrasystoles, a pulse of weak filling, blood pressure 75/40 mm RT. Art. Heart rate 130 beats. in 1 min, CVP neg. The abdomen is soft, painless, no diuresis.

Ringer’s solution 300 ml, polyglucin 300 ml, diphenhydramine solution 1% 1 ml, dipyrone solution 50% 1 ml, vitamin B ₆ solution 2.5% 1 ml, glucose solution 5% were injected into the patient’s central vein 300 ml with contrakal 75 thousand units, reopoliglyukin 300 ml with trental 3 ml, 10% 4 Mildronate; after CVP reached positive numbers in parallel into the peripheral vein, a glucose solution of 5% 500 ml with clonidine 0.01% 0.5 ml was slowly dripped for 6 hours; at the same time, a central glucose solution was transfused with a glucose solution of 10% 300 ml with insulin 12 U and ascorbic acid 5% 4 ml, a glucose solution 5% 200 ml with novocaine 0.25% 200 ml, eufilin solution 2.4% 100 ml, Relanium solution 0.5% 1 ml, hemodesis solution 300 ml, plasma 750 ml, heparin 30 thousand units / day.

After 6 hours after said treatment in a serious condition, the patient sleeps, intact skin and visible mucous pale pink, T 36.6 ^{° C,} less than 1 with SBP. The vesicular breathing, no wheezing, NPV = 18 in 1 min. Heart sounds are muffled, rhythmic, heart rate = 95 in 1 min, CVP-30 mm H ₂ O, blood pressure 100/60 mm RT. Art. The abdomen is soft, painless. Diuresis was 450 ml. By the end of 1 day. the patient completely came out of shock. In the following days, clonidine was administered intramuscularly for 3 days, 0.5 ml 3 times a day, Mildronate was administered intravenously 4 ml until day 14. The toxemia phase proceeded within 4-11 days. During this period, hyperthermia was 37,6-38 ° ^C. In order to control this condition need only one session of plasmapheresis. During the period of acute toxemia on the 8th day anemia / HB 80 g / ml was detected; Er.-2.7 ˙ 10 ¹² . NT 35% /. However, it was quickly stopped by the introduction of 500 ml of a single-group erythra suspension against the background of the proposed therapy. After 11 days. the disease proceeded without complications by 28 days. the wounds have completely healed. The patient was discharged for 30 days.

PRI me R 2. Patient C. 45 years old received thermal burns with flame. Diagnosis at admission: burn disease, shock III tbsp. thermal burn II-III Art. burn surface area 65%
The condition at admission is severe, the consciousness is clear, excited, undamaged skin and visible mucous membranes are pale, T 35.4 ^about C, a symptom of a pale spot more than 3 s. Hard breathing, no wheezing, NPV 28 in 1 min. Heart sounds are deaf, isolated extrasystoles, pulse of weak filling of blood pressure 80/60 mm RT. Art. Heart rate 135 beats. in 1 min, CVP neg. The abdomen is soft, painless, there is no diuresis.

The therapy was carried out according to the proposed method: Ringer's solution 400 ml, polyglucin 400 ml, diphenhydramine 1% 2 ml, dipyrone 50% 2 ml, vitamin B ₆ solution 2.5% 2 ml, solution was injected into the central vein of the patient glucose 5% 400 ml with contracal 100 thousand units, reopoliglyukin 400 ml with trental 4 ml, mildronate 10% 5 ml.

 After the CVP reached positive numbers, a glucose solution of 5% 400 ml with clonidine 0.01% 1 ml was slowly dripped for 5 h in parallel into the peripheral vein; at the same time, a 10% glucose solution 400 ml with insulin 12 U and a 5% ascorbic acid solution 5 ml, a glucose solution 5% 200 ml with novocaine 0.25% 200 ml were poured into the central vein, eufilin solution 2.4% 12 ml, Relanium solution 0.5% 1.5 ml, haemodesus solution 400 ml, plasma 800 ml, heparin 35 thousand units / day.

After 6 h after intensive care in a serious condition, the patient sleeps, intact skin and visible mucous pale pink, and T 36.1 ^C. SEP less than 1 s. Hard breathing without signs of swelling of the subglottic space and wheezing. NPV 20 in 1 min. Heart sounds are muffled, rhythmic, heart rate 106 beats. in 1 min, CVP 45 mm H ₂ O, blood pressure 100/60 mm RT. Art. The abdomen is soft, painless. Diuresis was 400 ml. By the end of 2 days. the patient completely got out of the shock state. In the next 4 days. against the background of infusion-transfusion therapy, intramuscular administration of clonidine of 0.01% 1 ml 3 times a day was continued. Mildronate was administered intravenously in 5 ml until 14 days. The toxemia phase lasted 9 days, was accompanied by mild hyperthermia, which was adjusted by infusion therapy and did not require extracorporeal treatment methods. Anemia manifested on day 6. (HB 80-60 g / l; Er. 2.5-3 ˙ 10 ¹² ; NT25-30%) was stopped by double transfusion of 500 and 250 ml of a single-group erythro-suspension. By the end of 2 weeks, the condition stabilized and was not complicated in the future. By 30 days dense wound healing has occurred. The patient was prescribed for 40 days.

PRI me R 3. Patient S. 20 years old received thermal burns in a train car. Diagnosis at admission: burn disease, shock III tbsp. thermal burns II-III Art. burn surface area 75%. Status upon admission: serious condition, clear consciousness, intact skin and visible mucous membranes pale, T 35 ^° C, symptom of a pale spot more than 3 s. The vesicular breathing, no wheezing, NPV26 in 1 min. Heart sounds are deaf, single electrosystoles, pulse of weak filling, heart rate 140 beats. in 1 min, blood pressure 75/40 mm RT. Art. CVP neg. The abdomen is soft, painless. No urine.

The therapy was carried out according to the proposed method: Ringer's solution of 500 ml, polyglucin 500 ml, diphenhydramine 1% 3 ml, dipyrone 50% 3 ml, vitamin B ₆ solution 2.5% 3 ml, solution was injected into the central vein of the patient glucose 5% 500 ml with contracal 125 thousand units, reopoliglyukin 500 ml with trental 5 ml, 10% mildronate 6 ml; after the CVP reached positive numbers, a glucose solution of 5% 500 ml with clonidine 0.01% 1.5 ml was infused dropwise for 4 hours in parallel into the peripheral vein; at the same time, a 10% glucose solution of 500 ml with insulin 12 U and a solution of ascorbic acid 5% of 6 ml, a glucose solution of 5% 250 ml with novocaine 0.25% 250 ml were poured into the central vein, euphilin solution 2.4% 15 ml, Relanium solution 0.5% 2 ml, hemodine solution 500 ml, plasma 850 ml, heparin 40 thousand units / day, after 6 hours the condition is serious, the patient is sleeping, intact skin integument and mucous visible pale pink, T 36 ^o C, SBP less than 1 s. Hard breathing, no wheezing, NPV 22 in 1 min. Heart sounds are muffled, rhythmic, heart rate 110 beats. in 1 min, CVP 35 mm H ₂ O, BP 95/65 mm Hg. Art. The abdomen is soft, painless. Diuresis was 600 ml.

By the end of 2 days. big came out of a state of shock. In the next 5 days. against the background of infusion-transfusion therapy, intramuscular administration of clonidine of 0.01% 1.5 ml 3 times a day was continued. Mildronate was administered intravenously in 5 ml until 14 days. The toxemia phase lasted 8 days, was accompanied by moderate hyperthermia, which was adjusted by infusion therapy and did not require extracorporeal treatment methods. Anemia manifested on the 6th day / HB 90-70 g / l; Er. 2.5-3.0 ˙ 10 ¹² ; NT 30-35% /, was stopped by double transfusion of 500 and 250 ml of a single-group erythro-suspension. By the end of 2 weeks, the condition stabilized. By 30 days complete wound healing has occurred. The patient was discharged for 42 days.

 Comparison of the treatment results of the experimental (using the proposed method) and control (by the known method) shows that the use of clonidine in this category of patients with replenished BCC does not cause hypotension, and, in combination with antiplatelet agents, mildronate and relanium, successfully cope with the shock state in burns patients, in the future, this method allows to correct anemia, contributes to the rapid epithelization of the burn surface and the prevention of purulent-septic complications. As a result, in patients with superficial burns and burn disease, the length of hospital stay was reduced by 5 days, in patients with deep burns to 20% for 4 days, with deep burns of 20-40% of the surface for 4 days and 3 days in patients with deep burns over 40%

Claims (1)

The METHOD FOR TREATING BURNN SHOCK by introducing Ringer's solution, polyglucin, diphenhydramine, dipyrone, vitamin B ₆ solution, glucose solution, reopoliglyukin, novocaine, insulin, ascorbic acid, strophanthin, hemodez, euphilin, plasma, contrycal and heparin, additionally characterized in that mildronate, clonidine, trental and relanium, while under the control of central venous pressure, Ringer's solution 300 500 ml, polyglucin 300 500 ml, 1% diphenhydramine 1 3 ml, 50% analgin 1 3 ml, 5 are injected into the central vein % glucose solution 300 500 ml with contracal 75 125 thousand units, reopoliglyukin 300 500 ml with trental 60 100 mg in 3 5 ml, 10% mildronate 4 6 ml, after achieving positive values of the central venous pressure in the peripheral vein or through the second system to the central vein infusion of 5% glucose solution 300 500 ml with clonidine 0.4 μg / kg / h in 0.5 1.5 ml of 0.01% solution, at the same time, 10% is introduced through the first system into the central vein glucose solution 300 500 ml with insulin 13 IU and 5% ascorbic acid 4 6 ml, 5% glucose solution 150 250 ml with 0.25% novocaine 150 25 0 ml, 2.4% solution of aminophylline 10 15 ml, 0.05% solution of strophanthin 0.5 - 1 ml, 0.5% solution of Relanium 1 2 ml, hemodez 300 500 ml, plasma 750 - 850 ml, heparin 30 40 thousand units / day, after exiting the shock, continue the administration of clonidine intramuscularly 0.5 to 1.5 ml 3 times a day for 3-5 days and a 10% solution of mildronate 4 6 ml intravenously to 14- th day of treatment.