RU2039557C1 - Method for treating pyo-inflammatory diseases of abdominal cavity - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: this method prescribes carrying out antibacterial and detoxication therapy, intravenously administering about 100 to 200 mg/ml of mexidol 3 or 4 times a day during cure. EFFECT: this method allows considerable reduction of dosage of administered antibiotics, prevention of associated complications; higher effectiveness for treating peritonitis, acute pancreatitis, cholecystitis, and other pyo-inflammatory disorders in post-operative period.

Description

 The invention relates to medicine, namely to methods for treating inflammatory and purulent-inflammatory diseases of the abdominal cavity.

 Known methods including antibiotic therapy. The duration of antibiotic administration is determined by the nature of the inflammatory process and is 5-7 days (Strukov A.I. Petrov V.I. Paukova V.E. Acute diffuse peritonitis, M. 1987, p. 228-229). In the preoperative and postoperative period, infusion therapy is used in parallel with antibiotic therapy.

 The negative side of antibiotic therapy is an increase in the number of antibiotic-resistant strains of certain pathogenic microorganisms, a decrease in non-specific resistance and immunity factors.

 There is also a method of treating purulent-inflammatory diseases of the abdominal cavity, including active detoxification of the body by extracorporeal lympho-and hemosorption, which is carried out against the background of hemodilution and forced diuresis (Dotsenko A.P. Sipovets A. A. Hemosorption in the treatment of endogenous intoxication syndrome in patients with diffuse peritonitis Clinical Surgery, 1985, issue 1, pp. 46-48).

 However, during treatment with this method, a significant loss of total protein and electrolytes occurs.

 In order to increase the general resistance of the body during purulent-inflammatory complications of the abdominal cavity in the postoperative period, extracorporeal irradiation of the patient’s blood with ultraviolet rays is used (Popov V.A. Peritonit, L. 1985, p. 218).

 However, UFOK enhances the bactericidal properties of blood, which is accompanied by the simultaneous decay of a large number of microbial bodies and the release of biologically active products leading to hypotensive and pyrogenic effects, as well as transistor release of fibrinogen, which leads to an increase in the blood coagulation system. In this regard, the use of UFOK in the early period of purulent-inflammatory complications is not recommended.

 As a prototype, a method has been adopted for the treatment of purulent-inflammatory complications in patients in the postoperative period, including antibiotic therapy using various antibiotics and sulfonamides against the background of antifungal drugs. At the same time, detoxification therapy is carried out, including the introduction of water-salt (Trisol, Quartzol, Atssol, etc.) and colloidal solutions (polyglyukin, reopoliglyukin, hemodes, etc.).

 Prescribe such vitamins and conduct a wide range of restorative therapy.

 However, the introduction of a large number of antibiotics leads to an increase in the number of strains of microorganisms that are resistant to their action. Moreover, in the exudate of the abdominal cavity with peritonitis, microbial associations are more often detected.

 Destructive processes in the abdominal cavity lead to the development of pathogenic microflora. This requires intensive infusion therapy aimed at stabilizing indicators, improving microcirculation, and compensating for water-electrolyte, protein, and energy losses. A side effect of such therapy is intestinal paresis and intestinal obstruction.

The terms of treatment in a known manner is 10 days or more. Mortality reaches 20%
The objective of the invention is to provide an effective method for the treatment of purulent-inflammatory diseases, which can reduce mortality and reduce treatment time.

 The essence of the invention lies in the fact that in a method of treating purulent-inflammatory diseases, including antibacterial and detoxification therapy, Mexidol is additionally intravenously administered in a patient's dose of 100-200 mg / ml 3-4 times a day for 3-4 days.

 The use of Mexidol as an anti-inflammatory agent allows you to relieve intoxication in a short time, normalize body temperature, improve blood rheological properties, stimulate energy processes, stabilize lipid peroxidation, stimulate the system of humoral non-specific defense, correct antioxidant defense, which contributes to a significant improvement in treatment results, reduction in mortality and reduction the duration of treatment is 3-5 times.

 The method allows to reduce the dose of antibiotics administered and thereby prevent allergic and other complications associated with them. The method is highly effective in the treatment of peritonitis, acute pancreatitis, cholecystitis and other purulent-septic diseases. It can be used to prevent purulent-septic complications in the postoperative period.

 The technical result is achieved due to the fact that the anti-inflammatory effect of Mexidol, which was used as a psychotropic drug, was established. Its ability to inhibit trypsin, chymotrypsin, and leucinaminopeptisade was experimentally established.

 The method is as follows.

 After establishing a clinical diagnosis and surgical removal of the source of peritonitis, the patient undergoes sanitation of the abdominal cavity and antibiotic therapy is prescribed taking into account the sensitivity of the isolated microorganisms to the prescribed drugs.

 Along with antibacterial therapy, detoxification therapy is carried out, including intravenous administration of water-salt (triesol, quartasol, acesol, etc.) and one of the colloidal solutions (homodes, polyglucin, reopoliglukin, etc.). Solutions for parenteral nutrition (glucose, fructose, balanced amino acid solutions, fatty solutions) are administered.

 Additionally, in the treatment process, Mexidol is administered intravenously in a daily dose of 100-200 mg / ml 3-4 times a day for 3-4 days.

 PRI me R 1. Patient K-in, 19 years old (medical history N 4807) was admitted to the clinic 11/21/91. About 8 hours ago, the patient suddenly had a sharp pain in the upper abdomen, which gradually spread to other parts of the abdominal cavity. The patient had no ulcer history. Upon admission, the patient's condition is moderate. Pulse 104 beats / min, rhythmic, satisfactory filling, blood pressure 110/70 mm, tongue coated with a white coating, dry. The abdomen is not involved in the act of breathing, it is swollen, muscle tension is expressed during palpation, especially in the right half, with deeper palpation, pain is more pronounced on the right. A positive symptom of Shchetkin-Blumberg in all departments. Intestinal noises are hardly heard. Blood test HB-145, white blood cells 7.7 thousand sticks 4, segments 78, lymphocytes 13, monocytes 5. Urinalysis: rel. density 1011, protein, sugar, acid reaction. With a panoramic radiography of the abdominal cavity, the presence of free gas was not detected. The patient has a clinical picture of diffuse peritonitis, however, the source of peritonitis is not entirely clear. In this regard, the patient underwent urgent laparoscopy: in the abdominal cavity, a cloudy effusion with flakes of fibrin is more along the right lateral canal and in the subhepatic space. Parietal and visceral peritoneum swollen, hyperemic. In the right iliac region, inflammatory infiltrate.

 Conclusion: diffuse fibrinous-purulent peritonitis. Emergency operation. Lower-median laparotomy. The appendix is swollen, hyperemic. Appendectomy performed. During drainage of the abdominal cavity, purulent exudate with an admixture of mucus and bile from the upper floor of the abdominal cavity was noted. The incision is extended up. A further audit revealed a cryptic ulcer of the anterolateral surface of the pyloric wall, penetrating into the hepatoduodenal ligament. The perforation site is covered by the gall bladder and the lower surface of the liver. Perforated hole with a size of 1.0 x 0.5, the edges of the ulcer are dense, suturing the ulcer according to Polikarpov. The abdominal cavity was sanitized with an isotonic solution of sodium chloride and chlorhexidine. Installed drainage and subhepatic space and pelvic cavity. Histological examination: fibrinous periappendicitis. Bacteriological examination of the contents of the abdominal cavity: fungi such as Canola.

 In the postoperative period, the patient was prescribed complex therapy, including parenteral administration of ampicillin, saline solutions (chlorosol, quartasol), reopoliglyukin.

 Mexidol was additionally prescribed, which was administered intravenously for 3 days at a dose of 200 mg / ml three times a day.

 The postoperative period in the patient passed without complications. Drainage from the abdominal cavity was removed on the 4th day. On the 3rd day after the operation, intestinal noises began to be heard, and a day later there was an independent stool. The wound healed by primary intention. An. blood from 28.11: urea 6.3 g / l, bilirubin 7 μm / l, cholesterol 3.5 mmol / l; total protein 67 g / l, sugar 5.1 mmol / l, ALT 23 units; AST 35 units, alkaline phosphatase 14 mmol / L. 06.11. the patient is in satisfactory condition transferred to separate gastroenterology for further antiulcer treatment.

 PRI me R 2. K-VA M. A. 72 years old (source. Disease N 26013) was admitted to the hospital 10/17/91. Ill three days ago. There were pains in the epigastric region, which then spread throughout the abdomen, vomiting twice, stool and gas retention was noted.

 On examination, the patient's condition is serious. Pulse 108 beats. in minutes rhythmic, satisfactory filling, blood pressure 140/80 mm Well, the tongue is dry, the stomach is slightly swollen. With superficial palpation, the greatest muscle tension of the anterior abdominal wall. With deep palpation, the abdomen is painful in all departments, but great soreness is expressed along the right lateral hypochondrium. A positive symptom of Shchetkin-Blumberg. Intestinal noises are not heard. Diagnosis: acute appendicitis. Spilled peritonitis. Emergency surgery: mid-median laparotomy. In the abdominal cavity, a significant amount of turbid effusion with fibrin. The peritoneum is edematous, hyperemic, intestinal loops are swollen, in many places with fibrinous overlays. The appendix is located retrocecal, black with perforation in the apex. Appendectomy, blockade of the mesentery root by 1/4 novocaine solution (100 ml) was performed. The abdominal cavity is drained, fibrinous deposits are removed if possible, washed with a solution of furatsillina and chlorhexidine, drained. The postoperative period was difficult. Prescribed antibiotic therapy (ampicillin, kanamycin, gentamicin), as well as etazole, meromidazole.

 Massive infusion therapy was carried out, including saline solutions (Acesol, Chlosol, Lactosol), reopoliglyukin. In addition, Mexidol was administered intravenously at a dose of 100 mg 4 times a day for 4 days.

 Gradually, the patient's condition began to improve, on the 4th day intestinal noises appeared and gases began to escape. The effects of endotoxemia waned a week later. After a week en. blood: HB 138, white blood cells 5.2, pal 1, ESR 2.

 Biochemical blood tests without features.

Ex 3 days 7 days DK 1.2 0.52 0.75 Avg. pier 0.78 0.51 0.29 TF 6.2 9.2 14.2 OSH 5.2 4.9 2.5
The patient was discharged from the hospital for 5 days.

Claims (1)

 METHOD FOR TREATING PURULENT INFLAMMATORY DISEASES OF THE ABDOMINAL CAVITY, including antibacterial and detoxification therapy, characterized in that mexidol is additionally administered intravenously at a dose of 100 to 200 mg / ml 3 4 times a day for 3-4 days.