RU2067007C1 - Method for treating burnt patients - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying wet fabric inserts to the central sagittal frontooccipital area. Electrodes are arranged over the inserts so that the positive electrode is set on the front and the negative one is set on the back of the head. Then, constant and rectangular or sharp triangular biphasic pulsating current with frequency of 60 to 90 Hz, frequency change period of 3 min and frequency increment of 0.5-1.0 Hz, where the constant-to-alternating current ratio being equal to 1:1, is supplied. The total current strength is varied from 0.5 to 3.0 mA with action duration being equal to 30 min. The treatment course duration is 5-15 days 1 or 2 times a day depending on disease severity degree. One day treatment pause is permissible after 4-5 days. EFFECT: simplified method; accelerated treatment course. 4 dwg

Description

 The invention relates to medicine, namely to combustiology.

 In the literature, there are known methods of general anesthesia, prevention of infectious and inflammatory diseases by exposing the central nervous system to an electric signal (ed. St. N 11303353, ed. St. N 12206714, ed. St. N 554871, ed. St. N 1074543).

 However, they do not solve the problem of treating a heavy contingent of patients, the mechanisms of the effect of electrical signals of various parameters on the brain in various diseases have not been explained and studied.

 The closest analogue is a method of stimulating the antinociceptive system, which includes applying a retromastoidal direct current to the forehead region and then a rectangular pulse current with a frequency of 70 80 Hz with a ratio of direct and pulse currents (2 5) 1 with a total current strength of 5 25 mA and exposure duration 25 35 min (see ed. St. N 1522500).

 However, this method is not effective enough in the treatment of burn patients, although some acceleration of wound healing has been noted. The use of only one frequency of exposure from the range of 70 to 80 Hz is not always quite effective due to the presence in some patients of others that selectively activate the antinociceptive system. It is known that such a frequency of activation in a patient can have one of the values in the range 60–90 Hz; therefore, the use of an electric signal with a periodically changing frequency increases the effectiveness of treatment. When applying the fronto-mastoid location of the electrodes, there is a high probability of the passage of electric current through the soft tissues of the skull cover. This reduces the effect of electric current on the brain, therefore, to increase efficiency, the current strength is increased to 25 mA. A current of such strength is poorly tolerated by burn patients, side effects, severe burning under electrode pads, anxiety, fear are noted, after the procedure, some patients experience headaches. With a central-sagittal fronto-occipital arrangement of the electrodes and a negative (active) electrode on the back of the head, the maximum passage of electric current through the subcortical structures of the brain is achieved.

 The claimed invention is aimed at improving the effectiveness of the results of the traditional treatment of patients with burns due to the activation of adaptive and anti-stress mechanisms of self-regulation.

 The problem is solved by simultaneous exposure to the central fronto-occipital region with direct current and a rectangular or pointed-biphasic pulse current with a frequency of 60 90 Hz and a frequency change period of 3 minutes and a frequency step of 0.5 1.0 Hz with a ratio of direct and pulse current 1 1 and the total current value of 0.5 to 3.0 mA for 30 minutes, the course of treatment is from 5 to 15 days according to 1 2 procedures per day.

 The peculiarity of the course of the disease in burn patients determines the need for new treatment methods. In this category of patients, maladaptation mechanisms are most pronounced under the influence of traumatic stress. Severe pain, sleep disturbance, dyspeptic disorders in the victims require correction and a large consumption of pharmacological agents (narcotic analgesics, barbiturates, etc.). The use of mesodiencephalic modulation (MDM) in patients with burns makes it easier to solve many problems associated with the difficulties of pharmacotherapy.

 Mesodiencephalic modulation (MDM) is an electrotherapy method in which selective activation of central regulatory systems (hypothalamic-pituitary-adrenal, opioid, etc.) is achieved by exposing a specially selected weak electric signal to the median structures of the brain, which leads to the release of biologically into the systemic circulation active compounds of neuropeptides, causing a decrease in the severity of the stress reaction and an increase in the effect of adaptation of the body.

 MDM electrotherapy method, which uses highly specific pulsed currents of low frequency and predominant effect on the subcortical-stem sections of the brain (mesodiencephalic zone). For this purpose, rectangular pulsed currents are mainly used in a narrow 60 to 90 Hz frequency range with a maximum of 77 Hz, a duration of 3.0 5.0 ms and an amplitude of 0.5 3.0 mA. Other electrical signals are also used: spiky, two-phase and with a high-frequency filling of 10,000 160,000 Hz. The method is implemented using the apparatus MDM-1, MDM-3, MDM-101, Transair-2, etc. approved for use in medical practice and produced by the domestic industry.

 The MDM method stimulates the release of neuropeptides into the systemic circulation. Neutropeptides themselves constitute a large multifunctional group of a neuroregulator, each of which has a set of characteristic physiological activities. For MDM, the selective activation of a group of opioid peptides formed in the nervous system, digestive tract, skin, genital glands, and in immunocompetent cells is most characteristic. The spectrum of action of opioid peptides is extremely high, in functional terms they are regulators of the activity of organs and tissues, in connection with which they take part not only in the regulation of pain perception processes, but also affect neuronal activity, memory and behavior, participate in the regulation of the endocrine functions of the body, stress reactions, cardiovascular activity, etc. Some of these effects appear in doses lower than those at which they cause analgesia, and suggest that pain regulation is not a major function of opioid peptides.

 The main clinical and biological effects of MDM are: activation of adaptation of the patient’s body, manifested in a decrease in pain, normalization of sleep and appetite: an increase in the body’s defenses, prevention of infectious complications, and, when they develop, a reduction in the term for relief of complications and an improvement in homeostasis; removal from a pre- and coma during hypoxia of a heavy contingent of patients; biostimulation of reparative processes in burn wounds, reducing the time of preoperative preparation and improving the engraftment of autodermografts; the possibilities of monotherapy with drug intolerance and the limitation of pharmacotherapy.

 The mechanisms of action of MDM are to increase the concentration in the peripheral blood of opioid peptides (in particular beta-endorphin), pituitary hormones (in particular, somatotropic hormone), as well as in modulating the feedback system of ACTH and cortisol concentrations, in improving indicators of cellular and humoral immunity. Apparently, under the influence of MDM, generalized changes in the multilateral correlation of neuroendocrine regulatory structures occur (Fig. 1). The induced shifts persist after the MDM course (in a partially transformed form).

 In FIG. 1 it can be seen that the MDM method has a nonspecific effect, leading to the activation of a sufficiently strong and long-term adaptation simultaneously with the antistress effect. This makes the MDM method universal in treating patients in the acute phase of a burn disease and in its subsequent periods.

 A study of the dynamics of the correlation of the concentration of the above indicators in comparison with the data on the integration of pain, sleep and wakefulness, increased appetite and decreased hyporexia indicate the differentiated nature of the changes caused by MDM, since subordination, coordination and response distribution are inevitable in the systemic reaction of constantly working brain centers levels of functional state (Fig. 2, 3, 4).

 Activation of the antinociceptive system of the brain leads to an improvement in the processes of microcirculation, serotonin metabolism and metabolism, equalization of the reaction and feedback between organs, systems and central regulatory mechanisms. These manifestations of the general adaptation syndrome are reflected in the subsequent anti-inflammatory and biostimulating action.

 One of the criteria for a favorable course of burn disease is the appearance of healthy, sound sleep in patients, indicating a significant improvement in their somatic status.

 The figure shows that sleep plays one of the important functions in the self-regulation of the body of patients with burns and its normalization under the influence of MDM facilitates the course of the disease.

 In the mechanism of action of MDM, it is important to reduce hyporexia and improve appetite in patients with burns, which are directly related to improving the function of the gastrointestinal tract, secretion of the digestive glands, and absorption and motor functions.

 Based on the main criteria of the mechanism of action, this electrotherapy method is indicated for patients with severe manifestations of acute and chronic stress and maladaptation, developed as a result of burn injury. Indications for the choice of the MDM method are determined based on an assessment of the severity of the systemic reaction of the body to burn injury and / or local tissue reaction. Indication for MDM is pain and severe manifestations of exudative inflammation in superficial epidermal burns; the need to improve blood and lymph circulation in the paranecrotic zone and stimulate the formation of a full granulation cover in the preoperative period with deep burns, and in the postoperative period of stimulation of regenerative processes. The MDM method is indicated for both limited and extensive burns, with the exception of their localization in the region of the fibrous part of the head, upper half of the face, auricles and posterior-lateral parts of the neck. However, after their healing and preservation of indications for MDM, this method can be used in such patients in full. The MDM method can be used in all periods of a burn disease in patients with a favorable and dubious prognosis, especially in conditions of a forced deficiency of analgesics and drugs. With adequate implementation of this technique, the effect of treatment is noted in 85% of cases.

 The method is as follows.

 Moistened cloth pads are superimposed on the central sagittal fronto-occipital region, a positive electrode on the forehead and a negative electrode on the back of the head are placed on them. Then, rectangular or acutely-biphasic pulses are fed that are better tolerated by burn patients with a frequency of 60 to 90 Hz with a frequency change period of 3 minutes and a frequency step of 0.5 to 1.0 Hz for 30 minutes, while supplying constant and pulse currents in the ratio 1 1. The total current strength is changed from 0.5 to 3.0 mA, the exposure time is 30 minutes Course treatment 5 15 days 1 - 2 times a day, depending on the severity of the disease, a break in treatment is allowed for 1 day after 4 5 days.

 Examples.

Example 1. Patient C. 40 years. Diagnosis: a burn of hot oil of II III AB degree on an area of 14% of the body surface, of which 2.5% were removed from the state of shock using intensive care methods. However, the patient retained severe pain in the area of burn wounds, sleep disturbances, depression, and fever. In order to strengthen the adaptive capabilities of the body and the prevention of infectious complications of the patient, from 2 days after the injury, a course of MDM treatment was carried out daily (with a break after the 5th session) for 7 days in combination with traditional methods of treatment. Curative current 3.0 mA, duration of sessions 30 min, two-phase pointed current form, pulse current frequency
60-90 Hz with a frequency change period of 3 min and a frequency step of 1 Hz. The tolerance of the used MDM method is good, there were no adverse reactions during and after the end of the MDM session. After the first session, an improvement in the general condition was noted: the pain decreased, during the procedure the patient fell asleep, night sleep returned to normal. After the second session, the appetite recovered, the psycho-emotional state improved, the temperature dropped to subnormal numbers. In peripheral blood, normalization of the Arena formula was noted due to a reduction in the stab shift from 11 to 4%, an increase in the lymphocyte content from 7 to 22%, and elimination of toxic granularity of neutrophils. The content of average molecules in the blood plasma decreased from 0.408 to 0.243 units. Indicators of biochemical homeostasis ranged within subnormal values. On the 7th day after the injury, a significant increase in the plasma content of beta-endorphin from 6.1 to 10.4 pmol / L and somatotropic hormone from 0.78 to 1.52 ng / ml was noted. In complex therapy, drugs, analgesics, sleeping pills are canceled. Against this background, the course of the burn disease is smooth, there were no complications. IIIA degree burns healed by 16 days, skin itching decreased. A good granulation cover formed by 19 days. Operated on 21 days after injury. Graft engraftment - 100% donor wounds healed without suppuration. With a period of in-patient rehabilitation, the patient spent 26 beds / days in the department. The outcome is recovery.

 Example 2. Patient S. 31 years. Diagnosis: burns with boiling water of the II-III degree AB on an area of 28% of the body surface, of which 5% were removed from the state of shock using intensive care methods. However, the patient's condition continued to be severe, severe pain in the area of burn wounds, sleep disturbance, appetite, depression, high fever. In order to enhance the adaptive capabilities of the body and the prevention of infectious complications, the patient was treated with a 10-day course of treatment of MDM daily from day 3 after an injury (with a break for 1 day after the 5th session) in combination with traditional methods of treatment. Therapeutic current is 2.5 mA, the duration of the sessions is 30 minutes, the shape of the pulse current is pointedly biphasic, the oscillation frequency of the pulse current is 60 90 Hz with a frequency change period of 3 minutes and a frequency step of 0.5 Hz. The tolerance of the used MDM method is good, there were no adverse reactions during and after the end of the MDM session. Starting from the 3rd session, there was a clear improvement in general condition, pain decreased, during the procedure, the patient fell asleep, normalized night's sleep, restored appetite, improved psycho-emotional state, temperature decreased to subfebrile numbers. In the peripheral blood, normalization of the Arena formula was noted due to a reduction in the stab shift from 12 to 4%, an increase in the lymphocyte content from 8 to 23% and the elimination of toxic granularity of neutrophils. The content of medium molecules in blood plasma decreased from 0.421 to 0.260 units. The level of serotonin in blood plasma decreased from 1.20 to 0.86 μmol / L, congestion in the lungs was eliminated, peripheral microcirculation improved (skin warming and normalization of the filling of the venous pattern of saphenous veins on the hands and feet). Indicators of biochemical homeostasis remained within subnormal values. On the 7th day after the injury, a significant increase in the content of beta-endofin in the blood plasma from 6.7 to 10 pmol / L and somatotropic hormone from 0.84 to 1.51 ng / ml was noted. In complex therapy, drugs, analgesics, sleeping pills are canceled. Against this background, the course of the burn disease is smooth, there were no complications. Burns of III A degree healed by 17 days, skin itching decreased. A good granulation cover formed by 21 days. Operated on 23 days after the injury. Graft engraftment 100% donor wounds healed without suppuration. He spent 36 beds / days in the department with a period of in-patient rehabilitation. The outcome is recovery.

 These examples illustrate the fact that the used MDM method significantly reduces or eliminates pain, normalizes sleep and appetite, and reduces psycho-emotional stress. Under the influence of MDM, the somatic status of patients improves, and itchy skin decreases after wound healing. The use of MDM reduces the consumption of narcotic, analgesic and sedatives, up to their complete abolition.

 With extensive severe burns in patients with a dubious prognosis, pronounced manifestations of maladaptation syndrome are noted, especially in the acute stage of a burn disease. The latter dictates the need to change the tactics of MDM, the number of sessions increases to 15 procedures, and with a long stay of the patient in the hospital, course treatment is repeated after a month.

 Example 3. Patient D. 41 years. Diagnosis: a burn with a flame of III AB IV degree on an area of 48% of the body surface, of which 36% were removed from the state of shock using intensive therapy methods. However, in the following days, the patient's condition continued to be severe, severe pain in the area of burn wounds, sleep disturbance, appetite, depression, high fever. Intensive therapy continued, aimed at reducing intoxication, preventing infectious complications and correcting metabolic disorders. To enhance the adaptive capabilities of the body after healing burns on the face from the 14th day after the injury, the patient received a 15-day course of treatment of MDM daily (intermittently after 4 and 11 sessions). Therapeutic current is 2.5 mA, the duration of the sessions is 80 minutes, the shape of the pulse current is rectangular, the frequency of the pulse current is 60 90 Hz with a frequency change period of 3 minutes and a frequency step of 1.0 Hz. The tolerance of the used MDM method is good, there were no adverse reactions during and after the end of the MDM session. Starting from the 3rd session, a distinct improvement in the general condition of the patient began: pain decreased, night sleep normalized, appetite recovered, the psycho-emotional state improved, the temperature decreased to subfebrile numbers. In peripheral blood, normalization of the Arena formula was noted due to a decrease in the stab shift from 16 to 6% increase in the lymphocyte content from 5 to 28%, toxic granularity of neutrophils was eliminated. When control x-ray eliminated congestive plethora in the vessels of the lungs. Against this background, an improvement in serotonin levels in blood plasma was noted with a decrease from 1.60 to 1.06 μmol / L (normal 0.84 ± 0.1 μmol / L). The total number of T-lymphocytes (Troc) and active T-lymphocytes (Tact) increased, respectively, from 462 to 868 per cubic meter. mm and from 370 to 620 per cubic meter. mm Dysglobulinemia decreased due to an increase in serum immunoglobulin G from 12.2 to 16.6 g / L. The content of medium molecules in blood plasma decreased from 0.690 to 0.420, and then to 0.240 units. Indicators of biochemical homeostasis improved and fluctuated within subnormal values. On the 19th day after the injury, a significant increase in the plasma content of beta-endorphin from 6.1 to 10.5 pmol / L and somatotropic hormone from 0.81 to 1.81 ng / ml was noted in the blood plasma. The ratio of ACTH and cortisol levels in serum improved significantly from 182.3 pg / 30.4 μg (normal 63.1 pg / 10.6 μg) to 68.8 pg / 18.4 μg. Narcotic drugs and sleeping pills were canceled, and doses of analgesics were reduced to a minimum. Against this background, the further course of the burn disease is smooth, there were no complications. Burns of the III A degree healed by 20 days, skin itching decreased. A good granulation cover formed by 28 days. A repeated course of MDM was carried out using the same technique. The patient underwent 8 operations 1 necrectomy, 2 osteonecrectomy and 5 autodermoplasty. The defect of the skin is completely restored. Graft engraftment 100% donor wounds healed without suppuration. With a period of in-patient rehabilitation (he learned to walk with support on a cane and self-care), he spent 143 beds / days in the department. Disability of the II group is issued.

 Studies have shown that a single use of MDM in this group of patients provides a clinical effect only during the first 10-12 hours after the end of the session, and then levels out. On the contrary, the use of a 2-fold exposure to MDM during the day contributes to the prolongation of the clinical effect almost until the end of the day.

 Example 4. Patient K. 14 years. Diagnosis: a burn with a flame of III AB of the IV degree on an area of 45% of the body surface, of which 36% were removed from the state of shock using intensive therapy methods. However, the patient's condition continued to be severe, severe pain in the area of burn wounds, sleep disturbance, appetite, irritability, tearfulness, depression, high fever persisted. The patient underwent intensive therapy aimed at reducing intoxication, preventing infectious complications and preparing wounds for the prompt restoration of the integrity of the skin. In order to enhance the adaptive capabilities of the patient’s body after healing of burns on the face from the 20th day after the injury, a 15-day course of MDM treatment was carried out daily (with a break for 1 day after the 5th session and after the 11th session) twice a day 30 min in combination with traditional methods of treatment. Therapeutic current is 1.0 mA, the shape of the pulse current is sharp-biphasic, the oscillation frequency of the pulse current is 60-90 Hz with a frequency change period of 3 minutes and a frequency step of 0.5 Hz. The tolerance of the used MDM method is good, there were no adverse reactions during and after the end of the MDM session. Starting from the 3rd day of the use of MDM, a distinct improvement in the general condition began: the pain decreased, the patient fell asleep during the procedure, night sleep returned to normal, her appetite was restored, her emotional state improved, her temperature decreased to subfebrile numbers. In peripheral blood, normalization of the Arena formula was noted due to a reduction in the stab shift from 18 to 5%, an increase in the lymphocyte content from 3 to 26%, and elimination of the toxic granularity of neutrophils. The total number of T-lymphocytes (Troc) and active T-lymphocytes (Tact) increased, respectively, from 442 to 825 per cubic meter. mm and from 340 to 656 per cubic meter. mm X-ray control data showed the elimination of congestive pulmonary congestion. Positive dynamics of serotonin content in blood plasma (from 1.20 to 0.76 μmol / L) was noted. Dysglobulinemia decreased due to an increase in serum immunoglobulin G from 11.4 to 17.2 g / L. The content of average molecules in the blood plasma decreased from 0.678 to 0.420, and then to 0.260 units. Indicators of biochemical homeostasis remained within subnormal values. On the 27th day after the injury, a significant increase in the content of beta-endorphin from 6.5 to 11.5 pmol / L and somatotropic hormone from 0.81 to 1.81 ng / ml was noted. The ratio of ACTH and cortisol levels in serum improved significantly from 163.3 pg / 35.4 μg (normal 63.1 pg / 10.6 μg) to 71.6 pg / 17.1 μg. In complex therapy, narcotic drugs and sleeping pills were canceled, analgesic drugs were reduced. Against this background, the course of the burn disease is smooth, there were no complications. Burns of III degree A healed by 27 days, skin itching decreased. A good granulation cover formed by 30 days. Moved 2 autodermoplasty. Graft engraftment 100% donor wounds healed without suppuration. With a period of in-patient rehabilitation, she spent 94 beds / days in the department. The outcome is recovery.

 The proposed method was applied in 142 patients with various severity of burns. The use of MDM with extensive severe burns and a favorable prognosis increases the adaptive capabilities of the body, facilitates the course of burn disease, and helps prevent the development of respiratory and cardiovascular failure, early infectious complications (pneumonia, sepsis).

 The use of MDM increases the results of treatment in the risk group by 10-15%, i.e., in patients with a dubious prognosis of burn disease. Autograft grafting results are improved by 12–15% compared with traditional methods of treatment. The volume of pharmacotherapy is reduced by 18% due to the reduction in the consumption of drugs, analgesics and sedatives compared with an adequate group where MDM was not performed. The use of MDM twice a day in the most severe category of patients increases the effectiveness of treatment and the effectiveness of rehabilitation measures. YYY2

Claims (1)

 A method of treating patients with burns, including applying direct and pulsed electric current to brain structures using cutaneous electrodes, characterized in that the effect is applied to the central sagittal fronto-occipital region by simultaneously supplying constant and rectangular or acutely pointed two-phase pulse currents with a frequency of 60 -90 Hz and a frequency change period of 3 min and a frequency step of 0.5-1.0 Hz with a ratio of direct and pulsed currents of 1: 1 and a total current value of 0.3-3.0 mA for 30 minutes, the course of treatment from 5 to 15 days for 1-2 treatments per day.

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