RU2154484C2 - Method of treatment of "diabetic foot" syndrome - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: invention relates to use of ozone in surgery. Method involves intraarterial administration of ozonized physiological solution as an antiseptic. Topical treatment with ozonized physiological solution is carried out for two stages. At the first stage suppurative-necrotic tissues are removed by jet under pressure in outlet 80 atm. At the second stage tissues are infiltrated by jet under pressure in outlet 150 atm. In part case, intraarterial administration of ozonized physiological solution is carried out in therapeutic dose up to 5 times per 24 h, treatment course is 15 days. EFFECT: decreased amount of pelvic limb amputations, decreased level. 2 cl, 1 ex

Description

 The invention relates to purulent surgery and can be used to treat the syndrome of "Diabetic foot".

 Currently, various methods are being used to treat patients with diabetic foot syndrome. The closest analogue of the proposed method in the treatment of diabetic foot syndrome is intravenous administration and local use of sodium hypochloride [1]. This method can significantly reduce the first phase of the course of the wound process. However, with the intravenous administration of the drug, it is not possible to achieve a sufficiently high concentration in the blood directly flowing to the affected area of the foot due to recirculation in the circulatory system. In addition, sodium hypochloride is not a strong antiseptic against certain strains of microorganisms located in the affected limb area.

 The aim of this invention is to improve the results of treatment of patients with diabetic foot syndrome, reduce the number of amputations of the lower extremities and reduce their level.

 This goal is achieved by the fact that in the method of treating diabetic foot syndrome, which consists in conducting an antiseptic effect, an ozonized physiological solution is used as an antiseptic by its intra-arterial administration and local application for treating the wound surface.

 With intra-arterial administration, ozonized physiological saline is administered in a therapeutic dose up to five times a day, and the course of treatment is carried out up to 15 days.

 Local exposure to ozonized physiological saline is carried out in two stages with a stream under pressure from 80 to 150 atm.

 The method is as follows.

 Produce ozonation of physiological saline using any ozone generator authorized in the medical industry. Catheterize the femoral artery according to the Seldinger pediatric subclavian catheter. Enter 5000 units. heparin, 5.0 trental, 400 ml of ozonized physiological solution of sodium chloride using a syringe dispenser for 30 minutes, at a concentration of 400 μg / l, for 10 days.

 This dose is selected on the basis of experimental studies. With a lower dose, the antiseptic activity of the solution decreases, and with a larger dose, a toxic effect on the artery wall and the body as a whole is possible. The frequency of administration is set depending on the neglect of the process in the affected limb and the type of pathogen (from 1 to 5 times a day, and the course of treatment can be up to 15 days). With purulent-inflammatory processes in the foot, along with the intra-arterial administration of ozonized physiological saline, it is applied topically in the form of a jet under pressure in two stages. This method is carried out using a device for hydropressive treatment of wounds (according to the application N 920032.05 (048913) with a positive decision in 1995). The first stage is the removal of purulent-necrotic tissue, microbial and foreign bodies. The optimum pressure of the jet at the outlet is 80 atm, the most appropriate distance from the nozzle to the wound is 10 cm, and the angle of the jet is 45 degrees with respect to the wound surface. After removal of purulent-necrotic tissues, the second stage is the infiltration of tissues with ozonized physiological saline to a depth of 10 to 30 mm in order to destroy microorganisms in the depths of the tissues, since they have the main effect on the course of the wound process. In this case, use a stream of solution with a higher pressure (up to 150 atm at the outlet), at a distance of 5 cm, at right angles to the surface of the wound.

 Using the surface biopsy method according to Kamaev, it was proved that on the 8th - 9th day in 40% of cases the number of neutrophils decreased and blast cells appeared. In 60% of cases, gas-liquid chromatography revealed the waste products of anaerobic infection and volatile fatty acids in the wound. After 3 to 5 treatments, the latter were not determined. The intra-arterial administration of ozonized physiological saline solution allows the arterial bed to be sanitized against microbes and toxins, and according to the transcutaneous determination of oxygen tension in tissues, it improves tissue oxygenation of the affected limb.

 Example. Patient V. born in 1926 (N ИБ 23/2) was admitted to the clinic on 05/02/1996 with a diagnosis of diabetes mellitus, severe form, type 1, diabetic foot syndrome - mixed form, foot phlegmon. On admission, the general condition is serious, tachycardia - pulse 110 beats per minute, temperature 38.5 degrees. When viewed in the area of the right foot, marked hyperemia, swelling, on the plantar surface fluctuation areas, the pulse on the back of the foot is not determined, the sensitivity is reduced. The patient was urgently operated on. An autopsy of the phlegmon of the foot, necrectomy with excision of the affected tendons within healthy tissues was performed. About 50 ml of creamy pus was released, which was then taken for bacteriological culture and determination of volatile fatty acids. The purulent focus is sanitized with ozonized physiological saline under pressure in two stages according to the method described above. Catheterization of the femoral artery by Seldinger pediatric catheter, infusion: 5000 units. heparin, 5.0 trental, 400 ml of ozonized physiological saline three times a day, for 10 days. Two-stage wound treatment was performed daily for 15 days before the appearance of granulations, then levomecolic and furacilin ointments were used.

 Bacterial culture at admission: Staphylococcus aureus 10 microbial bodies in 1 g of tissue, volatile fatty acids were determined. After 10 days, Staphylococcus aureus 10 microbial cells in 1 g of tissue, volatile fatty acids on the 5th day after the start of treatment were not determined. Blood glucose was corrected by human insulin, blood glucose ranged from 8 to 12 mmol / L. After 35 days, the patient was discharged home in satisfactory condition, the wound in the phase of epithelization.

 All patients underwent correction of blood glucose, as well as the treatment of concomitant diseases.

Literature
1. V.K. Gostischev. Theses of the All-Russian Conference: treatment of diabetic foot syndrome, proceedings of a scientific-practical conference: Modern aspects of diagnosis, treatment, prevention of lower limb lesions in patients with diabetes mellitus. Moscow 1996 Institute of Surgery. A.V. Vishnevsky, endocrine Research Center of the Russian Academy of Medical Sciences, State Health Administration of the Moscow Region Administration, Diabetic Foot Center.

Claims (2)

 1. A method of treating diabetic foot syndrome, including intra-arterial administration of an antiseptic, characterized in that an ozonized physiological solution is used as an antiseptic and a two-stage local exposure to ozonized saline is carried out, while at the first stage purulent-necrotic tissues are removed by a jet with outlet pressure 80 atm, and at the second stage, tissues are infiltrated with a jet with a pressure at the outlet of 150 atm.  2. The method according to claim 1, characterized in that the intra-arterially ozonated physiological solution is administered in a therapeutic dose up to five times a day, and the course of treatment is carried out up to 15 days.