RU2161515C2 - Method for performing translumbal drug ionophoresis in the cases of cerebrocranial trauma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves introducing drug into subarachnoid space through lumbar puncture and supplied directly to pathological focus with ionophoresis. The lumbar needle and implantable periosteal needles above the focus play the roles of needle electrodes is drained after performing puncture. EFFECT: prevented intracranial postoperative complications. 1 dwg

Description

 The invention relates to medicine, specifically to neurosurgery, can be used in neurology.

 The relevance is associated with a large number of patients who need effective treatment of certain neurological symptoms, early relief of insufficiency of the central nervous system functions, the length of hospital stay in the acute and recovery period.

 The proposed method allows to increase the effectiveness of treatment.

Closest to the claimed is intranasal electrophoresis of drugs. In both nostrils, gauze turundas are introduced, soaked in a medicinal solution (antibiotics, vitamins, amino acids) and connected to the electrode, the second electrode is placed in the occipital region. Current strength 0.5 - 2 mA. The duration of the procedures is 10-30 minutes. On a course of up to 20 procedures (V. G. Yasnogorodsky, T. V. Karachintseva Handbook of physiotherapy. - M .: Medicine, 1992, p. 34). The disadvantages of the prototype are that:
1. there is no dosage dosage;
2. lack of concentration over the pathological focus;
3. loss of the drug in the soft tissues.

 The purpose of the invention is to increase the effectiveness of the treatment of traumatic and non-traumatic brain diseases, a possible reduction in the length of hospital stay of patients.

 The essence of this method is that the drug is administered in acceptable doses through a lumbar puncture in the cerebrospinal fluid system. Before the alleged pathology, the drug (antibiotics, vitamins, nootropic, antienzyme and other drugs) are delivered by iontophoresis. At the same time, ordinary injection needles are implanted subperiosteally above the pathological focus with the rule of uniformity. Implantable needles and a needle in the lumbar puncture serve as needle electrodes. Depending on the purpose, the method is used up to twenty times. Current 2 mA. Duration up to 20 minutes. The device "Stream 1". The proposed method is as follows: a lumbar puncture is performed in the subarachnoid space between the L 4-5 vertebrae, 10.0 ml of cerebrospinal fluid is extracted and mixed with drugs, the solution is slowly introduced through the same needle into the cerebrospinal fluid. On the head, above the post-trepanation defect, 1 to 3 injection needles are implanted subperiosteally. The lumbar needle and implantable needles act as a needle electrode, which are connected to the apparatus "Stream 1". The polarity depends on the charge of the introduced substance. The current strength in order to avoid vegetative dysfunction, smoothly, within 2 minutes, adjusted to 2 mA. The duration of iontophoresis is 20 minutes. A course of 20 sessions (drawing).

The proposed method has the following advantages:
1. the blood-brain barrier is passed;
2. increases the effectiveness of treatment by increasing the dose in the outbreak;
3. impact on a specific area of the central nervous system;
4. The possibility of reducing the time of inpatient treatment.

 When using this method revealed: dysfunction of the autonomic nervous system, manifested in the appearance or increase of tachycardia, hyperhidrosis, increased blood pressure. These reactions are not observed when smoothly increasing the current to a nominal value for 2 minutes and a smooth shutdown for 2 minutes.

Contraindications:
1. Hypertension 2-3 stages
2. Tachy-bradyarrhythmias
3. General intolerance to physiotherapy
Example:
Patient R-in, and. N 8586, enrolled in the National Chechnya Central City Hospital N 23, Yekaterinburg.

 Diagnosis at admission: severe brain contusion.

 Clinical diagnosis: fracture of the arch and base of the skull. A severe brain contusion with compression of the brain substance by intracerebral hematoma and cerebral detritus.

 At admission, craniotomy was performed with removal of the hematoma and detritus. On the 6th day after the operation, purulent meningoencephalitis developed painfully. Identification of the microbial agent failed. The liquor is cloudy, viscous, cytosis 800/3, protein 2.5 g / l.

Conducted antibiotic therapy:
intravenously drip: cefamezin 4 g / day, ampicillin - sodium salt 6 g / day
endolumbar: ampicillin - sodium salt 0.2 g / day (without iontophoresis).

 Within 7 - 9 days, the cytosis remained at the same level, the protein increased to 3 g / l.

 On the 10th day, the method of translumbal iontophoresis of ampicillin - sodium salt at a dose of 0.2 g, introduced through a lumbar needle connected to a positively charged electrode, was connected.

 On the 11th day - the cerebrospinal fluid is muddy, viscous, cytosis 700/3, protein 3 g / l.

 On the 12th day - cerebrospinal fluid of lower viscosity, cloudy with flakes, cytosis 500/3, protein 3 g / l.

 On the 13th day - the cerebrospinal fluid is cloudy, with single flakes, of the same viscosity, cytosis 450/3, protein 3 g / l.

 On the 14th day - the cerebrospinal fluid is slightly viscous, cloudy, with single clumps of pus, cytosis 500/3, protein 2.5 g / l.

 On the 15th day - the cerebrospinal fluid is inviscid, slightly turbid, with single clumps of pus, cytosis 300/3, protein 1.5 g / l.

 On day 16, the cerebrospinal fluid is slightly turbid, inviscid, cytosis 200/3, protein 1.5 g / l.

 From the ward, RAO was transferred to the neurosurgery department for further treatment.

 The method was applied in nine patients with post-traumatic intracranial infectious complications and one patient with post-injection embologic meningoencephalitis.

 Two patients died due to an increase in the infectious process.

 Eight patients were discharged in satisfactory condition.

 When using the method of this method of administering antibacterial drugs, in most cases the speed of sonogenic mechanisms increases, which reduces the time spent in hospitals by 1/6 times, increases the effectiveness of treatment, makes it possible to prevent intracranial infectious complications.

Claims (1)

 The method of translumbal iontophoresis, characterized in that the drug substance is introduced into the subarachnoid space through a lumbar puncture, is fed directly to the pathological site by iontophoresis, while the lumbar needle and implantable subperiosteal needles above the site serve as needle electrodes.

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