RU2164421C2 - Method for treating the cases of peritonitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves washing abdominal cavity with an antiseptic solution in performing operation. The antiseptic solution is exposed to high voltage pulsating electric discharge for 3-4 s per 1 cm². Pulse package duration is 0.15-0.25 s and pause duration is 0.15-0.25 s. Electrohydraulic converter traveling speed is 0.12 s/cm². Distance between the radiation source and the abdominal cavity is equal to 25-30 cm. The abdominal cavity is washed with 6% polyvinyl pyrrolidone solution during 10-14 min. EFFECT: prevented postoperative complications.

Description

 The invention relates to medicine, namely to methods for treating patients with various forms of peritonitis.

 A known method of treating peritonitis, which consists in washing the abdominal cavity with solutions of medicinal substances / B.D Savchuk, 1979; VK. Gostischev et al. , 1992 /. In this case, an antiseptic is mechanically mixed in the abdominal cavity and toxic substances are removed together with the used medicinal solution, the abdominal cavity is sutured and drained with perforated drainage tubes.

 However, the known method does not provide a sufficient degree of sanitation of the abdominal cavity from purulent exudate, bacteria and their toxins, fibrin deposits, as it can be used for simultaneous treatment with a limited exposure due to the toxicity of the used antiseptics, which leads to an increase in the duration of treatment and flying.

 A known method of treating peritonitis without taking into account its prevalence, including washing the abdominal cavity with medicinal solutions, exposure to low-frequency ultrasound in a solution of kanamycin / A.I. Strukov et al., 1987 /, in continuous and pulsed modes / ed. testimonial. N 944543, 1982 /.

 However, the known method provides only intraoperative sanitation of the abdominal cavity in the mode of its sound, excluding the development of ultrasonic cavitation. It is known that the suppression of microbial flora and the acceleration of purification of biological tissues from purulent necrotic masses is most pronounced when a complex of secondary factors of low-frequency ultrasound is initiated (NCHUZ /: cavitation, acoustic currents, variable sound pressure, implemented at the phase boundary, drug solution - biological tissue surface / Г .A. Nikolaev et al. 1980 /. Since the known method implements the treatment of the abdominal cavity only in the regime of acoustic currents, it does not provide a sufficient degree of its rehabilitation from bacte s and their toxins, as evidenced by the treatment duration and high mortality in peritonitis, despite the use of modern treatments.

 The objective of the invention is the prevention of postoperative bases and the reduction of treatment time and flying.

 The achievement of the task is ensured by the fact that in the method of treating peritonitis, which consists in treating the abdominal cavity with solutions of medicinal substances, exposure to a physical factor, aspirating the spent antiseptic solution with drainage of the abdominal cavity in the postoperative period, the antiseptic solution in the intra- and postoperative periods is affected by high-frequency pulsed electric discharge / VIER / and products of plasma-chemical reactions initiated by them in a medicinal solution, from a strictly defined distance Ia in two modes and final washing the abdominal cavity of 6% solution of polyvinylpyrrolidone.

 A patent search showed that at the filing date of the application, there are no known methods of treating peritonitis with the indicated distinguishing features.

 The proposed method for the treatment of peritonitis is based on the use of a set of physicochemical factors of the electro-hydraulic effect provided by a high-frequency pulsed electric discharge (VER) in an antiseptic medium and a spray-aerosol regime to increase the efficiency of abdominal sanitation, intraperitoneal detoxification, and stimulation of the motor-evacuation function of the gastrointestinal tract and local immunity, ultimately contributing to a reduction in treatment time and mortality.

 The electro-hydraulic / EG / effect simultaneously initiates a whole range of physicochemical and biological factors: high pressure pulses, shock waves, cavitation, hydrodynamic flows, ultraviolet radiation, electromagnetic field, formation of active radicals. These factors affecting inflammatory exudate and peritoneum stimulate intestinal motility and local immunity. The above-mentioned factors of SEER in the jet-aerosol regime and in the antiseptic medium significantly exceed those induced in the ultrasonic field, which has a more pronounced bactericidal effect on aerobic and anaerobic microflora, contributing to more effective sanitation of the abdominal cavity, diffusion of drugs into tissues, dehydration and improving the plastic properties of the inflamed peritoneum, the destruction of toxins, the activation of an antiseptic. Subsequent peritoneosorption with a 6% solution of polyvinylpyrrolidone promotes the binding of the remaining toxins, dead bacteria, thereby enhancing the detoxification effect.

 It is known to use a high-frequency pulsed electric discharge / VER / for the treatment of serous surfaces using a converter / ed. testimonial. N 1731237, 1992 /, placed in a probe made of a transparent material with a perforated working part, through an antiseptic solution.

 However, the practical use of the known device for the treatment of serous surfaces is impossible. In particular, the distance from the VIER source to the surface of the peritoneum should exclude the destructive effect on the latter. We experimentally established that this distance should be 25-30 mm. In addition, the use of a vinyl chloride tube with a perforated working part for the probe significantly reduces UV radiation, cavitation, hydrodynamic flows, and the electromagnetic field, since the latter factors penetrate through several perforations. This leads to the fact that it is difficult to carry out the dosed effect of VER on the peritoneum, and in some cases it is impossible. In practice, the foregoing does not allow for complete sanitation of the abdominal cavity during surgery, and even more so under laparoscopic control due to the arising technical difficulties caused by the destructive process in the abdominal cavity and the violation of the anatomical and topographic relationships between organs. Even the most thorough intraoperative treatment of VER with the proposed probe does not allow affecting all parts of the abdominal cavity, since pathogenic microflora, which is insensitive to traditionally used antiseptics, remains in hard-to-reach areas / folds of the peritoneum. All this leads in some cases to undesirable side effects in the form of damage to the mesothelium and the formation of residual purulent cavities, which requires repeated surgical interventions and ultimately significantly increases the duration of treatment and mortality in peritonitis.

 For the treatment of peritonitis used the known device / ed. testimonial. N 1731237, 1992 /, in which there is a power source, a generator of high-frequency electrical pulses / HVEI / - "Urat-2", which is connected through a flexible current lead to a transducer made in the form of an electro-hydraulic probe that ensures the distribution of secondary factors of the EG effect in the abdominal cavity and representing a rod opposing linear electrode system with a discharge gap rod-cone. One of the electrodes is made in the form of a transforming hollow truncated cone, and the other electrode in the form of a rod, has a removable nozzle in the form of a nozzle for remote jet-aerosol treatment of a drug solution with a torch, used in the treatment of local peritonitis.

 The parameters of VER in the treatment of peritonitis were identified and worked out at the Department of General Surgery of the OGMA in animal experiments.

 For the experiment we took a group of 35 outbred dogs weighing 6-9 kg with acute spilled peritonitis caused by intraperitoneal administration of fecal suspension, which amounted to 7 series of experiments (5 dogs each).

Dogs with a blunt needle were intraperitoneally injected with 5% fecal suspension at the rate of 0.11 g / kg weight. 8-18 hours after infection of the abdominal cavity under nembutal anesthesia, a laparotomy was performed, upon examination, all signs of acute diffuse peritonitis were found, exudate was sown to identify and quantify the bacterial flora, and samples were taken for toxicological and pathological studies. Exudate was removed, the abdominal cavity was washed with 0.25% gibitana solution / 0.5 ml / cm ² peritoneum / for 4-6 minutes. After drainage, the abdominal cavity was again filled with an antiseptic solution, the EG probe transducer was introduced, and a stepwise electro-hydraulic treatment of the cavity was carried out with the EG exposure parameters: potential difference 3-5.7 kV; current strength 0.5 kA; discharge frequency 50-70 Hz; exposure time 1-4 s / cm ² ; the distance between the sources of VER and the peritoneum is 25-30 mm. Then the spent antiseptic solution was aspirated and histological, bacteriological and toxicological studies were performed. After that, a solution of polyvinylpyrrolidone (6%) was additionally introduced at the rate of 0.5-1.0 ml / cm ² peritoneum for 10-14 min followed by its removal by electric suction, washing was performed from the surface of the peritoneum to determine and quantify microflora, and material was taken on toxicological studies. The abdominal cavity was sutured, anesthesia was stopped, and the animals were monitored for 7 days.

 The results of the study are presented in table 1. From them it follows that the proposed method for the treatment of acute spilled peritonitis in comparison with the known ones is more effective, provides higher survival of animals.

The proposed method is used in the treatment of 36 patients with peritonitis. At the same time, the effectiveness of intraoperative rehabilitation of the abdominal cavity significantly increased, due to the more pronounced effect of suppressing purulent microflora and local detoxification, as well as accelerating the reparative processes of the peritoneum, which significantly reduces treatment time and mortality from 40-60% to 15%. We can say that the developed method for the treatment of acute diffuse peritonitis gives better results in the treatment of patients compared with the known:
- a more pronounced bactericidal effect is observed;
- reduced treatment time for patients from 16-18 to 10-14 days;
- there is no need to use a large number of antiseptics for washing the abdominal cavity;
- in the postoperative period there is no formation of residual purulent cavities;
- local detoxification of the abdominal cavity is carried out by neutralizing toxic substances, followed by their removal from the body directly during surgery;
- early stimulation of local immunity and intestinal motor-evacuation function is observed;
- Perhaps the widespread use of this method in surgical departments;
- provides a reduction in complications and mortality from peritonitis.

 The technique of electro-hydraulic treatment of the peritoneum with peritonitis has some features depending on the area of the lesion.

The method is as follows. In acute diffuse peritonitis in the intraoperative period, after removal of the destruction site, washing the abdominal cavity with an antiseptic solution, the peritoneum VER is treated through an antiseptic solution. Parameters of exposure to VER: potential difference 3.1-5.7 kV, current strength 0.5 kA, discharge frequency 50-70 Hz, exposure time 3-4 s / cm ² with pulse train duration 0.15-0.025 s, pauses 0.15-0.25 s, with an electro-hydraulic conversion speed of 0.12 s / cm ² and a distance between the source and peritoneum of 25-30 mm. The treatment is carried out by moving the EG transducer in a circular and linear reciprocating motion, first in the area of the source of peritonitis, so that, if possible, the entire infected surface is exposed to its direct effect. At the end of the operation, local peritoneosorption with 6% polyvinylpyrrolidone solution was carried out for 10-14 minutes.

Example. Patient L., 74 years old, was admitted to 1 x / o OGKB N 1 12/14/94, with complaints of nausea, vomiting, abdominal pain of a spilled character, bloating, weakness. From the anamnesis revealed: pain occurred 3 days ago, did not seek medical help. Objectively: the patient’s condition is severe, inhibited, the skin is pale, the features of the face are pointed. The tongue is dry, coated with a white coating. The abdomen is not involved in the act of breathing, swollen on palpation, sharply painful in all departments, positive symptoms of peritoneal irritation. Hemodynamics is stable - the pulse is 126 beats per minute, blood pressure 110/70 mm RT. Art., body temperature 38.6 ^o C. On the blood side, leukocytosis 19.0 · 10 ⁹ / l with a shift of the leukocyte formula to the left, leukocyte intoxication index / LII / 11 units. As a result of the examination, the diagnosis was made: Acute appendicitis. Spilled peritonitis. After short-term preoperative preparation, 2 hours after admission under endotracheal anesthesia, a mid-median laparotomy was performed. About 500 ml of a turbid effusion with a colibacillary odor was found; in the right iliac region, fibrin deposits on the loops of the small intestine. The appendix is thickened, dark crimson in color with a necrosis site at the apex, where there is a perforation of 0.1 cm. Appendectomy was performed using the ligature-invagination method with immersion of the appendix stump and the application of individual serous-muscular sutures. The abdominal cavity is drained, exudate is taken to determine the microflora and sensitivity to antibiotics. The abdominal cavity was filled with an antiseptic, an electro-hydraulic probe transducer was introduced, and a stepwise EG treatment of the abdominal cavity was performed for 10-12 min with a potential difference of 4.6 kV, a current strength of 0.5 kA, a discharge frequency of 50-70 Hz, an exposure time of 3-4 s / cm ² , with a pulse train duration of 0.15-0.25 s, pause 0.15-0.25 s, travel speed of the EG transducer 0.12 s / cm ² , the distance between the VEER source and the peritoneum is 25-30 mm The abdominal cavity was drained with an electric suction pump and a 6% solution of polyvinylpyrrolidone was injected for 10-14 minutes, after which it was removed. Intestinal decompression was performed by nasointestinal intubation, 250 ml of a 0.25% novocaine solution was introduced into the root of the small intestine. Through separate punctures in the hypochondria and in the right and left iliac regions, tubular silicone drains were introduced into the abdominal cavity. Performed flat tamponade of the abdominal cavity according to Mikulich-Makokha using local application sorption hemosorbent VNIITU-1. In the postoperative period, on days 2, 4, and 6, EG-jet-aerosol treatment of the adjacent loops of the intestine and parietal peritoneum was performed during ligation and tampon changing according to the method described above, with an exposure of 2 s / cm ² . For drainage from the abdominal cavity for 2 days a moderate amount of serous-hemorrhagic exudate (up to 150 ml) was allocated. On the 5th day, the patient's condition improved significantly - intoxication decreased clinically and laboratory, appetite appeared. By 5 days, intestinal paresis was resolved - an independent stool appeared. On the 7th day, the laparostomy was eliminated, the abdominal cavity was sutured through all layers with sutures on the shock absorbers. In the future, the postoperative period proceeded smoothly, the sutures were removed on the 14th day, recovery came, and was discharged in satisfactory condition.

Claims (1)

A method of treating acute spilled peritonitis in the intraoperative period, which consists in washing the abdominal cavity with an antiseptic solution and exposing it to a physical factor, characterized in that the antiseptic solution in the abdominal cavity is exposed to a high-voltage pulsed electric discharge for 3-4 s / cm ² with a pulse train duration of 0 , 15 - 0.25 s, pauses 0.15 - 0.25 s, when the electro-hydraulic conversion speed is 0.15 s / cm ² and the distance between the source and peritoneum is 25 - 30 mm, after which the abdominal cavity is for 10 - 14 yn washed with 6% aqueous solution of polyvinylpyrrolidone.

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