RU2188633C2 - Method for treating burns and thermochemical injuries of respiratory tract - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering superoxide dysmutase preparation at a dose of 16 to 40 mg and alpha-tocopherol at a dose of 100 to 300 mg as a part of infusion therapy on the background of tracheobronchial tree treatment. The tracheobronchial tree treatment is carried out by performing curative and diagnostic brochoscopies accompanied by local antiseptic and mucolytic therapy. EFFECT: enhanced effectiveness of treatment.

Description

 The invention relates to medicine, namely to anesthesiology-resuscitation and cambustiology, and can be used in the treatment of patients with inhalation lesions.

 Numerous methods are known for the treatment of burns and thermochemical lesions of the respiratory tract, the main points of which are to provide air access to the respiratory tract; sanitation of the tracheobronchial tree in various ways, including the implementation of therapeutic and diagnostic bronchoscopy; local drug therapy with mucolytics and antiseptics (through ultrasound and other inhalations, irrigation of the surface of the upper respiratory tract with bronchoscopy, intrabronchial instillation of drugs using the larynx syringe or transnasal catheter and other methods), conducting infusion therapy (Gerasimova L.I., Loginov L .P., Smolsky B.G. Diagnosis and treatment of burns of the respiratory tract. // Vestn. Surgery. - 1979.- T. 123, 8. - P.96-100; Karvayal H.F., Parks D.Kh. Burns in children: Trans from English. - M.: M ditsina, 1990. - 510 s .; Kurbanov Sh.I. Thermal inhalation lesions in burned patients: Diagnosis and treatment.Abstract of dissertation of a doctor of medical sciences - M., 1994. - 36 s .; Abston SE, Rutan T .C., Varon RE Treatment of burns. Inhalatory injury // Robl. Surg. - 1987. - Vol. 24, 6. - P. 370-384; DiVincenti FC, Pruitt B.A., Recler JM Inhalation injuries // J. Trauma. - 1971, - Vol. 11, 2. - P.109-117 and others).

 Common disadvantages of all of the above methods are the relatively low treatment efficacy and the high incidence of developing complications.

 There is a method of treating burns of the respiratory tract, according to which, to ensure effective removal of incomplete combustion products and accelerated healing before bronchoscopy, intravenous administration of unitiol is carried out, and after the tracheobronchial tree is sanitized with solutions of antiseptics and mucolytics, the affected surface is irradiated with low-intensity laser radiation (A.B. .Mironov, Yu.V. Sinev, L. I. Gerasimova, A. Yu. Skripal. RF patent 1708344 "Method for the treatment of burns of the respiratory tract").

The specified method has the following disadvantages:
- the method does not provide for the elimination of the action of reactive oxygen species, the generation of which is one of the main pathogenetic factors of damage to the tracheobronchial tree during inhalation injury;
- for the implementation of the method requires a laser, which is not available in most medical institutions of the Russian Federation.

 The closest in combination of essential features is the method according to which large doses of glucocorticoids (up to 3 g per day) are administered as part of complex drug therapy, administered by intravenous infusion, inhalation and irrigation of the tracheobronchial tree (Boenko S.K., Polishchuk S. A. , Rodin VI, Respiratory tract injuries in burned ones. - Kiev: Health, 1990. - 136 p .; Kostyuchenko A.L., Gurevich K.Ya., Lytkin MI Intensive care of postoperative complications. - St. Petersburg : Special Literature, 2000 .-- 535 p .; Bernard GR, Luce JM, Sprung C. L., et al. High-dose corticosteroids in patients with adult respiratory distress syndrome // N. Engl. J. Med. - 1987. - Vol. 31. - P. 1565-1570).

The specified method has the following disadvantages:
- the relatively low efficiency of the method is due to the fact that glucocorticoids do not have the ability to inactivate reactive oxygen species and lipid peroxidation products, the generation of which leads to damage to the mucous membrane of the respiratory tract and pulmonary parenchyma;
- the use of glucocorticoids does not allow to quickly restore blood circulation and adequate gas exchange in the lungs;
- the use of large doses of glucocroticoids carries a risk of developing a number of side effects.

 The aim of the invention is to increase the effectiveness of the treatment of burns and thermochemical injuries of the respiratory tract by introducing into the complex therapy preparations with the ability to destroy active oxygen species and lipid peroxidation products.

 Superoxide dismutase converts the radical superoxide anion into hydrogen peroxide, which is then destroyed by the catalase and glutathione enzyme system to water and oxygen. Thus, superoxide dismutase prevents the formation of more toxic reactive oxygen species, which damage macromolecules and cells, in comparison with the radical superoxide anion. The introduction of superoxide dismutase preparations also reduces the intensity of lipid peroxidation processes. In addition, superoxide dismutase indirectly prevents thrombosis, disruption of the kinin system, restores the permeability of microvessels, and has other effects. The introduction of superoxide dismutase prevents the inactivation of nitric oxide caused by the action of superoxide anion radical, which significantly improves pulmonary blood flow and gas exchange. Alpha-tocopherol has the ability to inactivate another type of reactive oxygen species - singlet oxygen (delta and sigma), which is formed as a result of a "jump" of one of the electrons in the oxygen molecule to a higher energy level or as a result of a spin change by an unpaired electron. Thus, the joint administration of antioxidants - human superoxide dismutase and alpha-tocopherol provides inactivation of the main types of reactive oxygen species and provides restoration of lung function.

Human superoxide dismutase is part of the Erisod preparation, the manufacturing technology of which was developed by employees of the State Research Institute for Highly Clean Biological Products (St. Petersburg). In appearance, the substance of the preparations is a white powder, hygroscopic, odorless. The substance is soluble in water and in a 0.9% solution of sodium chloride for injection. The drug is non-toxic, with the intravenous administration of LD _{50 is} not installed. The use of the drug in clinical practice is allowed on the basis of registration certificate 97-335-8 (VFS 42-2765-96), issued in accordance with the order of the Ministry of Health of the Russian Federation 335 of November 14, 1997.

 The method is as follows. Drug therapy in patients with burns and thermochemical injuries of the respiratory tract is administered drugs based on human superoxide dismutase (drug erisod) in doses of 16 to 40 mg per day and alpha-tocopherol in a dose of 100 to 300 mg per day. In this case, human superoxide dismutase preparations are administered intravenously and by inhalation (using ultrasonic inhalers), and alpha-tocopherol is administered intramuscularly or by mouth. For intravenous administration, superoxide dismutase preparations are added to solutions of crystalloid, glucose and amino acids and administered intravenously; the rate of administration is from 2.0 to 4.0 mg of enzyme per hour.

Clinical example. Patient L-va Zh.G., 48 years old, and.b. 32081 was admitted to the Clinic for Thermal Lesions of VMedA on March 15, 1998 with a diagnosis of Combined injury. Inhalation vapors of methanesulfonyl chloride, chlorine and hydrochloric acid. Chemical burn with an acid reagent 18% / I-IIIa degree linden, trunk, upper and lower extremities. Chemical burn of eyes with an acid reagent of I-II degree. Explosive injury. Multiple fragmentation blind wounds of the soft tissues of both legs. From the anamnesis of injury: the victim was in protective equipment (filtering gas mask, oilcloth apron, rubber gloves) and took samples from a reactor in which intermediate products of dioxidine synthesis were chlorinated at a temperature of +70 ^o С. A reactor explosion occurred. The victim was doused with a hot chemical reagent. Protective agents began to melt from the action of an acid reagent. Running out of the room, the victim tore off her gas mask, resulting in an inhalation lesion. First aid - rinse burn wounds with running water for 30 minutes. The clinic of thermal lesions delivered after 1 hour from the moment of injury.

 The patient complains of pain in the wounds, a feeling of sore throat, cough with discharge of a large amount of sputum mucosa. At the initial examination: the skin of the face, upper and lower extremities is swollen, hyperemic. There are numerous blind shrapnel wounds in the lower leg region. When fibrobronchoscopy performed at 11 hours and 30 minutes, the following was found: in the oral cavity and larynx — pronounced edema, hyperemia of the mucosa, whitish-gray areas. The glottis is narrowed, the vocal cords are thickened. The trachea is hyperemic, there are also areas of pale gray. The mucosa was irrigated with 5% sodium bicarbonate solution. The toilet of burn wounds was completed, aseptic dressings were applied.

 A puncture and catheterization of the right femoral vein according to Seldinger was performed, and infusion therapy was started. The patient was injected with 90 mg of prednisolone intravenously, and 100 mg of hydrocortisone in the tracheobronchial tree. Starting from 18 hours (7 hours after admission), erisod (superoxide dismutase from human red blood cells) was introduced into the composition of the infusion therapy, which was administered intravenously at a rate of 2 mg per hour (in total, the patient received 34 mg of the drug by the end of the first day). During the first day, intramuscular injections of alpha-tocopherol were carried out twice (1 ml of a 30% solution). In the following days, erisod was administered intravenously at a rate of 12 mg per day. During the treatment and diagnostic bronchoscopy on the next day, the presence of multiple erosions and submucosal hemorrhages against the background of hyperemic mucosa was established, and an erosive endotracheobronchitis was diagnosed. The further course of the injury is smooth, discharged in satisfactory condition 69 days after the injury.

Claims (1)

 A method for the treatment of burns and thermochemical injuries of the respiratory tract, including the sanitation of the tracheobronchial tree by means of therapeutic and diagnostic bronchoscopy with local treatment with antiseptics and mucolytics, as well as the implementation of infusion therapy, characterized in that superoxide dismutase is administered in a dose of 16 to 40 mg and alpha-tocopherol in a dose of 100 to 300 mg.