RU2192866C2 - Method for treating the cases of ischemic and purulent necrotic lesions in lower extremities - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying tourniquet to the extremity. 10-150 ml of ozone and oxygen mixture is intraosseously injected during 20-30 min. Ozone concentration is 2500-5000 mcg/l. EFFECT: prolonged therapeutic concentration in lesion area; enhanced effectiveness of treatment.

Description

 The invention relates to medicine and can be used in the treatment of ischemic and purulent-necrotic lesions of the lower extremities with atherosclerosis and diabetes mellitus.

 There is a method of intraosseous infusion of fluids, solutions of antiseptics, antibiotics, ozone-saturated solutions (Atyasov N. I. Intraosseous route of administration in surgical, anesthesiology and resuscitation practice. Gorky. Volgo-Vyat. Book publishing house, 1970. 30 S.).

 However, the known method does not allow to introduce once a large amount of ozone and does not create a sufficient therapeutic concentration in the lesion, ozone with blood flow is quickly removed from the affected area, while its antihypoxic and antibacterial activity decreases. Ozone is introduced in a carrier dissolved in the infusion medium (0.9% sodium chloride solution); saturation of physiological solution with ozone requires a certain amount of time and technical equipment.

 The technical effect is to improve the results of treatment of ischemic and purulent-necrotic lesions of the lower extremities in patients with atherosclerosis and diabetes mellitus.

 The essence of the invention lies in the fact that in the method of treating purulent-necrotic lesions of the lower limb by intraosseous administration of drugs, 100-150 ml of an ozone-oxygen mixture with an ozone concentration of 2500-5000 μg / l is administered regionally for 20-30 minutes, creating a long therapeutic concentration drug substance and the largest contact surface of gas, blood and tissues in the affected area.

 The method is as follows. The site of the proposed puncture is treated with antiseptic solutions, a rubber tourniquet is applied to the upper third of the lower leg to slow the leaching of drugs into the general bloodstream. Under aseptic conditions, anesthesia of the soft tissues and periosteum is performed at the proposed point of injection. The calcaneus is punctured at a standard point (posterior to the external ankle and 2.5-3.0 cm below it) by the intraosseous needle by lightly pressing on the handle and simultaneously rotating it. After passing through the cortical plate (determined by the characteristic crunch and the sensation of a failed needle), the needle is advanced deeper into the spongy substance, and then it is slightly pulled back, thereby creating a large surface of contact and absorption. Signs of a correctly performed puncture are the sensation of a failed needle, its firm fixation in the bone, pain when trying to aspirate the bone marrow or infusion of a solution. To relieve pain during the administration of drugs into the venous channel of the bone, 5 ml of a 1% solution of novocaine are pre-infused through a needle. Then, using a syringe, 100-150 ml of an ozone-oxygen mixture with an ozone concentration of 2500-5000 μg / l are injected over a period of 20-30 minutes, depending on the stage of the reparative process. After exposure in 20-30 minutes, the tourniquet is removed. The needle is removed, the puncture site is treated with an antiseptic and an aseptic dressing is applied.

 Clinical examples. Patient A., 64 years old, East. illness 6566/346, was admitted to the Mordovian Republican Clinical Hospital on 10/11/99 with a diagnosis of type II diabetes mellitus. Diabetic angiopathy of the lower extremities III - IV Art. Purulent-necrotic phlegmon of the lateral, medial and plantar fascial-cellular spaces of the left foot. Upon admission, surgical treatment was performed: autopsy, necrectomy and drainage of the cellular spaces of the left foot. Conservative treatment aimed at correcting carbohydrate disorders, homeostasis, detoxification, antibacterial and immunotherapy, dressings with the use of antiseptics was carried out. In complex treatment, the method of intraosseous administration of ozone with a concentration of 5000 μg / L in 150 ml daily was used. The course of treatment was 10 procedures. The patient was discharged on the 35th day in satisfactory condition. The purulent-inflammatory process was stopped, the wounds healed by secondary intention. Surgical treatment was limited to "minor" surgical interventions.

 Patient P., 61 years old, East. Disease 6946, was admitted to the purulent department of the Mordovian Republican hospital on 10.26.99 with a diagnosis of type II diabetes mellitus, severe course, insulin-using. Diabetic angiopathy of the lower extremities III - IV Art. Chronic osteomyelitis of the V metatarsal bone of the left foot, fistulous form in the acute stage. Phlegmon lateral plantar space of the left foot. Chronic osteomyelitis of the nail phalanx of the first toe of the right foot in the acute stage, phlegmon of soft tissues of the first toe. Chronic bronchitis, pneumosclerosis.

 November 17, 1999 - operation: resection of the nail phalanx of the first toe of the right foot. Autopsy, necrectomy, sequestrectomy and drainage of the phlegmon of the cellular space of the left foot.

 He received treatment aimed at normalizing carbohydrate, protein, fat metabolism, homeostasis, antibacterial and immunotherapy. Daily dressings with the use of antiseptics and ointments, depending on the stage of the reparative process. In the complex treatment, the method of intraosseous injection of ozone into the calcaneus with a concentration of 5000 μg / l in a volume of 100 ml daily was used. Number of procedures - 8. Discharged in satisfactory condition. Spent 31 bed days. The wounds healed by secondary intention, the inflammatory process was stopped. Osteomyelitis in remission.

 Compared with the known solution, the proposed method implements a much higher concentration of the drug substance in the lesion, which cannot be achieved by any of the methods used so far (intra-arterial, intravenous, intramuscular, subcutaneous, intraosseous administration of ozone in dissolved form). This is achieved by the fact that, firstly, ozone is injected more, secondly, ozone is administered regionally, under a tourniquet, and the drug with blood flow is not removed from the injection zone, thirdly, interstitial distribution (impregnation) of all layers from the inside out , including those affected by a purulent process, i.e. the entire area of the lower tourniquet - bone, periosteum, muscles, fascia, fiber, up to the skin. The largest contact surface of gas and blood is reached, which cannot be achieved by other methods, since the gas is filtered through a bone (bone filter) with pore sizes not exceeding 100-150 microns. The method is safe for thrombosis and embolism, because The bone is a filter and does not pass particles that can cause the above complications. In addition, when implementing the method does not require expensive equipment, operating conditions, as we can do in the handling.

Claims (1)

 A method of treating ischemic and purulent-necrotic lesions of the lower extremities, including applying a tourniquet and intraosseous administration of drugs, characterized in that 100-150 ml of an ozone-oxygen mixture with an ozone concentration of 2500-5000 μg / l is administered regionally for 20-30 minutes.