RU2196577C2 - Method for treating peritonitis - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: during the complex of therapy, during and after operation, it is necessary to add lycopin to wash abdominal cavity in the course of operation and for inner intake after operation. For washing one should use a lycopin solution at 1:4000 dilution rate, after operation lycopin dosage corresponds to 1-2 g/d. The method provides pronounced improvement of results after treating peritonitis due to increased tissue tolerance degree under hypoxia conditions. EFFECT: higher efficiency of therapy. 3 ex

Description

 The invention relates to medicine, specifically to methods for treating purulent-septic diseases of the abdominal cavity, including peritonitis.

 It is known that in case of peritonitis and other purulent diseases of the abdominal cavity, drugs of a radioactive effect are used that are aimed both at bacterial intervention [1] and at correction of the internal environment of the body, including acid-base balance [analogue-2], as well as at correction of motor evacuation disorders bowel activity [3].

 Despite the presence of, it would seem, the most modern drugs aimed at eliminating bacterial contamination, reducing intoxication and replenishing water-electrolyte disturbances, peritonitis is a formidable disease that causes constant concern for surgeons. Moreover, peritonitis accompanies wartime injuries, defeats in catastrophes and other emergency situations. Mortality in this disease continues to be high, and the treatment time is relatively long.

 There is a method of treating peritonitis, adopted as a prototype, including eliminating the focus of infection by surgical intervention or delimiting it using adequate drainage, suppressing infection in the abdominal cavity and outside using antibacterial drugs and washing (lavage), fighting intestinal obstruction, correction of water disorders -electrolyte balance, protein metabolism and acid-base balance [4].

 The aim of the invention is to reduce the duration of treatment.

 This goal is achieved by the fact that lycopene is used as a medicine, moreover, in the intraoperative period, lycopene is used in a dilution of 1: 4000, and in the postoperative period - at a dose of 1-2 g per day.

 The drug lycopene is a type of β-carotenoid; by its chemical structure it contains a chain of hydrocarbons with a large number of unfilled double bonds. The composition of lycopene is known and recorded in the form of a hygienic certificate by the Nutrition Institute for 72-TsTS-1361 in 1996. According to the certificate, the drug contains 99.9% of pure lycopene. As the certificate shows, to date, lycopene has been used as a dietary supplement exclusively for the prevention of coronary heart disease and atherosclerosis.

 Pure lycopene is obtained from natural tomatoes using ether-free extraction. In the form of liposomes, the drug is soluble in water and physiological saline. In surgery, lycopene has not been used to date.

 We are the first to propose the use of the drug lycopene in surgical pathology as a method of treating peritonitis by intraoperative washing of the abdominal cavity at a concentration of 1: 4000 and by taking the drug orally in the postoperative period at a dose of 1-2 grams per day.

 The method is as follows.

 When a patient is admitted with a diagnosis of peritonitis, sharp pains in the abdomen are noted, aggravated by movement, change in body position and coughing of the patient; note the patient's forced position, increased heart rate, fever. When examining the abdomen, a restriction of the mobility of the abdominal wall is revealed, during palpation, protective tension of the muscles of the anterior abdominal wall, positive symptoms of Shchetkin-Blumberg are revealed. A blood test reveals leukocytosis, a shift in the formula to the left, an acceleration of ESR, and hypercoagulable syndrome.

 During the operation, the lunge of the abdominal cavity, the presence of fibrin deposits on the swollen bluish loops of the small intestine are determined. The pulsation of the vessels is sluggish, the veins are dilated.

 After surgical removal of the primary focus of infection and the implementation of a standard toilet of the abdominal cavity with washing with physiological saline, a solution of antibiotics and antiseptics, the abdominal cavity in the final stage of the operation (intraoperatively) is washed with two liters of saline containing lycopene at a dilution of 1: 4000. After treatment, the abdominal cavity is sutured, leaving drainage in the lateral canals. In the postoperative period, in addition to antibiotics, drugs that support the cardiovascular system, and detoxification therapy, the patient is administered 1-2 g of lycopene through the mouth in the form of a probe solution for 2-3 days and then up to 10 days of the postoperative period in capsules.

 The postoperative course without complications, the restoration of intestinal motility for 2-3 days with the simultaneous disappearance of symptoms of inflammation and irritation of the peritoneum. The patient is discharged 8-9 days after surgery. On average, the duration of treatment is reduced by 25-40%. Further complications are not observed.

 The method is confirmed by the following specific examples.

 Example 1. Patient B., 43 years old, was admitted to the surgical department with a diagnosis of acute appendicitis, diffuse peritonitis. He was urgently operated. During the operation, in addition to effusion in the abdominal cavity, pus and fibrin raids on the swollen loops of the small intestine, numerous small hemorrhages are revealed that also spread to the mesentery. The bowel loops themselves were cyanotic, with signs of severe swelling. The pulsation of the vessels was somewhat sluggish, the veins were dilated. The clinical picture corresponds to diffuse purulent peritonitis, as a complication of acute gangrenous appendicitis with perforation of the process. After an appendectomy and a standard toilet of the abdominal cavity with washing with physiological saline, the abdominal cavity is washed intraoperatively with two liters of saline containing lycopene at a dilution of 1: 4000. After treatment, the abdominal cavity is sutured, leaving drainage in the lateral canals. In the postoperative period, in addition to antibiotics (gentamicin 2 g / day, ampiox 1 g / day), drugs that support the cardiovascular system, and detoxification therapy, the patient received 2 grams of lycopene through the mouth in the form of a probe solution for 3 days and then in within 6 days of the postoperative period in capsules.

 Postoperative course without complications. Drainages removed on the 3rd day. The restoration of peristalsis occurred on the 2nd day of the postoperative period. Symptoms of inflammation and irritation of the peritoneum disappeared at the same time. The patient was discharged on the 9th day after the operation in satisfactory condition. Further complications were not observed.

 In this patient, the use of lycopene, obviously, had a positive effect on the resolution of intestinal paresis, which occurred much earlier than in patients with a similar severity of peritonitis, which allowed to reduce the patient’s hospital stay and to avoid complications.

 Example 2. Patient S., 55 years old, was hospitalized in the emergency department with a diagnosis of acute gangrenous cholecystitis, diffuse peritonitis. During the operation, it was established that the patient has a gangrenous changed gall bladder with perforation, diffuse gall peritonitis. Produce cholecystectomy, evacuation of effusion from the abdominal cavity, washed with physiological saline, to which lycopene was added at a dilution of 1: 4000. The abdominal cavity is sutured, drainage is introduced into the gallbladder bed and into the right lateral canal. In the postoperative period, antibiotics are administered (gentamicin 2 g / day, ampiox 1 g / day), detoxification therapy is carried out. They introduce drugs that support the cardiovascular system, and the patient receives the drug lycopene at 1.5 g / day through the mouth in the form of a solution for 2 days and for the next 6 days in capsules. The postoperative period was uneventful. The patient on the 3rd day after surgery completely normalized bowel function. The wound healed by primary intention. On the 7th day, skin sutures were removed, and on the 8th day the patient was discharged in satisfactory condition.

 In this patient, the smooth course of the postoperative period is largely due to the use of lycopene both during the operation and in the immediate postoperative period. Postoperative wound healing by primary intention.

 Example 3. Patient B. 82 years old was admitted to the surgical department with a diagnosis of blunt trauma to the abdomen, diffuse peritonitis. On the operation revealed a rupture of the wall of the small intestine, diffuse peritonitis. During the audit, the bowel loops are significantly swollen, cyanotic, and there are multiple point hemorrhages on the serous cover. In all parts of the abdominal cavity, a cloudy effusion, fibrin overlay. Resection of 5 cm of the small intestine is performed. After rehabilitation of the abdominal cavity, 1.5 liters of physiological saline with lycopene in a dilution of 1: 4000 are introduced into the latter. Peritoneal dialysis is performed. In the postoperative period, drugs that support the cardiovascular system are prescribed, detoxification therapy, antibiotic therapy are prescribed (Ampioks 2 g / day, gentamicin 1.5 g / day). The patient also receives orally lycopene at a dose of 1 g / day in the form of a solution for the probe for 3 days and then for 7 days in the postoperative period in capsules. The postoperative period was uneventful. Intestinal motility recovered by 3 days of the postoperative period. The laparotomy wound healed by primary intention.

 In this case, the introduction of lycopene led to the recovery of a patient of advanced age with a very severe pathology by the 10th day of the postoperative period.

 Observation of the operated patients showed a reduction in the treatment time for patients with peritonitis by 25-40% due to the use of lycopene compared with previously known management schemes for this category of surgical patients.

 The use of the drug lycopene is not obvious to specialists in the field of abdominal surgery and, moreover, the drug lycopene was not used in surgery, but was used only as a dietary supplement to prevent atherosclerosis and prevent myocardial infarction.

 The use of the drug lycopene by direct injection into the abdominal cavity was performed for the first time, and a pronounced positive effect is based on the previously unknown property of the direct effect of lycopene in terms of increasing tissue tolerance to hypoxic injury and prolonging their experience in conditions of hypoxia, which occurs with circulatory disorders in conditions peritonitis.

 The availability of the drug lycopene, its use since 1996 as a dietary supplement makes it possible to implement the proposed method for the treatment of peritonitis, almost directly according to the description of the invention, for surgeons of specialized hospitals, and with the accumulation of clinical material - for its widespread distribution, including in the military field surgery.

 The method is directly ready for use and has important socio-medical and economic importance.

Sources of information
1. Kanshin N.N. Treatment of purulent peritonitis. Herald of Surgery, 1980, v. 125, 9, p. 108-113.

 2. Ryabov G.A. Syndromes of critical conditions. M .: Medicine, 1994, 368 p.

 3. Shalimov A. A., Shaposhnikov V.I., Pinchuk M.G. Acute peritonitis. Kiev, 1981, 265 p.

 4. Kuzin M.I. et al. Peritonitis. BME, M., 1982, p. 91-102.

Claims (1)

 A method of treating peritonitis, characterized in that during surgery, when washing the abdominal cavity, lycotin is used at a dilution of 1: 4000, and in the postoperative period, lycopene is administered in a dose of 1-2 g per day.