RU2207887C2 - Method for treating abdominal cavity in the cases of peritonitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves treating inflammation focus with aerosol jet by applying high frequency insufflation techniques. Speed is selected to be equal to 100-120 cycles per min; pressure is 25-40 mm of mercury column large. Treatment duration is 5-7 min. The number of sessions is 6-9. Aerosol has oxygen, local anesthetic agents, antiseptic agents, fibrinolytic agents, and antihistamine preparations when dealing with fibrinous exudate. Fibrinous purulent or purulent exudate being the case, aerosol has oxygen, local anesthetic agents, antiseptic agents, glucocorticoids, immunomodulator agents, antibiotics and antihistamine preparations. EFFECT: enhanced effectiveness of treatment; prevented infection generalization over the abdominal cavity. 3 cl

Description

 The invention relates to medicine, in particular to abdominal surgery, and can be used in clinics of a surgical profile.

 Known methods of treating the abdominal cavity with peritonitis.

 1. Peritoneal dialysis - its essence lies in the introduction of fluid through the drainage located in the hypochondria, with the assumption that, washing the abdominal cavity, it will be removed through the drainage of the abdominal cavity in the small pelvis / Veronsky G.I., Yaunts R.A., Flowing abdominal lavage in the treatment of diffuse peritonitis. Surgery, 1980, 9, p. 58-61; Radionov V.V., Lemin G.P., Abdominal lavage in the postoperative period with diffuse purulent peritonitis of appendicular origin. Surgery. 1985, 9, p. 99-102 /.

 2. Hypothermic perfusion - washing the abdominal cavity with a large amount of cold solution / up to 30 liters per day /, washing the abdominal cavity with its own liquid, is independently discharged through the drainage from the pelvis / Tatishvili G. G., Tamazashvili TM, Tevdaradze ID , Abdominal hypothermia in the treatment of postoperative peritonitis. Herald of Surgery, 1985, 12, p.139-142 /.

 3. Hyperthermic perfusion - washing of the abdominal cavity is carried out with a solution with a temperature of 40-41 degrees / Deryabin II, Lizonets MN, Peritoneal dialysis, M., Medicine, 1991, S. 168 /.

 4. The introduction and aspiration of abdominal lavage fluid during laparoscopy / Petrov VI, Sytkin AP, Prolonged postoperative sanitation of the abdominal cavity using a laparoscope with widespread purulent peritonitis. Surgery, 1987, 7, p. 30-34 /.

Disadvantages of analogues:
1. The possibility of the spread of infection to more distant parts of the abdominal cavity.

 2. The low efficiency of peritoneal dialysis due to the rapid formation of channels in the abdominal cavity, due to prolapse of fibrin filaments and the formation of adhesions fragmenting it, which makes it impossible to fully complete the full course of treatment, also limits the possibility of the required number of sessions.

 3. The washing out of a large amount of protein and electrolytes from the body by the flowing fluid, which leads to the development of hypoproteinemia and disruption of water-electrolyte metabolism.

 4. The need for each session of peritonealon dialysis of a large amount / from 13-15 to 30 liters per day / of expensive medicinal solutions / Karimov Sh.I., Tursunov KN, Asrarov A.A. and others. The effectiveness of peritoneal dialysis, intestinal lavage and enteral tube nutrition in the complex treatment of spilled purulent spilled peritonitis. Guidelines, Tashkent, 1984, 14 pp. /.

 As a prototype for the closest technical essence, we have chosen a method for treating the abdominal cavity with peritonitis / RU 2154505 C1, 08.20.2000 /. The method consists in exposing the mesothelium of the abdominal cavity to a drug mixture consisting of oxygen, local anesthetics, antiseptics, ganglion blockers, antibiotics, fibrinolytics, glucocorticoids, immunomodulators and antihistamines. The drug mixture is administered in the form of an aerosol using high-frequency insufflation at a rate of 3 liters per 1 minute for 10-15 minutes, under a pressure of 70 mm Hg, with the number of sessions from 9 to 20.

The disadvantage of the method selected as a prototype are:
- the need to install additional drains leads to damage (irritation) of the peritoneum and, as a result, to further adhesion formation;
- the spread of drug aerosol at a speed of 3 l in 1 min occurs almost throughout the abdominal cavity, which leads to irritation of the unchanged sections of the mesothelium and to sweat additional exudate, which in the future can cause adhesions;
- high pressure, 70 mm Hg, used in the distribution of drug aerosol, limits the mobility of the diaphragm, which can lead to a violation of the lungs (hypostatic pneumonia);
- the duration of the procedure (10-15 minutes), which causes unpleasant subjective sensations due to limited mobility of the patient (nausea, a feeling of fullness in the abdomen and lack of air).

 All of the above disadvantages of the prototype does not allow its effective use in the local inflammatory process of the abdominal cavity.

 The objective of the invention is to increase the efficiency of the method of treating the abdominal cavity in the treatment of limited / local / localized peritonitis, which is achieved by eliminating additional irritation of the unchanged portions of the peritoneum, eliminating the spread of infection through the abdominal cavity, preventing adhesions, and also by reducing treatment time.

 The problem is solved in that a limited area of the abdominal cavity with peritonitis, i.e. directly the initial focus of inflammation, treated with a stream of medicinal aerosol consisting of oxygen, local anesthetics, antiseptics, antibiotics, fibrinolytics, glucocorticoids, immunomodulators and antihistamines using high-frequency insufflation at a speed of 1-1.5 liters with a frequency of 100-120 cycles in 1 min for 5-7 minutes, under a pressure of 25-40 mm Hg, in the number of sessions from 6 to 9.

 In the case where there is fibrinous exudate in the focus of inflammation, the drug aerosol consists of oxygen, a local anesthetic, antiseptic, fibrinolytic and antihistamine, and with fibrinous-purulent and purulent exudate - oxygen, local anesthetic, antiseptic, glucocorticoid, an immunomodulator antihistamine drug.

 The method is as follows. After installing the drains / two drains parallel to each other with an inspirator diameter of 0.4 cm, an expirator 0.6 cm / to the area of inflammation, starting 3-4 hours after the operation, the abdominal cavity is insufflated with medicinal aerosol / 2 composition / depending on contents / fibrinous - oxygen, local anesthetic, antiseptic, fibrinolytic and antihistamine; purulent and purulent - oxygen, local anesthetic, antiseptic, glucocorticoid, immunomodulator, antibiotic and antihistamine. The number of sessions / 6-9 / depends on the clinical and laboratory data. Enzyme-linked immunosorbent assays are used as criteria for monitoring the course of the inflammatory process and the level of adhesion formation.

 Insufflation is carried out by a mounted installation of two devices - an ALBEDO ultrasonic generator and a VAVILEK-1 high-frequency respirator.

 In this case, the area of inflammation, the optimal allowable increase in pressure in the abdominal cavity and the speed of treatment of the peritoneal area with medicinal aerosol are taken into account.

 High-frequency insufflation of medicinal aerosols is carried out by patients of moderate and severe severity.

 For maximum effectiveness, medicinal formulations contain the following components - 1% solution of novocaine 5.0, blocks peritoneal interoreceptors, stimulates peristalsis, furatsilin 4.0, antibiotic 1.0 (depending on the sensitivity of microorganisms), carry out bactericidal action on pathological microorganisms, fibrinolysin - 10.0 / 150 units / - provides dissolution of fibrin filaments, preventing the occurrence of adhesions in the abdominal cavity, prednisone 0.5 ml / 15 mg / - glucocorticoid hormone inhibits the development of fibroblasts, mind reduces the inflammatory reaction of the peritoneum, suprastin or diphenhydramine 1.0 ml - antihistamines, reduce the sensitization of the body, immunofan - the immunomodulator has a local and general immunocorrective effect, oxygen - creates a certain gas layer in the inflammation zone, thus preventing the development of adhesions, reduces reaction of the peritoneum to mechanical irritation, oxygenates the cells.

 High-frequency insufflation of drug aerosol at a rate of 1-1.5 l / min, for 5-7 minutes under a pressure of 25-40 mm Hg, a frequency of 100-120 cycles per 1 min with the direction of the aerosol stream to the area of the eliminated source of inflammation improves local microcirculation of blood, allows you to most effectively process a limited area of the abdominal cavity. Eliminates the possibility of the spread of infection and possible complications. It is proved by bench tests and in an experiment on rabbits using a 1% solution of methylene blue in the form of a marker.

 Treatment of the area of inflammation is carried out during the day 2-3 sessions, depending on the severity and stage of peritonitis. The age and concomitant diseases of the patient do not limit the time and number of sessions.

 The procedure does not affect the patient's condition and is not aggravating for him.

 We give examples from clinical practice.

 1. Patient B., 39 years old, medical history 10883, was admitted to the hospital in serious condition with a diagnosis of acute appendicitis / gangrenous-perforated appendicitis, pelvic abscess, local peritonitis /.

 On June 12, 2000, an appendectomy and abdominal drainage were performed on an emergency basis. Immediately after the operation, for the next two days, high-frequency insufflation of drug aerosols (RFA) was performed. A total of 6 sessions of 5 minutes. For each session, 4.5 ml of the drug solution and 11 liters of oxygen with a pressure of 25 mm Hg were consumed. Art. with a speed of 1 l / min and with a frequency of 100 cycles in 1 min. The patient did not experience any unpleasant sensations during the procedures. Drainages removed on the second day. High-frequency insufflation of drug aerosols was carried out against the background of complex treatment. Postoperative course without complications. The wound healed by primary intention. The patient was discharged in satisfactory condition for outpatient monitoring by a surgeon in a clinic. The duration of treatment in the clinic was 7 beds-day.

 2. Patient G., 43 years old, medical history 8633, was admitted to the hospital in an emergency in a serious condition with a diagnosis of gangrenous-perforated appendicitis / retrocecal location of the appendix /, local peritonitis.

 Operation - appendectomy, drainage of the abdominal cavity according to a proven technique. In the postoperative period VCHILA was carried out / a total of 7 sessions were completed /. Drainages removed on the 3rd day. Parameters of high-frequency insufflation of medicinal aerosols - frequency 110 cycles per 1 min, pressure 35 mm Hg, speed 1.3 l / min, consumption of medicinal aerosol 6 ml per session for 6 min, 13 liters of aerosol. VCHILA was carried out against the background of complex treatment without subjective and objective deterioration of the general condition of the patient. The wound healed by primary intention. The postoperative period without features. In satisfactory condition, is discharged for outpatient observation by a surgeon. The length of stay in the hospital is 10 days.

 3. Patient K., 64 years old. The medical history 10718, was admitted to the hospital on an emergency basis: 06/07/2000 in serious condition with a diagnosis of acute appendicitis, peritonitis.

 The diagnosis after surgery is gangrenous cholecystitis. Secondary phlegmonous appendicitis, limited serous-fibrinous peritonitis.

 07/07/2000 operation - laparotomy, appendectomy, cholecystectomy, drainage of the abdominal cavity according to the technique worked out in the clinic.

 In the postoperative period, RFID was performed / frequency of 120 cycles per 1 min under a pressure of 40 mm Hg. and its speed is 1.5 l / min. Consumption of 15 liters of oxygen per session, 7 ml of drug solution for 7 minutes.

 A total of 9 sessions over 3 days. VCHILA was carried out against the background of complex therapy without deterioration of subjective and objective parameters. The postoperative period without complications. The wound healed by primary intention. The patient in satisfactory condition was discharged under the supervision of a surgeon at the place of residence. The patient was in the clinic for 12 days.

 We give examples of the treatment of peritonitis by the method prototype.

 1. Patient S., 41 years old, medical history 2005, was admitted to the hospital on January 31, 2000 in an emergency with a diagnosis of gangrenous-perforated appendicitis, local unlimited serous-fibrinous peritonitis. In an emergency, an appendectomy, sanitation of the abdominal cavity was performed by lower middle access. Installed - a transverse drainage tube into the mesogastric region and 2 drainage tubes (through the right and left iliac regions) are brought into the small pelvis. After the operation, VCHILA was performed through drainage tubes for 3 days (a total of 14 procedures were performed lasting 10 minutes each with a flow rate of 60 ml of the drug mixture and about 30 liters of oxygen per session. The aerosol was supplied at a pressure of 70 mm Hg at a speed of 3 liter per 1 minute). During TAKE-IN into the abdominal cavity and for several hours after it noted a feeling of bloating of the abdomen of a bursting nature, nausea, an increase in general weakness and difficulty breathing. The drainage installed in the small pelvis on the left, on the 2nd day ceased to function. Comprehensive treatment of peritonitis was carried out in the generally accepted way. The patient had a fever for four days. The wound healed by primary intention. Irregular stool, stimulation of bowel function required. 02.15.2000 was discharged for outpatient treatment. The duration of treatment was 15 bed days.

 2. Patient Sh., 47 years old, medical history 5600, was admitted to the clinic March 22, 2000 in connection with a perforated duodenal ulcer, local unlimited serous-fibrinous peritonitis. On an emergency basis, March 22, 2000, the operation was a laparotomy, suturing of a duodenal ulcer, sanitation of the abdominal cavity, drainage of the abdominal cavity. In the postoperative period, high-frequency insufflation of drug aerosol was performed for 4 days - 17 sessions. From the 4th day, exudate from the abdominal cavity was noted, in addition to the drainage tube in the right iliac region, which was removed. The remaining drains were removed on the 5th day. Subsequent suppuration of the postoperative wound occurred in the standing area of the drainage (in the right iliac region). For 8 days in the postoperative period there was a constant dry cough. Complex treatment was carried out according to the generally accepted technique. Intoxication phenomena persisted for a long time. The wound healed by secondary intention. The patient was discharged on the 16th day for outpatient treatment. Upon discharge from the hospital and after 1 year from the time of the operation, he complains of discomfort, periodic bloating, irregular stools, which are indirect signs of the development of adhesive disease.

 According to this method / high-frequency insufflation of medicinal aerosols / abdominal cavity was treated in 38 patients with limited inflammation. Of these, 21 women, 17 men aged 17 to 86 years. The cause of peritonitis was - about. appendicitis, about. pancreatitis, about. cholecystitis and perforated gastric ulcer. All patients in the postoperative period had no complications from the abdominal cavity.

 This method allows you to more effectively treat the local inflammatory focus in the abdominal cavity, reduces treatment time by 4-8 days by improving local blood microcirculation and eliminating the possibility of the spread of infection, as well as additional irritation of unchanged sections of the peritoneal mesothelium. The inventive method prevents the development of adhesions.

Claims (3)

 1. A method of treating the abdominal cavity with peritonitis by high-frequency insufflation with a medicinal aerosol consisting of oxygen, local anesthetics, antiseptics, antibiotics, fibrinolytics, glucocorticoids, immunomodulators and antihistamines, characterized in that the insufflation is carried out directly to the site of the initial focus of inflammation at a rate of 1- 1.5 l / min for 5-7 minutes under a pressure of 25-40 mm RT. Art. with a frequency of 100-120 cycles in 1 min, in the amount of 6-9 sessions.  2. The method according to claim 1, characterized in that in the presence of fibrinous exudate, the drug aerosol consists of oxygen, local anesthetics, antiseptics, fibrinolytics and antihistamines.  3. The method according to claim 1, characterized in that in the presence of purulent-purulent and purulent exudate, the drug aerosol consists of oxygen, local anesthetics, antiseptics, glucocorticoids, immunomodulators, antibiotics and antihistamines.