RU2214250C2 - Method for treating gynecological patients in case of operative interference - Google Patents

Abstract

FIELD: medicine, gynecology. SUBSTANCE: in the course of operation patients should be intravenously injected with ozonized physiological solution (OPS) at the quantity of 400 ml at 1-2 mg/l concentration. After operation, patients are intravenously injected with OPS by drops at the quantity of 400 ml and 1-2 mg/l concentration, once daily, at 3-d-long course. In case of increased traumaticity of operative interference it is necessary to intraperitoneally inject about 600-1000 ml OPS at 4-5 mg/l concentration. The present innovation enables to exclude the usage of antibiotics. EFFECT: higher efficiency. 1 cl, 2 ex

Description

 The invention relates to medicine, namely to operative gynecology.

 Known routine methods for the management of gynecological patients who underwent surgical intervention, using broad-spectrum antibiotics (mainly cephalosporin series), metrogil. On average, anti-inflammatory therapy lasts 7-10 days.

 This treatment is often complicated by symptoms of antimicrobial intolerance and does not always achieve the desired result, given the concomitant somatic pathology. Patients experience complications during the postoperative period (prolonged intestinal paresis, inflammatory infiltration, complications in healing of the surgical wound).

 There are also known methods of using dissolved ozone preparations in the treatment of surgical diseases (1), severe forms of peritonitis (2, 3, 4), using hydropressive methods of ozone therapy in the treatment of purulent wounds (5).

 However, in these cases, ozone therapy was used against the background of an existing infection in combination with other antimicrobial agents and detoxification methods. Long courses of antimicrobial drugs (10-20 days) led to allergic reactions, impaired liver and urinary system, and the development of dysbiosis.

 The purpose of the invention is to increase the effectiveness of the treatment of gynecological patients undergoing surgical treatment.

 This goal is achieved by introducing an ozonized physiological solution with a concentration of 1-2 mg / l of 400.0 ml intravenously during surgery and for another 3 days after the operation period in the same dose and concentration once a day. In the case of the most complex, traumatic surgical interventions that require dissection of adhesions after repeated laparotomy, sanitation of the abdominal cavity after opening of the appendages, as well as patients with a high infectious index, the abdominal cavity was treated with ozonized physiological saline (RB) in an amount of 400.0-800.0 ml, with a concentration of dissolved ozone 4-5 mg / l during stomach cutting and another 200.0 ml of OGF of the same concentration was left in the abdominal cavity before it was closed. In total, treatment of the abdominal cavity required 600.0-1000.0 ml of OGF, with an ozone concentration of 4-5 mg / L. This group of patients was also given an intravenous infusion of FGF of 400.0 ml with an ozone concentration of 1-2 mg / l during the operation and 400.0 ml of FGF of the same concentration for 3 days after the operation period 1 time per day. In 86% of cases, the intravenous and intra-abdominal administration of FGR allowed to completely abandon the administration of antibiotics and only 14%, given the burdened somatic history and the special trauma of the surgical intervention, a single dose of the cephalosporin series antibiotic was intravenously administered once.

 Example 1: Patient O., 49 years old. Medical history N 1356/5. Hospitalized for surgical treatment for multiple uterine fibroids. The patient’s somatic history is aggravated by hypertension, an insulin-resistant form of diabetes mellitus, and a drug disease. Laboratory data: general blood and urine tests and biochemical blood parameters within normal limits. Blood glucose 5.5 g / l. According to the coagulogram, signs of hypercoagulation were noted: APTT 28 s, fibrinogen B ++++, prothrombin index 88%. According to the immunogram, a decrease in T-E-ROCK.

 The patient underwent surgery in the amount of extirpation of the uterus with appendages. During the operation and within 3 days of the postoperative period, OFR of 400 ml was administered with an ozone solution concentration of 1-2 mg / l intravenously. Antibiotics were not administered.

 Normal body temperature, complete restoration of bowel function by the end of 3 days were noted throughout the postoperative period. The sutures from the skin wound were removed on the 8th day, healing by primary intention. The vaginal wound is completely epithelized by 15 days.

 The blood counts remained within normal limits, without a decrease in hemoglobin, with insignificant short-term leukocytosis. Blood glucose remained within 5.5 g / l. Correction of the state of hypercoagulation before the operation was noted: APTT - 38 s, B + fibrinogen, 81% IPT. According to the immunogram, an increase in T-E ROCK by 8.2%, an increase in IgM by 21%.

 The patient was discharged on the 18th day in a satisfactory condition. On the skin - a completely healed wound without infiltration. When examining the vagina in the mirrors: the healing of the vaginal wound is complete, the matching of the edges is good. Vaginal examination: there is no infiltration in the pelvis.

 Example 2. Patient 3., 34 years. Medical history 1455/5.

 The patient was admitted for surgical treatment with a diagnosis of multiple uterine fibroids. Internal and external endometriosis. Hemorrhagic syndrome. Anemia. During hospitalization, Нb 88 g / l, the patient showed moderate hypercoagulation (aPTT - 38 s), immunosuppression state - phagocytosis 55%, BM-ROCK 5%, IgG 11.87 g / l, IgA 0.8 g / l. The patient complained of constant pain, aggravated during menstruation, menorrhagia, increasing weakness, disability. A history of two interventions for endometrioid ovarian cysts: endoscopic resection of the ovaries and gluttony with removal of endometriomas. The upcoming glorification was to be the third. The patient was performed the planned volume of surgical intervention. The complexity of the operation was determined by a pronounced adhesive process, multiple endometrioid heterotopies on the ovaries, pelvic peritoneum, and ligaments. All foci of endometriosis were coagulated. During the operation, the abdominal cavity was sanitized using an FGF of 400 ml with an ozone solution concentration of 4-5 mg / L and 200 ml of the GFR solution of the same concentration was left in the abdominal cavity before suturing the abdominal wall. Intraoperatively and within 3 days of the postoperative period, the patient was also intravenously injected with an OF of 400 ml. The postoperative period was uneventful. Normalization of the general analysis of blood, coagulation and immune systems was noted. Healing of the surgical wound by primary intention. By the time of discharge from the hospital, the vaginal examination data is without pathological changes, respectively, according to the volume and terms that have passed since the operation. Follow-up: pains did not resume, blood counts remained within normal limits, disability was fully restored.

 The proposed method for the treatment of acute respiratory infections of gynecological patients who have undergone laparotomy causes positive changes in blood formation parameters and the body's immune system, which contributes to faster rehabilitation and reduces the number of purulent-septic complications, allows you to refuse to use antibiotics or significantly reduce their dose. The use of FGD can reduce the cost of treatment and reduce the number of complications associated with antibiotic therapy.

Sources of information
1. Collection of scientific papers. Voronezh Regional Hospital: specialized medical care. - 1996. - S.368-369.

 2. The journal "Bulletin of Surgery named after II Grekov", 1995, 3. - P. 56-60.

 3. Collection of scientific papers "Actual problems of internal medicine and dentistry." - 1997. - S.29-30.

 4. The journal "Anesthesiology and Intensive Care". - 1998, 6, - P. 56-58.

 5. Collection of scientific papers "Actual problems of medicine". Voronezh, 1993.-S.28-29.

Claims (2)

 1. A method of treating gynecological patients undergoing surgical interventions, including drug and ozone therapy, characterized in that the intravenous administration of ozonized physiological solution is carried out during the operation in an amount of 400 ml with a concentration of 1-2 mg / l, and after surgery, the patient 1 time per day, a course of 3 days intravenously drip 400 ml of OFR concentration of 1-2 mg / L.  2. The method according to p. 1, characterized in that in cases of increased morbidity of surgical interventions, 600-1000 ml of OPF with a concentration of 4-5 mg / l are intraperitoneally administered.