RU2223767C2 - Method for treating purulent wounds - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: one should carry out ozonization of environment and wounds. After that the wound should be treated with mixture prepared ex tempore out of ozonized water and poviargol solution. Then one should apply bandage impregnated with the same mixture. Ozonized water is obtained due to passing ozone-oxygen mixture at 200 mcg/l concentration. Concentration of poviargol in solution corresponds to 0.1-0.3%. The method suggested enables to decrease the risk for distributing hospital infection. EFFECT: higher efficiency of therapy. 2 ex

Description

 The invention relates to medicine, namely to surgery and traumatology, and is intended for the treatment and prevention of purulent complications of wounds.

 A known method of treating postoperative wounds using ozonated aqueous solutions with an ozone concentration of 4 mg / l (Vasina T.A., Sidorova I.V., Zaitsev V.Ya. et al. Results of the use of ozonated solutions in the clinic // Ozone in Biology and medicine: Abstracts of the report - N.-Novgorod, 1992.- S. 40-41).

 However, the proposed method is not very effective in case of high contamination of postoperative wounds with opportunistic microflora, since for complete inactivation of microorganisms only with an ozone-containing solution, its concentration should be higher than the acceptable therapeutic, and the toxic effect of ozone is manifested.

 There is also a method of treating purulent wounds (RF patent 2142279; IPC A 61 K 33/38, A 61 N 7/00, publ. 10.12.99; BI 34) by washing them with a solution of silver-containing antiseptic - poviargol in low concentrations (0.1 -0.3%) treated with ultrasound.

 However, despite the high bactericidal activity of the antiseptic used, when it is processed with ultrasound, the risk of air contamination by dressing microbes from the wound still remains, and the sanitation of the room requires additional costs and time.

 Closest to the claimed is a method for the prevention of purulent-septic complications in trauma hospitals, which consists in treating the room with ozone and a wound surface with a 1% solution of poviargol (Gnetnev A.M., Kolmykova A.S. Prospects for the integrated use of poviargol and ozone to combat hospital infection in surgical hospitals // Silver in medicine, biology and technology. - Novosibirsk, 1996. - Issue 5. - P. 80-84).

The disadvantage of this method is that ozone is used as a bactericidal agent for air purification of dressing rooms and chambers, thereby reducing the microbial pollution of the environment of the entire room. In addition, the method regulates the long-term — for 3-4 hours, patients with purulent wounds without dressings in the room with a working ozonizer producing ozone - from 0.2 to 3.5 mg / h. Moreover, in these rooms ozone concentrations can be created that exceed the maximum permissible levels of 0.1 mg / m ³ (BME, 1981. - T.17. - P.249).

 The objective of the invention is the acceleration of the rehabilitation of chronic purulent wounds.

 The problem is solved in that the proposed method for the treatment of purulent wounds produces air ozonation of the environment and the wound surface, including locally, then the wounds are treated with a mixture prepared ex tempore from ozonated water obtained by passing an ozone-oxygen mixture through it a concentration of 200 μg / l and a solution of poviargol in a concentration of from 0.1 to 0.3%, then apply a bandage soaked in the same mixture.

 The use of air ozonation of the wound surface and processing it with a mixture of low concentrations of poviargol water solution and ozonated water, as well as environmental ozonation, can successfully and quickly sanitize non-healing purulent wounds, pressure sores infected with polyantibiotic-resistant mixed microflora. This makes it possible to avoid the toxic effects of high concentrations of ozone and to use the silver-containing drug poviargol more economically.

 The method is as follows.

 The room where the wound dressing is performed (dressing rooms, wards) is sanitized with ozone. After removing the dressings and wound toilet, a limb with an open wound or an area with a bedsore is placed in a plastic chamber (bag). The wound surface is treated with ozone, which is fed through the tube into the chamber from the ozonizer at a concentration of 200 μg / l for 20-30 minutes. Then, the wound is washed with a mixture of solutions of poviargol (State Reg. 97/167/27; pharmaceutical art. 42-2845-97 approved on May 27, 1997) in a final concentration of 0.1-0.3% and ozonized water prepared ex tempore by passing through it an ozone-oxygen mixture at a concentration of 200 μg / L.

 After the wound has been sanitized, a dressing impregnated with the same mixture is applied to its surface. This treatment of the wound is carried out daily on dressings, until complete epithelization or until the wound is sanitized and prepared for skin plasty.

 Example 1. Patient I., 42 years old, (IB 2636) was undergoing treatment at SarNIIITO for a relapse of a brain tumor. She underwent surgery: removal of a tumor of the middle cranial fossa on the left. In the postoperative period, a pressure sore of 18x12x5 cm was formed in the sacral region, the sacrum was the bottom of the wound, a large amount of purulent discharge was noted, from which Proteus vulgaris was isolated (resistant to 18 antibiotics).

 Prior to the dressing, ozonation (sanitation) of the air of the dressing chamber was carried out. The course of treatment included a daily 30 min treatment of the bedsore with gaseous ozone, and then the wound was washed with a prepared ex tempore mixture of ozonated distilled water and poviargol and a bandage impregnated with this mixture was applied. On the 10th day, the wound cleansed, the discharge became serous, scanty, single fresh granulations appeared, and marginal epithelization began. Three weeks after the start of treatment, the bedsore decreased to a size of 6x6x2.5 cm. The bottom of the wound is covered with fresh granulations, there is marginal epithelization, wound contraction. Thus, after a month the inflammatory process was stopped, there is no discharge, the wound was almost completely epithelized. The patient was discharged home.

 Example 2. Patient U., 30 years old, (i.p. 205) was treated at SarnIIITO for polytrauma: closed posterior dislocation of the left lower leg, fracture of the head of the left fibula, fracture of the left radius in a typical place, lacerated wound 25x15 cm in the upper third of the left leg, closed skull injury, concussion, shock of the II degree. After the initial surgical treatment of the wound without cutting off the flap with perforation of the skin and excision of the subcutaneous tissue for a month, traditional treatment with antibiotics was performed. Dry necrosis of 15x15 cm was formed, and after necrectomy a wound of 6x15x0.5 cm was formed, the bottom of which was muscle tissue. Abundant purulent discharge was noted, from which Staphylococcus aureus was isolated in association with Enterobacter agglomerans (resistant to 15-18 antibiotics).

 On the 8th day after the start of treatment with the proposed method, fresh granulations appeared, purulent discharge sharply decreased, then the edge epithelization began. After 2.5 weeks, the wound was completely cleansed of pus, the inflammatory process was stopped, the size of the wound decreased to 4x8x0.1 cm. The wound was prepared for skin plastic. After surgery, the sutures were removed on the 10th day, healing by first intention.

The method is used in the treatment of 63 patients with post-traumatic purulent complications, long-term non-healing wounds, the area of which ranged from 10 to 600 cm ² and was often covered with necrotic masses. Nine patients had 2-3 wounds. Polyantibiotic-resistant microorganisms were isolated from the wound discharge. All patients were treated with antibiotics for a long time and without success.

 After treatment with the proposed method, purulent discharge decreased after 2-5 days, fresh granulations appeared, marginal epithelization started, and wounds cleansed from purulent discharge. Thus, in the treatment of the proposed method, healing of the pathological lesion was achieved, the inflammatory process was stopped, in most patients complete epithelization of the wounds was achieved.

The medical and clinical effectiveness of the proposed method is:
- to reduce the risk of spread of hospital infection;
- in the successful treatment of long-term non-healing purulent post-traumatic wounds without the use of expensive antibiotics;
- to reduce the length of hospital stay by 10-12 days.

Claims (1)

A method for treating purulent wounds, including air ozonation of the environment and treatment of wounds with povargol, characterized in that after ozonation of the environment and wounds, the wounds are treated with a mixture prepared ex tempore from ozonated water obtained by passing an ozone-oxygen mixture through it at a concentration of 200 μg / l and a solution of poviargol in a concentration of from 0.1 to 0.3%, and then apply a bandage soaked in the same mixture.