RU2252781C1 - Method for treating purulent meningitis - Google Patents

Abstract

FIELD: medicine, anesthesiology-resuscitation, infectology, detoxication.

SUBSTANCE: the innovation suggested interrupts infectious-toxic shock, moreover, after that it is necessary to prescribe peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg. Then one should sample patient's blood to obtain leukocytes to be washed and diluted in 0.9%-NaCl solution, activated due to incubation with immunophan and intravenously injected for a patient. Then comes peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg once daily for 5 d. The innovation enables to decrease the number of complications and lethality due to decreasing immunodeficiency.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

Description

The invention relates to medicine, namely to anesthesiology-resuscitation, infectology and detoxification methods, can be used in the treatment of purulent meningitis of various etiologies.

There is a method of treating purulent meningitis in infectious patients, which is regulated by order No. 375 of the Ministry of Health of the Russian Federation of December 23, 1998, which consists in the following: relief of infectious toxic shock, antibiotic therapy, hormone therapy with glucocorticosteroids, anti-inflammatory, desensitizing, diuretic therapy.

The disadvantage of this method is that it does not take into account cellular T-immunodeficiency developing in infectious patients and inhibition of the phagocytic activity of neutrophils and macrophages, and does not include immunomodulators in the complex treatment (Blagoveshchensky S.V., Kachkov I.A., Zubova Yu.E. et al. Bacterial infection and immunodeficiency as key factors determining the nature of the course and outcome of purulent-inflammatory diseases of the central nervous system // Medical Immunology. - 2002. - T.4. - No. 2. - S.229-230).

Closest to the proposed is a Method for the prevention and treatment of sepsis in Ozhegovyh patients (Patent No. 2133341, A 61 K 35/14, 38/08, 12/20/1998).

The task of the invention is to increase the effectiveness of the treatment of purulent meningitis.

The task is achieved by the fact that, after stopping the infectious toxic shock, before administration of blood, Reaferon-EU-Lipint is orally administered at a dose of 10,000-15,000 IU / kg and the leukocytes washed and diluted with immunofan are administered intravenously, then the patients take Reaferon- orally EC-Lipint at a dose of 10000-15000 U / kg once a day for 5 days.

The method is as follows: a patient with purulent meningitis after stopping an infectious toxic shock is orally prescribed Reaferon-EU-Lipint at a dose of 10000-15000 U / kg, then an extracorporeal treatment of leukocytes with immunofan is performed. Blood sampling from a patient's vein is carried out in an amount of 400-500 ml. Vials with exfused and heparinized blood are centrifuged for 15 min at a speed of 2000 rpm, after which the plasma is exfused. A leukocyte film is collected in a sterile vial and diluted with a solution of NaCl-0.9% - 200-250 ml and medium 199-200250 ml, red blood cells are returned to the patient, 75-125 μg of immunofan per 1 × 10 ⁹ leukocytes are injected into the vial; the resulting solution is incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution is removed from the vials to a white blood cell film, then the white blood cells are washed 3 times with a sterile NaCl solution of 0.9% - 390-485 ml, washed leukocytes are diluted with NaCl 0.9% - 50-100 ml and intravenously drip is transferred to the patient. Subsequently, the patient takes orally Reaferon-EC-Lipint at a dose of 10000-15000 IU / kg once a day for 5 days.

Comparison of the treatment results of the experimental (with Reaferon-EU-Lipint and extracorporeal treatment of leukocytes with Imunofan) and control (by the known method) groups (Table 1) shows that the use of Reaferon-EU-Lipint with extracorporeal treatment of leukocytes with Imunofan can reduce the duration of treatment, reduce the total number of complications and reduce mortality in patients with purulent meningitis of various etiologies.

Table 1 Group, n Bed day, days Complications,% Mortality,% Control, 50 patients 36,2
± 1.28 88.0
± 4.0 24.0
± 3.03 Researched, 50 patients 21,4
± 1.33
<0.001 32,0
± 3.41
<0.001 10.0
± 2.45
<0.001

Clinical example 1.

Patient A. 20 years. Diagnosis at admission: purulent meningitis, infectious toxic shock II tbsp.

By the end of 1 day the patient came out of shock: T = 38.9 ° C, blood pressure = 120/70 mm Hg,

CVP = 50 mm H ₂ O, heart rate = 102 beats per minute, NPV = 22 per minute, SBP = 2 seconds, diuresis was 30 ml / hour, consciousness was stunning (13 points on the Glasgow scale), cytosis of cerebrospinal fluid 16,200 / ml, cerebrospinal fluid protein - 4.63 g / l, LII = 12.8; immunoregulatory index = 0.81; the phagocytic index 11.0, taking into account the patient’s condition, he was orally prescribed Reaferon-EU-Lipint 10,000 thousand units / kg (for 5 days) and a session of extracorporeal treatment of leukocytes with immunofan was performed. After blood sampling from the patient's vein in an amount of 400 ml, the bottles with exfused and heparinized blood were centrifuged for 15 min at a speed of 2000 rpm, after which the plasma was exfused. A leukocyte film was collected in a sterile vial and diluted with 0.9% - 200 ml NaCl solution and 199-200 ml medium, red blood cells were returned to the patient, 75 mcg immunofan per 1 × 10 ⁹ leukocytes was introduced into the vial; the resulting solution was incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution was removed from the vials to a white blood cell film, then the white blood cells were washed 3 times with a sterile solution of 0.9% - 390 ml NaCl, the washed white blood cells were diluted NaCl 0.9% - 50 ml and intravenous drip was transferred to the patient.

After a session of complex immunotherapy on day 7: T = 36.5 ° C, clear consciousness (15 points on the Glasgow scale), cytosis of cerebrospinal fluid 4 cells / ml, cerebrospinal fluid protein - 0.26 g / l, LII = 0.5 ; immunoregulatory index -1.67; phagocytic index - 36, there were no septic complications.

Clinical example 2. Patient C. 45 years. Diagnosis at admission: Purulent meningitis, infectious toxic shock of the second century.

The state after getting out of shock is very serious, consciousness is stupor (10 points on the Glasgow scale), T = 39.5 ° C, BP = 120/70 mmHg, heart rate = 120 beats per minute, CVP = 90 mm H ₂ O, SBP = 3 sec, diuresis 45 ml / h, cytosis of cerebrospinal fluid 14800 / ml, cerebrospinal fluid protein - 5.12 g / l, LII = 11.4; immunoregulatory index = 0.6; the phagocytic index 9.0, taking into account the patient’s condition, she was orally prescribed Reaferon-EU-Lipint 13000 thousand units / kg (for 5 days) and a session of extracorporeal treatment of leukocytes with immunofan was performed. After blood sampling from the patient's vein in an amount of 450 ml, the bottles with exfused and heparinized blood were centrifuged for 15 min at a speed of 2000 rpm, after which the plasma was exfused. A leukocyte film was collected in a sterile vial and diluted with 0.9% - 225 ml NaCl solution and 199-225 ml medium, red blood cells were returned to the patient, 100 mcg immunofan per 1 × 10 ⁹ leukocytes was introduced into the vial; the resulting solution was incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution was removed from the vials to a white blood cell film, then the white blood cells were washed 3 times with a sterile NaCl solution of 0.9% - 435 ml, the washed white blood cells were diluted NaCL 0.9% - 75 ml and the patient was intravenously dripped.

After the session: T = 36.8 ° C, clear consciousness (15 points on the Glasgow scale), cytosis of cerebrospinal fluid 7 cells / ml, cerebrospinal fluid protein - 0.31 g / l, LII = 1.1; immunoregulatory index = 1.2; phagocytic index 28, there were no septic complications.

Clinical example 3. Patient S. 49 years. Diagnosis at admission: Purulent meningitis, infectious toxic shock III tbsp.

Admission condition: very serious condition, coma consciousness (8 points on the Glasgow scale), skin and visible mucous membranes are pale, T = 38.0 ° C, SBP for more than 3 seconds. The vesicular breathing, no wheezing, NPV = 26 per min. Cardiac tones are muffled, single extrasystoles, a pulse of weak filling, heart rate = 140 beats per minute, blood pressure = 75/40 mm Hg, CVP - neg. The abdomen is soft, painless. No urine. After the patient emerged from shock: coma consciousness (8 points on the Glasgow scale), T = 39.8 ° C, pale skin, SBP more than 5 seconds. Hard breathing, single dry rales, NPV = 30 per min. Heart sounds are muffled rhythmic heart rate = 124 beats per minute. HELL = 110/50 mm Hg, CVP = 100 mm H ₂ O, diuresis - 20 ml / h, LII = 13.5, cerebrospinal fluid cytosis 17100 / ml, cerebrospinal fluid protein - 4.61 g / l, immunoregulatory index = 0.7; the phagocytic index 8.0, taking into account the patient’s condition, he was orally prescribed Reaferon-EU-Lipint 15,000 thousand units / kg (for 5 days) and an extracorporeal treatment of leukocytes with immunofan was performed.

After blood sampling from the patient's vein in an amount of 500 ml, the bottles with exfused and heparinized blood were centrifuged for 15 min at a speed of 2000 rpm, after which the plasma was exfused. A leukocyte film was collected in a sterile vial and diluted with 0.9% - 250 ml NaCl solution and 199-250 ml medium, red blood cells were returned to the patient, 125 μg immunofan per 1 × 10 ⁹ leukocytes was injected into the vial; the resulting solution was incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution was removed from the vials to a white blood cell film, then the white blood cells were washed 3 times with a sterile NaCl solution of 0.9% - 485 ml, the washed white blood cells were diluted NaCl 0.9% - 100 ml and intravenous drip was transferred to the patient.

After the session, T = 36.7 ° C, clear consciousness (15 points on the Glasgow scale), cytosis of cerebrospinal fluid 6 cells / ml, cerebrospinal fluid protein - 0.24 g / l, LII = 0.7; immunoregulatory index = 1.3; phagocytic index 32, there were no septic complications.

The proposed method allows to reduce the duration of treatment, reduce the total number of complications and reduce mortality in patients with purulent meningitis of various etiologies.

Claims (1)

A method of treating purulent meningitis, including the relief of infectious toxic shock, characterized in that, in addition, after relief of the shock, the patient is prescribed oral administration of Reaferon-EU-Lipint at a dose of 10000-15000 U / kg, then the patient's blood is taken, his leukocytes are washed, washed and they are diluted with 0.9% NaCl solution, then the leukocytes are activated by incubation with Imunofan and administered intravenously to the patient, then Reaferon-EC-Lipint is administered orally at a dose of 10000-15000 U / kg once a day for 5 days.