RU2268717C1 - Method for treating endometritis in puerperal period - Google Patents

Abstract

FIELD: medicine, obstetrics, gynecology.

SUBSTANCE: one should intravenously inject Reamberin 1.5% up to 400 ml solution daily, percutaneously affect with magneto-infrared laser, wave length being 0.89 mcm, impulse power of infrared radiation corresponds to 4 W. One should affect uterine and adnexal area alternatively, at exposure being about 2-3 min for every region, radiation frequency being 5 Hz and 50 Hz altered every other day. Since the second day of therapy one should additionally supply laser light flow directly towards uterine area through vaginal arch for 1 min at frequency of 1000 Hz. Total course of therapy corresponds to about 5-7 d. The innovation enables to increase immunological body strength, decrease relapse frequency and decrease side effects of curative preparations applied.

EFFECT: higher efficiency of therapy.

2 ex, 1 tbl

Description

The invention relates to medicine, namely to obstetrics and gynecology, and can be used to treat postpartum endometritis.

One of the most urgent problems of obstetrics is postpartum endometritis (PE), the frequency of which is from 3-8% in the total population of births, and among patients with postpartum inflammatory diseases more than 30% (Abramchenko V.V., Kostyuchek D.F., Perfilyeva GN “Purulent-septic infection in obstetric and gynecological practice.” - SPb., 1994, Savelyeva GM, Antonova LV. “Acute inflammatory diseases of the internal genital organs of women.” - M .: Medicine, 1987 . - p. 160).

The urgency of the problem of PE is determined not only by its significant prevalence, significant economic losses, but also by its possible complications (peritonitis, sepsis, septic shock) (Ryabtseva IT “Septic shock in obstetrics” // Emergency care in extreme conditions in the obstetric clinic / Under Edited by E.K. Aylamazyan. - L .: Medicine, 1985. C.118-137; Gorin BC, Serov VN, Semenkov NN, Shin AP "Diagnosis and treatment of postpartum endometritis." Akush. And gyn. - 2001. - No. 6. - S.10-14).

The likelihood of developing endometritis after abdominal delivery increases by 5-10 times compared with spontaneous delivery, its frequency remains stably high, despite the significant number of proposed methods of prevention and treatment (E. Palchik et al. “Cytokine therapy in combination with a low-energy laser in prevention of purulent-septic complications after cesarean section. "Materials of the 5th Russian Scientific Forum" Protection of Maternal and Child Health ". - Moscow - 2003. - P.213-214).

The clinical picture of PE is currently characterized by a late manifestation of symptoms, the presence of atypical, erased forms, for which a mismatch between the general reaction of the body and the severity of the local pathological process is often characteristic (Kulakov V.I., Zik I.R., Kulikova N.N. - Postpartum infectious diseases. M., 1984).

There are various methods of treating postpartum endometritis, consisting in drug treatment, including antibacterial drugs of various groups, in various combinations, detoxification and desensitization therapy, uterotonic drugs. Often, a combination of medications with physical factors of influence is used: currents, drug electrophoresis, ultrasound therapy, UHF, ultraviolet radiation, helium-neon laser (Nakimova Z.A., Sokolova I.E., Kiryushchenkov AM, Voropaev SD “Etiology, clinic and principles of antibiotic therapy of postabortion endometritis "// Akush. and gyn. - 1986. - No. 12. - P.52-54; Lineva OI" Antibacterial therapy of infectious pathology of the female reproductive system "Samara - 1999. - S. 36-42).

The disadvantage of this method is not always its sufficient effectiveness, which often leads to negative consequences, such as the administration of massive doses of antibiotic therapy leads to suppression of the immunological reactivity of the body, reduces the natural resistance of the uterine mucosa to microorganisms, and can also lead to the selection of antibiotic-resistant forms of pathogens. The disadvantages include the duration of treatment and the possibility of developing a chronic course of the disease.

The closest set of essential features to the claimed invention is a method of treating diseases, which we took as a prototype, including the intravascular effect of helium-neon laser radiation on blood for 15-35 minutes, a course of treatment of 2-5 sessions ("A method for the treatment of acute postabortion endometritis" Mikhailov V.D., Zakharova I.V. MKI A 61 N 5/06, description of the invention No. 94028152 from 07.25.94).

The prototype and the claimed have the following significant features: they use low-intensity laser radiation, which leads to stimulation of tissue metabolism, immunogenesis, increases blood flow in the pelvic organs, reduces pain sensitivity, increases blood oxygen saturation, has an anti-inflammatory effect.

The disadvantage of this method is the invasiveness of the method, that is, violation of the integrity of the skin, contact with blood - all this necessitates a thorough and time-consuming disinfecting treatment, injury to the walls of blood vessels is possible.

The invention is aimed at solving the problem of developing a method for the treatment of endometritis in the postpartum period.

The solution to this problem provides a reduction in the duration of treatment, an increase in the immunological forces of the body, a decrease in the frequency of relapse, and also a decrease in the side effects of drugs.

To achieve this technical result, the claimed invention of a method for the treatment of postpartum endometritis includes the following essential features: transdermal exposure of the uterus and appendages and direct exposure of the uterus through the vaginal arch by magnetic infrared laser radiation, additional use of the intravenous preparation Reamberin 1.5%.

In relation to the prototype, the claimed invention has the following distinctive features: exposure to the uterus and appendages by magnetic infrared laser radiation is carried out in a non-invasive way, and direct exposure to the uterus through the vaginal arch by magnetic infrared laser radiation and the use of intravenous administration of Reamberin 1 ,5%.

The following causal relationship exists between the distinguishing features and the result: the use of laser therapy in puerperas with purulent-inflammatory complications (external and intracavitary irradiation) leads to a significant improvement in microcirculation in the pelvic organs, stimulates the processes of immunoprotection, improves the functional activity of cell membranes, and enhances absorption oxygen tissues, which leads to a pronounced analgesic and anti-inflammatory effect. And the simultaneous administration of the intravenous drug Reamberin 1.5%, which activates the antioxidant enzyme system, has a detoxifying and antihypoxic effect, which can significantly increase laser therapy in puerperas.

According to the information available to the authors, the set of essential features characterizing the essence of the claimed invention is not known, which allows us to conclude that the invention meets the criterion of "novelty."

According to the authors, the essence of the claimed invention for a specialist does not follow explicitly from the known level of medicine, since the use of laser therapy in combination with the intravenous administration of Reamberin 1.5% antioxidant cannot be detected from it, which allows us to conclude that the criterion is “inventive step”.

The set of essential features, the essence of the invention, in principle, can be used repeatedly in medicine, in particular in obstetrics and gynecology, to obtain a technical result consisting in a more complete recovery after endometritis, reducing treatment time and reducing the number of complications, which allows us to conclude on the compliance of the invention with the criterion of "industrial applicability".

This method is as follows.

The Rikta-02 quantum therapy apparatus was used for treatment; this apparatus allows combining pulsed narrow-band infrared radiation, together with a constant magnetic field and pulsating red light, a pulsed radiation power of 4 W, a wavelength of a pulsed infrared laser of 0.89 μm. The simultaneous complex effect on the body of several fields can significantly increase the therapeutic efficiency of the device compared to monotherapy with one field or alternate exposure to the same fields. This is ensured by synergism and potentiation of physicochemical and biological reactions.

The method of exposure is as follows: during a session of quantum therapy, the patient is in a supine position. Fields of exposure: the projection area of the uterus and appendages, transcutaneously through the front wall of the abdomen, alternately, with the exposure of the emitter for 2-3 minutes in each zone. The radiation frequency of 5 Hz and 50 Hz, alternated every other day. The irradiation method is stable contact with light pressure. From the second day, the uterine projection area was transvaginally irradiated with an optical nozzle G-1 with a radiation frequency of 1000 Hz, with the mandatory use of a disposable sterile protector (condom), for 1 minute.

The procedures were carried out once a day, the total exposure time of up to 10 minutes. The course of treatment is from 5 to 7 days.

Laser therapy was supplemented by the intravenous administration of Reamberin 1.5% - 400 ml of solution per day. Reamberin - a domestic drug, is a balanced isotonic detoxifying infusion solution with antihypoxic effect. The composition of which includes: the active substance is mixed sodium N-methyl-glucamine salt of succinic acid, trace elements in optimal concentrations. Reamberin has a pronounced antihypoxic and antioxidant effect, has a positive effect on aerobic biochemical processes in the cell during ischemia and hypoxia, reduces the production of free radicals, restores the cell’s energy potential, inactivates the Krebs cycle hyperenzymatic processes, normalizes the acid-base balance and blood gas composition.

To determine the effectiveness of the proposed method of treatment under observation were 60 puerperas with endometritis of varying severity. Of these, 37 (61.7%) women were delivered by cesarean section; in 23 (38.3%) women, delivery occurred through the natural birth canal. The age of the subjects was from 18 to 40 years. All pregnant women had risk factors for infection.

The severity and form of the disease were evaluated according to the clinic (fever, uterine subinvaluation, pathological nature of the lochia), ultrasound control on the LOGIQ 100 PRO device and laboratory results.

All patients received traditional therapy for postpartum endometritis, including antibiotic therapy, uterotonic drugs, etc.

32 (53.3%) of the women who made up the main group received magnetic infrared laser therapy and intravenous administration of a 1.5% Reamberin solution against the background of conventional therapy.

After the first procedure, 90% of women noted a significant improvement in overall health. In 83% of women after the first procedure, the pain syndrome stopped, in other women the pain completely disappeared from the second procedure.

At the end of the course of therapy, a clinical examination was performed using ultrasound scanning, indicating a regression of the phenomena of endometritis. The positive dynamics of laboratory parameters was observed: the number of leukocytes statistically significantly decreased to normalization, and ESR decreased.

We have studied the state of the immune and interferon status in puerperas who received laser therapy in the complex treatment of postpartum diseases against the background of Reamberin infusion therapy.

In a comparative analysis of indicators of immune and interferon status, phagocytic activity, we found that in postpartum women, after treatment, a significant increase in gamma IFN from 44.2 ± 10.8 to 108.4 ± 1.3 ME and alpha IFN from 134.0 ± 8.2 to 167.5 ± 1.3 ME in comparison with a group of patients who received traditional anti-inflammatory treatment.

In addition, against the background of laser therapy, there was a tendency to an increase in the level of total T cells and normalization of B cells, as well as an increase in the initial phagocytic activity from 55.2 ± 0.3 to 75.0 ± 2.4 and a phagocytic number from 1 , 4 ± 0.1 to 3.3 ± 0.1.

Indicators of immune and interferon status in puerperas before and after the proposed treatment Indicators Before treatment After treatment Syv. IFN (ME) 5.5 ± 1.8 6.4 ± 0.3 alpha IFN (ME) 134.0 ± 8.2 167.5 ± 1.3 gamma IFN (ME) 44.2 ± 10.2 108.4 ± 1.3 T-total (%) 40.2 ± 0.5 50.3 ± 1.1 B cells (%) 25.4 ± 0.6 28.4 ± 1.5 T-helpers (%) 25.3 ± 0.8 30.0 ± 7.5 T-suppressors (%) 23.4 ± 0.7 27.2 ± 1.7 FA% 55.2 ± 0.3 75.0 ± 2.4 F.Ch. 1.4 ± 0.1 3.3 ± 0.1

There was not a single patient who did not have a therapeutic effect. The use of this therapy avoided curettage of the uterine cavity and reduced hospital stay.

In the control group of patients receiving conventional treatment, 60% of women underwent curettage of the walls of the uterine cavity, and there was also a need to change antibiotics and extend the duration of treatment in a hospital.

Thus, using objective criteria for the effectiveness of treatment - improving the general condition, positive dynamics of ultrasound scanning and laboratory indicators, reducing the duration of treatment and hospital stay, we obtained the following technical result.

Treatment of postpartum endometritis occurs most fully with the combined use of laser therapy and intravenous administration of Reamberin antioxidant.

This means that the proposed method for the treatment of postpartum endometritis is the most effective compared to that used in modern practical medicine.

Example I. Patient Peninsula S.T., 35 years old, history of childbirth No. 2166.

Diagnosis: II urgent delivery. Head presentation. Scar on the uterus. Repeated elective caesarean section. Moderate polyhydramnios. HFPN. Chronic intrauterine hypoxia of the fetus. Risk of IUI. Colpitis.

An operation is performed - cesarean section. From the second day after the operation, body temperature is 37.2 °. On the fourth day, body temperature increased to 38 °. The patient complained of pain in the lower abdomen, chills.

Objectively: the condition of the postpartum woman is satisfactory. The skin and visible mucous membranes are pale pink in color. A / D 100/60 mm Hg PS 87 beats in 1 ', rhythmic, satisfactory properties. Body temperature 38 °. Uterus on palpation of a mild consistency, painful. The bottom of the uterus is one transverse finger below the navel.

Gynecological status: external genitalia are developed correctly. When viewed in the mirrors, the cervix is not eroded, the discharge is dirty gray in color, with an unpleasant odor. In a bimanual examination, the body of the uterus is enlarged to 15 weeks of pregnancy, a soft texture, painful on palpation and displacement. The cervical canal is freely passable for the examining finger.

Diagnosis: IV day after repeated planned retrovesical caesarean section. Endomyometritis.

Clinical examination was performed: general blood test: Er - 4.0 · 10 ¹² / l, heme - 109 g / l, lake - 12.5 · 10 ⁹ / l, pal - 17, seg - 55, eos - 4, mon - 3, lymph - 25, ESR - 32 mm per hour. Urinalysis - without pathology. Smear from the vagina - III degree of purity.

Inoculation of flora from the cervical canal - in the inoculation from c / canal, abundant growth of IV st. Es coli - predominantly, Staph. aureus - sensitive to cefazolin. Ultrasound examination of the pelvic organs: uterus 140 × 95 × 120, spherical shape. The uterine cavity is expanded, M echo - 18 mm, there is a thickening of the endometrium along the anterior and posterior wall, in a significant amount in the clot cavity.

Taking into account the patient’s complaints, medical history, clinical and laboratory examination data, laser therapy was prescribed for the projection of the uterus and appendages, through the front wall of the abdomen, with an emitter exposure of 3 minutes for each zone, against the background of conventional therapy for endometritis. The radiation frequency of 5 Hz and 50 Hz, alternated every other day. From the second day, the area of the projection of the uterus was transvaginally irradiated using an optical nozzle G-1, the radiation frequency of 1000 Hz. Laser therapy was supplemented by the intravenous administration of Reamberin 1.5% - 400 ml of a detoxifying infusion solution with antihypoxic effect. The number of procedures performed is 5.

After the first procedure, an analgesic effect was noted, an improvement in the general condition. The temperature returned to normal after the second procedure.

After completion of the course of therapy, the patient's condition is satisfactory, body temperature 36.6 °. Bimanual study: the uterus was reduced to the size corresponding to the days of the postpartum period, dense, painless on palpation and displacement. Discharges are ordinary, moderate. A general blood test and a general urine test - without pathology. Smear from the vagina - II degree of purity. Sowing flora from the cervical canal - pathogenic microflora was not found. Ultrasound examination of the pelvic organs - the size of the uterus is 100 × 70 × 90, the shape is ovoid, the cavity is closed.

The patient was discharged home on the 8th day, in satisfactory condition. When observing the patient for 1 year, the deterioration and relapse of the disease was not noted.

Example II Patient T-va Z.R., 30 years old, history of childbirth No. 1903.

Diagnosis: I urgent delivery in 30 years. Head presentation. OAA RSA. Risk of IUI. Colpitis. Planned cesarean section.

On the second day after the operation, an increase in body temperature to 37.7 ° was noted, the patient complained of aching pain in the lower abdomen. On palpation: the uterus is of a soft consistency, painful, the bottom of the uterus is at the level of the navel. In the general blood test: Er - 3.4 · 10 ¹² / l, heme - 106 g / l, lake - 9.5 · 10 ⁹ / l, pal - 7, seg - 59, eoz - 2, mon - 8, lymph - 24, ESR - 28 mm per hour. Urinalysis - without pathology. A smear from the vagina - white blood cells - 30-35 in the s / s, epit. - 20-27, mixed flora, cocci, gardnerella 3-4 cells in the village. Ultrasound examination of the pelvic organs - the uterus is spherical, the size of the uterus is more than normal. The uterine cavity is expanded, in the clot cavity in a significant amount.

Considering the medical history, patient complaints, objective and laboratory examination, laser therapy was prescribed for the projection area of the uterus and appendages, 2 minutes for each zone (radiation frequency of 5 Hz and 50 Hz), antibiotic therapy was not performed during laser therapy. From the second day, the area of the projection of the uterus was transvaginally irradiated using an optical nozzle G-1, the radiation frequency of 1000 Hz. Laser therapy was supplemented by the intravenous administration of Reamberin 1.5% - 400 ml of a detoxifying infusion solution with antihypoxic effect. In total, three procedures were performed.

After the first procedure, an analgesic effect was noted, the patient drew attention to the increased separation of the lochia. Body temperature returned to normal. After treatment, a significant improvement was noted. A clinical examination was carried out: in a bimanual examination, the uterus corresponds to the days of the postpartum period, dense, painless on palpation and displacement. The cervical canal passes the tip of the examining finger. Discharges are vernal, in moderation. A general blood test and a general urine test - without pathology. Ultrasound examination of the pelvic organs - Uterus 110 × 75 × 95, ovoid form. The cavity is closed.

The sutures were removed on the 7th day after the operation, the patient was discharged home in satisfactory condition. When observing the patient for 8 months, the deterioration and relapse of the disease was not noted.

Clinical and experimental studies of the proposed method for the treatment of postpartum endometritis, compared with the known method (prototype), showed the effectiveness of the proposed method of treatment, increasing immunity, reducing treatment time and accelerating recovery.

Claims (1)

A method of treating endometritis in the postpartum period, including laser therapy, characterized in that they use Reamberin 1.5%, administered intravenously to 400 ml of solution per day, and are transdermally exposed to a magnetic infrared laser, wavelength 0.89 μm, pulsed infrared radiation power 4 W, to the area of the uterus and appendages, alternately, with an exposure of 2-3 minutes for each zone, the radiation frequency of 5 Hz and 50 Hz alternating every other day, and from the second day of treatment, the laser light flux is additionally delivered directly the uterus through the vaginal arch for 1 min with a frequency of 1000 Hz, the entire course of treatment is 5-7 days.