RU2272577C1 - Method for diagnosing acute appendicitis cases in small children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves intramuscularly introducing 20% sodium oxybutyrate solution at a dose of 50-70 mg/kg of child body mass. Local muscular tension being observed in the right iliac region, acute appendicitis diagnosis is set.

EFFECT: accelerated diagnosis procedure.

Description

The invention relates to medicine, namely to pediatric surgery, and can be used to diagnose acute appendicitis in children of a younger age group.

Acute appendicitis is the most common surgical disease in childhood. Appendectomy accounts for up to 75% of emergency surgical interventions in children, and the mortality rate from acute appendicitis is on average 0.2-0.4%; in the younger age group (children under 5 years) mortality is ten times higher than the average level. This is due to the more severe course of acute appendicitis in young children compared to older children, as well as to significant difficulties encountered in the diagnosis.

A known method for the diagnosis of acute appendicitis (OA) in children of a younger age group during physiological sleep (E.A. Stepanov, A.F. Dronov, Acute appendicitis in young children, M., Medicine, 1974, p. 78).

However, examination during physiological sleep requires a rather long wait.

The closest to the achieved positive result is a method for the diagnosis of OA in children of a younger age group, which consists in setting the child an enema with a solution of chloral hydrate, which causes drug sleep (Ya.B. Yudin, Yu.D. Prokopenko, Acute appendicitis in children, M., Medicine , 1998, p.30).

However, the drug is currently discontinued. Therefore, the search for methods to diagnose children in a younger age group as soon as possible remains relevant. The authors offer a simple, affordable and reliable way to finally establish a diagnosis in a short period of time.

A positive result of the proposed method is to reduce the time of diagnosis.

A positive result is achieved by the fact that children of the younger age group are injected intramuscularly with 20% sodium oxybutyrate, which causes drug sleep, at a dose of 50-70 mg per kilogram of body weight of the child.

The method is as follows.

In order to diagnose OA, a child is injected intramuscularly with 20% sodium oxybutyrate at a dose of 50-70 mg per kilogram of body weight of the child to achieve drug sleep. The introduction of 20% sodium oxybutyrate leads to a decrease in the body temperature of the child without the use of anti-inflammatory drugs (analgin, ortofen, ...), which have an analgesic effect. After intramuscular injection of the drug, deep enough sleep occurs in 20-30 minutes to start examining the child. The child is in a relaxed state, motor excitement, psychoemotional reactions disappear. With superficial palpation of the abdomen, local muscle tension remains in the right iliac region. The absence of an analgesic effect allows you not to miss the local pain.

The dose of the drug is selected in such a way that it does not cause toxic adverse reactions and creates optimal conditions for examining the child. The study of a sick child during medical sleep makes it possible to obtain reliable data on the pulse rate, respiration, and facilitates auscultation.

The inventive method was applied in 198 patients under the age of 5 years with suspected acute abdomen. No adverse and toxic reactions were detected. In 138 cases, the diagnosis of acute appendicitis was made and it is possible that these children would have been operated on before.

Clinical examples:

1. Popova Sofya, 2 years 10 months, was taken to the surgical department of the Department of Internal Medicine with complaints of abdominal pain, vomiting, fever up to 39 degrees. From the anamnesis it is known that the girl fell ill at about one in the morning, began to complain of abdominal pain, fever, was hospitalized with a diagnosis of acute cystitis. I received treatment, but the condition of the child did not improve, abdominal pain, vomiting persisted, the temperature did not subside. In the blood test, leukocytosis grew. The patient was examined in a medical dream after intramuscular injection with a 20% solution of sodium oxybutyrate in a dose of 6.0 ml. Body temperature decreased, the abdomen participates in breathing, with superficial palpation, local muscular tension in the right iliac region is determined. With deep palpation: the abdomen is soft, painful in the right iliac region, the girl wakes up, repels her arm, cries. Liver, spleen, kidneys are not enlarged. Urinating is painless.

Based on the anamnesis, an objective examination, the diagnosis was made: acute appendicitis. The child was operated on, the gangrenous modified appendix was discovered and removed. The postoperative period was uneventful.

2. Aitmuhamedova Louise, 1 year old, was delivered to the ODB with complaints of abdominal pain, fever up to 39 degrees, vomiting, and loose stools. In the morning, DTP was revaccinated with polio. The condition of the child is regarded as moderate. He does not want to make contact. It was examined in medical sleep after intramuscular administration of a 20% solution of sodium oxybutyrate in a dose of 3.5 ml. Body temperature decreased. On examination, it was found that the abdomen was not swollen, soft on palpation, accessible in all departments, rumbling along the large intestine. On palpation of the abdomen, the girl does not wake up. In the area of the outer upper square of the right buttock, an injection trace under the hemorrhagic crust. Around the injection injection, soft tissue infiltration, the skin is hyperemic, palpation is painful - the child cries, wakes up.

Based on the examination, data for acute surgical pathology of the abdominal organs were not revealed. A pediatrician is invited to the child to decide on further tactics for examination and treatment.

It should be noted that in all the examined patients, it was not possible to reject the diagnosis of acute appendicitis on the basis of clinical symptoms and objective examination data before using a 20% sodium oxybutyrate solution.

Thus, the use of a 20% solution of sodium oxybutyrate allows you to create optimal conditions for research, you can easily establish the symptoms of appendicitis or remove this diagnosis in a short period of time, which leads to quick and proper treatment of the child. The method is simple and affordable, significantly reduces the time of observation of the patient to establish a final diagnosis.

Claims (1)

A method for diagnosing acute appendicitis in children of a younger age group, comprising administering a drug to achieve medical sleep, providing optimal conditions for examining a child, characterized in that a 20% sodium oxybutyrate solution is administered intramuscularly at a dose of 50-70 mg as a drug to achieve medical sleep per kilogram of body weight of the child, and in the presence of local muscle tension in the right iliac region, a diagnosis of acute appendicitis is established.