RU2290913C1 - Method for preventing and treating stress-lesions of gastrointestinal tract in patients in case of critical states - Google Patents

Abstract

FIELD: medicine, therapy.

SUBSTANCE: one should apply ozonotherapy, in the morning to an empty stomach it is necessary to fulfill gastric lavage, through a nasogastric probe introduce ozonized physiological solution with its subsequent removal to carry out enema. Then, through a two-lumen rectal catheter one should perform flow-type insufflation with ozone-oxygen mixture. In diurnal hours one should daily carry out intravenous injection of 200 ml ozonized physiological solution at ozone concentration at the output from apparatus being 1 mg/l. Then comes subcutaneous injection of ozone-oxygen mixture at ozone concentration being 2500 mcg/l onto reflexogenic areas in projection of spinous processes and along paravertebral line of Th₈-L₂ area. Then these areas should be applied with ozonized oil followed by their vacuum massage for about 5-7 min. The innovation suggested decreases the number of complications due to decreasing medicinal loading upon the body.

EFFECT: higher efficiency of prophylaxis and therapy.

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Description

The present invention relates to medicine, namely to therapy, and can be used for the prevention and treatment of complications (for example, burn shock) from the gastrointestinal tract (GIT).

The terms stress stomach damage or acute stomach damage syndrome (SJS) are the damage that occurred when the mechanisms of its protection were violated in critically ill patients (see "Prevention of stress damage to the upper gastrointestinal tract in critically ill patients" Methodical recommendations of the Russian Association of Specialists in Surgical Infections (RASHI), Moscow, 2004). These terms appeared not so long ago. But at the moment, the problem of prevention and treatment of gastrointestinal stress injuries is very acute, since gastrointestinal stress injuries play an important role in the pathogenesis and outcomes of patients with critical conditions. Therefore, the search and development of new ways to prevent these conditions in patients is an urgent task.

The first publication on duodenal ulcers as complications of severe burns appeared in 1982. The author of the article, T.V. Curling, reported 10 cases that were diagnosed at autopsy. He described their pathoanatomical picture and touched on their possible etiology. After this publication, reports of ulcers developing in the gastrointestinal tract after severe burns periodically appeared. For a long time, these ulcers were attributed to relatively rare complications that occur only in 0.09-3.0% of cases. Recent studies show that this complication is much more common than was commonly thought. Large statistics on this issue are presented by the Brooke Military Medical Center in the USA. According to American scientists, such ulcers are observed in 25% of cases. In the literature of recent years, data appear on an increase in the number of these complications, which is probably due to an increase in the frequency of severe burns, an increase in the number of scientific publications, more frequent autopsy, as well as an increase in the quality of intravital diagnostics. In 30-50% of cases, Curling's ulcers are complicated by severe gastrointestinal bleeding, which aggravates the course of the disease and often becomes the direct cause of death of patients. According to some authors, mortality exceeds 60%. At the autopsy of those who died from severe burns, hyperemia and edema of the gastrointestinal mucosa were observed. Characteristic erosion in the form of small defects 0.5-5.0 cm in diameter, covered with fibro-purulent plaque, were found in the distal stomach and duodenum. Erosion was rare in the esophagus and small intestine. The morphological picture of Curling's ulcers was similar to acute peptic ulcers that form after physical and mental overload (stress ulcers). In the pathogenesis of complications of critical conditions, severe stress, intense pathological pain impulse from the lesion focus, causing changes in the central neurohumoral regulation of the body, generalized hypoxia, microcirculatory disorders and other multifactorial disorders caused by thermal trauma play a role. Endotoxins resulting from trauma affect humoral factors. Systems supporting homeostasis are involved in the pathological process. Disorders of vascular platelet and coagulation hemostasis occur. Thrombin and plasmin systems are activated. Platelets and coagulation factors, intithrombin III, components of the fibrinolytic system are irreplaceable. In the area of the wound surface, healthy tissues, in the adrenal glands, kidneys, lungs, myocardium, liver, brain and gastrointestinal tract, acute thromboses, heart attacks and hemorrhages occur. Severe functional multiple organ failure develops. Microcirculatory disorders, which in turn lead to deep tissue hypoxia, contribute to the development of acute ulceration mechanisms.

Therefore, for the prevention and treatment of acute gastrointestinal ulcers, it is necessary to take measures to restore violations of the microcirculation of the gastric mucosa, intestinal motility, and reduce tissue hypoxia.

A known method of treatment and prevention of ulceration in severely burnt patients, including the use of a medicinal product, for example, Kvamatel, which is used to suppress the pathological activity of the peptic factor (N.A. Zhuchkova and others. "Clinical and laboratory features and prevention of gastroduodenal pathology in case of burn diseases "abstracts at the International Congress" Combustiology at the Turn of the Century "Moscow, October 9-12, 2000, p. 74).

However, the effectiveness of the known method is quite small and does not reduce the risk of stress injuries of the stomach, since it is assumed that only one factor, in this case, “Kvamatel,” can be used (only antibiotics can be used, or only plasmapheresis, or only immune preparations).

For the prototype of the invention, a well-known method for the prevention and treatment of stress damage to the gastrointestinal tract in critically ill patients by drug therapy is selected (see "Prevention of stress damage to the upper gastrointestinal tract in critically ill patients" Methodical recommendations, Russian Association of Specialists on surgical infections (RASHI), Moscow, 2004).

The known method has a comprehensive nature and is aimed at maintaining and optimizing factors that ensure the structural and functional integrity of the digestive tract. The treatment complex includes activities aimed at

- to protect the upper respiratory tract: monitoring of respiration, ensuring patency of the upper respiratory tract, if necessary, intubation of the trachea;

- to support hemodynamics - adequate venous access, infusion therapy, blood transfusion, plasma preparations, platelets;

- IPP intravenously;

- naso-gastric intubation and gastric lavage;

- clinical and laboratory monitoring, endoscopic examination / treatment.

The disadvantages of this method include its complexity, the use of multiple drugs for therapy, the action of which is aimed at a particular organ separately, which increases the risk of side effects and allergic reactions. In the known method there is no targeted effect on one of the most important etiopathogenetic links, which play a large role in the development of stress damage - nerve impulses coming from the central and peripheral nervous systems.

The objective of the invention is to reduce the complications caused by drug therapy, and reduce the drug load on the patient’s body, increase the efficiency of the method by breaking the pathological chain of reflexogenic changes in microcirculation.

The problem is solved in that in the known method for the prevention and treatment of stress injuries of the gastrointestinal tract in critically ill patients by drug therapy, the patient undergoes systemic and local administration of ozone in solution and daily subcutaneous chipping of reflexogenic zones of Th ₈ -L ₂ ozone-oxygen a mixture with an ozone concentration of 2500 μg / l in a mixture and subsequent vacuum massage in the same areas with ozonated oil until persistent hyperemia of the skin appears.

The present invention meets the criteria of "novelty" and "inventive step", since when conducting patent information research, the authors did not identify sources of patent and scientific and technical information that would discredit the novelty of the proposed method, as well as technical solutions with essential features of the proposed technical solution .

The range of therapeutic effects of ozone is well known today: its high oxidizing properties, which cause antibacterial, viricidal, fungicidal effects, are used in the clinic for local sanitation of foci of purulent infection, and also as a means of simulating the functions of monooxygenase systems that transform hydrophobic xenobiotics into hydrophilic and, therefore, most conducive to oxidative detoxification.

From the sources of patent literature the use of ozone-oxygen mixture is known:

- for the treatment of gastric ulcer (application for invention No.2000122931 from 03.09.2000, publ. 2003.07.20, IPC A 61 K 33/00, 33/14, A 61 P 1/04), in which the treatment is carried out in 3 stages the second and third stages of treatment consists in the introduction of an ozonated sodium chloride solution in one case with an ozone concentration of 500-800 μg / l for 8-10 minutes at a solution temperature of +10 - + 12 ° C, in another case, the ozone concentration is 100 -1200 μg / l at a solution temperature of +40 - + 42 ° C;

- for detoxification of the gastrointestinal tract using ozone in patients with pancreatic necrosis (patent No. 2194513, IPC A 61 K 33/00, 33/14 and A 61 P 31/00, publ. from 2002.12.20), which consists in the fact that in the postoperative period through a nasogastric tube, an ozonized physiological solution is injected into the lumen of the small intestine for 7 days with an ozone concentration of 4-7 mg / l, and rectal insufflations with an ozone-oxygen mixture are simultaneously carried out with interruptions of 3-4 days.

In known methods, ozone therapy is carried out, as a rule, at the local level.

The use of ozone therapy at the system level is known, for example, “The method of detoxifying the body” (patent No. 22030066, IPC A 61 K 33/00, 33/14, A 61 M 1/28, publ. 2003.04.27), in which for the treatment of patients with For diseases accompanied by severe endotoxemia, donor blood plasma is treated with an ozonized isotonic sodium chloride solution in a volume of 200 ml with an ozone concentration in the solution of 2 mg / L.

In the proposed method for the prevention and treatment of stress damage to the gastrointestinal tract in patients in critical conditions, ozone is used at the local level (gastric lavage, rectal insufflation in the form of an ozone-oxygen mixture), at the system level (intravenous administration of an ozone-oxygen mixture dissolved in saline solution) and additionally carry out subcutaneous injection of 100 ml of an ozone-oxygen mixture with an ozone concentration of 2500 μg / l in the reflexogenic zones on the back in the region of Th ₈ -L _{2 of the} spine in the projection of the spinous processes and along the paravertebral line, followed by vacuum massage in this zone with ozonated oil. The reflexogenic zone is selected according to the book "Essays on the methods of oriental reflexology." Hawaa Luvsan. Novosibirsk, 1991, S.-332.

The proposed method allows using the following positive effect.

To implement the method, the only drug used is ozone, which is introduced into the body in various ways - intravenously, by drinking, during lavage, rectal insufflations, subcutaneously into reflexogenic zones, and massage with ozonized oil. The point of application of ozone depended on the route of administration. The systemic effect of ozone on the body was carried out by its intravenous administration and allowed, firstly, to reduce the level of pain impulse from tissue receptors and, secondly, by acting on the central nervous system, to increase the level of intrinsic endorphins, which also reduces pain.

Local exposure was carried out during lavage and rectal insufflation.

Local exposure to ozone was carried out by exposure to reflexogenic zones by ozone and using vacuum massage on ozonized oil of the same zones. The use of ozone at the local and systemic levels contributes to the reactivation of oxygen hemostasis, the restoration of disequilibrium in pro- and antioxidant systems, has an immunomodulatory effect, allows you to correct homeostasis, enhance energy metabolism in the cell, improve microcirculation and peripheral circulation.

The proposed method for the complex treatment and prevention of stress damage to the gastrointestinal tract in critically ill patients stops the reflexogenic effect of the main focus on the gastrointestinal tract, eliminates or significantly reduces microcirculation disorders and tissue hypoxia.

Necessary to accept these expensive drugs like antacids gastroprotectives antagonists, H ₂ receptor inhibitors, proton pump was not. The method was tested on 12 patients with signs of burn shock aged 23 to 52 years with burns 11-111AB -! on the area from 35 to 60% of the body surface, received in the Nizhny Novgorod Republican Burn Center in the period from 2 to 70 hours after injury and in 2 patients with Lyell syndrome with a lesion area of 60 and 80% of the body surface. The treatment was carried out in the intensive care unit. The application of the method allows to prevent or stop a developing pathological process - stress ulcers of the stomach and duodenum. The risk of gastrointestinal bleeding is reduced, the likelihood of developing allergic reactions and side effects of drug therapy is reduced.

The proposed method is as follows.

In the early post-traumatic period, that is, from the first hours of a burn disease, the following complex treatment is carried out for 5-7 days. The patient in the morning on an empty stomach spend gastric lavage with the introduction through a nasogastric tube of 500 ml of ozonized physiological saline. The solution is obtained by bubbling with an oxygen-ozone gas mixture with an ozone concentration at the generator output of 3 mg / l with a gas flow rate of 1 l / min. Processing 1 liter of solution takes 20 minutes. To obtain ozone, an ozone generator AOT-M-01-Arz-01/1 (TU - 944-001-07513518-97) of the Medozons company is used. After the solution is introduced into the stomach, the probe is closed for 10 minutes, after which the liquid is removed from the stomach and the stomach is washed to clean water. Then a cleansing enema is performed. After an enema, through a double-lumen rectal catheter, flow insufflation with an ozone-oxygen mixture with an ozone concentration of 150-200 μg / l and a gas flow rate of 250 l / min is carried out for 12-15 minutes. Excess exhaust gas mixture is discharged into a container of water (water lock). During the day, an intravenous infusion of an ozonized physiological solution with an ozone concentration of 1 ml / L at the outlet of the apparatus of 200 ml daily is performed and then a subcutaneous injection of 100 ml of an ozone-oxygen mixture with an ozone concentration of 2500 μg / L is carried out in reflexogenic areas on the back in the region of Th ₈ -L _{2 of the} spine in the projection of the spinous processes and along the paravertebral line. Then Otri-ozonide ozonized oil is applied to this zone and vacuum massage is carried out for 5-7 minutes until persistent hyperemia of the skin appears. The condition of patients is monitored dynamically with fibrogastroscopy at 2, 5, 7 days after admission and monitoring the state of the antioxidant system (bio-chemiluminescence method) at 1, 3, 5, 7 days after the start of ozone therapy

This set of activities is carried out daily for 5-7 days.

An example of a specific performance is given in the form of an extract from the medical history.

Extract from the medical history No. 218339

Patient M., 27 years old, was admitted to the ROC on 06.22.05 (injury 22.06.05)

Dz: contact burn ShAB - IV Art. head, trunk, upper limbs on an area of 32% pov. body. Burn disease in the stage of septicotoxemia. Entered with residual effects of burn shock and signs of incipient delirium. Given the depth and area of thermal damage, the development of delirium, the risk of acute stress ulcer formation in the upper gastrointestinal tract is regarded as high.

In order to prevent the development of stress-related damage to the gastrointestinal tract, the patient was prescribed treatment - a course of ozone therapy for 5-7 days according to the proposed method: in the morning on an empty stomach, gastric lavage with the introduction of 500 ml of ozonized physiological solution through a nasogastric tube. The solution was obtained by bubbling an oxygen-ozone gas mixture with an ozone concentration at the generator output of 3 mg / l with a gas flow rate of 1 l / min. Processing 1 liter of the solution was carried out for 20 minutes. To obtain ozone, an ozone generator AOT-M-01-Arz-01/1 (TU - 944-001-07513518-97) of the Medozons company was used. After the solution was introduced into the stomach, the probe was closed for 10 minutes, after which the fluid was removed from the stomach and the stomach was washed to clean water. Then a cleansing enema was performed. After an enema, through a double-lumen rectal catheter, flow insufflation was carried out for 12-15 minutes with an ozone-oxygen mixture with an ozone concentration of 150-200 μg / l and a gas flow rate of 250 l / min. Excess exhaust gas mixture was discharged into a container of water (water lock). In the daytime, an intravenous infusion of ozonized physiological solution was carried out with an ozone concentration at the outlet of the apparatus of 1 mg / L, 200 ml each. Then, up to 100 ml of an ozone-oxygen mixture with an ozone concentration of 2500 μg / L on the back was injected subcutaneously in the region of the reflexogenic zone of Th ₈ -L ₂ spine in the projection of the spinous processes and along the paravertebral line. Then Otri-ozonide ozonized oil was applied to this zone and vacuum massage was performed for 5-7 minutes until persistent hyperemia of the skin appeared.

Such therapeutic tactics allowed to stop the developing pathological process (stress ulcers of the stomach and duodenum). As a result of the treatment, the picture of the gastrointestinal tract lesion was stopped, signs of gastric bleeding were not observed. When control FGDS ulcers were not found.

7 days after the start of therapy, the delirium was stopped, there are no clinical signs of stress lesions of the gastrointestinal tract, the patient was transferred from the intensive care unit to the general ward.

Dynamics of laboratory blood parameters: leukocytes 11.3 to 19.1, red blood cells 3.53 to 2.83, hematocrit 36.2 to 30.

Extract from the Case History No. 218000

Patient G., 43 years old, was admitted to the ROC on 05.31.05 (trauma on 05.28.05)

Dz: burn with flame SHAB - IV Art. head, torso, limbs in an area of 60% pov. body. Burn disease in the stage of septicotoxemia. After admission, signs of alcohol-intoxication delirium appeared, which also increases the risk of gastrointestinal stress damage. Given the depth and area of thermal damage, the risk of acute stress ulcer formation in the upper gastrointestinal tract is regarded as high.

A patient with the goal of preventing the development of stress lesions of the gastrointestinal tract was prescribed a course of ozone therapy according to the proposed method for 5-7 days.

When FGDS 01.06.05 (performed the next day after admission), a peptic ulcer of the esophagus, erosive gastritis, erosive duodenitis were found.

As a result of the treatment, the picture of the gastrointestinal tract lesion was stopped, signs of gastric bleeding were not observed. When control FGDS found ulceration scarring. Dynamics of laboratory blood parameters (May 31 - June 10, 2005): leukocytes 3.2 to 26.1 red blood cells 4.42 to 35.8 hemoglobin 151 to 122, hematocrit 42.8 to 34.0.

Claims (1)

A method for the prevention and / or treatment of stress injuries of the gastrointestinal tract in critical conditions, including drug therapy, characterized in that ozone therapy is used as drug therapy, for this, gastric lavage is performed on an empty stomach in the morning with the introduction of an ozonized physiological solution through a nasogastric tube followed by removing and conducting a cleansing enema, after which through a double-lumen rectal catheter, flow insufflation with an ozone-oxygen mixture is carried out, and in the daytime, intravenous infusion of an ozonized physiological solution with an ozone concentration of 1 ml / l at the outlet of the apparatus of 200 ml per day is carried out daily, followed by subcutaneous administration of an ozone-oxygen mixture with an ozone concentration of 2500 μg / l on reflexogenic zones in the projection of the spinous processes and along the paravertebral line in the region of Th ₈ -L ₂ , then ozonated oil is applied to these zones and their vacuum massage is carried out for 5-7 minutes.