RU2296515C1 - Method for preventing suppuration of femoral stump in patients with gangrene-complicated ischemic foot form - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with preventing purulent-septic complications in early post-surgical period at surgical treatment of gangrene-complicated ischemic foot form. During 3-5 d before operation and during 7-8 d after it one should introduce perorally ADP-37 preparations for patients at the dosage of 6 capsules daily followed by intramuscular injection of mexidol immediately after operation at the dosage of 2.1 mg/kg body weight, and during the next 3 d - at the same dosage every 12 h. Surgical wound should be treated with a gel that contains 2%-mexidol followed by affecting the wound with impulse magnetic field at 0.5-1.0 Tl intensity.

EFFECT: the innovation enables to prevent the development of purulent complications, stimulate reparative process, reconstruct the structure and the functioning of microcirculatory system in limb's soft tissues.

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Description

The invention relates to medicine, in particular to surgery, and can be used for the prevention of purulent-septic complications in the early postoperative period in the surgical treatment of various diseases.

The urgency of the problem of the prevention of wound infection in general surgery and gynecology is explained by the significant spread of purulent-inflammatory diseases, a decrease in immunological reactivity and an increase in allergization of the population, a change in the species composition of the microbial flora, and an increase in the resistance of microorganism strains to a wide range of antibiotics and antiseptics.

Prevention of purulent-septic complications in patients with a diabetic foot complicated by gangrene after amputation of an extremity when wound healing is impaired (suppuration of a wound, necrosis of skin flaps forming a stump reaches 62.7% is especially relevant).

There is a method for the prevention of purulent-septic complications in the postoperative period in patients with type II diabetes mellitus with antioxidants and intravenous laser blood irradiation (E. V. Lebedko. "Antioxidants and energy of quantum generators in the complex treatment of purulent-necrotic lesions in patients with diabetes mellitus." Abstract of dissertation for the degree of academician of medical sciences, Moscow, 2000).

However, the known method does not allow to exclude the use of antibiotics, which leads to the manifestation of the known negative consequences of antibiotic therapy. In addition, with such prophylaxis, the number of purulent complications continues to remain high (V.T. Mironov. “Comprehensive treatment of patients with ischemic form of the diabetic foot complicated by necrosis.” Abstract of dissertation for the degree of Candidate of Medical Sciences, Moscow, 2005 )

The reasons for the high predisposition of patients with type II diabetes mellitus to the development of purulent-necrotic complications are a violation of all types of metabolism, a slowdown in regeneration processes, impaired blood microcirculation, the development of immunological disorders and a change in blood counts (blood coagulation time, prothrombin index, fibrinolytic activity, etc. .). Antibacterial therapy has no effect on these processes.

Known closest to the claimed method of treatment and prevention of purulent-inflammatory diseases in the postoperative period, including the introduction of a patient mexidol intravenously at a dose of 100 mg 30 minutes before surgery and within 3 days after surgery intramuscularly in the same dose every 12 hours (Pat. RF No. 2191014, IPC A 61 K 31/4412, publ. 2002).

The disadvantage of this treatment method is that Mexidol does not affect the activity of cellular antioxidant enzymes and the correction of local antioxidant tissue homeostasis.

The invention solves the problem of increasing the effectiveness of suppuration of suppuration of the femoral stump in patients with an ischemic form of the foot complicated by gangrene.

The problem is solved due to the fact that the method of prevention consists in the fact that for 3-5 days before surgery and for 7-8 days after surgery, the patient is orally administered the drug ADP-37 at a dose of 6 capsules per day, then Mexidol is administered intramuscularly first, immediately after surgery, at a dose of 2.1 mg / kg body weight and in the next 3 days, at the same dose every 12 hours, and the surgical wound is treated with a gel containing 2% mexidol, followed by exposure to the wound with a pulsed magnetic field with an intensity of 0 , 5-1.0 T.

ADF-37 is a biologically active food supplement, including spirulina containing selenium, copper and zinc, obtained by special cultivation, bioflavonoid complexes from natural raw materials, concentrated dry extracts of ginseng, echinacea, green tea, vitamins B, C, E , beta-carotene, manufacturer "Veta-Grand", Russia. Registration No. 77.99.20.919B.0003 10.10.03. Available in capsules 504.6 mg.

The technical result of the proposed method of prevention is to increase the effectiveness of prophylactic procedures - the method allows to minimize complications - suppuration of the thigh stump in patients with an ischemic form of the foot complicated by gangrene, during treatment by the claimed method is practically not observed. In addition, the technical result of the claimed method also includes expanding the range of products for the prevention of postoperative complications in diabetic patients with ischemic foot shape.

The method is as follows.

After establishing a clinical diagnosis and setting the date of surgery for 3-5 days before surgery and 7-8 days after surgery, ADF-37 is orally administered to patients at a dose of 6 capsules per day, mexidol is administered intramuscularly immediately after surgery at a dose of 2.1 mg / kg body weight and in the next 3 days - in the same dose every 12 hours, and the surgical wound is treated with a gel containing 2% mexidol, followed by exposure to the wound by a pulsed magnetic field with an intensity of 0.5-1.0 T.

Clinical trials of the proposed method were carried out as follows: 103 patients were divided into two groups - the main and control. The main group included patients, the treatment of which was carried out by the proposed method, - 50 people. The control group consisted of 53 people who, for prophylactic purposes, were injected intravenously with 100 mg of Mexidol 30 minutes before the operation, followed by the administration of Mexidol intramuscularly in the same dose every 12 hours for 3 days.

The research results showed that in the main group, wound healing by primary intention was 100%, i.e. in all patients, in the control group, primary intention healing was 30%, i.e. 16 patients out of 53.

The average duration of postoperative hospital stay in the main group of patients was 13.9 ± 2.3 days, and in the control group - 23.5 ± 2.9 days.

Thus, the use of the drug ADP-37 and Mexidol in postoperative treatment by the proposed method prevents the development of purulent complications, stimulates the reparative process, helps to restore the structure and functioning of the microcirculatory system of soft tissues.

The invention is illustrated by examples.

Example 1

Patient A., 63 years old, was admitted to the hospital with a diagnosis of type II diabetes mellitus, ischemic form of the right foot, complicated by gangrene.

For 3 days, the patient took the drug ADP-37 at a dose of 6 capsules per day, after which the amputation of the right thigh was performed at the level of the middle third.

Immediately after surgery, the patient was intramuscularly administered Mexidol at a dose of 2.1 mg / kg body weight and in the next 3 days - in the same dose every 12 hours. At the same time, within 7 days after the operation, the patient took the drug ADP-37 at a dose of 6 capsules per day.

The surgical wound is treated with a gel containing 2% Mexidol, followed by exposure to the wound with a pulsed magnetic field at a dose of 1.0 T.

A temperature reaction in the postoperative period was not observed.

Sutures were removed on the 10th day, wound healing by primary intention.

Example 2

Patient K., 67 years old, was admitted to the hospital with a diagnosis of ischemic form of the diabetic foot complicated by gangrene.

For 5 days, the patient took the drug ADP-37 at a dose of 6 capsules per day, after which the amputation of the right lower limb was performed at the level of the middle third of the thigh.

Immediately after surgery, the patient was intramuscularly administered Mexidol at a dose of 2.1 mg / kg body weight and in the next 3 days - in the same dose every 12 hours. At the same time, for 8 days after the operation, the patient took the drug ADP-37 at a dose of 6 capsules per day.

The surgical wound was treated with a gel containing 2% mexidol, followed by exposure to the wound with a pulsed magnetic field at a dose of 0.5 T.

A temperature reaction in the postoperative period was not observed.

Sutures were removed on the 10th day, wound healing by primary intention.

Claims (1)

A method for the prevention of suppuration of the femoral stump in patients with an ischemic form of the foot complicated by gangrene in the postoperative period, which consists of administering ADP-37 in a dose for 3-5 days before surgery and for 7-8 days after surgery. 6 capsules per day, mexidol is administered intramuscularly first immediately after surgery at a dose of 2.1 mg / kg body weight and in the next 3 days - at the same dose every 12 hours, and the surgical wound is treated with a gel containing 2% mexidol, followed by exposure to the wound pulsed magnetic Ol 'with intensity 0.5-1.0 Tesla.