RU2303470C2 - Medical rehabilitation method for treating burned patients having acute inhalation injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying treatment in Zakharyin-Gedda skin region corresponding to trachea, bronchi and lungs. Bipolar asymmetric electric pulses having positive part amplitude of 25 V and negative part amplitude belonging to the range of 0-185 V and pulse frequency of 7-12 Hz. Exposure time is equal to 1.4-1.6 min per each Zakharyin-Gedda skin region within a treatment session.

EFFECT: enhanced effectiveness of treatment.

Description

The invention relates to medicine, namely to methods for treating burned with acute inhalation injury, using a physiotherapeutic effect on the patient's body.

Known drug methods for treating people burned with acute inhalation injury, based on the ingestion of drugs (see, for example, RF patent No. 2188633, IPC A61K 1/00, 2002). Medication methods, as a rule, have side effects and do not always provide the necessary therapeutic effect.

The closest in essence to the proposed one is a method of rehabilitation treatment of burned with acute inhalation injury, including physiotherapeutic effect (massage) on areas of the skin of the burned (see article S. Smirnov and others. Inhalation injury. Medical newspaper, 2004, No. 51 of 07.07 .2004). The disadvantages of this method include significant periods of treatment, due to the insufficiently effective effect on the affected organs.

The present invention is aimed at solving the problem of reducing the duration of treatment by effectively influencing the electroneurostimulating impulses through the Zakharyin-Geda reflexogenic zones on the condition of internal organs affected by an inhalation injury.

This problem is solved by the fact that in the method of rehabilitation treatment of burned with acute inhalation injury, including a physiotherapeutic effect on areas of the skin of the burned, with a physiotherapeutic effect, they act on the skin zones of Zakharyin-Ged, corresponding to the trachea, bronchi, lungs, bipolar asymmetric electrical impulses with the amplitude of the positive part of 25 V and the amplitude of the negative part in the range from 0 to 185 V at a pulse frequency of 7-12 Hz, and the time Via a session for each zone of the skin Zakharyin-Ged corresponding to the trachea, bronchi, lungs is 1.4-1.6 minutes, and daily spend one session.

The choice of the Zakharyin-Ged zones corresponding to the trachea, bronchi, and lungs as the area of exposure to percutaneous electroneurostimulation is due to the fact that when these zones are exposed, the maximum positive therapeutic effect takes place in relation to the affected internal organs, which, in acute inhalation injury, are the trachea, bronchi , lungs, and therefore the greatest reduction in treatment time.

As our clinical studies based on the treatment of 35 patients with acute inhalation injury showed, it is the impact on these areas with bipolar asymmetric electric pulses with an amplitude of the positive part of 25 V and an amplitude of the negative part in the range from 0 to 185 V at a pulse frequency of 7-12 Hz that provides the maximum reduction of treatment time. With other parameters of electric impulses, the positive therapeutic effect was less. The exposure time in the session for each zone of 1.4-1.6 minutes is also optimal for the maximum reduction of treatment time, since with a lower exposure the therapeutic effect was insignificant, and with a larger exposure there was only a useless and uncomfortable effect on the patient’s skin without positive therapeutic effect. Conducting one session every day is due to the fact that it is physically difficult for patients to tolerate a greater number of sessions, which, moreover, does not provide as a result of reducing treatment time.

The proposed method of rehabilitation treatment of burned with acute inhalation injury is as follows.

Percutaneous electroneurostimulation was performed using the apparatus CHENS-2M, which acts with a bipolar asymmetric electric pulse. The exposure was carried out by the skin zones of Zakharyin-Ged, corresponding to the trachea, bronchi, lungs, bipolar asymmetric electric pulses with an amplitude of the positive part of 25 V and an amplitude of the negative part in the range from 0 to 185 V at a pulse frequency of 7-12 Hz, the current consumption of the device 4.5 mA, and the exposure time in the session for each area of the skin of Zakharyin-Ged, corresponding to the trachea, bronchi, lungs, is 1.4-1.6 minutes. The total total exposure time did not exceed 5 minutes. The course of treatment did not exceed 10 sessions. Sessions were held daily.

The method of exposure is labile: light “ironing” stroking, massaging the movements with a multi-electrode head by the method of contact scanning in the above Zakharyin-Ged zones.

We observed 35 patients who, from the first day of admission to the hospital, in addition to drug treatment, underwent percutaneous electroneurostimulation of Zakharyin-Ged zones (trachea-bronchi-lungs). All patients had either an isolated acute inhalation injury (IT) or acute inhalation injury, which was combined with damage to the skin in the amount of up to 10%. The etiological factor for the occurrence of a burn is flame, inhalation of smoke, combustion products. Acute IT was classified according to clinical, fibrobronchoscopic and radiological studies as IT of I degree of severity, I-II degree of severity, II degree of severity.

The monitoring was carried out according to clinical indicators - respiratory rate, depth of respiratory excursions, breathing tests of Stange and Genche were measured, and systolic and diastolic blood pressure were also monitored.

Spirograms were recorded on a Metatest-1 apparatus. Vital lung capacity (VC), maximum lung ventilation (MVL), minute respiratory volume (MOD), and forced lung capacity (FVC) were calculated from the spirogram. Each patient was calculated the maximum values of the obtained data in percent.

Before treatment, all patients had a rapid pulse, superficial frequent breathing. A decrease in VC to 1.2 ± 0.2 L was detected with an increase in the minute volume of respiration to 7.28 ± 0.15 L / min. A decrease in MVL to 3.5 ± 0.3 l / min was found without a significant change in FVC.

A positive therapeutic effect was obtained:

- there was a decrease in pain, which led to more free breathing after the first procedure. Obviously, electroneurostimulation of the Zakharyin-Ged zones provides sufficient reflex anesthesia with a subsequent decrease in bronchospasm;

- decreased respiratory rate with increasing depth of the respiratory excursions of the chest;

- at initially lower blood pressure, there was an increase in both systolic and diastolic pressure by 5 ± 5 mm RT. Art., with initially elevated blood pressure, systolic pressure decreased by 10 ± 5 mm RT. Art., while diastolic pressure at 5 + -5 mm RT. Art. The normal baseline blood pressure values for each patient remained unchanged;

- according to spirographic data, after a course of electrical stimulation, VC increased by 2.52% with a decrease in MOD by 1.2%, the MVL increased by 0.58% with stabilization of the forced vital capacity of the lungs. This confirmed the effectiveness of the ongoing rehabilitation treatment. The improvement of external respiration occurs due to a decrease in the number of respiratory cycles per minute and an increase in tidal volume, which leads to a decrease in the minute volume of respiration and an increase in the maximum ventilation of the lungs, a more stable forced vital capacity of the lungs.

Examples:

1. Arefiev A.R., 45 years old. Diagnosis: burn with a flame of I-II-IIIA degree with a defeat of 6% of the skin surface of the body (PT) - face, hands, forearms. IT II degree of severity. Before treatment: pulse rate - 24 in 1 minute, blood pressure - 100 to 60 mm Hg Hallmark test - 15 seconds, Genche test - 10 seconds. ZHEL - 1.2 liters per minute, MOD - 6.1 liters per minute, MVL - 2.2 liters per minute. After treatment: respiratory rate - 18 in 1 minute, blood pressure - 120 to 70 mm Hg. The Stange test is 30 seconds, the Genche test is 20 seconds. VC increased by 2.7%, MOD decreased by 1.9%, MVL increased by 1.9%.

2. Antonov V.M., 47 years old. Diagnosis: burn with a flame of I-II-IIIA severity (hands, face, ears). IT I-II severity. Before treatment: respiratory rate - 22 per minute, blood pressure -140 per 90 mm Hg The Stange test - 18 seconds, the Genche test - 15 seconds. JELL - 1.5 liters per minute, MOD - 5.2 liters per minute, MVL 3 liters per minute. After treatment: respiratory rate - 17 per minute, blood pressure - 120 by 75 mmHg, Stange test - 28 seconds, Genche test - 24 seconds. JELL - an increase of 3.4%, MOD decreased by 2.5%, MVL increased by 2.3%.

3. Vysotsky F., 44 years old. Diagnosis: burn of the respiratory tract. Before treatment: respiratory rate - 25 per minute, blood pressure - 150 to 90 mm Hg, Stange test - 19 seconds. Genche test - 15 seconds. ZHEL - 1.8 liters per minute, MOD - 7 liters per minute, MVL - 2.5 liters per minute. After treatment - reducing the respiratory rate to normal - 16 per minute, blood pressure-130 to 75 mm Hg Hallmark test - 29 seconds, Genche test - 22 seconds. VC increased by 3.4%, MOD decreased by 4%, MVL increased by 5%.

The proposed method for the rehabilitation treatment of burned with acute inhalation injury reduces the treatment time by effective exposure to electroneurostimulating impulses through the Zakharyin-Geda reflexogenic zones on the condition of internal organs affected by an inhalation injury.

Claims (1)

A method of reconstructive treatment of burns with acute inhalation injury, including exposure to areas of the skin, characterized in that as areas of the skin use Zakharyin-Geda zones corresponding to the trachea, bronchi, lungs, and are exposed to bipolar asymmetric electric pulses, the amplitude of the positive part is 25 V and the amplitude of the negative part from 0 to 185 V at a pulse frequency of 7-12 Hz, and the exposure time in the session for each zone is 1.4-1.6 minutes, one sea is carried out daily Su.