RU2314100C1 - Method for correction of ischemic bowel damage at acute intestinal obstruction - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: method involves intravenous administration of 1% serotonin-adipinate solution diluted in 5-10 ml of physiological solution in the dose 0.1-0.2 mg/kg of body mass that is carried out immediately after elimination of acute intestinal obstruction. Then this solution is administrated into the damaged intestine mesentery. Method provides enhancing effectiveness of bowel ischemic damage correction based on elimination of smooth-muscle insufficiency of microcirculation channel of intestine. Invention can be used in surgery operation in case of acute intestinal obstruction accompanying with ischemic damage of bowel.

EFFECT: improved method of correction.

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Description

The method relates to medicine, namely to surgery, and can be used to correct ischemic lesions of the intestine after the elimination of acute intestinal obstruction.

Despite significant advances in surgery and intensive care, the results of treatment of acute intestinal obstruction (OKN) cannot be considered satisfactory. Among the frequent acute surgical diseases of the abdominal organs, intestinal obstruction is accompanied by a high mortality rate of up to 60% (Ermolov A.S. et al. // Congress of Surgeons of the Republics of Central Asia and Kazakhstan, 5th: Abstracts of the report Tashkent in 1991; 1: 160; Kalish Yu.I. et al. // Surgery 1996; 6: 103-108).

It is known that OKN is accompanied by ischemia, hypoxia and intestinal paresis. At the same time, necrobiotic changes in the intestinal wall develop first, and then total necrosis of the area involved in the pathological process, followed by its perforation and the development of peritonitis.

There are various ways of correcting hemodynamic and microcirculatory disorders in case of OKN (V.T. Zaitsev et al. // Clinical Surgery 1990; 1: 23-25; S.A. Ataev et al. // Vesti. Surgery 1993. ; 3-4: 31-34, etc.).

As a prototype of the proposed method for the correction of ischemic bowel lesions in case of OKN, a method was used that improves microcirculatory and bioenergetic processes in the intestinal wall by intraoperatively introducing a microirrigator into the mesentery of the intestine through which a drug mixture consisting of ATP solution, cocarboxylase was injected, twice a day, heparin, hydrocortisone, ampicillin, novocaine (S.A. Ataev et al. // News, Surgery 1993; 3-4: 31-34). The disadvantage of the proposed method is that the authors focus on the violation of the bioenergetic processes of the intestinal wall in case of OKN, from which there is an incomplete adequacy of corrective measures.

From our point of view, the mechanisms for the development of pathological changes in the intestinal wall with OKN are more complex and are associated not only with the violation of bioenergy processes, but also with the development of smooth muscle insufficiency of the microvasculature of the intestine.

The purpose of the invention is to provide the greatest efficiency in the correction of ischemic intestinal lesions in case of OKN by combining intravenous and intramuscular administration of serotonin-adipinate to reduce pathological changes in the intestine, improve its microcirculation and normalize the tone of blood vessels of the microvasculature.

The purpose of the invention is achieved by the fact that after eliminating OKN, 0.1-0.2 mg / kg of body weight of a 1% solution of serotonin-adipate is intravenously administered to the experimental animal (cat), and then the drug is injected into the mesentery of the affected intestine at the same dose. Moreover, in all experimental animals, a morphological examination of the intestine indicates the absence of visible violations of the structure of the intestinal wall or its insignificant changes.

The method is as follows.

An experimental animal (cat) under chloral anesthesia (0.08 g / kg) performs laparotomy. Simulate acute intestinal obstruction by ligation of the small intestine with cloth strips in two places at a distance of 3-4 cm between them (S.A.Shalimov et al. // Guide to Experimental Surgery. - M .: Medicine, 1989. - P.206 ) After 2 hours, the tissue bands squeezing the intestinal area are cut, and 0.1-0.2 mg / kg of body weight (1% solution) of serotonin-adipate dissolved in 5.0 ml of physiological saline and then in the same the dose of the drug is injected into the mesentery of the affected intestine. The abdominal cavity is sutured tightly.

It is known that in the microvasculature there are rhythmic fluctuations of blood vessels, called endogenous vasomotor (EV), vasomotion, myogenic regulation of microvessels, etc. Endogenous vasomotor motility is due to the automatism of smooth muscles (GM). Thanks to EV, the body maintains a normal metabolism between blood and tissues. Violations of EV causes tissue hypoxia, as a result of which mono- and multiple organ failure develops, often leading to death. To denote violations of automatism and contractility of the GM organism, we previously proposed the term smooth muscle failure (GMN) by analogy with the term “insufficiency of the contractile function of the myocardium” (A.P. Simonenkov, V.D. Fedorov, A.V. Fedorov, etc. / / News. RAMS. - 1994. - No. 6. - S.11-15). The mechanism of endogenous vasomotorism is due to the fact that serotonin, released in a particular micro vessel from platelets, interacts with the serotonin receptors of GM fibers isolated from each other and causes a reduction in the GM micro vessel. Normally, platelets constantly (continuously) adsorb serotonin from enterochromaffin cells of the gastrointestinal tract and are constantly excreted in the microvasculature, thereby ensuring the continuity of the stimulus necessary for the reduction of GM microvessels, and the summation of these contractions is recorded as endogenous vasomotor.

Thus, we have every reason to believe that intestinal ischemia that occurs with OKN leads to a complete cessation of platelet entry into the microvasculature of the intestinal wall and disrupts the normal process of constant release of serotonin from platelets. Therefore, the continuity of the stimulus necessary for the reduction of GM microvessels is not ensured. Developing GMN is the main pathogenetic link in vascular insufficiency, contributing to tissue hypoxia and ischemic damage to the intestine. Therefore, for the correction of ischemic bowel damage in case of OKN and based on the ability of serotonin to increase blood flow rate, oxygen saturation of tissues, correct impaired GM function and tissue hypoxia (A.P. Simonenkov, V.D. Fedorov // Bull. Expert biol. Medicine. - 1997. - T.123. - No. 1. - P.103-110; A.B. Gorpinich et al. // Method for the correction of ischemic lesion of the liver under conditions of its bleeding. Patent for the invention No. 2134576; A.P. Simonenkov, V.D. Fedorov, M.V. Klyuzhev and others // News. RAMS. - 2004. - No. 1. - P.46-48), intravenous administration with erotonin-adipate after the elimination of OKN, which will contribute to the elimination of GMN of the microvasculature and the restoration of normal metabolism between blood and tissues. Additional (local) administration of serotonin adipate directly into the mesentery of the affected intestine will increase the concentration of serotonin in pathologically altered tissues and enhance the effect of intravenous (systemic) administration of this drug.

Based on the data previously obtained by us (A.P. Simonenkov, V.D. Fedorov, A.V. Fedorov, etc. // Abstracts of the V All-Russian Congress of Resuscitation Anesthesiologists. - Moscow. 1996. - T. 2. - P.97; A.P. Simonenkov, V.D. Fedorov, V.M. Klyuzhev, V.N. Ardashev and others // News. RAMS. - 2004. - No. 1. - P.46-48 ; A.P. Simonenkov, N.A. Kortun, O.Yu. Vrublevsky // Vesti, intensive care. - 2005. - No. 2. - P.64-66) when using serotonin-adipinate to eliminate GMN in patients, operated on abdominal organs and having functional intestinal obstruction and / or vascular insufficiency, patients with local (different types of vagotomy) and regional denervation (traumatic spinal cord rupture), and in patients with coronary heart disease (CHD) to improve microcirculation and reduce hypoxia was chosen dose of the drug of 10 mg.

The study was performed on 14 adult cats. In 8 animals, the elimination of OKN was combined with the administration of serotonin-adipinate according to our methodology. 6 animals (control group) elimination of OKN was not supplemented by the introduction of the drug. Animals were withdrawn from the experiment after 1 hour. The material for the morphological study was a section of the ischemic intestine, which was processed according to the method: hematoxylin and eosin.

Our data indicate that in the control group of animals (without administration of serotonin) during a morphological study of the intestinal wall it was determined: paretic expansion of the capillaries of the mucosa, submucous and muscle membranes with perifocal massive and focal hemorrhages, with diapedetic impregnation with red blood cells, in the vessels there is a pronounced marginal standing neutrophilic white blood cells with their exit beyond the vascular wall, mainly in the muscle and mucous membranes, pronounced granular dystrophy Oia smooth myocytes. We can assume that the above changes are irreversible.

In the group of animals, where the elimination of OKN was combined with the introduction of serotonin-adipinate according to the method we proposed, no morphological examination of the visible intestinal wall structure was observed, or were present in a small amount.

Examples of specific performance.

Example 1. Cat No. 2. Operation July 14, 2006

Under chloral anesthesia (0.08 g / kg), a laparotomy was performed. On a section of the intestine with a length of 6 cm, located 40-50 cm from the pyloric part of the stomach, cloth bands are laid in two places at a distance of 3-4 cm between them. A loop of the intestine is immersed in the abdominal cavity, the wound is covered with napkins moistened with saline. After 2 hours, the tissue bands compressing the loop of the small intestine were removed. The abdominal cavity is sutured in layers tightly. The animal was withdrawn from the experiment after 1 hour.

This example illustrates figure 1, which shows the histostructure of the wall of the small intestine of cat No. 2 2 hours after the application of tissue bands on the intestinal tract. Hematoxylin and eosin stain. X10 lens. In the mucous membrane, a pronounced paretic expansion of the capillaries is determined, with erythrocytes surrounding the blood vessels in the tissue, and a large number of neutrophilic leukocytes in the villi. In the submucous and smooth muscle membranes focal and diffuse diapedetic hemorrhages are detected, in the dilated vessels, the marginal standing of neutrophilic leukocytes with their exit beyond the vascular wall, the formation of focal leukocyte inflammatory infiltrates. The expressed granular dystrophy of smooth myocytes is determined.

Example 2. Cat number 3. The mass of the animal is 4 kg. Operation 08/14/06. Under chloral anesthesia (0.08 g / kg), a laparotomy was performed. On a section of the intestine 6 cm long, located 40-50 cm from the pyloric part of the stomach, cloth bands are laid in two places at a distance of 3-4 cm between them. A loop of the intestine is immersed in the abdominal cavity, the wound is covered with napkins moistened with saline. After 2 hours, the tissue bands compressing the loop of the small intestine were removed. 4 mg (1% -0.5 ml of solution) of serotonin-adipate diluted in 5.0 ml of physiological saline are slowly introduced into the isolated femoral vein, and then, at the same dose, the drug is introduced into the mesentery of the affected intestine. The abdominal cavity is sutured in layers tightly. The animal was withdrawn from the experiment after 1 hour.

This example illustrates figure 2, which shows the histostructure of the wall of the small intestine of cat No. 3 2 hours after the application of tissue bands to the intestinal tract, in combination with the introduction of serotonin-adipinate. Hematoxylin and eosin stain. X10 lens. Mild edema of the mucous membrane is determined, in the crypt region there are full-blooded capillaries without hemorrhage into the surrounding vessels of the tissue, and a moderate amount of neutrophilic leukocytes in the form of marginal standing in the muscular membrane in the vascular lumen, without leaving them outside the vascular wall. No destructive changes found.

Example 3. Cat No. 4. The mass of the animal is 3 kg. Operation 08/28/06

Under chloral anesthesia (0.08 g / kg), a laparotomy was performed. On a section of the intestine with a length of 6 cm, located 40-50 cm from the pyloric part of the stomach, cloth bands are laid in two places at a distance of 3-4 cm between them. A loop of the intestine is immersed in the abdominal cavity, the wound is covered with napkins moistened with saline. After 2 hours, the tissue bands compressing the loop of the small intestine were removed. 6 mg of mass (0.6 ml of a 1% solution) of serotonin-adipate diluted in 5.0 ml of physiological solution was slowly injected into the isolated femoral vein, and then, at the same dose, the drug was introduced into the mesentery of the affected intestine. The abdominal cavity is sutured in layers tightly. The animal was withdrawn from the experiment after 1 hour.

This example illustrates figure 3, which shows the histostructure of the wall of the small intestine of cat No. 4 2 hours after ligature is applied to the intestinal tract in combination with the administration of serotonin-adipinate. Hematoxylin and eosin stain. X10 lens. Mild edema of the mucous and submucous membranes is determined, in the crypt region there are full-blooded capillaries without hemorrhages in the surrounding tissue vessels, in the muscle membrane between the circular and longitudinal layers there are single full-blooded vessels with the edge standing of neutrophilic leukocytes without leaving them outside the vascular wall. No destructive changes found.

Thus, our proposed method for correcting ischemic bowel damage in acute intestinal obstruction allows us to provide the most effective correction for ischemic bowel damage in case of OKN by combining intravenous and mesenteric administration of serotonin-adipinate to reduce pathological changes in the intestine, improve its microcirculation and normalize the tone of blood vessels in the microvasculature. The method can be used in clinical conditions in patients with acute intestinal obstruction.

Claims (1)

A method for the correction of ischemic bowel damage in acute intestinal obstruction (OKN), which includes administering a drug for surgical removal of OKN, characterized in that a 1% solution of serotonin-adipinate is used as a drug, which is administered intravenously immediately after eliminating OKN in a dose 0.1-0.2 mg / kg body weight, and then in the same dose into the mesentery of the affected intestine, and the administration of serotonin-adipinate is carried out in 5-10 ml of physiological saline.

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