RU2320335C1 - Method for prophylaxis of arising complication in post-operation treatment of patients - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: invention relates to a method for prophylaxis of arising complications in period of post-operation treatment of patients. Method involves carrying out cannulation of umbilical vein in patients. During post-operation period intraportal infusions of ozonized sodium chloride physiological solution is carried out in the dose 200 ml, 2 times per 24 h. The ozone concentration in solution is 3-5 mg/l at the rate of administration 10 ml/min. Immediately before infusion 10 ml of 0.25% novocain solution is administrated by intraportal route. Method provides rapid administration of ozonized solution into the portal system and without development of pain syndrome and adverse responses of body as dyspeptic disorders.

EFFECT: improved method of prophylaxis.

2 ex

Description

The invention relates to medicine, mainly to surgery, and can be used to prevent complications in the postoperative period.

As you know, the occurrence of complications in the postoperative period is not uncommon. Their frequency reaches 6-27.5% or more (O. B. Milonov et al. Postoperative complications and dangers in abdominal surgery. - M: Medicine. - 1990. - P.5). Surgery, anesthesia and the postoperative state of the body significantly exacerbate the existing shifts of homeostasis caused by the disease. Prevention of complications against this background is the main objective of postoperative treatment. For this, in the early postoperative period, patients are given varying degrees of intensive care. Its specific content is determined by the type and severity of the disease, the features and scope of the surgical intervention, the presence of concomitant diseases and their severity, the age of the patients, as well as the capabilities of the medical institution. However, the main thing in the prevention of postoperative complications is the restoration of blood oxygen transport and microcirculation, replenishment of the circulating blood volume, maintenance of vital organs (lungs, heart, kidneys, liver, intestines) and immunoprotection, ensuring adequate metabolism, reducing endogenous intoxication, creating conditions for healing of the surgical wound (A. L. Kostyuchenko et al. Intensive care of postoperative complications. - St. Petersburg: SpecLit. - 2000. - P.7-21).

In this regard, ozone therapy has a particular breadth of effects on the human body, i.e. use for the treatment of triatomic oxygen, called ozone. Ozone therapy has an antihypoxic effect, maintains a high blood flow velocity in the microvasculature, enhances the adaptive reactions of the respiratory and cardiovascular systems, activates metabolic processes, regulates the state of lipid peroxidation and antioxidant system, provides immunomodulatory as well as analgesic, anti-inflammatory, bactericidal, antiviral and action (I.A. Rudko, E.P. Romanova. Pathogenetic aspects of ozone therapy. - M. - 2005. - P.16-24; O.V. Maslennikov, K.N. .Kontorshchikova. Guide to ozone therapy. - Nizhny Novgorod: Vector TiS. - 2005. - P.18-33). This served as the basis for the use of ozone therapy for the treatment of patients in the postoperative period.

The use of oxygen to prevent complications in the postoperative period has long been known in the medical literature. In particular, its use inside is described in the form of oxygen cocktails or by introducing in the form of a gas of 2000-3000 cm through a tube into the stomach. Such oxygen therapy is started in the preoperative period and continued after surgery (TP Makarenko et al. Management of the postoperative period in patients with a general surgical profile. - M: Medicine. - 1976. - P.50-51). In the presence of organ hypoxia after operations, extracorporeal membrane blood oxygenation or oxygenobarotherapy is also used (O.B. Milonov et al. Postoperative complications and dangers in abdominal surgery. - M: Medicine, - 1990. - P.339; A.L. Kostyuchenko and et al. Intensive care of postoperative complications. - SPb: SpecLit. - 2000. - P.442). A common drawback of such methods for preventing postoperative complications is the use of diatomic oxygen, which is chemically and biologically less active than atomic oxygen released during the decomposition of triatomic oxygen of ozone.

An analysis of the medical literature shows that the use of ozone after surgery is possible in different ways. It is known to use ozonized physiological solution of sodium chloride or discillary water for drinking or to administer these solutions through a probe into the stomach and large intestine, as well as for intravenous infusion (I.E. Idov. Aspects of the use of ozone in medicine. - Anestesiol. Resuscitation. - 1997. - No. 1. - S.90-94). So, after operations for cholelithiasis, 400 ml of ozonized physiological saline solution is injected into the peripheral vein (G.A. Bartseva et al. Effect of ozone therapy on hemostasis in patients after surgery for cholelithiasis. - Clin. Lab. Diagnosis. - 2001. - No. 11. - S.14-15.). Also, intravenous administration of an ozonized sodium chloride solution with an ozone content of 1-2 μg / ml is used for postoperative rehabilitation of patients operated on for oncological diseases (I. A. Rudko, E. P. Romanova. Pathogenetic aspects of ozone therapy: a Training manual. - M . - 2005. - P.26).

The patent literature also describes these methods of ozone therapy. So, the published “Method of decontamination of the gastrointestinal tract using ozone in patients with pancreatic necrosis” (RF patent No. 2194513, IPC A61K 33/00, publ. Bull. 35, 2002), which is carried out by introducing through a nasointestinal probe into a thin the intestine of an ozonized sodium chloride solution in a volume of 200 ml with an ozone concentration of 4-7 mg / l for 7 days of the postoperative period. In addition, from the first day after the operation, an ozonized mixture with an ozone concentration of 30 mg / L of 300 ml volume is intrarectally administered, maintaining the exposure for 15 minutes. The course of treatment uses 7 intrarectal injections with an interval of 3-4 days. This method provides for the impact on the microflora of both the small and large intestines in order to prevent complications from the gastrointestinal tract.

Also known is the "Method of adaptation of the human body in pathological processes accompanied by metabolic disorders" (RF patent No. 2132192, IPC АКК 33/00, publ. Bull. No. 18, 1999), which involves a single intravenous administration of ozonized sodium chloride solution 200-400 ml with an ozone concentration of 2-6 mg / l, and then, depending on metabolic parameters or in the presence of bacterial infections, the need for repeated infusions of this solution is determined. Also described is a "Method for the prevention of the development in the early postoperative period of acute gastroduodenal ulcers in patients with colorectal cancer" (RF patent No. 2274455, IPC АКК 33/00, publ. Bull. No. 11, 2000), which provides for intravenous administration of ozonized physiological saline solution salt before surgery in the amount of 3 infusions, one daily. A common disadvantage of introducing an ozonized solution of sodium chloride into peripheral veins is a decrease in the concentration of ozone in the patient’s blood due to dilution in the bloodstream. As a result, not so much ozone is delivered to vital organs. The elimination of this drawback is possible by regional perfusion of individual organs of patients. So, for the purpose of regional ozone therapy of the liver, for the prevention of complications from this organ in the postoperative period, intraportal infusions of ozonized physiological saline solution in a volume of 400 ml with an ozone concentration of 4-7 mg / l are used. Depending on the peculiarities of the postoperative period and laboratory parameters of the patient’s homeostasis, 7-10 such infusions are prescribed (M.I. Gulman, Yu.S. Vinnik, S.V. Miller et al. Correction of homeostasis in acute pancreatitis by ozone therapy. - Krasnoyarsk. - 2003. - S.65-66). There are also reports of lower concentrations of ozone (1.0-1.5 mg / l) in the intra-physiological physiological saline solution administered in order to improve the antitoxic function of the liver and prevent the development of such postoperative complications as liver failure (O.V. Maslennikov, KN Kontorschikova, Guide to Ozone Therapy. - Nizhny Novgorod: Vector TiS. - 2005. - P.142). The disadvantage of this method of postoperative prevention of complications is the significant duration of intraportal infusion, since the rapid administration of portal vein solutions is impossible. As a result, the ozonized sodium chloride solution loses a large amount of ozone, which reduces the therapeutic effect.

The prototype of the claimed invention is "Treatment of endotoxemia in patients with destructive pancreatitis" (RF patent No. 2199326, IPC A61K 33/00, publ. Bull. No. 6, 2003). This method involves intraportal administration of an ozonized solution of physiological saline solution from the first day after surgery in an amount of 400 ml per 1 procedure with an ozone concentration of 4-5 mg / L. The course of treatment consists of 7-10 procedures performed one at a time daily. The disadvantage of this method is the low efficiency of such treatment, since in order to obtain the proper result from intravenous administration of an ozonated solution, a high rate of its introduction into the body is necessary, since ozone quickly decomposes. Scientific studies have shown that at room temperature 5 minutes after saturation with ozone of physiological saline solution, ozone concentration decreases by 17.0%, after 10 minutes - by 29.0%, after 15 minutes - by 37.0%, after 20 minutes - by 43.0%, after 25 minutes - by 46.0%, after 30 minutes - by 50.0% (N.A. Efimenko, N.E. Chernyakhovskaya. Ozone therapy in a surgical clinic. - M. - 2001. C .46-49). The portal vein is not a trunk. Blood flows through it into the liver and undergoes disinfection there. Therefore, it has a strictly defined speed of passage through the liver. Therefore, forced infusions of any medicinal solutions cause an increase in intraportal pressure, accompanied by a sharp pain syndrome, and in cases of continued such administration, nausea and vomiting. In addition, it was found that intraportal infusions at a rate of 65-70 ml / min and, to a lesser extent, at a rate of 30-35 ml / min cause not only an increase in intra-portal pressure, but also pressure in the portal venules and sinusoids. This is accompanied by transudation of fluid into the liver parenchyma with the development of its edema, a violation of the morphological structure and function of the liver. While intraportal injections at a rate of 3-4 ml / min (60-80 cap / min) do not cause such changes (O. Inyakin. Features of the optimal rate of intraportal infusion according to the functional and morphological state of the liver. - Abstract of diss. Cand. - Saransk. - 2001. - S.8-15). Thus, to obtain the expected therapeutic result, intraportal infusion of 400 ml of ozonized physiological saline solution with the proper speed is not possible. This disadvantage is eliminated in the proposed technical solution. The aim of the present invention is to prevent the occurrence of postoperative complications. This goal is achieved in that the daily dose of 400 ml of ozonized physiological saline solution is divided into 2 parts, administered after 12 hours at 200 ml at a rate of 10 ml per minute, and to prevent possible pain and dyspeptic disorders during infusion immediately before it conducting intraportally injected 10 ml of a 0.25% solution of novocaine.

Detailed description of the invention and examples of its practical implementation

Patients during surgery perform cannulation of the umbilical vein. The catheter placed in the umbilical vein is washed with a weak heparin solution to prevent thrombosis. In the postoperative period, starting from the first day, intraportal administration of ozonized physiological saline solution is carried out. To do this, using a special device, for example, the UOTA-60-01 Medozon installation, ozonize 200 ml of physiological saline solution with the creation of an ozone concentration in the solution of 3-5 mg / l. While the physiological saline is being ozonized, 10 ml of a 0.25% solution of novocaine are drawn into the syringe, connected to the cannula of the catheter located in the umbilical vein, and slowly (over 2 minutes) injected into the portal system. After ozonation of physiological saline solution is complete, they quickly fill the infusion system, for example, “System for the Transfusion of Infusion Solutions” (Registration certificate of the Ministry of Health of the Russian Federation No. 2005/322), and immediately connect it to the umbilical vein catheter, and the ozonized solution is injected at a speed 10 ml in 1 minute. At the end of the infusion of the ozonated solution, the catheter in the umbilical vein is filled with 1 ml of weak heparin to prevent thrombosis. The same procedure for infusion of ozonized physiological saline solution is carried out 12 hours after the first injection. Infusions are carried out daily 2 times a day, 200 ml for 6 days after surgery. Clinically monitor the patient's condition and laboratory blood counts.

Example 1. B-naya S-h EM, 74, and. No. 14089/889, was admitted to the surgical department of the City Hospital of Emergency Medicine No. 2, Rostov-on-Don, Moscow City Hospital due to postcholecystectomy syndrome, obstructive jaundice. In blood tests: leukocytes - 12.1 × 10 ⁹ / l, stab neutrophils - 10%, segmented neutrophils - 70%, eosinophils - 2%, lymphocytes - 14%, monocytes - 4%, total bilirubin - 135.55 mmol / l, direct bilirubin - 99.24 μmol / l, blood urea - 8.8 mmol / l, aspartate aminotransferase (ACT) - 0.66 mmol * h / l, analinaminotransferase (ALT) - 1.32 mmol * h / l. In connection with severe jaundice, the patient after preoperative preparation for 2 days underwent surgery endoscopic papillosphincterotomy with retrograde cholangiography. An expansion of the common bile duct up to 2 cm with a filling defect of 1.9 × 1.5 cm and a sharp narrowing of the terminal portion of the common bile duct was found. Attempts to remove the stone with a Dormia basket were unsuccessful. Nasobiliary drainage is installed in the common bile duct. After 2 days, the patient was reoperated in an open way. An operation was performed on laparotomy with choledocholithotomy and the application of choledochoduodeno-anastomosis according to Jurash, the umbilical vein was cannulated, drainage tubes were installed in the subhepatic space. In the postoperative period, from the first day ozone therapy was started by intraportal infusion of an ozonized physiological solution of sodium chloride 200 ml 2 times a day after 12 hours with a rate of 10 ml per 1 minute. The concentration of ozone in the solution was 3-5 mg / L. To prevent pain and dyspeptic phenomena on the rapid infusion of ozonized physiological solution on the eve of its implementation, 10 ml of 0.25% novocaine solution was intraportally administered. Ozone therapy was continued for 6 days. An improvement in the general condition of the patient’s body was noted. A significant decrease in bilirubin content was detected in biochemical blood parameters (3 days after the start of ozone therapy, the level of total bilirubin was 33.05 μmol / l, direct - 22.65 μmol / l), normalization of transaminase concentration: ACT - 0.42 mmol * h / l, ALT - 0.64 mmol * h / l and urea (6.4 mmol / l). At the end of 6 days of ozone therapy in the general analysis of blood of leukocytes 8.2 × 10 ⁹ / l, stab neutrophils - 6%, segmented neutrophils - 62%, eosinophils - 2%, lymphocytes - 23%, monocytes - 7%, total and direct bilirubin approached the norm (25.25 μmol / L and 10.00 μmol / L, respectively). The levels of transaminases (ACT - 0.32 mmol * h / l, ALT - 0.48 mmol * h / l) and urea (5.4 mmol / l) were within normal limits. Clinical observations of the patient and laboratory parameters indicated the absence of complications in the postoperative period. 13 days after the operation, the patient was discharged for outpatient treatment in satisfactory condition.

Example 2. B-naya L-a Z. D., 71, and.b. No. 43166/2465, was admitted to the surgical department of the City Hospital of Emergency Medicine No. 2, Rostov-on-Don, with a diagnosis of postcholecystectomy syndrome, choledocholithiasis, obstructive jaundice. Upon admission, the patient was of moderate severity, there was severe jaundice and scratching of the skin on the body. In the blood test: leukocytes - 10.2 × 10 9 / l, stab neutrophils - 16%, segmented neutrophils - 67%, eosinophils - 3%, lymphocytes -10%, monocytes - 4%, total bilirubin - 150.00 mmol / l, direct bilirubin - 65.40 μmol / l, ACT - 0.82 mmol * h / l, ALT - 2.14 mmol * h / l, urea - 8.6 mmol / l. The patient underwent fibragastroduodenoscopy, during which a diverticulum located near the large duodenal papilla (parafatellar diverticulum) was detected in the duodenum. In connection with the presence of a diverticulum, it was decided not to do papillosphincterotomy. A nasobiliary drainage was performed and retrograde cholangiography was performed, during which an expansion of the common bile duct up to 3 cm was revealed, in its lumen there were several shadows with a diameter of up to 1.2 cm, suspicious of stones. After preoperative preparation for 4 days, the patient was operated on. Performed laparotomy, choledocholithotomy, the imposition of choledochoduodenoanastomosis according to Jurash, cannulation of the umbilical vein, drainage of the subhepatic space. From the first day of the postoperative period, ozone therapy was carried out daily by intraportal administration of an ozonized physiological solution of sodium chloride according to the proposed method. Ozone therapy was stopped after 6 days. The patient's condition has improved significantly. She could get out of bed, walk around the room. Her intestinal motility recovered on the 3rd day after surgery, on the 6th day there was an independent stool of usual color in the last portions. Postoperative complications did not occur. Blood tests showed a favorable course of the postoperative period: after 3 days of ozone therapy, the number of leukocytes decreased to 9.0 × 10 ⁹ / l, in leukocyte blood counts - stab neutrophils 8%, segmented neutrophils - 68%, eosinophils - 2%, lymphocytes - 16%, monocytes - 6%. The level of total bilirubin decreased to 27.85 mmol / L, direct bilirubin - to 17.45 mmol / L. The ACT content was 0.74 mmol * h / l, ALT was 1.42 mmol * h / l, and urea was 7.0 mmol / l. Upon termination of the course of zonotherapy in blood tests, total and primordial bilirubin approached the upper limit of the norm (22.65 mmol / L and 7.50 μmol / L, respectively), and transaminases and blood urea were within normal limits (ACT - 0.50 mmol * h / l, ALT - 0.64 mmol * h / l, urea - 6.3 mmol / l). 14 days after the operation, the patient was discharged from the hospital in satisfactory condition.

Thus, the above examples show that the proposed method for preventing complications during postoperative treatment of patients has the following advantages: 1 - allows you to quickly introduce an ozonized solution of sodium chloride into the portal system, 2 - eliminates the development of pain and adverse reactions in the form of dyspeptic disorders on jet intraportal administration of ozonized physiological saline solution. All this increases the effectiveness of the therapeutic effect to prevent the occurrence of complications in the postoperative period. The proposed method is tested on 12 patients. Postoperative complications did not arise in any case. Patients were promptly discharged from the hospital in satisfactory condition.

Claims (1)

A method for preventing complications during postoperative treatment of patients, including intraportal administration of an ozonized physiological solution of sodium chloride, characterized in that immediately before each infusion of this solution, 10 ml of a 0.25% solution of novocaine is introduced into the portal system, and then intraportal infusion of the ozonized solution is carried out sodium chloride with an ozone content of 3-5 mg / l daily 2 times a day, 200 ml at a rate of 10 ml in 1 min for the first 6 days after surgery.