RU2382640C1 - Method of treating patients with pyoinflammatory diseases of lower extremities at background of diabetes mellitus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for treatment of patients with pyoinflammatory diseases of lower extremities at the background of diabetes complex treatment is realised, which includes introduction of insulin, antiaggregants and antibacterial therapy. As antibacterial therapy, cell-associated introduction of preparations is realised. For this purpose isolated autoblood formed elements in amount 1-1.45 ml per 1 kg of patient's weight are mixed with 5 ml of 20% ceftriaxone solution and 0.3 ml of dymethylsulfoxide, incubated during 30 minutes, 1 ml of distilled water is added per 5 ml of isolated autoblood formed elements, and stood during 10-15 minutes. Obtained solution is introduced into artery, feeding affected region, 1 time a day during 7-10 days.

EFFECT: increase of concentration of antibacterial preparations in affected tissues due to reversible depositing of erythrocytes in microcirculatory channel of lower extremities.

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Description

The invention relates to medicine, in particular to surgery and antibacterial therapy, and can be used, for example, for the treatment of infectious and inflammatory diseases of the lower extremities against diabetes mellitus.

There is a method of treating trophic ulcers in patients with diabetes mellitus, for this purpose, an injection of a medicinal mixture consisting of 4 ml of 10% solution of anecaine, 25 mg of chymopsin, 80 mg of actovegin, 0.5 ml of proserin is injected into the region of the Achilles tendon. The drug mixture is administered along the periphery of the Achilles tendon in the projection of the peripheral nerves n.tibialis and n.suralis on the lower leg (patent RU No. 2332990, IPC A61K 31/14, 03/27/2007).

The disadvantage of this method is the low concentration of antibacterial drugs, which inhibits the healing of infected wounds.

The technical result is to increase the effectiveness of treatment with infectious and inflammatory diseases of the lower extremities against diabetes mellitus by intraarterial administration of extracorporeally modified and antibiotic-rich blood cells, which leads to the healing of infected wounds.

The technical result is achieved by the fact that in the method of treating patients with purulent-inflammatory diseases of the lower extremities on the background of diabetes mellitus by administering insulin, antiplatelet agents and antibacterial therapy, which is carried out by cell-associated administration of drugs, for which the selected uniform elements of autoblood in the amount of 1- 1.45 ml per 1 kg of patient’s body weight is mixed with 5 ml of a 20% solution of ceftriaxone and 0.3 ml of dimethyl sulfoxide, incubated for 30 minutes, 1 ml of distilled water is added per 5 m l of the selected shaped elements of autologous blood, incubated for 10-15 minutes. The resulting solution is injected into the artery that feeds the affected area, 1 time per day for 7-10 days.

The method is as follows.

Under sterile conditions, 50 ml of blood is drawn from a vein into a 50 ml syringe with 5000 units of heparin. It is stirred by shaking, closed with a needle and a cap, and placed in a cannula support for up to 1 hour. Then, the settled plasma layer is removed and 1-1.5 ml per 1 kg of patient’s body weight are collected in a syringe with shaped autologous blood elements 5 ml of 20% ceftriaxone solution and 0.3 ml of dimethyl sulfoxide. Then incubated for 30 min at a temperature of 37 ° C, periodically mixing. After incubation, add 1 ml of distilled water to 5 ml of isolated autologous blood cells, then incubate for 10 min at room temperature and injected into the artery that feeds the affected area, 1 time per day for 7-10 days.

According to preliminary experimental data obtained, treatment of the formed elements with distilled water in the above volume (1 ml per 5 ml of autologous blood formed elements) under the studied conditions leads to a decrease in extracellular osmolarity to 200 mmol / l and causes a reversible increase in volume and a change in the shape of red blood cells, but does not cause their hemolysis. At the same time, there is also a change in the morphological and functional characteristics of red blood cells (a decrease in membrane stiffness, a decrease in osmotic resistance, and an increase in aggregation ability). These changes in red blood cells cause a reversible deposition of cells introduced into the arterial bed in the microvasculature of the lower extremities and a long-term increase in the concentration of antibacterial drugs in the tissues of the limb-fed artery.

Experimental animal studies have shown that the use of the number of cells indicated in the claimed method does not lead to disruption of macro- and microcirculation in the pool of the punctured artery and is not accompanied by impaired limb function.

Case Studies

1. Patient R., born in 1955, hospital patient card No. 6892/417. Was admitted to the purulent surgery department of MRCB on 08.26.08 g with a diagnosis of diabetes mellitus, type 2, severe course, stage of decompensation. Diabetic angiopathy of the vessels of the lower extremity, complicated by putrefactive-necrotic phlegmon of the right foot. Diabetic nephropathy.

A history of 2 weeks ago in a city hospital operation - exarticulation of the 1st toe of the right foot. The postoperative course was complicated by suppuration of the wound and the development of foot phlegmon, about which the patient was hospitalized in MRCB. Upon admission, the foot is edematous, hyperemic. In the projection of the 1st toe of the right foot, there is a wound 3 × 4 cm in size with purulent discharge, flaccid granulations of dirty gray color. Blood glucose 14.5 mmol / L; leukocytes 11.3 · 10 ⁹ / l, hemoglobin 122 g / l, ESR 42 mm / h.

The patient was prescribed insulin, antiplatelet agents and antibacterial therapy.

The antibiotic (ceftriaxone at a dose of 1000 mg) was administered by the method of directional transport by regional intra-arterial cell-associated infusion into the right femoral artery. The frequency of administration was 1 time per day for 7 days. Locally made dressings with dioxidine. Against the background of treatment, the phenomena of inflammation on the foot stopped on the 7th day. By the 9th day, the wound cleansed, granulation appeared. Gradually, marginal epithelization began. On the 28th day, the wound 0.5 × 1 cm in size, clean, epithelization from the edges. Glycemia stabilized at a level of 6.8-8.2 mmol / L, white blood cells 7.8 · 10 ⁹ / L, hemoglobin 128 g / L, ESR 16 mm / h. September 24, 2008 the patient was discharged for outpatient treatment.

2. Patient S., born in 1942, hospital patient card No. 7011/426. Was admitted to the purulent surgery department of MRCB 08/29/08. Diagnosis: type 2 diabetes mellitus, severe course, decompensation stage - diabetic foot. Phlegmon of the left foot.

Sick since February 2008, when there was hyperemia and edema and hyperemia of the 1st finger of the left foot. She was treated in the district hospital without improvement. In view of the progression of the phlegmon of the foot of the patient, amputation of a limb was proposed, which she categorically refused. Sent to MRKB. When entering the area of the 1st interdigital gap, the wound is 4 × 4 cm with purulent discharge, necrosis of soft tissues and tendons. The patient was prescribed insulin, antiplatelet agents and antibacterial therapy.

The antibiotic (ceftriaxone at a dose of 1000 mg) was administered by the method of directional transport by regional intra-arterial cell-associated infusion into the left femoral artery. The frequency of administration was 1 time per day for 10 days. Against the background of treatment, the phenomena of hyperemia and edema of the foot significantly decreased. On 2.09.08 (4 days after admission), the 1st and 2nd toes of the left foot were exarticulated with resection of the heads of the metatarsal bones, necrectomy. Suggestive stitches are applied. In the postoperative period, the phenomena of edema and hyperemia of the foot stopped. The wound was filled with granulations. On the 14th day, marginal epithelization appeared. On the 25th day, the wound is 1 × 0.7 cm in size, clean, epithelized from the edges. September 25, 08 the patient was discharged for outpatient treatment.

In experiments on animals (dogs), a comparative analysis of the distribution of ceftriaxone during intravenous administration, intraarterial administration (on an intact carrier) and intra-arterial cell-associated administration was performed. It was found that cell-associated intra-arterial administration creates in the muscle tissue of the limb 3-5 times higher concentrations of the drug than intravenous administration. 180 minutes after administration, the concentration of the drug created during its cell-associated administration exceeds that of intravenous administration by 3 times, and with intra-arterial administration, by 2.2 times.

The clinic conducted a comparative analysis of the effectiveness of intravenous administration, intraarterial (on an intact carrier) and intraarterial cell-associated administration of ceftriaxone in patients with purulent-necrotic complications of diabetes mellitus.

A study of the dynamics of the wound process (based on cytograms from the surface of the wounds) and a number of clinical indicators. Patients were divided into 3 groups. In the first group, ceftriaxone was administered intravenously, in the second - intraarterially on an intact carrier (0.9% sodium chloride solution), in the 3rd - cell-associated antibiotic therapy was carried out according to the claimed method. Based on the analysis of the results of treatment of 45 patients with purulent-necrotic complications of diabetes mellitus, it was found that the application of the method has a more pronounced antibacterial and wound healing effect, which allows faster and more effective relief of the clinical manifestations of the disease compared to traditional antibiotic regimens. In patients of the 3rd group, an earlier appearance (in comparison with patients from the 1st and 2nd groups) of the appearance of granulations, acceleration of marginal epithelization of wounds was recorded. An increase in the frequency of the inflammatory-regenerative type of wound discharge cytograms and a decrease in the inflammatory-degenerative type were noted.

Thus, the claimed method of treatment of infectious and inflammatory complications of diabetes mellitus allows you to quickly and efficiently stop the clinical manifestations of the disease in comparison with traditional antibiotic therapy regimens, accelerates the restoration of limb function and reduces the duration of inpatient treatment.

Claims (1)

A method of treating patients with purulent-inflammatory diseases of the lower extremities against diabetes mellitus by administering insulin, antiplatelet agents and antibacterial therapy, characterized in that cell-associated drug administration is carried out as antibacterial therapy, for which the isolated autologous blood cells are isolated in an amount of 1-1, 45 ml per 1 kg of patient’s body weight is mixed with 5 ml of a 20% solution of ceftriaxone and 0.3 ml of dimethyl sulfoxide, incubated for 30 minutes, 1 ml of distilled water is added per 5 ml of extract PARTICULAR autologous blood corpuscles, incubated for 10-15 min, then the resulting solution is introduced into the artery feeding the affected area, 1 times a day for 7-10 days.