RU2388505C1 - Method of abdominal cavity sanation by general peritonitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine notably to the field of surgery and may be used for general peritonitis treatment. For it abdominal cavity is irrigated with ozonised physiological solution of sodium chloride with concentration 20 mcg /ml and then is drained. Then in right and left hypochondriums and right and left iliac regions drainage tubes with ultrasonic sources are installed. Then ultrasonic vibration is measured in the middle level of abdominal cavity. If ultrasonic vibration is less than 500 kHz additional drainage tubes with ultrasonic sources are installed in right and left side channels of abdominal cavity. No more than 1 litter of the above mentioned ozonised physiological solution is infused in every drain tube daily. Besides continuous 500 kHz ultrasonic exposure is prescribed for the 1st-4th days and continuous 400 kHz ultrasonic exposure is prescribed for the 5th-7th days of therapy.

EFFECT: method provides the most effective abdominal cavity sanation thanks to steady and simultaneous abdominal cavity ultrasonic exposure in combination with bactericidal effect of ozonised solution in specified regime.

1 tbl, 1 ex

Description

The invention relates to medicine, surgery, and relates to methods of sanitation of the abdominal cavity with diffuse peritonitis.

Currently, the following abdominal sanitation methods are known, which are used for diffuse peritonitis:

A known method of intraoperative flow sanitation of the abdominal cavity with diffuse peritonitis, which consists in installing drainage after eliminating the source of peritonitis, but before washing the abdominal cavity [1].

A known method of intraoperative sanitation of the abdominal cavity with peritonitis with saline perfused ozone with an ozone concentration of 1.2 μg / ml Use uniformly sprayed under a pressure of 60-65 atm. high-vapor stream of ozonized physiological solution [2].

A known method of combined sanitation of the abdominal cavity with diffuse peritonitis using hypo- and hyperthermic ozonated solutions, which alternately alternate 2-3 times during surgery [3].

A known method of intraoperative hardware sanitation of the abdominal cavity with diffuse peritonitis using the apparatus "Geyser" and hyperosmolar polyionic solutions [4, 5].

All the above methods of sanitation of the abdominal cavity are not adequate enough, because do not provide the necessary sterility of the peritoneum, which contributes to the progression of endotoxemia and peritonitis.

A known method of postoperative sanitation of the abdominal cavity with the help of drains installed in the upper and lower floors of the abdominal cavity, as well as five multiperforated irrigation tubes: in the right and left side channels, both mesenteric sinuses and zigzag along the small intestine. 3-4 hours after the operation, an antiseptic solution saturated with carbon dioxide is injected into the abdominal cavity under pressure. Removing it from the abdominal cavity takes place by gravity, under the pressure of an air cushion, which was formed after the sparging of CO ₂ , after which the anti-hypoxant solution Mafusol is introduced into the abdominal cavity [6]. The disadvantage of this method is the increase in pressure in the abdominal cavity, which with diffuse peritonitis can contribute to the progression of paresis of the gastrointestinal tract and, as a result, endotoxemia. The presence of drainage along the loops of the small intestine is traumatic and in conditions of inflammation can cause pressure sores on its walls and perforation. In addition, the removal of the spent solution from the abdominal cavity is carried out by gravity, which can lead to fluid leakage and the formation of abscesses of various localization.

A known method of sanitation of the abdominal cavity in the treatment of purulent peritonitis by peritoneosorption with a sorbent saturated with an antibiotic, the drug Algipor is used as a sorbent. Algipor dressings are placed in the left lateral canal, the left subphrenic space and envelop the anastomosis zone [7].

There is a method of sanitation of the abdominal cavity with generalized peritonitis, which consists in supplying oxygen through irrigator tubes installed in the right and left mesenteric sinuses, right and left subphrenic spaces, derived through laparomtoma. In the opposite direction, a physiological solution is supplied to the laparostomy, the discharge of which is carried out through drainage tubes installed in the pelvic cavity, the right and left side channels. The method provides for the presence of a device for laparostomy and scheduled revision after 24-48 hours [8].

Methods of sanitation of the abdominal cavity, which are based on the application of a laparostomy [7, 8], allow controlling the course of the process and preventing such complications as the formation of abscesses, adhesive obstruction. Along with this, they have a number of disadvantages. These include the high invasiveness of the method due to the large loss of fluid, proteins, electrolytes, the formation of intestinal fistulas, suppuration of the median wound and the formation of ventral hernias.

Known methods of sanitation of the abdominal cavity in the form of relaparotomy "according to the program" and "on demand" [9]. “On demand” relaparotomy is performed when the process progresses, complications of peritonitis occur: bleeding from the digestive tract, perforation of the hollow organ, the formation of abdominal abscesses, etc. The disadvantage of this method is its high morbidity and the absence of clear criteria, in the presence of which we can say with confidence about the need for repeated intervention and, therefore, late diagnosis of developed complications, the danger of incomplete elimination of the source of peritonitis. Program sanitation of the abdominal cavity, along with the presence of positive aspects, is a constant monitoring of the state of the abdominal cavity, and has several disadvantages. These include the formation of intestinal fistulas, relapse of intra-abdominal and gastrointestinal bleeding, prolonged intubation of hollow organs and catheterization of the great vessels, which increases the risk of nasocomial complications, wound healing by secondary intention, followed by the formation of ventral hernias. When using the above methods, the length of stay of patients in the hospital is from 20 to 50 days.

A known method of sanitation of the abdominal cavity, including washing the abdominal cavity, installing drainage and sonication of ultrasound medium (300 kHz) and low frequency (14.7 kHz) [10]. Sounding is carried out both during the operation and in the postoperative period through contrapertural openings in the abdominal wall. Washing the abdominal cavity with a solution of an antiseptic. Ultrasound exposure is performed in the postoperative period. At the same time, ultrasonic emitters are placed in drainage tubes only for the duration of the simultaneous sounding with their subsequent extraction.

The disadvantages of the known method of sanitation of the abdominal cavity are significant trauma due to the periodic establishment and extraction of ultrasound emitters into the drainage tubes in the postoperative period, the short duration of exposure to ultrasound scoring, a limited scope of scoring.

Closest to the proposed one is a method of closed drainage ultrasonic sanitation of the abdominal cavity in the prevention and treatment of infectious complications of gunshot wounds of the abdomen [11]. At the end of the operation, in the first 4 days of treatment, flow-washing aspiration dialysis with a 0.02% solution of furatsilin in an amount of 1.5-2.0 l is carried out for 1.5-2 hours 2 times a day. After dialysis, the drains are alternately closed and ultrasound with an acoustic frequency of 26.5 kHz is introduced into each open drain for 2 min by means of a channelized waveguide using the URSK-7N-18 apparatus. Ultrasound treatment is combined with the introduction through the drainage of a medicinal composition consisting of dioxidine, gentamicin, trypsin. From 5 to 8 days of treatment, this procedure is carried out 1 time per day, while the amount of dialysis solution is 400 ml.

The short duration of the ultrasonic effect, the impossibility of simultaneously voicing the entire peritoneal cavity, repeated introduction of the waveguide into the drains are the disadvantages of this method and increase its invasiveness. The use of furatsillin as an antiseptic may cause the growth of nasocomial flora.

A new technical challenge is to increase the adequacy of sanitation of the abdominal cavity with diffuse peritonitis by reducing the bacterial contamination of the peritoneal cavity, significantly reducing the morbidity, and mortality.

To solve the problem in the method of sanitation of the abdominal cavity with peritonitis, including washing the abdominal cavity, installing drainages, installing ultrasonic emitters and subsequent exposure to ultrasound, washing the abdominal cavity with ozonized physiological sodium chloride solution with an ozone concentration of 20 μg / ml, drainage, placed they are installed with ultrasonic emitters in the right and left hypochondria, right and left iliac areas, while determining the level of ultrasound oscillations in the middle floor of the abdominal cavity and for ultrasonic vibrations less than 500 kHz, additional drains with ultrasonic emitters are installed along the right and left lateral abdominal canals, and the above-mentioned ozonized physiological saline in an amount of at least one liter is additionally introduced into each drain daily and exposure to ultrasound is carried out continuously with a frequency of 500 kHz from the first to the fourth day and with a frequency of 400 kHz in the next from the fifth to the seventh day.

New in the method is that the abdominal cavity is washed with an ozonized physiological solution of sodium chloride with an ozone concentration of 20 μg / ml, the drains with ultrasonic emitters placed in them are installed in the right and left hypochondria, right and left iliac regions, and the level of ultrasonic vibrations is determined in the middle floor of the abdominal cavity and with values of the level of ultrasonic vibrations less than 500 kHz, additional drains with ultrasonic emitters are installed on the right and left at least one liter of the above-mentioned lateral canals of the abdominal cavity, in addition to each drainage, the above-mentioned ozonized physiological saline is additionally added daily, and ultrasound is applied continuously at a frequency of 500 kHz from the first to the fourth day and with a frequency of 400 kHz in the next from fifth to seventh day.

The method is as follows. After performing median laparotomy, eliminating the source of peritonitis and removing exudate, the peritoneal cavity is washed with an ozonized physiological solution of sodium chloride with an ozone concentration of 20 μg / ml until a clear wash liquid is obtained. An ozonized physiological solution with an ozone concentration of 20 μg / ml is obtained by sparging a physiological solution of sodium chloride using the POLICOR-B ozonizer [12]. After washing with an ozonated solution, abdominal drainage is performed by installing at least 4 cigar-shaped drains in the right and left hypochondria, right and left iliac regions. The emitters are placed in the drains according to the number of drains. Using a small multi-channel device for ultrasonic therapeutic treatment of postoperative cavities [13] determine the level of ultrasonic vibrations in the middle floor of the abdominal cavity. If the level of ultrasonic vibrations in the middle floor of the abdominal cavity is less than 500 kHz, additional drains with ultrasonic emitters are installed along the right and left side channels of the abdominal cavity. The middle wound is sutured in layers, tightly. Sounding by ultrasound is performed continuously for at least 7 days using an ultrasound device consisting of an external stationary generator with the ability to work in standalone mode [13]. The device has ultrasonic emitters with the generation of ultrasonic signals with a frequency of 400-500 kHz. The first four days, ultrasound scoring is carried out with a frequency of 500 kHz continuously. In the next fifth, sixth and seventh days, sonication by ultrasound is carried out with a frequency of 400 kHz continuously. The sounding medium is an ozonized physiological solution of sodium chloride with an ozone concentration of 20 μg / ml, which is additionally injected daily in an amount of at least one liter into each drainage. Extraction of emitters from the abdominal cavity is carried out simultaneously with drainages not earlier than on the 7th day of the postoperative period.

Washing the abdominal cavity is carried out with an ozonized physiological solution of sodium chloride with an ozone concentration of 20 μg / ml. At a given ozone concentration, the growth of pathogenic flora is completely inhibited. An increase in ozone concentration can lead to the manifestation of the toxic properties of the solution.

The number of installed drains and, accordingly, ultrasonic emitters depends on the size of the affected area and the volume of the patient's abdominal cavity and is at least 4 pieces.

The installation of drains with ultrasonic emitters in the right and left hypochondria, right and left iliac regions provides a sufficient outflow of pathological contents from the abdominal cavity and adequate sounding of the upper and lower floors of the abdominal cavity.

When the level of ultrasonic vibrations is less than 500 kHz in the area of the middle floor of the abdominal cavity, additional drains with ultrasonic emitters are installed in the lateral channels, which contributes to the uniform and simultaneous sounding of the entire peritoneal cavity.

When dubbing with a frequency of 500 kHz in the first four days, there is a decrease in bacterial contamination by 80%.

In the next fifth, sixth and seventh days of rehabilitation, the frequency of ultrasonic scoring is reduced to 400 kHz. A lower frequency of ultrasound scoring can increase the period of purification of the abdominal cavity from pathogenic flora and necrotic tissues.

The continuity of exposure to ultrasound in an environment of ozonized physiological solution of sodium chloride with a concentration of 20 μg / ml for at least 7 days contributes to a more rapid cleaning of the abdominal cavity from pathogenic flora and necrotic tissues. An additional introduction of the above ozonated physiological saline is necessary for the uniform distribution of ultrasonic vibrations and enhance bactericidal action.

The combination of the proposed features of the claimed invention leads to an increase in the adequacy of sanitation of the abdominal cavity with peritonitis due to the complete cleansing of the peritoneal cavity from pathogenic flora and necrotic tissues, a significant reduction in trauma due to a one-time installation and subsequent, seven days later, one-time extraction of drains with ultrasonic emitters and, as a result, a decrease in mortality.

An experimental study was conducted of the antibacterial action of an ozonized physiological solution of sodium chloride with an ozone concentration of 20 μg / ml with medium-frequency ultrasound (400-500 kHz) on museum strains of microorganisms that are most common with diffuse peritonitis, at maximum concentrations (Staphylococcus aureus, Streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Enterobacter, Enterococcus, Acinetobacter, C. Albicans). Each strain with a concentration of 10 ⁶ , 10 ⁷ , 10 ⁸ mt / m ³ - in the indicated physiological solution was placed in a sterile container. To generate ultrasound, an original autonomous ultrasonic emitter was used [13]. The microflora of the studied strains, divided into 3 groups, was subjected to various influences.

In the first group, the exposure was carried out with an ozonized physiological solution of sodium chloride with an ozone concentration of 20 μg / ml, in the second group with ultrasound and an ozonated physiological solution of sodium chloride with an ozone concentration of 20 μg / ml, the third group was control, it was not exposed. 24 hours after treatment, solid culture media were inoculated, the results of which were evaluated after 24 hours.

The results of the study showed that ozonated (20 μg / ml ozone) physiological solution of sodium chloride has a bactericidal effect on microorganisms, which are the most common causative agents of peritonitis, with a titer of up to 10 ⁸ mt / m ³ . However, taking into account the rather rapid half-life of ozone, there is a need for frequent addition of this solution.

When using ultrasound and ozonated physiological solution of sodium chloride with an ozone concentration of 20 μg / ml, microflora growth was not obtained in any of the cases.

Thus, when using a combination of ultrasound with a frequency of 400-500 kHz and an ozonated physiological solution of sodium chloride with an ozone concentration of 20 μg / ml, the growth of pathogenic bacterial flora is completely suppressed.

Table 1 shows the results of inoculation of microorganisms on solid nutrient media.

The mode of the proposed method was tested in an experiment on rats of the Wistar strain with a body weight of 250-300 g. All animals were male. All rats under general anesthesia underwent simulation of peritonitis with a 10% fecal suspension at the rate of 1.5 ml / 300 g of animal mass. After performing minilaparotomy, 10% of fecal suspension was introduced into the abdominal cavity. After 24 hours, all animals developed a pattern of diffuse peritonitis. When opening the abdominal cavity, plethora of the peritoneum with the presence of small-pointed hemorrhages on the parietal and visceral sheets of the peritoneum, the presence of a serous-fibrinous exudate of a widespread nature attracted attention. All animals were divided into 3 groups. The control (1) group included 30 rats with a model of peritonitis, which did not perform any interventions. The second group (30 rats) - carried out the rehabilitation of the abdominal cavity according to the prototype method. The third group (30 rats) - carried out the rehabilitation of the abdominal cavity by the proposed method.

The second group included 30 rats with a model of peritonitis, which was performed scoring in the environment of physiological saline.

On the first day after the development of peritonitis, animals of this group underwent laparotomy, collection of exudate from the abdominal cavity for bacterial culture, removal of exudate from the abdominal cavity, washing with physiological saline, after which the abdominal cavity was voiced in saline using an ultrasonic emitter for 4 minutes. Then the device was removed from the abdominal cavity, the wound of the anterior abdominal wall was sutured in layers, tightly. Every 24 hours for 8 days, a relaparotomy and voicing of the abdominal cavity in saline were performed. Bacterial inoculation from the abdominal cavity was carried out on the 1st, 3rd, 5th and 7th days before each scoring session.

The main (3) group consisted of 30 individuals with a model of peritonitis, which was reorganized by the proposed method. 24 hours after the introduction of fecal suspension, a wide laparotomy was performed. After laparotomy, exudate was removed and the abdominal cavity was washed with an ozonized physiological solution of sodium chloride with an ozone concentration of 20 μg / ml, after which one ultrasonic emitter was placed in the abdominal cavity. The wound of the anterior abdominal wall was sutured in layers tightly. An ultrasound transducer was in the abdominal cavity for 7 days. During the first, second, third and fourth days, exposure to ultrasound was carried out with a frequency of 500 kHz. On the fifth, sixth and seventh days - 400 kHz. Bacterial inoculation from the abdominal cavity was carried out on the 1st, 3rd, 5th and 7th days of scoring.

The results of bacteriological studies in the second and third groups of animals on the 1st and 3rd day did not differ from each other. In both cases, abundant growth of Escherichia coli was observed at concentrations of 10 ⁶ , 10 ⁷ , 10 ⁸ mt / m ³ . On the 5th day, there was a meager growth of Escherichia coli in animals of the third group at a concentration of 10 ³ mt / m ³ . While in 10 ⁴ , 10 ⁵ , 10 ⁶ , 10 ⁷ , 10 ⁸ mt / m ^{3 the} growth of E. coli was not observed. In the second group, on the 5th day, moderate growth of Escherichia coli was observed at concentrations of 10 ⁶ , 10 ⁷ , 10 ⁸ mt / m ³ . On the 7th day in animals of the third group of growth of Escherichia coli was not observed, all crops remained sterile. At the same time, in animals of the second group, there was a meager growth of E. coli at concentrations of 10 ³ mt / m ³ .

In the control group, mortality was 100%. In the second group, mortality was 60%. In the main group, all animals survived, mortality was 0%.

An example of a clinical implementation of the method.

Patient D., medical history No. 5600/1175, was admitted on 09.12.08 as an ambulance to the surgical department of the clinic of the Siberian State Medical University with complaints of hernial protrusion in the left inguinal region, abdominal pain, frequent vomiting, hiccups. Vomit light yellow, with an unpleasant intestinal odor.

Ds: Primary Disease: Constrained direct inguinal hernia on the left.

Complication of the main: Necrosis of the omentum and area of the small intestine. Acute small bowel obstruction. Spilled serous fibrinous peritonitis.

AZ: he became ill on 12/07/08, when abdominal pains, nausea, repeated vomiting appeared.

About-but: a serious condition, clear consciousness, the skin is pale cyanotic, marble in color, turgor is reduced. Shortness of breath at rest 24 bpm Heart sounds are deaf, arrhythmic, tachycardia 110 beats / min. The abdomen is moderately swollen, soft, evenly involved in the act of breathing, painful along the left lateral canal, the symptoms of Shchetkin-Blumberg, Voskresensky are positive. In the left inguinal region, a hernial protrusion, dense, 10 * 8 cm, does not set into the abdominal cavity, is moderately painful, the symptom of a cough push is negative, the skin over it is not changed. OAK: Hb 160 g / l, Er. 4.8 × 10 ¹² / L, L 11.0 × 10 ⁹ / L.

OAM: St. yellow, translucent, ud. weight 1020, reaction 6.0, protein - 0.74 g / l., glucose - neg., L 2-3 in s / sp. Er 0-1 in n / a., Epithelium flat single.

Blood biochemistry: bilirubin total / pr. 10.4 / OTR μmol / L, ACT 4.0 (N up to 7.5), ALT 6.2 (N up to 11.3), glucose 3.8 mmol / L, creatinine 0.15 μmol / L, urea 9.6 mmol / l, amylase 40 PIECES.

In an emergency, under the ETN, the operation was performed: 12/09/2008 Hernia cutting. Laparotomy Resection of the omentum and ileum with the formation of an intestinal anastomosis. Abdominal drainage. After processing the surgical field in parallel and 2 cm above the inguinal fold, an incision was made in the skin and subcutaneous tissue. The hernial sac lies medial to the inguinal canal, opened, 100 ml of hernia water of dark brown color with an unpleasant colibacillary odor is released. The contents of the hernial sac are a lock of a large omentum of black color and a necrotic loop of the small intestine. From the side of the inguinal canal, resection of the small intestine is not possible for technical reasons; a large omentum has been resected. Performed median laparotomy, in the abdominal cavity diffusely a large amount of effusion (about 2 l) of serous-fibrinous nature. The abdominal cavity is drained. A section of the small intestine of black color, 10 cm long, was removed into the abdominal cavity, a small intestine was resected with an anastomosis applied side to side.

According to the proposed method of sanitation, the abdominal cavity was washed with 4 liters of ozonized physiological sodium chloride solution with an ozone concentration of 20 μg / ml. In the right and left hypochondria, right and left iliac areas, drainages with ultrasonic emitters were installed and the level of ultrasonic vibrations in the middle floor of the abdominal cavity was determined, which amounted to 380 kHz, additional installation of drains with ultrasonic emitters along the right and left side channels of the abdominal cavity was performed. Re-determined the level of propagation of ultrasound in the abdominal cavity, whose frequency corresponds to 500 kHz. The wounds of the anterior abdominal wall and left inguinal region are sutured in layers, tightly.

In the postoperative period, starting from 1 day, 500-1000 ml of ozonized physiological sodium chloride solution with the above concentration was injected into each drainage. Sounding was carried out in the first four days with a frequency of 500 kHz, from fifth to seventh day 400 kHz.

Sowing of discharge from the abdominal cavity was performed: on the 1st day there was a continuous growth of E. coli at concentrations of 10 ⁶ , 10 ⁷ , 10 ⁸ mt / m ³ , on the 3rd day - a moderate growth of E. coli at concentrations of 10 ³ , 10 ⁴ , 10 ⁵ mt / m ³ , and the crops of 10 ⁶ , 10 ⁷ and 10 ⁸ mt / m ^{3 are} sterile, on the 5th day there was a sparse growth of E. coli at concentrations of 10 ³ , 10 ⁴ , 10 ⁵ mt / m ³ , and the crops of 10 ⁶ , 10 ⁷ and 10 ⁸ mt / m ³ - remained sterile, on the 7th day of growth of pathogenic flora was not observed, all crops were sterile.

The postoperative period was uneventful, the drains with ultrasonic emitters were removed from the abdominal cavity on the 7th day, the wounds of the anterior abdominal wall in these areas healed by second intention. Sutures from the median wound were removed on the 9-10th day, healing by primary intention. Analysis data after surgery:

OAK: Hb 129 g / l, Er. 3.1 × 10 ¹² / l, CPU 0.9, L 8.8 × 10 ⁹ / L, P / I - 1%, S / I 74%, Eo - 1%, L / F 18%, MP 6 %, ESR 20 mm / h.

OAM: St. yellow, translucent, ud. weight 1020, reaction 6.0, protein neg., glucose neg., L 2-3 in n / a., Er 0-1 in n / a, epithelium flat single.

Blood biochemistry: total protein 68 g / l, total bilirubin / pr. 10.4 / neg micromol / L, ACT 5.0 (N up to 7.5), ALT 6.2 (N up to 11.3), glucose 3.8 mmol / L, creatinine 0.11 μmol / L, urea 6.6 mmol / l

Coagulation system: fiber. total 4.0 g / l, fibrinogen B neg., MHO 1.22.

Discharged on the 10th day in satisfactory condition for outpatient monitoring of the surgeon at the place of residence.

Thus, the proposed method improves the adequacy of sanitation of the abdominal cavity with diffuse peritonitis, less traumatic with a significant reduction in mortality.

Literature

1. RU 99115444 A. Ivachev A.S. and others. "A method of intraoperative flow rehabilitation of the abdominal cavity with diffuse peritonitis", 2001.05.10.

2. RU 2098019 C, Bulynin V.I. "The method of abdominal sanitation with peritonitis", 1997.12.10.

3. RU 2198663 C1, Glukhov A.A. and others. "The method of combined rehabilitation of the abdominal cavity" 2003.02.20.

4. Vinnik Yu.S., Ryabov A.A., Neighbors A.D. et al. “Effective abdominal sanitation is the key to solving the problem of endotoxemia with widespread purulent peritonitis” // Collection of scientific and practical works dedicated to the 120th anniversary of the Krasnoyarsk Military Hospital. - Krasnoyarsk, 2005 - p. 54-55.

5. Dering V.F., Yuditsky NN, Karachev V.N. et al. “Tactics of treatment of diffuse peritonitis” // Collection of scientific and practical works dedicated to the 120th anniversary of the Krasnoyarsk military hospital. - Krasnoyarsk, 2005 - p. 63-66.

6. RU 2234254 C2, A. Glukhov and others. "The method of sanitation of the abdominal cavity in acute widespread peritonitis", 2004.08.20.

7. RU 2004116459 A, Bykov A.D. and others. "A method for the treatment of purulent peritonitis", 2005.11.10.

8. RU 2242170 C2, M. Belyaev and others. "A method of sanitation of the abdominal cavity with generalized peritonitis and a device for its implementation", 2004.12.20.

9. Peritonitis: A Practical Guide / Ed. B.C. Saveliev, B.R. Gelfand, M.I. Filimonova. - M .: Litterra, 2006 .-- 208 p.

10. RU 2003362 C, Yudin V.A. and others. "A method of treating purulent abdominal wounds with ultrasound and a device for its implementation", 11/30/1993.

11. KG Ibishov, “Overdrain closed ultrasound rehabilitation of the abdominal cavity in the prevention and treatment of infectious complications of gunshot wounds of the abdomen” // Bulletin of Surgery. I.I. Grekova. - 1999. - T.158, No. 2 - p.40-42 (prototype).

12. Technical description and operation manual for the POLIKOR-V ozone generator // Institute of Physics SB RAS, Krasnoyarsk, 2006

13. RU 76231, Kovalev V.N. et al. Small-sized multi-channel device for ultrasonic therapeutic treatment of postoperative cavities, September 20, 2008.

Table 1 Strains of microorganisms, the concentration of microbial bodies in m ³ 1 group 2 group 3 group Ozonated physical a solution of 20 μg / ml ultrasound 400-500 kHz in ozonized physical. a solution of 20 μg / ml the control Escherichia coli (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth Staphylococcus aureus (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth Klebsiella (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth Enterobacter (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth Enterococcus (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth Acinetobacter (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth C. Albicans (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth Streptococcus (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth Pseudomonas aeruginosa (10 ⁶ , 10 ⁷ , 10 ⁸ ) No growth No growth Solid growth

Claims (1)

A method of sanitizing the abdominal cavity with diffuse peritonitis, including washing the abdominal cavity, installing drainages, installing ultrasound emitters and subsequent exposure to ultrasound, characterized in that the washing of the abdominal cavity is carried out with ozonized physiological sodium chloride solution with an ozone concentration of 20 μg / ml, drainage with them ultrasonic emitters are installed in the right and left hypochondria, right and left iliac areas, while the level of ultrasonic vibrations in s the lower floor of the abdominal cavity and with ultrasonic vibrations of less than 500 kHz, additional drains with ultrasonic emitters are installed along the right and left lateral channels of the abdominal cavity, and the above-mentioned ozonized physiological saline is additionally added at least one liter daily, and the impact ultrasound is carried out continuously with a frequency of 500 kHz from the first to the fourth day and with a frequency of 400 kHz in the next from the fifth to the seventh day.