RU2482894C1 - Method of combined treatment of children with severe thermal injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, and may be used for treating the children with severe thermal injuries. There are involved the detoxification and anticoagulant therapy to create the programmable anticoagulation conditions. It is followed by a procedure of intravenous laser blood irradiation at wave length 0.63 mcm and light guide output power 2.5 mW. The first procedure of intravenous laser blood irradiation is performed for 10 minutes, with the first 5 min - at 100 Hz, and the next 5 minutes - at a frequency of 1500 Hz. Further, the procedure of intravenous laser blood irradiation is performed for 14 min, each of 7 min at frequencies of 100 Hz and 1500 Hz. The sessions of intravenous laser blood irradiation are performed every 12 hours for 5-7 days.

EFFECT: method enables reducing the level of endogenous intoxication, improving the oxygen-transport blood function, accelerating the repair processes in burn wounds and reducing the area of plastics interventions by optimising the therapy.

3 ex

Description

The invention relates to medicine and can be used to treat children with severe thermal injury.

The anatomical and physiological characteristics and imperfection of the development of the child's body, the small age of the affected children (according to our data 4.01 ± 0.39 years) lead to the rapid development and high growth of burn intoxication, which aggravates the course of the burn disease and can lead to an unfavorable outcome. There are difficulties in carrying out certain methods of detoxification therapy associated with the need to impose an arteriovenous shunt, access to two or more main vessels, drainage of the thoracic lymphatic duct, exfusion of a large volume of blood (per child’s body weight), and technical and medical complications [1]. At the same time, sorption and dialysis methods include the availability of expensive equipment that is inaccessible in a general surgical hospital. The implementation of the plasmapheresis method is associated with the replenishment of protein losses, which is fraught with the risk of infection of the patient (viral hepatitis, syphilis, malaria, human immunodeficiency virus, cytomegalovirus and others), the development of allergic, immunological, metabolic, cardiovascular and other reactions during transfusion of donor fresh-frozen plasma (cryoplasm) and other protein preparations [2], and therapeutic plasma exchange in a volume exceeding 150% of the volume of circulating plasma (CPP) is considered unprofitable [3]. Treatment of children with burns with non-invasive (distant) laser therapy is carried out during acute burn toxemia or preparing a wound for surgical grafting [4], but is contraindicated in case of extensive and deep burns [5]. It should be understood that distant scattered low-intensity laser radiation loses energy as a result of reflection from the skin surface, temperature of the affected area, changes in the angle of incidence of the beam, individual properties of the irradiated integument of the body, and therefore the problem of the absorbed dose remains unresolved, and the effectiveness of the external effect is uncontrolled [6] .

It is known to use anticoagulant therapy in patients with burns by parenteral (subcutaneous, intravenous) bolus administration of heparin and / or irrigation of a burn wound with heparin [7]. However, in case of impaired tissue perfusion and in order to avoid differences in hypocoagulation and hypercoagulation, a long-term intravenous infusion of it during the day using an infusomat is recognized as the optimal method for the therapeutic use of anticoagulant [8].

The known method of intravenous laser blood irradiation (VLOK), performed in children by introducing a disposable sterile fiber KIVL-01 into the cubital vein at a wavelength of 635 nm, a power of 1.5-2 mW at the output of the fiber and the exposure time of 5-7 minutes, on devices laser therapy [4, 6, 9].

This method is the closest to the claimed technical essence and the achieved result and is selected as a prototype.

The disadvantage of this method, despite the fact that the VLOK method is widespread and approved for use in pediatrics, is: the trauma of performing multiple punctures of the cubital veins [4], the vastness of thermal damage, often involving access zones to the cubital veins, mainly the younger age of the victims, making it difficult and / or creating the impossibility of performing multiple venipuncture, the absence of indications when carrying out the VLOK procedure in children with thermal lesions for certain frequency modes and taking into account the initial and subsequent hemostasiological disorders [4, 9].

The objective of the invention is to increase the effectiveness of the treatment of burn disease.

The problem is solved by using the combined treatment of children with severe thermal injury: detoxification therapy, anticoagulant therapy and VLOK. Programmed anticoagulant therapy is started preliminarily before the start of VLOK and is carried out until hypocoagulation is achieved, controlled by chronometric tests of the coagulogram: activated partial thromboplastin time (APTT) and thrombin time (TB), and aggregate grams: coagulation constant “r + k”, then optical the fiber of the fiber is inserted into the inner space of the subclavian catheter until it stops, fixed in the head of the subclavian catheter and perform the VLOK procedure. Intravenous laser irradiation of blood is carried out by low-intensity radiation with a wavelength of 0.63 μm, a power of 2.5 mW at the end of the fiber. The time of the first VLOK procedure is 10 minutes, of which the first 5 minutes are carried out at a frequency of 100 Hz, and the next 5 minutes at a frequency of 1500 Hz. VLOK treatment sessions are carried out every 12 hours for a duration of 14 minutes. The first 7 minutes the radiation frequency is 100 Hz, and the second 7 minutes the frequency is 1500 Hz. VLOK sessions are performed within 5-7 days. Detoxification therapy is carried out constantly in the form of intravenous infusions of infusion preparations.

New in the proposed method of combined treatment is the preliminary, from the patient’s arrival, conducting programmable anticoagulant therapy with the creation of a hypocoagulation condition, using the subclavian catheter with the introduction of optical fiber into the inside of the catheter when performing the VLOK procedure, combined use of certain frequencies of low-intensity laser radiation (100 and 1500 Hz), the regulated time for each frequency when performing the VLOK procedure, so with the first session e for each frequency time was 5 minutes, and subsequent to - 7 min, regularity of session - every 12 hours and the duration of treatment for 5-7 days.

It is known that from the moment a burn injury is received, disorders occur in the microvasculature, intravascular thromboses leading to tissue hypoperfusion [10], which determines a further deepening of thermal damage and an increase in intoxication. It was noted that the use of heparin from the first hours of hospitalization helps to reduce the level of endogenous intoxication and in the complex treatment of burn disease favorably affects reparative processes, and at the same time, its cancellation leads to a significant increase in the level of endogenous intoxication [7]. Accordingly, in the acute period of a burn disease under conditions of increasing enzymatic activation of blood coagulation and fibrinolysis, the therapeutic effects of VLOK are reduced in proportion to hemostasiological and microcirculatory disorders in the vascular bed. As a result of this, the implementation of programmed anticoagulant therapy with the creation of a hypocoagulation condition will eliminate the initial disorders in the hemostatic system, supplement the membrane-stabilizing and angioprotective effects of intravascular low-intensity laser radiation, and ensure tissue perfusion recovery.

The laser radiation is fixed in the red region of the spectrum of 0.63 μm and its power is 2.5 mW at the output of the fiber during control in the window of the photodetector. To increase the effect of this therapeutic method, various frequencies of low-intensity laser radiation should be combined. It is known that from the first hours on the burn wound inflammatory processes occur that continue until complete epithelization and are accompanied by the course of endogenous intoxication. At the same time, the identification of different sensitivity of blood cells in children and adults [11] indicates the need for an individual approach to the VLOK procedure, where the final choice of regimes remains with the doctor [6]. In this regard, we selected the following frequencies of low-intensity laser radiation: 100 Hz, which ensures the release of biological membranes from toxic substances (detoxication), and 1500 Hz, which most effectively affects acute inflammatory processes (adversus inflammationem) [4, 5, 6]. In young children with thermal injuries, the lack of function of the organs of natural detoxification quickly occurs, which is expressed by an increase in the level of endogenous intoxication. An increase in the intensity of metabolic processes in the body with a burn disease justifies the frequency of the VLOK procedure every 12 hours.

In the proposed method of combined treatment, the use of a subclavian catheter for feeding low-intensity laser radiation into the vascular blood flow in children is optimal, as it eliminates additional puncture of the cubital veins, which are difficult and often have complications in young children. The length of the subclavian catheter used (AKO SYNTHESIS) is 13.5 cm. The length of the used optical fiber KIVL-01, freed from the needle and the fixing "butterfly", is 16 cm. Thus, when the optical fiber KIVL-01 is inserted into the internal lumen subclavian catheter until it stops in the head, a free arrangement of the distal end of the fiber in the intravascular space is achieved, which provides direct low-intensity laser radiation of the cellular and plasma blood composition. It should be noted that the distal end of the fiber is located in the space of the superior vena cava and thereby a larger volume of blood is exposed to radiation than when accessed through the cubital vein.

The essential features that characterize the invention, showed in the claimed combination of new properties that are not explicitly derived from the prior art in this field and are not obvious to a specialist.

An identical set of features was not found in the patent and medical literature.

This invention can be used in practical health care to increase the effectiveness of the treatment of burn disease and reduce the duration of hospitalization.

Indications for the use of the method are:

- Violations of microcirculation and oxygen status during periods of burn shock and acute burn toxemia;

- the severity of the inflammatory process;

- the need to stimulate reparative and regenerative processes in damaged tissues;

- difficulty and / or lack of multiple access to the cubital veins for performing the treatment procedure.

The method is as follows: children with thermal injuries upon admission to the hospital provide vascular access by catheterization of the subclavian vein according to the Seldinger method using a subclavian catheter (AKO SYNTHESIS, No. FS 012b0661 / 4158-06 of 11/17/2006), intended for injection of drugs or fluids into the hollow organs and body cavities, and used in pediatrics, pediatric and adult surgery with prolonged intravenous infusions into the central blood veins, blood substitutes and infusion solutions. From the moment of admission, they begin to carry out anticoagulant therapy with the creation of hypocoagulation conditions, controlled by the chronometric indicators of the coagulogram: activated partial thromboplastin time (APTT) and thrombin time (TB), and aggregate grams: coagulation constant “r + k” [12]. The anticoagulant is administered jet, intravenously and continuously throughout the day, the dose is calculated upon receipt by the value of the coagulation constant “r + k”, which characterizes the state of the initial phases of blood coagulation and the intensity of activation of the hemostasis system [12]. When performing the VLOK procedure, the patient is placed in a supine position, the Mustang 2000-2 + laser therapy apparatus (ALT) is sequentially turned on (Technological Research and Production Center, TU 9444-20025-29230815-2002) in the network, the initial radiation frequency is set to 100 Hz, open the package and take out a disposable sterile fiber with a needle KIVL-01 (Research Center "Matrix", TU 9444-005-72085060-2008), remove a single-use needle with a cap and a fixing "butterfly" from the optical fiber of the fiber, direct the fiber to the window of the photodetector, treated with an antiseptic solution subclavian head about the catheter, the optical fiber of the fiber is inserted into the inner lumen of the subclavian catheter, the tip of the fiber KIVL-01 is fixed from one end in the head of the subclavian catheter and from the other end in the latch connector of the KL-VLOK external radiating head, stop the Start button on the ALT "Mustang 2000-2 +" panel, after 5 minutes the value of the radiation frequency is changed to 1500 Hz and the procedure is continued for the next 5 minutes, at the end of the procedure the device is turned off, the optical fiber of the KIVL-01 fiber is removed, the emitting head is removed "CL ILIB" treated subclavian catheter head antiseptic solution, the procedure is considered completed fiber KIVL-01 is removed from the connector and latches utilized. The VLOK procedure is repeated every 12 hours for 7 minutes at each frequency (100 Hz and 1500 Hz) for 5-7 days.

Example 1. Patient M., 2 years old, medical history No. 4323, was treated at the MLPMU Children's City Hospital No. 4 in Tomsk, from July 11 to August 4, 2010. From the anamnesis it was revealed that the child received a thermal injury with boiling water in the area of the front and side surfaces of the trunk, face, back, right upper limb, front surfaces of the thighs, legs and feet with a depth of II-III degree, on an area of 26% (16% IIIB degree) . The index of the severity of the lesion (ITP) was 68 units, which in children under 3 years of age is associated with severe burn shock [13]. At the time of admission, after 60 minutes from the moment of injury, the patient's condition is severe, anxiety and chills are expressed, consciousness is preserved, symptoms of shock were clinically determined. The mucous membranes are pale pink, clear. The skin outside the burn wound is cool, pale. The nail beds are pale. Symptom of a "white spot"> 3 sec. Breathing 28-30 / min independent, puerile, uniform in all departments, with a hard tint. Heart sounds are loud, rhythmic. Heart rate (HR) 134-140 / min, blood pressure 110/75 mm Hg Central venous pressure (CVP) after catheterization of the subclavian vein is negative. The patient's body weight was 12 kg. From the moment of admission, on the basis of data from studies of the hemostatic system, anticoagulant therapy with the creation of a hypocoagulation condition is included in the intensive care regimen from the moment of admission. In the dynamics, the values of the APTT, TV and coagulation constants “r + k” lengthened 1.5-2.5 times - 74 sec, 28 sec and 19.8 min, respectively. The introduction of the anticoagulant was carried out continuously, jet, syringe infuser. On admission according to laboratory data, the expressed signs of CVD were determined: leukocytes 15.8 × 10 ⁹ , leukocyte intoxication index - 2.87, toxogenic granularity of neutrophils - 25%.

After 12 hours, hemodynamic parameters stabilized: heart rate 130 / min, CVP 50 mm water. Art., blood pressure 100/65 mm Hg The level of CVD was kept pronounced: the value of medium-weight molecules, determined at a wavelength of 254 nm (MSM ₂₅₄ ), increased to 0.31 cu, leukocytes 16.8 × 10 ⁹ , LII 2.7, TZN (25%). Additionally, oxygen deficiency was detected according to gas analysis of blood: SO ₂ - 89%, PO ₂ - 58.2 mm Hg, oxygen oxygenation index PO ₂ / FiO ₂ - 277.1 and percutaneous saturation (hemoglobin oxygen saturation) SpO ₂ <90%. According to the obtained data, the VLOK procedure was started: under aseptic conditions, the optical fiber was inserted into the head of the subclavian catheter all the way, fixed in it, low-intensity laser blood irradiation occurred for 10 min at a wavelength of 0.63 μm and a power of 2.5 mW at the output fiber, with the first 5 minutes at a frequency of 100 Hz, the next 5 minutes at a frequency of 1500 Hz. The following procedure was carried out after 12 hours, while under aseptic conditions, the optical fiber was inserted into the head of the subclavian catheter all the way, fixed in it, low-intensity laser blood irradiation occurred for 14 min at a wavelength of 0.63 μm and a power of 2.5 mW per the output of the fiber, with the first 7 minutes at a frequency of 100 Hz, the next 7 minutes at a frequency of 1500 Hz. The procedures were carried out every 12 hours for 5 days. Positive dynamics was noted: on the 3-5th day, leukocytes decreased to 6.6-9.0-8.8 × 10 ⁹ , LII was 1.0-1.0-0.9, TZN - 0-25-0 %, the value of MSM ₂₅₄ decreased to 0.25 cu, with the predominant accumulation of medium-molecular peptides in the patient's urine, which indicated their active removal from the body. Additionally, an improvement in oxygen status indicators without auxiliary oxygenation was revealed according to gas analysis of blood: SO ₂ - 92.9-93.9-95.3%, oxygen oxygenation index PO ₂ / FiO ₂ - 311-331-405; and percutaneous saturation (hemoglobin oxygen saturation) SpO ₂ - 92-94-96%. A total of 10 VLOK procedures were performed. The child’s burn disease proceeded favorably, there were no complications, on the 5-10 day the burn surface on the initial area of 16% of grade IIIb was cleared and had an active process of self-epithelization, replacement of damaged skin by surgical repair was performed on an area of 1%. The child was discharged from the hospital after 24 days. In this case, the VLOK method under the conditions of anticoagulant therapy, excluding additional venipuncture, made it possible to eliminate oxygen deficiency during the period of burn shock, stop the course of CVD, conduct targeted detoxification therapy in the general treatment regimen, accelerate the reparative processes in the burn wound that led to recovery, reduce the area the proposed surgical plasty, to exclude the development of complications of a burn disease. The length of stay was 23 bed days.

Example 2. Patient L. 1 year 6 months, medical history No. 4999, was treated at the Department of Anesthesiology and Reanimation of the Children's City Hospital No. 4 of Tomsk, from August 9 to August 23, 2010. From the anamnesis it was revealed that the child in the evening of August 4, 2010 received a thermal injury with boiling water on the face, scalp, neck, back, front surface of the chest, right thigh and right foot, II-III degree depth, on an area of 30% degree (25 % IIIab Art.). ITP amounted to 85 units, which applies to children under 3 years of age with extremely severe burn shock [13]. During the period of burn shock, a child in the Kolpashev Central District Hospital received infusion therapy, including glucose-salt and colloidal solutions, solutions of hydroxyethyl starch, donated freshly frozen plasma and red blood cells, antibiotics, analgesics. At the time of admission to the hospital, after 4.5 days from the moment of injury, the patient is in a serious condition, anxiety, clear, lethargic, hypodynamic consciousness. The mucous membranes are pale pink, dry, clean. The skin outside the burn wound is cool, pale, swelling of the soft tissues of the face and limbs is determined. The nail beds are pale pink, of sufficient filling. Symptom of a "white spot"> 3 sec. Breathing is independent, puerile, uniform in all departments, with a hard tint. Heart sounds - 150 / min, muffled, rhythmic, blood pressure 95/60 mm Hg, CVP 0 cm vg The patient's body weight was 11 kg. The abdomen is swollen, signs of intestinal paresis. Into the intensive care regimen from the moment of admission, based on data from a study of the hemostasis system, indicating the course of disseminated intravascular coagulation according to the hypercoagulation type - APTT 24.8 sec, TV 13.9 sec, RKFM 7.0 mg / 100 ml of plasma, coagulation constant blood r + k 5.1 min, anticoagulant therapy is included with the creation of hypocoagulation conditions. The introduction of the anticoagulant was carried out continuously, micro-jet, with a syringe infuser. Symptoms of burn toxemia were pronounced: the values of MSM ₂₅₄ were 0.34 cu, the number of peripheral blood leukocytes was 22.5 × 10 ⁹ , LII - 2.92, TSN - 25%. Signs of oxygen deficiency were detected according to gas analysis of blood: SO ₂ - 66.2%, PO ₂ - 40.5 mm Hg, oxygen oxygenation index PO ₂ / FiO ₂ - 192.8; and percutaneous saturation of SpO ₂ - 84%. After 12 hours of intensive and anticoagulant therapy, the value of MSM ₂₅₄ decreased slightly - to 0.33 cu, but at the same time, signs of hemostasiological disorders by hypercoagulation type persisted: TV 13.6 sec, APTT 27 sec, RKFM 24 mg / 100 ml plasma, coagulation constant "r + k" 7.3 min, signs of oxygen deficiency: SO ₂ - 84.6%, PO ₂ - 53.8 mm Hg, oxygen oxygenation index PO ₂ / FiO ₂ - 256.2 ; and percutaneous saturation of SpO ₂ - 90%. According to these data, reprogramming of anticoagulant therapy was performed. Upon reaching the fulfilled hypocoagulation condition: APTT - 49 sec, TV - 26 sec, coagulation constant “r + k” - 17.8 min, the proposed VLOK method was performed: under aseptic conditions, the optical fiber was inserted into the head of the subclavian catheter until it stops, fixed in it , low-intensity laser irradiation of blood occurred for 10 min at a wavelength of 0.63 μm and a power of 2.5 mW at the output of the fiber, with the first 5 min at a frequency of 100 Hz, the next 5 min at a frequency of 1500 Hz. Considering the high level of endogenous intoxication, the formation of a dense brown scab on the wound, it was decided to conduct the VLOK procedure every 12 hours during the period of acute burn toxemia (7 days). After 12 hours, the following procedure was carried out: under aseptic conditions, the optical fiber was inserted into the head of the subclavian catheter all the way, fixed in it, low-intensity laser blood irradiation occurred for 14 minutes at a wavelength of 0.63 μm and a power of 2.5 mW at the output of the fiber the first 7 minutes at a frequency of 100 Hz, the next 7 minutes at a frequency of 1500 Hz. The procedures were carried out every 12 hours for 7 days. The state was stable during the procedure. Positive dynamics was noted: leukocytes decreased to 21.6-9.0-8.8 × 10 ⁹ , LII - 1.17-1.0-0.9, respectively, TSN - 0-25-0%, the studied value of MSM ₂₅₄ decreased to 0.25 cu, with the predominant accumulation of medium-molecular peptides in the patient's urine, which testified to their active removal from the body. There was an improvement in oxygen status without additional oxygenation according to gas analysis: SO ₂ - 94-96.3-96.4%, oxygen index of oxygenation PO ₂ / FiO ₂ - 332.8-399.5-393.3 and percutaneous saturation of SpO ₂ - 92-95-97%. The child’s burn disease proceeded favorably, 12 sessions of the VLOK procedure were carried out, the scab completely went away on the 8-10th day from the moment of receiving the thermal injury, the wound surface on the 15% area had active epithelization, and on the remaining 15% area the burn wound had a pronounced papillary layer. There were no complications from the procedures. The resulting effect of VLOK was the active epithelization of damaged skin over the entire area. The child was discharged from the hospital after 20 days, and the total duration of the burn disease was 25 days. In this case, during acute burn toxemia, the correction of hemostasiological disorders and the effects of the proposed method for performing VLOK made it possible to conduct detoxification in the general treatment regimen, stimulate reparative processes in the burn wound, which led to recovery and avoided surgical plasty.

Example 3. Patient K., 6 years old, medical history No. 1822, received treatment at the MLPMU Children's City Hospital No. 4 in Tomsk, from March 28 to May 7, 2010. From the anamnesis it was revealed that during the inhalation, the child received a thermal injury with hot water in the region of the anterior abdominal wall, lateral surfaces of the trunk, left upper limb, perineum, anterior thigh surfaces with a depth of II-IIIa degree, on an area of 20% (16% IIIab degree) . The severity index of the lesion was 56 units, which refers to severe burn shock in children of this age [13]. Upon admission, after 60 minutes from the moment of the injury, the patient is in a serious condition, the behavior on examination is adequate, consciousness is preserved, the symptoms of shock were clinically determined. The mucous membranes are pale pink, clear. The skin outside the burn wound is cool, pale. The nail beds are pale pink. Symptom of a "white spot"> 3 sec. Breathing 20-24 / min independent, clean, uniform in all departments. Heart sounds are loud, rhythmic. Heart rate - 116-120 / min, blood pressure -100/60 mm Hg The central venous pressure after catheterization of the subclavian vein was 50 mm water column. The patient’s body weight is 20 kg. The intensive care regimen includes anticoagulant therapy in the form of a bolus of an anticoagulant with an interval of 4 hours without taking into account the initial disorders and further monitoring of the hemostatic system. Upon admission according to laboratory data, the signs of a systemic inflammatory response syndrome were determined: leukocytes - 10.4 × 10 ⁹ , LII - 2.62, TSN - 0%.

After 36 hours, the control measurements revealed normal hemodynamic parameters, there were no signs of oxygen deficiency: SO ₂ - 93.7%, PO ₂ - 67.6 mm Hg, oxygen oxygenation index PO ₂ / FiO ₂ - 321.9; percutaneous saturation of SpO ₂ - 97%. At the same time, an increase in the level of endogenous intoxication and signs of CVD was determined: the value of MSM ₂₅₄ was 0.33 cu, the number of leukocytes was 44.2 × 10 ⁹ , LII - 5.94 and TZN - 50%. In the clinical picture, a deterioration was noted: hyperthermia up to 38.5 ° C, tachycardia, tachypnea, decreased appetite, deepening of thermal damage was noted on the dressing - the entire surface is represented by degree IIIB and has a “marble” pattern with the formation of a brown scab. The antibiotics were changed, the regimen of anticoagulant therapy was not changed. On the 3-5-7th day, negative dynamics continued, oxygen deficiency arose: SO ₂ - 80.7%, PO ₂ - 45.9 mm Hg, oxygen oxygenation index PO ₂ / FiO ₂ - 218.57; percutaneous saturation of SpO ₂ - 90%, white blood cell count - 22.6-18.6-23.4 × 10 ⁹ , LII - 5.09-3.26-2.51, TSN - 50-75-75%, values MSM ₂₅₄ - 0.33-0.31-0.53 cu Based on clinical and laboratory data, the course of early burn sepsis was established. During dressings, the burn surface is in the form of a moist brown with a gray-green tinge of scab and fully corresponds to the III AB degree of depth of the lesion.

Over the next 15 days, the child received parenteral nutrition, antimicrobial therapy according to the sensitivity of the antibiotic to the pathogen (Pseudomonas aeruginosa), extracorporeal detoxification was not carried out, the regimen of anticoagulant therapy did not change. The wound surface was represented by 10% of the GPRS with a depth of IIIA degree and in the remaining 10% of the GPRSs with a depth of IIIB-IV degree. On the 24th day, surgical endoplasty was performed under endotracheal anesthesia on an area of 10% of GPRS, on the 40th day, burn wounds were epithelized completely and the child was discharged home in satisfactory condition. In this case, the absence of hemostasiological monitoring, the implementation of detoxification measures, including only infusion therapy, led to a severe course of a burn disease with the development of a septic state, the inevitability of surgical plastic surgery on a fairly large area and prolonged hospitalization.

The method was applied in 16 patients with thermal lesions. In a comparative aspect, the clinical material of the course of burn disease in children during periods of burn shock and acute burn toxemia is analyzed from the first to the 7th day. The areas of thermal damage varied from 15 to 40% of the total body surface area (GPRI), thereby being extensive, but non-critical. The main group (n = 16) included patients whose average age was 2.83 ± 0.65 years, the lesion area was 25.3 ± 2.43% of AKI, ITP 60.0 ± 6.75 units. The comparison group (n = 15) consisted of patients with an average age of 3.58 ± 0.75 years, a lesion area of 24.6 ± 1.94% of AKI, ITP 56.8 ± 5.13 units. Initial and subsequent disorders in the hemostatic system were not taken into account, and anticoagulant therapy was prescribed empirically in the main treatment regimen for patients of this group. Efferent detoxification methods have not been conducted. The groups were comparable in age, burn wound area, and lesion severity index (p> 0.05). The dynamics of endogenous intoxication was estimated by the number of leukocytes, the average molecular weight level (MSM ₂₅₄ ) in the plasma of patients at a wavelength of 254 nm in arbitrary units (cu), the values of the leukocyte intoxication index (LII) according to Kalf-Kalif (1941) and neutrophil toxogenic granularity (TSN,%), which are reflected in table 1 “Dynamics of intoxication markers in children with burn disease”.

According to the results obtained, during the period of burn shock, an increase in endogenous intoxication occurred in both groups and had a similar course (p> 0.05). In patients of the main group, on the 5-7th day, according to the parameters presented, there was a persistent decrease in the level of endogenous intoxication, significantly different from that in the comparison group (p <0.05), which indicated the effectiveness of the new treatment method.

Table 1

Dynamics of intoxication indicators in children with burn disease

Duration of observation Indicators L × 10 ⁹ LII MSM ₂₅₄ , conv. units TSN,% Admission The main group (n = 16) 17.7 ± 1.12 2.18 ± 0.32 0.315 ± 0.005 7.93 ± 2.19 Comparison Group (n = 15) 18.96 ± 3.17 3.24 ± 0.98 0,309 ± 0,005 7.5 ± 3.81 After 1 day The main group (n = 16) 14.12 ± 0.96 2.97 ± 0.47 0.338 ± 0.008 23.25 ± 3.45 Comparison Group (n = 15) 20.51 ± 3.31 3.52 ± 0.58 0.325 ± 0.011 27.5 ± 5.83 3rd day The main group (n = 16) 11.36 ± 1.21 1.68 ± 0.31 0.325 ± 0.015 21.72 ± 3.73 * Comparison Group (n = 15) 14.43 ± 1.58 2.87 ± 0.63 0.357 ± 0.012 37.5 ± 4.16 5-7th day The main group (n = 16) 12.61 ± 1.02 * 1.29 ± 0.16 * 0.311 ± 0.009 * 16.13 ± 3.31 * Comparison Group (n = 15) 17.08 ± 1.48 2.51 ± 0.20 0.438 ± 0.029 51.93 ± 4.44 Note: * - differences are significant in relation to the comparison group (p <0.05)

The dynamics of the wound discharge was significantly reduced in patients of the main group and averaged 7.9 ± 0.71 (p <0.05), while in the compared group - 15.4 ± 0.76 days. The treatment had a positive effect on the volume of surgical activity and the duration of hospitalization, so the area of operative plasty in the main group amounted to 1.72 ± 0.76% of OPPT, and in the compared group 7.64 ± 1.32% of OPPT. The total duration of hospitalization of patients with burn disease in the main group was 20.5 ± 1.23 bed days, and in the comparison group - 35.7 ± 2.26.

The application of the method proposed as an invention allows to achieve the following technical result: to eliminate numerous punctures of peripheral veins, reduce the level of endogenous intoxication, improve the oxygen-transport function of the blood, accelerate reparative processes, reduce the area of surgical plasty and thereby reduce the time of treatment and hospitalization.

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Claims (1)

A method for the combined treatment of children with severe thermal injury, including detoxification therapy, anticoagulant therapy and intravenous laser blood irradiation with a wavelength of 0.63 μm, a power of 2.5 mW at the end of the fiber, characterized in that the anticoagulant therapy is started preliminarily with the creation of a programmable condition hypocoagulation, upon reaching which the VLOK procedure is performed, for which the optical fiber of the fiber is inserted into the interior of the subclavian catheter until it stops, fixed in the head of a single-catheter and perform the first VLOK procedure for 10 minutes, with the first 5 minutes at a frequency of 100 Hz, and the next 5 minutes at a frequency of 1500 Hz, then perform the VLOK procedure for 14 minutes for 7 minutes at frequencies of 100 Hz and 1500 Hz , treatment sessions are carried out every 12 hours for 5-7 days.