RU2545743C1 - Moulded sorbent "t=lltl-1¦t¦", method for making it and method of treating endometritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to a moulded sorbent with the antibacterial properties for treating endometritis, representing nanodispersed mesoporous carbon having a specific adsorption surface of no more than 50 m²/g and a crushing strength of not less than 20 kg/cm², containing polyvinylpyrrolidone in an amount of not less than 5.0%, characterised by the fact that it is presented in the form of cylinders 2-4mm in diameter, 15-25mm long with one inner circular passage, to a method of treating it, as well as to a method of treating endometritis.

EFFECT: higher clinical effectiveness.

3 cl, 10 ex, 2 tbl

Description

The invention relates to the production of molded carbon sorbents for use in medicine, namely as applicators for the treatment of endometritis.

Inflammatory diseases of the genital area in women are a significant and still unsolved problem of modern gynecology. The frequency of this pathology has no tendency to decrease and still occupies a leading place in the structure of gynecological diseases, despite the use of modern diagnostic methods and the use of a wide range of antimicrobial agents (Gurtovoy B.L., Kulakov V.I., Voropaeva S.D. The use of antibiotics in obstetrics and gynecology. M .: 2004 .; Tirskaya Yu.I., Barinov S.V., Dolgikh T.I. et al. Microbiological study of postpartum complications in pregnant women of the infectious risk group // Novosibirsk University Bulletin. Series : Biolo tions, clinical medicine. 2013. T.11. №1. S.162-165). Damage to the endometrium in women of reproductive age is the cause of menstrual dysfunction, miscarriage, infertility and unsatisfactory results of assisted reproductive technologies, as well as a decrease in the quality of life of women.

Despite the development of the pharmacological basis of therapy, the treatment of this disease currently presents significant methodological and practical difficulties. The disadvantage of antibiotic therapy is that it does not eliminate a wide range of possible pathogenic microorganisms, including anaerobes and viruses. In addition, a number of antibacterial drugs have a range of side effects and contraindications.

Currently, studies are being conducted on the possibilities of non-traditional ways of treating endometritis: metabolic therapy (enhancing tissue metabolism and eliminating the effects of hypoxia), the use of hormone therapy to restore the structural and functional capabilities of the endometrium, electropulse and magnetotherapy (providing an analgesic, vasoprotective, trophotropic effect), interference current therapy (improvement of hemocirculation in the vascular basin of the small pelvis without the effect of hypermization, etc.). It is known that the use of efferent-lymphogenic technologies in the treatment of chronic nonspecific endometritis contributes to a more rapid leveling of the phenomena of endogenous intoxication due to the early restoration of the hemolymphocirculatory component (Ustinova EA, Ovsyannikova TV, Zalivina OA, etc. Sorption-lymphogenous therapy in the treatment of chronic nonspecific endometritis. // Successes in modern natural sciences. 2008. No. 2. P.97-98).

A known method of treating endometritis using low-frequency ultrasound in combination with intrauterine administration of the drug half-dan (sanitation of the focus of infection, detoxification and impregnation of the drug into the depths of biological tissues) (RF patent 2342173). A known method of treating endometritis by intrauterine administration of instillagel (RF patent 2232575). A known method of treating endometritis by intrauterine administration of a pyobacteriophage with subsequent use of infrared pulsed laser radiation (RF patent 2493863). The disadvantages of these methods are the use of a medicinal substance for indications not specified in the instructions of the drug, and possible allergic reactions to this medicinal product.

A known method of sorption treatment of acute nonspecific metroendometritis after abortion (RF patent 2145808). It is proposed to introduce a sorption drainage swab made of a nylon membrane with a dialysis pore size of 1.5-3.0 nm, filled with carbon-mineral sorbent SUMS-1 with xenoperfusate adsorbed on it, which is a solution of biologically active substances of xenosepleen with xenocytes in concentrations of 1.5-2.5 · 10 ⁵ .

To quickly suppress microflora in endometritis, stop the inflammatory process, prevent or quickly reduce general intoxication, reduce the frequency of generalization of the infectious process, a method for the intrauterine administration of sorption drainage swab made of a nylon membrane with a dialysis pore size of 1.5-3.0 nm, filled carbon-mineral sorbent SUMS-1 with metronidazole absorbed on it at a dose of 3 mg / ml (RF patent 2121842).

The main disadvantage of these methods is the small size of the dialysis pores of the nylon membrane (1.5-3.0 nm). Pathogenic microorganisms formed during purulent-septic inflammatory complications have dimensions (0.5 × 10 ³ ÷ 5.0 × 10 ³ ) nm, which exceeds the size of the dialysis pores of the nylon membrane and excludes the possibility of their adsorption on the porous surface of the sorbent. In addition, the SUMS-1 sorbent has a significant drawback: the basis of the material is aluminum oxide, the outer surface of which has acidic properties (pH <6-7) and strong polarity.

At the Federal State Budgetary Institution, the Institute for Hydrocarbon Processing Problems of the Siberian Branch of the Russian Academy of Sciences (IPPU SB RAS), a carbon sorbent with antibacterial properties was developed and obtained (RF patent No. 2481848, prototype). The carbon sorbent with antibacterial properties is round-shaped granules, contains 4.5-5.5% polyvinylpyrrolidone, characterized by a specific adsorption surface of less than 50 m ² / g and a total pore volume of less than 0.30 cm ³ / g. A method of producing a carbon sorbent with antibacterial properties involves impregnation of carbon hemosorbent granules with a 0.2-1.0% initiator solution in N-vinylpyrrolidone at pH 7.0-7.5, residual pressure 15-20 mm Hg. Art. and the ratio of hemosorbent: initiator solution in N-vinylpyrrolidone 1: 1.4-2.0 for 15-30 minutes, followed by a rise in temperature to 65-75 ° C, holding at this temperature for 0.5-8 hours in inert atmosphere, washing in water from the residual monomer and drying.

The use of powdered, granular, fibrous sorbents as applicators in gynecological practice is problematic. When such sorption materials are placed in membrane containers or when tissues rolled into tubes are used, their effectiveness and sorption activity are significantly reduced. It is an urgent task to set the shape of an input container with a carbon sorbent that is optimal for the treatment procedure.

The aim of the invention is to develop a molded carbon sorbent with antibacterial properties for use as an applicator in the treatment of endometritis in gynecology.

The proposed molded sorbent with antibacterial properties for the treatment of endometritis is a nanosized mesoporous carbon material in the form of cylinders with a diameter of 2-4 mm, a length of 15-25 mm with one inner channel of circular cross section and is characterized by a content of polyvinylpyrrolidone of at least 5.0%, a specific adsorption surface of not more than 50 m ² / g, crushing strength of at least 20 kg / cm ² .

Distinctive features of the proposed molded sorbent is its cylindrical shape and geometric dimensions: diameter 2-4 mm, length 15-25 mm, with one inner channel of circular cross section. These dimensions of the sorbent provide ease of its introduction into the uterine cavity. The presence of the channel ensures the accessibility of the outer and inner surfaces for sorption of bacterial cells. The sorbent is characterized by a content of polyvinylpyrrolidone in an amount of not less than 5.0%, a specific adsorption surface of not more than 50 m ² / g, a total pore volume of not more than 0.30 cm ³ / g, a mass fraction of ash of not more than 0.45%, a mass fraction of the total sulfur not more than 0.30%, crushing strength not less than 20 kgf / cm, pH 6.0-8.0.

The proposed method of manufacturing a molded sorbent involves mixing nanosized carbon with a binder, which is used as a 0.2-3.0% aqueous solution of polyethylene oxide, with a ratio of nanosized carbon: binder 1.0-1.2, extrusion of a plastic mixture, drying the extrudate, carbonization a binder in an inert medium at a temperature of at least 400 ° C, heat treatment in a hydrocarbon medium at a temperature of 750-950 ° C, activation with water vapor at a temperature of 700-950 ° C, pneumo-mechanical treatment and drying, followed by impregnation sorbent initiator solution in N-vinyl pyrrolidone, washing and drying.

The mixing of the carbon material with a binder and the extrusion of the mixture was carried out according to the patent of the Russian Federation 2057709 "Carbon product and method for its production." As a binder, a 0.2-3% aqueous solution of polyethylene oxide (polyethylene glycol) was used - a non-toxic polymer widely used as a medicine (dehydrating agent) (Instructions for use). Thus, toxic and undesirable components for biological objects are completely absent in the entire technological chain of sorbent production.

In addition, the extrusion is carried out at pressures not exceeding 20 kg / cm ² , which leads to less compaction of the ductile carbon material and ensures the preservation of the developed porous texture of the sorbent.

The physicochemical characteristics of carbon sorbents were determined by standard methods used in the study of carbon materials: the main texture characteristics — specific adsorption surface, total pore volume and pore size distribution were determined by nitrogen adsorption-desorption isotherms obtained using a Gemini 2380 instrument (USA ) The calculation of the adsorption specific surface area was carried out according to the BET equation. The amount of PVP polymer deposited on the molded carbon sorbent was determined by differential thermal analysis by mass loss, which was recorded by thermograms in the temperature range 330-340 ° C. The studies were carried out on a DTG-60H instrument from SHIMADZU (Japan), which simultaneously records thermal curves: temperature - - and DTA, TG. The accuracy of determining the temperature was - 1 ° C, and the weight change - 0.1%. Filming was carried out in an atmosphere of air, in the temperature range from room temperature to 1000 ° C, the sample was 10 mg, and the rate of temperature rise was 10 ° / min.

To illustrate the method of manufacturing a molded sorbent with antibacterial properties, examples are given (table 1).

Example 1 (prototype). A portion of hemosorbent (1.0 g) is poured into a three-necked flask, hermetically sealed and connected to a vacuum pump with a vacuum of at least 15 mm Hg. Art. and incubated at room temperature for 1 hour. Next, a pre-prepared 1.0% solution of the initiator (dinitrile azobisisobutyric acid - DINIZ) in N-vinylpyrrolidone (VP) is impregnated with a vacuum sample for 15 minutes at a ratio of hemosorbent: initiator solution in N-vinylpyrrolidone 1: 1.5. Then the vacuum pump is turned off, an inert gas (argon) is supplied to the flask, the temperature is raised to 68 ° C and held for 0.3 hours. Upon completion of the modification, the sample of the sorbent is removed from the flask and washing is carried out with distilled water at room temperature for 0.5 hours, after which the sample is dried at room temperature for 24 hours.

The amount of poly-N-vinylpyrrolidone deposited was 4.9%.

Example 2

50 g of nanosized carbon are mixed with a 0.5% aqueous solution of polyethylene oxide (PEO) in an amount of 60 ml, stirred for 30 minutes and extruded on a plunger extruder at a pressure of 25 kg / cm ² through a die with a diameter of 4.0 mm and an inner insert (needle ) with a diameter of 2.0 mm. The resulting long extrudates are cut to a length of 15-25 mm and dried at room temperature for 24 hours and at 105 ° C for 4 hours. Then carry out the carbonization of the organic binder. To do this, the chopped extrudates are placed in a flow furnace, inert gas is supplied, the temperature is raised to 400 ° C and held for 2 hours. Next, the temperature is raised to 850-870 ° C and heat treatment is carried out in a hydrocarbon medium for 4 hours and activation by water vapor at 850 ° C, after which the carbon products are cooled in an inert atmosphere, hydromechanical processing and drying are carried out. The resulting products have an outer diameter of 3.8 mm and a length of 20.0 mm.

To modify the surface, a sample of heat-treated extrudates in an amount of 2 g is placed in a three-necked flask, hermetically sealed and connected to a vacuum pump with a vacuum of at least 15 mm RT. Art. and incubated at room temperature for 1 hour. After that, a vacuum solution is impregnated with a 0.5% solution of the initiator DYNIZ in N-vinylpyrrolidone for 0.25 hours. Next, the vacuum pump is turned off, an inert gas is supplied to the flask, the temperature in the flask is raised to 69 ° C and held for 1.2 hours. At the end of the modification, the extrudates are removed from the flask and washed with distilled water at room temperature and dried for 24 hours at a temperature not exceeding 25 ° C.

Example 3

Similar to example 2, but the PEO content in the solution of 3.2%. The outer diameter of the outgoing plastic extrudates was 4.3 mm, and after shrinkage during the heat treatment, it was 4.1 mm, which exceeds the permissible diameter of the finished medical device. Such an increase in diameter is caused by the manifestation of post-extrusion swelling well known for polymer compositions and is associated with a high concentration of the PEO solution used as a binder.

Example 4

Similar to example 2, but the PEO content in the solution is 0.15%.

Example 5

Similar to example 2, but the ratio of carbon: binder is 0.9. Obtained in examples 4 and 5, the products have low strength, which is due to the non-optimal composition of the plastic composition.

Example 6

Similar to example 2, but the carbon: binder ratio is 1.3. The carbon product is not molded.

Examples 7-10 were carried out under the conditions of example 2 and demonstrate the influence of the distinctive features in the production method on the geometric dimensions, texture and strength characteristics of the products and the amount of the introduced antibacterial modifier N-polyvinylpyrrolidone.

An analysis of the physicochemical characteristics of the molded sorbents made it possible to determine the effect of the composition of the plastic carbon composition on the extrusion pressure and geometric dimensions of carbon products, the influence of the temperature-time parameters of heat treatment on the porous texture and strength of products, the influence of the impregnation and polymerization modes on the amount of modifier applied to the surface of carbon products with antibacterial properties.

The molded sorbent passed technical and toxicological tests at the Testing Laboratory Center of the Federal State Budgetary Institution of Science, Scientific Research Institute of Physical and Chemical Medicine of the Federal Medical and Biological Agency of Russia.

The proposed method for the treatment of endometritis involves the rehabilitation of the uterine cavity by placing the obtained molded sorbent with antibacterial properties in it in a nylon container with an attached thread for subsequent extraction in sterile form for 24 hours, twice or thrice until the pathogenic microflora is completely absent.

The molded sorbent is placed in a container of nylon fabric with attached dacron thread with a length of at least 20 cm, for subsequent removal, and sterilized. The applied kapron mesh fabric does not create obstacles for the passage of adsorbate through it and does not lose its drainage properties. The sterile container was introduced into the uterine cavity using a disposable UVB- “Vector” polymer device (conductor) (registration certificate No. FSR 2010/06872 of 03/01/2010).

A clinical trial of the proposed method for the treatment of endometritis in gynecology. The study included 80 patients with endometritis who, in addition to traditional antibiotic therapy, were introduced into the uterine cavity for treatment with a molded sorbent twice, three times, the duration of each application was 24 hours until the growth of pathogenic microflora was completely absent. The effectiveness of the treatment was monitored by seeding the uterine cavity on the microflora before and after sorbent administration, the levels of pro-inflammatory cytokines (interleukin 8 (IL-8), interleukin 1β (IL-Ιβ), interleukin 6 (IL-6), and necrosis factor were determined tumors of α (ΦΗΟ-α) and anti-inflammatory cytokines (interleukin 10 (IL-10), interleukin RAIL (IL-RAIL) in the uterine cavity, acute phase proteins (C-reactive protein) from blood plasma; the number of leukocytes, stab neutrophils, Peripheral blood SOY - Material sampling for k On-line studies were performed three times after each sorbent was extracted. Data processing was performed using the STATISTIKA-6.1 application package and standard Microsoft Excel mathematical tables. Comparison of the two dependent variables (before and after treatment) was carried out using Wilcoxon's T-test. To assess the effectiveness of the treatment, a comparison group was recruited: patients with endometritis receiving only traditional antibiotic therapy (n = 35).

Table 2 shows indicators of markers of the effectiveness of the sorbent.

In patients with endometritis, after the first rehabilitation of the uterine cavity by placing a molded sorbent in it, the immunological parameters changed as follows: the level of pro-inflammatory cytokines decreased for IL-8 by 3.7 times (p = 0.002669), IL-1β by 5.4 times (p = 0.002544), IL-6 decreased by 2 orders of magnitude (p = 0.004338), ΦΗΟ-α by 5.7 times (p = 0.003415), the content of C-reactive protein decreased by 1.4 times (p = 0.005241), the level of anti-inflammatory cytokine IL-RAIL increased by 1.7 times compared to the initial value (p = 0.005638), IL-10 - by 23 times (p = 0.005638), which indicates about stopping inflammation process. A significant decrease in leukocyte counts (p = 0.002540), SOE (p = 0.002540) and stab neutrophils (p = 0.003335) in the peripheral blood after treatment was also observed.

After extraction of the second molded sorbent from the uterine cavity, the immunological parameters changed as follows compared with the initial values: the level of pro-inflammatory cytokines decreased for IL-8 by 12.2 times (p = 0.003346), IL-1β by 4 times (p = 0 , 002544), IL-6 decreased by 2 orders of magnitude (p = 0.002570), TNF-α by 27 times (p = 0.003505), the content of C-reactive protein decreased by 2.2 times (p = 0.004053 ), the level of anti-inflammatory cytokine IL-RAIL increased compared with the initial value by 3.4 times (p = 0.005625), IL-10 - by 6.9 times (p = 0.002434). A significant decrease in leukocyte counts (p = 0.002434), SOE (p = 0.002534) and stab neutrophils (p = 0.003232) in the peripheral blood after treatment was also observed.

The results of inoculation of the uterine cavity to determine the spectrum of pathogens before and after administration also confirm the effectiveness of the therapy.

In a preliminary study of aspirates from the uterine cavity, the following pathogens were isolated before starting therapy: Ureaplasma urealyticum in 35% of patients, Staphylococcus in 75%, Enterococcus faecalis in 45%, Enterococcus faecium 83%, Candida albicans 23%, Pseudomonas aeruginosae 5, 6% In 24 (68.7%) cultures from the uterine cavity, a combination of several microorganisms took place. The most commonly observed associations are Enterococcus and Staphylococcus. Massive growth of pathogenic microflora was determined in all patients.

Sowing control was carried out immediately after extraction of the sorbent: After extraction of the first molded sorbent from the uterine cavity, poor growth of microflora was detected in 24% of patients, moderate growth of pathogens was detected in 36% and massive growth remained in 6% of patients. After extraction of the second sorbent from the uterine cavity, in the control of crops of growth of pathogenic microflora was not detected in 77% of cases and meager growth was noted in 23%. After extraction of the third sorbent in the control of crops, growth of pathogenic microflora was not detected in 100% of cases.

The use of the proposed molded sorbent in the complex of measures for the treatment of endometritis leads to: faster normalization of acute phase inflammation (quantitative characteristics of leukocytes, ESR, content of C-reactive protein) compared to patients who received traditional antibacterial therapy;

- to reduce local pro-inflammatory cytokines in the discharge from the uterine cavity;

- to the rapid normalization of clinical and laboratory parameters and regression of the inflammatory focus, which allows to reduce the total dose of antibacterial drugs used and the duration of their use, to reduce the number of applied infusion media. This has an economic effect;

- to decrease and earlier (on average 2 days) disappearances of the clinical manifestations of inflammation (normalization of body temperature, reduction of pain, disappearance of pusiform lochia). The length of hospital stay is reduced by 1.8 days, the percentage of organ-bearing operations is reduced;

- allows you to minimize the use of antibacterial drugs. The following is a description of the dynamics of the state of patients whose treatment was carried out by introducing the proposed sorbent.

1. Patient Ch., 28 years old. She was admitted to the gynecological department with a diagnosis of acute endometritis after a medical abortion in pregnancy for 8 weeks. From the anamnesis: at the age of 18, conservative treatment of cervical erosion was performed; the first pregnancy was interrupted at the request of the patient three years ago by medical abortion in the period of 10 weeks with repeated repeated curettage of the uterine cavity regarding the remains of the fetal egg; this second pregnancy was interrupted by medical abortion at the request of a woman for a period of 8 weeks, complicated by the development of postabortion acute endometritis on the third day, in connection with which treatment was performed in the gynecological department using a molded sorbent.

Prior to treatment, a massive increase in Enterococcus fa ecium, resistant to a wide range of antibiotics: levofloxacin, doxycycline, vancomycin and benzylpeicillin, was detected as a result of plating the uterine cavity. According to the results of ultrasound revealed uterine fibroids of small sizes. According to the biochemical analysis of peripheral blood, the number of leukocytes was 10 × 109, SOE - 16, stab neutrophils - 9. Immunological studies of blood plasma: IL level 8 - 2.20; IL 10 3.84; IL 1β - 8.6; IL RAIL - 27, 74; IL 6 - 0.54; ΦΗΟ-α - 4.02, C-reactive protein - 29.48. Under aseptic conditions, a molded sorbent was injected into the uterine cavity three times for 24 hours simultaneously with antibiotic therapy in accordance with sensitivity, microflora were detected.

In the control of sowing, after three days, the growth of pathogens was not detected. The level of leukocytes decreased to 8.3 × 10 ⁹ , SOE to 10, stab neutrophils to 3. The level of interleukins IL 1β, IL 6, ΦΗΟ-α and C-reactive protein decreased to 0 a IL 8 to 0.93. The level of IL-RAIL increased to 29.55, and IL 10 to 5.34. Body temperature did not increase during the observation period. The patient was discharged in satisfactory condition on the seventh day.

2. Patient B., 24 years old. She was admitted to the gynecological department with a diagnosis of acute endometritis after a spontaneous miscarriage during pregnancy 12 weeks.

From the anamnesis: the second pregnancy ended in the death of the ovum at the age of 8 weeks with the formation of retrochorial hematoma, complicated by endometritis after the instrumental removal of the dead ovum. Upon admission according to the results of ultrasound examination, the expansion of the uterus to 14-17 mm was revealed along the entire length due to heterogeneous contents. Body temperature 38.2 ° C, pulse 125 beats. per minute. Complete blood count: leukocytosis 10.7 × 10 ⁹ , SOE - 17, stab neutrophils - 8. According to immunological analysis of blood plasma, the level of IL 8 is 649.7; IL 10-0; IL 1β - 112.2; IL RAIL - 45.63; IL 6 - 1.36; ΦΗΟ-α - 7.23, C-reactive protein - 30.63. Inoculation of the uterine cavity revealed a massive increase in Enterococcus faecalis, which are resistant to antibiotics: doxycycline, levofloxacin and ciprofloxacin; massive growth of E. colli resistant to cefazolin, ceftriaxone, cefatoxime, amoxicillin-clavulanate. As a treatment, antibiotic therapy was carried out in accordance with the sensitivity of the identified microflora; in addition, a thrice-formed sorbent was introduced into the uterine cavity for 24 hours.

The results of the control culture after the end of therapy showed a lack of growth of microorganisms in the separated uterine cavity. The level of leukocytes decreased to 8.2 × 10 ⁹ , SOE - 8, stab neutrophils - 4. The level of interleukins decreased IL 8 to 0.46; IL 1β up to 0.78; IL 6 0.13; ΦΗΟ-α to 0.41, the level of C-reactive protein decreased to 5.24. The level of IL-RAIL increased to 98.56, and IL 10 to 15.10. Body temperature did not increase during the observation period. The patient was discharged in satisfactory condition on the sixth day. The results of control studies showed high efficiency of the therapy.

3. The comparison group. The treatment was carried out by the traditional method using only antibacterial drugs, without additional injection of the molded sorbent. Patient Sh., 35 years old. I was admitted to the gynecological department with a diagnosis of acute endometritis after a spontaneous miscarriage in pregnancy for 9 weeks. Upon admission, a moderate condition, body temperature 39.2 ° C, pulse 133 per minute. During a gynecological examination, the uterus is enlarged to 7-8 weeks, has a testy consistency, sharply painful on palpation, discharge purulent-bloody with an unpleasant odor. In peripheral blood: the number of leukocytes was 21.00 × 10 ⁹ , SOE - 25, stab neutrophils - 17. According to immunological analysis of blood plasma, the level of IL 8 is 29.30; IL 1β - 5.12; IL 10 - 2.61; IL 6 - 176.21; IL RAIL - 11.13; ΦΗΟ-α - 10.15; C-reactive protein 26.51. Inoculation of the uterine cavity revealed a massive growth of Staphylococcus epidermidis, which are resistant to antibiotics: moxifloxacin, levofloxacin. The treatment was carried out by III generation cephalosparins.

The results of the control culture after the end of treatment recorded a massive growth of Staphylococcus epidermidis in aspirate from the uterine cavity, resistant to moxifloxacin, levofloxacin. The level of leukocytes decreased to 15.23 × 10 ⁹ , SOE - 15, stab neutrophils - 9. The level of interleukins decreased IL 8 to 26.13; IL 1β up to 4.15; the level of IL 6 and ΦΗΟ-α decreased to 54.24 and 7.36, respectively, the level of C-reactive protein decreased to 23.68. The level of IL-RAIL increased to 40.35; IL 10 to 15.63. Thus, despite the decrease in pro-inflammatory cytokines and leukocytosis in the peripheral blood after antibiotic therapy in the uterine cavity, pathogenic microflora continues to be determined, which can lead to the formation of a chronic sluggish inflammatory process in the uterine cavity.

Table 1 Example The content of PEO in solution,% The ratio of nanosized carbon / binder, g / ml Extrusion Pressure, kg / cm ² The geometric dimensions of the sorbent, mm Porous texture Strength, kg / cm ² Polymerization Conditions The amount of PVP applied,% Outside diameter Length The total pore volume, cm ³ / g Specific surface, m ² / g Polymerization temperature, ° C Polymerization time, h one - - - spherical granules 0.24 38,0 0.26 * 68 2.0 4.9 2 0.5 1,2 25 3.8 20,0 0.25 45,2 25.1 69 1,2 4.2 3 3.2 1,0 48 4.1 20,0 0.25 42.1 28.3 69 5,0 5.3 four 0.15 1,2 eighteen 3.8 20.1 0.30 48,4 8.2 70 4.0 5.1 5 1,0 0.9 8 1.8 19.0 0.30 57.5 10,4 72 3.0 6.5 6 1,5 1.3 not formed - - - - - - - - 7 1,5 1,1 41 4.0 25 0.30 50,0 24.1 75 6.5 5.2 8 2.0 1,0 44 3,5 21 0.28 48,4 27.6 70 7.1 5,0 9 2.0 1,2 47 2.0 eighteen 0.27 47.0 25,4 69 5,4 5,4 10 2.0 1,1 49 2,8 19 0.30 45.9 31.9 71 8.0 5.9 Note: abrasion resistance,% / min

table 2 Indicator Average (interquartile range) P1 * P2 * P3 * Before starting therapy The main group (n = 80) Comparison Group (n = 35) After a single use of the sorbent 1 After repeated use of sorbent 2 IL-8 (pg / ml) 23.87 (13.70; 31.58) 6.37 (3.36; 10.18) 1.95 (0; 4.29) 10.58 (5.38; 15.46) 0.002669 0,003346 0.002644 IL-1β (pg / ml) 5.26 (4.56; 98.15) 0.98 (0.88; 3.34) 1.28 (0; 1.56) 3.34 (2.05; 4.58) 0,002544 0,002544 0,003467 IL-10 (pg / ml) 3.35 (0.72; 24.80) 77.26 (44.51; 184.52) 22.98 (0.44; 25.18) 38.55 (15.28; 25.64) 0,002312 0,001534 0,002832 IL-RAIL (pg / ml) 28.44 (25.16; 72.46) 48.79 (36.94; 112.34) 99.16 (66.34; 102.56) 32.15 (30.98; 74.68) 0,005638 0,005625 0,005548 IL-6 (pg / ml) 154.33 (87.14; 181.16) 1.06 (0.44; 1.24) 1.2 (0.05; 2.13) 4.37 (1.05; 8.52) 0.004338 0,002570 0,003385 TNF-α (pg / ml) 12.15 (5.64; 7.23) 2.13 (0.98; 4.23) 0.45 (0; 1.52) 4.65 (2.18; 6.45) 0,003415 0.003505 0,003615 C-reactive protein (mg / L) 31.64 (23.66; 36.28) 22.28 (16.8; 26.17) 14.6 (0.33; 15.71) 28.65 (26.77; 30.12) 0.005241 0,004053 0.005243 White blood cells (10%) 9.15 (8.07; 10.45) 8.87 (8.03; 9.71) 7.85 (7.50; 8.20) 9.08 (8.12; 9.18) 0,002540 0,002434 0,004230 ESR (mm / h) 16 (15; 17) 13 (12; 14) 10 (9; 11) 14 (13; 15) 0,002540 0,002534 0,002560 Band neutrophils (%) 9 (5; 10) 5 (2; 6) 3 (1; 3) 6 (4; 6) 0,003335 0,003232 0,005032 Note: * - statistically significant P between indicators before and after therapy: P1 - indicators after a single use of sorbent 1 in comparison with the initial values; P2 - indicators after repeated use of sorbent 2 in comparison with the initial values; P3 - indicators of the comparison group: conducting a parallel course of antibiotic prophylaxis

Claims (3)

1. A molded sorbent with antibacterial properties for the treatment of endometritis, which is a nanosized mesoporous carbon material containing polyvinylpyrrolidone, with a specific adsorption surface of not more than 50 m ² / g, characterized in that it is made in the form of cylinders with a diameter of 2-4 mm, length 15- 25 mm with one inner channel of circular cross section, and is characterized by a content of polyvinylpyrrolidone of not less than 5.0% and crushing strength of not less than 20 kg / cm ² . 2. A method of manufacturing a molded sorbent according to claim 1, including heat treatment of nanodispersed carbon in a hydrocarbon medium and activation with water vapor at temperatures of 700-950 ° C, pneumohydromechanical treatment, drying and impregnation of the sorbent with a solution of initiator in N-vinylpyrrolidone, characterized in that before heat treatment nanodispersed carbon is mixed with a binder, which is used as a 0.2-3.0% aqueous solution of polyethylene oxide, with a ratio of nanodispersed carbon: binder 1.0-1.2, the plastic mixture is extruded, dried extrudate and carbonization of the binder in an inert medium at a temperature of at least 400 ° C. 3. A method of treating endometritis, including sanitation of the uterine cavity using sorption material, characterized in that the sanitation of the uterine cavity is carried out by placing the molded sorbent according to claim 1 in a nylon container with attached thread for subsequent extraction in sterile form for 24 hours, twice or three times to a complete absence of growth of pathogenic microflora.