RU2587638C1 - Method of optimising treatment of deep burn - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention can be used for optimisation of treatment of deep burns III column at ICD-10. For this purpose, intensive care of burn shock and necrectomy within 3-5 days is followed by daily dressings with dihydroquercetin powder applied on a wound surface with microbial dissemination of not more than 10^3-4 m.c. per 1 cm² layer 1-2 mm. Simultaneously oral administration of biologically active additive “Lavitol-b” at 1 capsule 2 times a day at mealtimes is carried out. Also, hyperbaric oxygenation at 1.5-1.8 atm is carried out for 40 minutes. Further, delayed autodermoplasty is performed with free split-skin flap. From first postoperative day hyperbaric oxygenation at 1.5-1.8 atm is continued for 40 minutes for 7 days and oral administration of biologically active additive “Lavitol-B” for 15 days.

EFFECT: improvement of autograft, including due to considerable anti-inflammatory and regenerative effect, reducing intensity of lipid peroxidation processes and increasing activity of antioxidant protection system.

1 cl, 5 tbl, 2 ex

Description

The invention relates to medicine, in particular to surgery, and can be used to optimize the treatment of burns III tbsp. (according to ICD-10).

Burn treatment is an urgent surgical problem. The main objective of the treatment is to create optimal conditions for self-epithelialization of burn wounds or the complete engraftment of a free split autoderm graft. In this regard, the correction of disorders in local and general homeostasis is the basis of the pathogenetic use of drugs and methods with multicomponent effects.

The closest analogue to the claimed method is the "Method of stimulating wound healing of various origins with a natural antioxidant dihydroquercetin" [1]. This method has the following differences: 1) Laviocard + dietary supplement used in it contains only dihydroquercetin, while Lavitol-B contains arabinogalactan and dihydroquercetin, which expands the range of therapeutic effects; 2) the specified method does not provide for the simultaneous use of hyperbaric oxygenation (HBO).

A close analogue to the claimed method is a method using HBO to prepare for autodermoplasty surgery and in the postoperative period in children [2]. Significant differences of this method are: 1) the HBO method is used according to the standard method without simultaneous oral administration of the biologically active additive “Lavitol-B”; 2) the local effect of the antioxidant dihydroquercetin on the wound process in the wound is not provided.

The objective of the invention is the creation of a method for the treatment of burns III tbsp. (ICD-10), which reduces the healing time of burn wounds and the healing of autodermografts.

A method is proposed for optimizing the treatment of deep burns (Art. III according to ICD-10) by oral administration of the Lavitol-B dietary supplement containing arabinogalactan and dihydroquercetin, the simultaneous use of dihydroquercetin powder locally on the wound surface and hyperbaric oxygenation.

The dietary supplement "Lavitol-B" is a mixture of flavonoids "Lavitol (dihydroquercetin)" and a polysaccharide - arabinogalactan from Daurian larch. The ratio of dihydroquercetin and arabinogalactan is 1: 3 or 1: 5 [3]. Arabinogalactan has immunostimulating, antioxidant, bactericidal, membranotropic, hepatoprotective, prebiotic properties [4, 5]. Dihydroquercetin, being a natural antioxidant, is comparable in its antioxidant activity to alpha-tocopherol and is twice as active as beta-carotene [6, 7]. The combination of arabinogalactan with dihydroquercetin improves the absorption of the latter in the gastrointestinal tract. Among the methods with multicomponent exposure is hyperbaric oxygenation (HBO). HBO improves oxygen supply and microcirculation in the damaged area, reduces edema, inhibits bacterial proliferation and increases the effectiveness of antibiotic therapy, causes an increase in fibroblast proliferation and collagen production [8].

The possibility of using a method that combines drugs with antioxidant, immunostimulating properties and HBO, will provide a significant anti-inflammatory and regenerative effect.

The essence of the method: a method is proposed for optimizing the treatment of deep burns (Art. III according to ICD-10), which allows to reduce the healing time due to the oral administration of the biologically active supplement “Lavitol-B” containing arabinogalactan and dihydroquercetin, topical application of dihydroquercetin and HBO powder.

The task is achieved by the following: 1) oral administration of the biologically active additive “Lavitol-B” containing arabinogalactan and dihydroquercetin, helps to correct violations of lipid peroxidation (LPO) and activation of antioxidant protection (AOD); stimulates humoral and cellular immunity; 2) HBO improves oxygenation and microcirculation, has an antibacterial and general stimulating effect; 3) local use of dihydroquercetin powder “Lavitol cosmetic” stimulates reparative processes in the wound, reducing the time of the regeneration phase.

The proposed method is as follows. Patients with deep burns (stage III according to ICD-10) after intensive therapy of burn shock and necrectomy, perform daily dressings with dihydroquercetin powder for 3-5 days, which are applied to the wound surface with microbial seeding of not more than 10 ^3-4 m. t per 1 cm ² with a layer of 1-2 mm, at the same time, the dietary supplement "Lavitol-B" is administered orally 1 capsule 2 times a day with food and HBO is carried out for 1.5-1.8 atmospheres for 40 minutes daily in the OKA pressure chamber -MT. " Then they perform the operation - delayed autodermoplasty with a free split skin flap, on top of which paraffinized wound dressings are applied. From the first day of the postoperative period, HBO of 1.5-1.8 atmospheres is continued for 7 days and the oral administration of the Lavitol-B dietary supplement for 15 days.

A comparative analysis of the results of the application of the method was carried out in patients with the main (using the claimed method) (10) and control groups (10). The characteristics of burns in both groups are shown in table 1.

In the main group - 4 women and 6 men; in the control group - 7 men and 3 women. The average age of patients in the main group was 42.3 years, in the control group - 45.5 years. All patients underwent delayed autodermoplasty with a free split skin flap.

The results of the application of the proposed method were analyzed on the basis of the following indicators: clinical (duration of pain and temperature reaction), clinical blood analysis, course of the wound healing process, lipid peroxidation studies (diene conjugates, malondialdehyde) and antioxidant protection (vitamin E, ceruloplasmin) on the first day and the 21st day of treatment.

The results of clinical indicators in patients of the main and control groups are presented in table. 2.

The duration of the pain syndrome and temperature reaction in patients of the main group was 6.4 ± 0.9 days and 7.3 ± 0.4 days, respectively, and exceeded the similar indicators in the control group (12.5 ± 1.3 days and 12.1 ± 1.2 days).

Due to the more active course of the wound healing process in the main group, the terms of preoperative preparation decreased to 4.3 ± 0.8 days compared to the control group - 9.3 ± 1.4 days (Table 3).

Full engraftment of an autoderm graft was achieved in 100% in the main group and only in 65.6% in the control group, which required repeated operations and was accompanied by an extension of hospital treatment.

Thus, in the patients of the main group receiving topical use of dihydroquercetin powder (before autodermoplasty), as well as the biologically active additive Lavitol-B and HBO (before and after autodermoplasty), better treatment results were observed than in the control group. As a result of the active course of reparative processes, the time for delayed autodermoplasty was reduced and 100% engraftment of autografts was achieved.

The application of the proposed method showed a positive trend in terms of peripheral blood parameters (table. 4).

As can be seen from the table. 4, in patients of the main group treated with the proposed method, by the 21st day of treatment in the peripheral blood there was an increase in the number of red blood cells and lymphocytes, a decrease in white blood cells and ESR.

There was a positive dynamics of the processes of lipid peroxidation (LP) and an increase in the activity of antioxidant protection (AOD) in patients of the main group compared with the control group (Table 5).

Indicators of lipid peroxidation (diene conjugates, malondialdehyde) and AOD (vitamin E, ceruloplasmin) in patients of the main and control groups on the 1st day of treatment did not have significant differences. By the 21st day of treatment in patients of the main group, a significant decrease in the content of LPO products was noted compared with the control group. The diene conjugate indices decreased by 46.7% (from 56.5 ± 2.6 nmol / ml to 30.1 ± 2.2 nmol); malondialdehyde - by 48.8% (from 8.4 ± 1.1 nmol / ml to 4.3 ± 0.7 nmol / ml), while in the control group diene conjugates - by 21.2% (from 53, 4 ± 3.1 nmol / ml to 42.1 ± 5.2 nmol / ml); malondialdehyde - by 32.3% (from 9.6 ± 2.2 nmol / ml to 6.5 ± 1.7 nmol / ml). The content of AOD components increased significantly more in the main group than in the control group. In patients of the main group, the content of vitamin E increased by 35.3% (from 35.3 ± 1.2 μg / ml to 54.6 ± 1.4 μg / ml) and ceruloplasmin - by 34.6% (from 19 , 3 ± 0.9 mg / 100 ml to 29.5 ± 1.3 mg / 100 ml), and in the control group vitamin E - by 7.2% (from 37.4 ± 1.7 μg / ml up to 40.3 ± 1.2 μg / ml) and ceruloplasmin - by 2.4% (from 20.6 ± 1.5 mg / 100 ml to 21.1 ± 1.3 mg / 100 ml).

Thus, in the main group of patients as a result of the application of the proposed method, a decrease in the intensity of lipid peroxidation processes and an increase in the activity of the antioxidant defense system were observed.

When using the proposed method, no allergic reactions or other side effects were noted with the introduction of the biologically active additives "Lavitol-B", HBO and local application of dihydroquercetin powder.

Example 1

Patient O., 69 years old

Diagnosis: Thermal burn (boiling water) of the anterior abdominal wall, pubic area, perineum, posterolateral thighs of the III degree with an area of 10% of the body surface. Received 2 weeks after the moment of thermal injury in everyday life. Intensive care for burn shock was carried out in a community hospital. Upon receipt, the condition is satisfactory. Vesicular breathing. Heart sounds are clear, rhythmic. Pulse 86, rhythmic. Hell 130/90 mmHg The abdomen is soft, painless. The liver is not enlarged. Diuresis is not broken.

St. localis. On the anterior abdominal wall, in the area of the pubis, perineum and posterolateral thighs, burn wounds are presented in the form of a dense scab of dark brown color with marginal hyperemia and moderate purulent discharge. Pain sensitivity is absent or reduced. The total area of burn wounds is 1500 cm ² . Produced necrectomy, debridement of wounds with antiseptics. Then, from 2 days, dressings were performed with the application of dihydroquercetin powder on the wounds daily with a layer of 1-2 mm (microbial contamination did not exceed 10 ^3-4 mt per 1 cm ² ). At the same time, 4 sessions of HBO 1.5-1.8 atmospheres were performed for 40 minutes in a pressure chamber "OKA-MT" and oral administration of the biologically active additive "Lavitol-B" 1 capsule 2 times a day with meals. On the 5th day, an operation was performed - autodermoplasty with an area of 1500 cm ² free dermatome cleaved perforated (plastic coefficient 1: 2) skin flap, on top of which the wound coating "Parapran" was applied. From the first day of the postoperative period, HBO was continued for 1.5-1.8 atmospheres for 7 days and the oral administration of the Lavitol-B dietary supplement 1 capsule 2 times a day with meals for 15 days. Antibacterial therapy (ciprofloxacin) was performed. On the 12th day after autodermoplasty, complete engraftment of skin grafts was noted. Epithelization of the wound of the donor site occurred on 10 days.

In dynamics, the parameters of the products of lipid peroxidation and AOP were evaluated on the 1st and 21st day of treatment. A decrease in lipid peroxidation products was noted: diene conjugates from 46.1 nmol / ml to 30.2 nmol / ml, malondialdehyde from 26.4 nmol / ml to 9.6 nmol / ml. The level of AOD components increased: Vitamin E - from 39.2 μg / ml to 54.1 μg / ml, ceruloplasmin - from 19.7 mg / 100 ml to 31.4 mg / 100 ml.

Thus, the use of the proposed method, including the oral administration of the biologically active additive "Lavitol-B" and the use of HBO before and after autodermoplasty, as well as local - dihydroquercetin powder (before autodermoplasty), contributed to the stimulation of reparative processes and the full engraftment of an autoderm graft.

Example 2

Patient P., 51 years old

Diagnosis: Thermal burn (flame) of the anterior abdominal wall, left upper limb of the III degree with an area of 20% of the body surface. Received 10 days after the moment of thermal injury in everyday life. He received burns with a flame (intensive care of burn shock was carried out in a hospital in the community). The state of moderate severity. Vesicular breathing. Heart sounds are clear, rhythmic. Pulse 76, rhythmic. HELL 125/90 mm Hg The abdomen is soft, painless. The liver is not enlarged. Diuresis is not broken.

St. localis. On the anterior abdominal wall, along the anterolateral surface of the shoulder and forearm, there are burn wounds, which are represented by a dense scab of dark brown color with marginal hyperemia. Of the wounds - moderate purulent discharge. Pain sensitivity is reduced. The total area of burn wounds is 3000 cm ² . Produced staged necrectomy, debridement of wounds with antiseptics. Then, from 2 days, dressings were performed with the application of dihydroquercetin powder on the wounds daily with a layer of 1-2 mm (microbial contamination did not exceed 10 ^3-4 mt per 1 cm ² ). At the same time, the Lavitol-B dietary supplement was administered orally 1 capsule 2 times a day with meals, 3 HBO sessions of 1.5-1.8 atmospheres for 40 minutes in the OKA-MT pressure chamber. On the 4th day, an operation was performed - autodermoplasty with an area of 3000 cm ^{2 of} free dermatome cleaved perforated (plastic coefficient 1: 4) skin flaps, on top of which the Parapran wound cover was placed. From the first day of the postoperative period, HBO of 1.5-1.8 atmospheres was continued for 7 days and the introduction of the biologically active additive “Lavitol-B” 1 capsule 2 times a day with meals for 15 days. Antibacterial therapy (cefotaxime) was performed. On the 11th day after autodermoplasty, complete engraftment of skin grafts was noted. Epithelization of a wound of a donor site occurred on day 9.

In dynamics, the parameters of the products of lipid peroxidation and AOP were evaluated on the 1st and 21st day of treatment. A decrease in lipid peroxidation products was noted: diene conjugates from 39.2 nmol / ml to 20.4 nmol / ml, malondialdehyde from 29.3 nmol / ml to 10.4 nmol / ml. The level of AOD components increased: Vitamin E - from 39.7 μg / ml to 55.4 μg / ml, ceruloplasmin - from 19.9 mg / 100 ml to 34.2 mg / 100 ml.

The above examples show that the use of the proposed method, combining the oral use of the biologically active additive “Lavitol-B”, the antioxidant dihydroquercetin in the form of a powder on the wound surface and HBO, contributed to the correction of disorders in general and local homeostasis, allowing to achieve complete engraftment of autoderm grafts and healing of burn wounds .

Thus, the technical result of this invention is to improve the engraftment of a free split skin flap when performing autodermoplasty.

Bibliography

1. RF patent No. 2522214 dated 05/15/2014 "Method for stimulating wound healing of various origins with a natural antioxidant dihydroquercetin."

2. Atamanenko M.R., Khitrik I.R. The experience of using hyperbaric oxygenation in the rehabilitation of burn injuries in children. Hyperbaric physiology and medicine. - 1998. - No. 4. - S. 21-22.

3. Premixes Lavitol-V [Electronic resource] - Access mode: [http://www.ametis.ru/node/236]

4. Medvedeva E.N., Babkin V.A., Ostroukhova L.A. Larch arabinogalactan - properties and prospects of use (review). Chemistry of plant materials. 2003. No1. S. 27-37.

5. Arabinogalactan [Electronic resource] - Access mode: http: //www.Arabinogalactan/Useful%20properties%20arabinogalactan.html

6. Umninsky A.A. et al., Biochemistry of flavonoids and their importance in medicine. - Pushchino, 2007 .-- 99 s.

7. Lavitol (dihydroquercetin) [Electronic resource] - Access mode: http://www.ametis.ru/

8. Hyperbaric oxygenation [Electronic resource] - Access mode: [http://baroxhbo.blogspot.ru/2014/06/hbot.htm].

Claims (1)

A way to optimize the treatment of deep burns III tbsp. according to ICD-10, characterized in that after intensive therapy of burn shock and necrectomy, they are ligated for 3-5 days daily with dihydroquercetin powder, which is applied to the wound surface with microbial colonization of not more than 10 ^3-4 mt per 1 cm ² with a layer of 1-2 mm, at the same time, the dietary supplement "Lavitol-B" is administered orally 1 capsule 2 times a day with meals and hyperbaric oxygenation of 1.5-1.8 atmospheres is carried out for a duration of 40 minutes, then delayed autodermoplasty with a free split skin graft and from the first day of the postoperative period continue hyperbaric oxygenation of 1.5-1.8 atmospheres for 40 minutes for 7 days and the oral administration of the biologically active additive "Lavitol-B" for 15 days.