RU2620858C1 - Method for fat embolism syndrome prevention for patients with multiple injuries in case of long bones fractures - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: prevention of fat embolism syndrome (FES) is carried out according to the following scheme: hematoma is punctured in the fracture area, long bones are immobilized using extrafocal osteosynthesis by means of a rod apparatus according to the minimally invasive immobilization osteosynthesis principle. Then, 200 mg of mexidol solution per 200 ml of isotonic solution is administered intravenously twice a day for 3 days, and for the subsequent 2 days, 200 mg 2 times a day, intramuscularly, 40 ml of Essentiale per day, intravenously, 5000 units of heparin 4 times a day, subcutaneously, under the control of blood clotting for 5 days.

EFFECT: invention improves efficiency of fat embolism syndrome prevention for victims with polytrauma with long bonesfractures.

1 ex

Description

The invention relates to medicine, in particular to traumatology, and in particular to methods for the prevention of fat embolism, and can be applied, in particular, in patients with polytrauma who are at risk on the scale for predicting fat embolism syndrome (hereinafter referred to as SZHE). The use of only surgical techniques does not completely solve the problem of prophylaxis of SEC in case of polytrauma. Changes in homeostasis that inevitably occur during polytrauma, predisposing to the development of fat embolism, dictate the need for an integrated approach and a combination of surgical and medical methods for correcting such disorders.

Analogs

Known methods of pharmacological prevention of this syndrome, which include the use of heparin, lipostabil, protease inhibitors (Apanasenko B.G., Reshetnikov E.A., Danilchenko A.G. and others. On the possibilities of early diagnosis, prevention and treatment of fat embolism. // Orthopedist., Traumatol. And prosthetics. - 1968. - No. 9. - P. 22-27. Grabovoi A.F., Rudenko A.T. Fat embolism in severe trauma // Military Medical Journal - 1989. - No. 5. - From 27-29. Lavrinovich TS, Liepa ME, Slutsky LI Lipids and blood coagulation after bone damage. - Riga: Zinatne, 1979. - 190 p.). It is known to use sodium hypochlorite for detoxification in various endo- and exogenous intoxications (conclusion of the USSR Pharmacological Committee No. 1718 of 04/03/1991 "On the safety of sodium hypochlorite as a detoxifying agent"), based on the oxidizing ability of sodium hypochlorite with respect to xenobiotics.

Criticism of analogues

Changes in homeostasis that predispose to the development of fat embolism syndrome, which inevitably occur during polytrauma, dictate the need to use not only surgical, but also medication methods for correcting such disorders. The use of the above drugs in analogue methods does not exclude the possibility of the occurrence of fatty hyperglobulinemia with the subsequent development of fatty embolism syndrome. Acting on various links of the pathogenesis of fat embolism, the above drugs prevent the formation of fat globules, but do not affect already formed ones. In addition, the use of lipostabil and protease inhibitors is expensive (the use of lipostabil in recommended dosages for prophylactic purposes requires 300-600 thousand rubles per patient).

Prototype

Closest to the claimed invention is a "Method for the prevention of fat embolism syndrome during arthroplasty of large joints", RF patent No. 2153341, which is taken as a prototype. The essence of the prototype method consists in drip infusion of a solution of sodium hypochlorite in dosages of 0.03-0.06% solution in a volume of up to 1/10 of the bcc for several days, depending on the severity of fat globulinemia.

Prototype criticism

The disadvantage of the prototype method is that during the interaction of the hypochlorite of the anion with the lipid components of human blood lipoproteins, oxidative degradation of the lipid components of the lipoprotein occurs. Moreover, this applies not only to free fatty acids and triglycerides, but also fully phospholipids, which are natural emulsifiers of fats. LDL lipids are subject to the greatest oxidative changes under the influence of the hypochlorite anion, and oxidative degradation affects not only lipids located in the outer layer (phospholipids and cholesterol), and LD particles located in the nucleus (triglycerides and cholesterol esters). Thus, the destruction of phospholipids, which are natural emulsifiers of fats, can be a provoking factor in the syndrome of fat embolism, and the destruction and deficiency of phospholipids contribute to the disruption of the compensatory capabilities of the body.

The purpose of the invention

The purpose of the invention is to increase the effectiveness of prevention of fat embolism syndrome in polytrauma with fractures of long tubular bones.

The goal is achieved by puncture of the hematoma in the fracture zone, immobilization osteosynthesis, drug correction of homeostasis disorders, contributing to the development of fat embolism syndrome.

SUMMARY OF THE INVENTION

The essence of the proposed method is as follows: hematoma is punctured in the fracture zone to relieve stress in the fascial-fascial case, then the long tubular bones are immobilized using extra focal osteosynthesis using the rod apparatus according to the principle of minimally invasive osteosynthesis as the first stage of sequential osteosynthesis.

To prevent the risk of developing a fat embolism syndrome in a patient, treatment is carried out according to the following scheme: 200 mg of Mexidol solution is administered intravenously per 200 ml of isotonic solution twice a day, for 3 days, and the next 2 days - 200 mg 2 times a day intramuscularly. In addition, the patient receives an essence of 40 ml per day intravenously, heparin (in the absence of contraindications) for 5000 units. 4 times a day subcutaneously under the control of blood coagulability for 5 days.

These drugs in this combination have not been previously used, namely, the proposed as an invention scheme for the prevention of fat embolism syndrome gives a positive result. The use of Mexidol solution for the purpose of the invention is new.

Examples of specific performance of the method

Patient A. was admitted to the department of combined trauma with a closed fracture of the tibia and a bruise of the brain. The patient was punctured in the fracture zone to relieve stress in the bone-fascial case, then they were immobilized with long tubular bones using extra focal osteosynthesis using the core apparatus according to the principle of minimally invasive immobilization osteosynthesis, as the first stage of sequential osteosynthesis. A scheme for the prevention of fat embolism syndrome was prescribed according to the following scheme: intravenously, 200 mg of Mexidol solution per 200 ml of isotonic solution twice a day, for 3 days, and the next 2 days - 200 mg 2 times a day intramuscularly. Additionally, the patient was prescribed an essential 40 ml per day intravenously, heparin 5000 units. 4 times a day subcutaneously under the control of coagulability, for 5 days. The results of prophylactic treatment of fat embolism syndrome: neither clinical nor laboratory signs of fat embolism were observed in the patient. The patient was further treated in full.

Features of the invention, distinctive from the prototype

Prototype: from the moment the endoprosthesis components are installed, an intravenous infusion of a 0.03-0.06% sodium hypochlorite solution in a volume of 1 / 12-1 / 10 of the circulating blood volume (BCC) is carried out. The method allows to prevent the development of fat embolism syndrome due to the oxidation of the lipid components forming the fat globule and the formation of their water-soluble forms, which leads to the destruction of the drop of fat itself.

Invention:

- produce a puncture of the hematoma in the fracture zone to relieve stress in the bone-fascial case,

- then immobilize the long tubular bones using extra focal osteosynthesis by means of a rod apparatus according to the principle of minimally invasive immobilization osteosynthesis,

- treatment is carried out according to the following scheme: 200 mg of Mexidol solution is administered intravenously per 200 ml of isotonic solution twice a day, for 3 days, and the next 2 days - 200 mg 2 times a day intramuscularly, an essence of 40 ml per day intravenously , heparin for 5000 units. 4 times a day subcutaneously under the control of blood coagulability for 5 days.

The positive effect of the application of the invention

An increase in pressure in the fracture zone and inside the bone marrow canal is an inducing factor in SLE. Therefore, aspiration puncture in the fracture zone helps to relieve tension in the fracture zone and, accordingly, in the bone marrow canal, thereby reducing the possibility of fat emboli entering the vascular bed due to the pressure difference. The use of the prophylaxis method according to the above scheme in 50 patients with multiple and combined injuries of the musculoskeletal system contributed to the prevention of the development of fat embolism, only 2 patients showed a manifestation of fat embolism in the form of a short-term appearance of petechial rashes. The method allows to prevent the development of fat embolism syndrome by reducing intraosseous pressure in the fracture zone, inactivating lipid peroxidation, reducing the deficiency of highly saturated phospholipids, which are natural emulsifiers of fats, and suppressing platelet aggregation.

Information sources

1. Krause A.L., Voitovich A.V., Mamaeva E.V., Zhuchkov S.L., Vasilyeva E.N., Kulik V.I. A method for the prevention of fat embolism syndrome during arthroplasty of large joints. RF patent No. 2153341. Bulletin of inventions, 2-2003. - prototype.

2. Apanasenko B.G., Reshetnikov E.A., Danilchenko A.G. and others. On the possibilities of early diagnosis, prevention and treatment of fat embolism. // Orthopedist., Traumatol. and prosthetics. - 1968. - No. 9. - S. 22-27.

3. Grabovoi A.F., Rudenko A.T. Fat embolism in severe trauma // Military Medical. journal - 1989. - No. 5. - S. 27-29.

Claims (1)

A method for the prevention of fat embolism in patients with polytrauma of long tubular bones, characterized in that the prevention of fat embolism syndrome (FZE) is carried out according to the following scheme: hematoma puncture is performed in the fracture zone, long tubular bones are immobilized using extrafocal osteosynthesis using a core apparatus according to the principle of minimally invasive immobilization osteosynthesis, then 200 mg of Mexidol solution is administered intravenously per 200 ml of isotonic solution twice a day, for 3 days, and the next 2 seconds ducks - 200 mg 2 times a day intramuscularly, an essence of 40 ml per day intravenously, heparin 5000 units. 4 times a day subcutaneously under the control of blood coagulability for 5 days.