RU2646797C2 - Method for treatment of postoperative wound complications under conditions of systemic inflammatory reaction after caesarean section - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: for treatment of complications of a postoperative wound under the conditions of a systemic inflammatory reaction after caesarean section, the wound is treated with an ozone-oxygen mixture. Around the wound a "gas shaft" is formed from an ozone-oxygen mixture with an ozone concentration of 2 μg/ml. The mixture is injected subcutaneously in a volume of 10-15 ml for each 5 cm of wound length at a distance of 1-2 cm from the wound edges. The mixture is administered every other day for 5 days.

EFFECT: decreased number of purulent-necrotic complications of postoperative wounds in the new mothers after caesarean section.

1 ex, 1 dwg

Description

The invention relates to medicine, namely to the specialty of obstetrics and gynecology, and can be used for the prevention and treatment of purulent complications of postoperative wounds of patients operated on for septic endometritis with a pronounced systemic inflammatory reaction.

Analogs of the invention:

1. There is a method of treating trophic ulcers and long-term non-healing purulent wounds (RF Patent for invention No. 2218197, 2003), which consists in the use of ultraviolet radiation with a wavelength of 0.337 μm and ozone therapy with an ozone concentration of 0.7-1 mg / l and an exposure of 1-15 minutes by creating an ozone environment in the wound area.

The disadvantage of this method is the impossibility of its application to affect the microflora located in the deep layers of tissue structures of the wound, tightened with primary sutures.

2. There is a method of treating wound infection with ozone by treating a wound with an atmosphere of ozone at a concentration of 50 mg / l (Belokurov Yu.N., Molotkin VN Ozone therapy of purulent wounds, 1995).

The disadvantage of this method is the high concentration and long exposure time to ozone, which entails a high degree of toxicity of the latter, and this leads to damage to the cell membranes of not only bacteria, but also blood cells (Idov N.E. Aspects of changes in ozone in medicine. Journal anesthesiology and resuscitation, 1997 - N 1 - S. 90-93).

3. There is a method of treating purulent wounds, which consists in flushing superficial wounds or cavities with ozonated distilled water, obtained by passing an ozone-oxygen mixture through it at a concentration of 200 μg / l for 60 minutes. The method allows for the rehabilitation of wounds to avoid changes in high concentrations of ozone (RF Patent No. 2223768, from 02.20.2004).

The disadvantage of this method is the implementation of its bactericidal action only in the upper layers of the wound surface.

4. A known method of treating purulent wounds (RF Patent 2068263 dated 02.11.1992) by exposing an anesthetic jet under pressure of 40-50 atm from a distance of 8-10 cm from the wound surface, then with a fine stream of ozonized solution with a high pressure of 70-90 atm from a distance of 2-3 cm from the surface of the wound with an exposure of 4-5 s / cm ^{2 the} area of the wound.

The disadvantages of this method are:

1. The possibility of damage to healthy cells and the spread of infection to deeper layers of the wound as a result of pressure from an ozonated stream of liquid.

2. Preservation of the danger of bacterial pollution due to micro-spraying.

Prototype of the invention

The closest in purpose and combination of essential features is a method of treating purulent wounds (RF Patent No. 2223768 dated 02.20.2014) by performing necrectomy, washing the surface or cavities with ozonated distilled water obtained by passing an ozone-oxygen mixture through it at a concentration of 200 mg / l for 60 minutes Then carry out air ozonation with an ozone-oxygen mixture at a concentration of 50 mg / l for 20-30 minutes, then neutralized with a 1% sodium bicarbonate solution. After that, it is treated with a solution of poviargol in a concentration of from 0.1 to 0.3% and a bandage is applied.

Prototype criticism

The disadvantages of this method are:

- a combination of several stages of treatment and several drugs increases the cost of treating purulent wounds;

- The use of ozone in high concentrations, which may have a toxic effect. In addition, only the upper layers of the wound surface are exposed to the ozone-oxygen mixture.

The purpose of the invention

The aim of the invention is to increase the effectiveness of the treatment of complications of a postoperative wound in conditions of a systemic inflammatory reaction after cesarean section.

SUMMARY OF THE INVENTION

The proposed method produces subcutaneous administration along the perimeter of the postoperative wound of an ozone-oxygen mixture with an ozone concentration of 2 μg / ml. The mixture is injected uniformly subcutaneously symmetrically, at a distance of 1-2 cm from the edges of the wound, to create a gas shaft in a volume of 10-15 ml for every 5 cm of the length of the wound. The introduction of the mixture begins from 1 day from the moment of suturing and is repeated until the primary wound healing (photo 1).

The oxidizing properties of ozone provide a bacteriological, fungicidal, and viricidal effect. At the same time, unlike many well-known antiseptics, ozone does not irritate and does not destroy the integumentary tissues of the human body, because unlike microorganisms, cells of a multicellular organism possess an antioxidant defense system.

When ozone enters the bloodstream, it interacts with the erythrocyte membrane, resulting in the formation of ozonoids, which trigger the work of the intracellular antioxidant system. The introduction of ozone facilitates the release of oxygen by oxyhemoglobin and thus improves the oxygen supply to tissues. It is important to note the positive effects of ozone on microcirculation processes.

Medical ozone is able to correct the violation of cellular immunity, as well as have a modeling effect on the humoral link (Association of Russian Ozone Therapists. The official representation on the Internet of the Association of Russian Ozone Therapists. Dermatovenerology).

Clinical example

Puerpera M. house number 3 after cesarean section on the 3rd day with a diagnosis of

postoperative period 3 days, infiltrate postoperative wounds. Peripheral blood counts: ESR-62 mm / h, leukocytes - 12.2 * 10 ⁹ / l, red blood cells 3.4 * 10 ¹² / l. Infiltrate measuring 4-5 cm from the edges of the wound. The edges are hyperemic, with local temperature. When revising the wound, purulent discharge was not received. The patient started treatment by the proposed method. An ozone-oxygen mixture with an ozone concentration of 2 μg / ml was injected subcutaneously symmetrically, at a distance of 1-2 cm from the edges of the wound, to create a gas shaft in a volume of 10-15 ml for every 5 cm of the length of the wound. Sterile dressing.

On the 2nd day from the start of treatment, the infiltrate decreased in a volume of 2 cm from the edges of the wound.

On the 3rd day, subcutaneous administration of the ozone-oxygen mixture in the same concentration was repeated. Wound hyperemia disappeared, the temperature returned to normal.

On the 5th day after the start of treatment, there is no discharge from the wound.

Peripheral blood counts: ESR - 23 mm / h (N in the postpartum period), white blood cells 9.8 * 10 ⁹ / l, red blood cells 3.7 * 10 ¹² / l.

After 7 days from the start of treatment with the proposed method, the inflammatory process was stopped.

Thus, the use of the proposed method for subcutaneous administration of an ozone-oxygen mixture made it possible to improve the course of the wound process, prevent purulent complications of the postoperative wound and shorten the treatment time for patients after cesarean section.

Distinctive features of the invention and prototype are:

1. The use of the method for the prevention of purulent-inflammatory complications of a postoperative wound in conditions of a systemic inflammatory reaction, and not a purulent-necrotic wound.

2. The ozone-oxygen mixture is introduced into the tissue around the sutured postoperative wound, creating a "gas shaft".

3. Ozone-oxygen mixture is used as monotherapy, and not in combination with other therapeutic agents.

4. The concentration of the ozone-oxygen mixture is 2 μg / ml, and not 200 μg / l.

Characterization of medical and economic efficiency

The method improves the efficiency of treatment of postoperative wounds in conditions of a systemic inflammatory reaction due to local enhancement of the nonspecific immune response, local antiseptic effect, and also provides prophylaxis of purulent-necrotic complications, including anaerobic infection, lymphatic drainage. improved oxygen delivery to ischemic tissues, reduces treatment and rehabilitation costs.

Proposed as an invention, a method of treating a postoperative wound was used in 30 puerperas after cesarean section, in which in the postoperative period there was a clinic of a systemic inflammatory reaction.

Of these, 16 patients were admitted with inflammatory postoperative wound infiltrate. In all patients, the infiltrate resolved, suppuration of the wound among puerperas was not noted.

Proposed as an invention, the method allows to reduce the number of purulent complications of postoperative wounds in puerperas after cesarean section. There was a decrease in septic complications in puerperas. The consumption of dressings and medicines was reduced.

Information taken into account

1. RF patent No. 2218197. 2003 - a prototype.

2. Belokurov Yu.N., Molotkin V.N. Purulent Wound Ozone Therapy, 1995

3. Idov I.E. Aspects of the use of ozone in medicine // Anesthesiology and Intensive Care, 1997 - N 1 - C. 90-93.

4. RF patent No. 2223768, 2004

5. RF patent 2068263, 1992.

6. Association of Russian ozone therapists.

Claims (1)

A method for treating complications of a postoperative wound under conditions of a systemic inflammatory reaction after cesarean section, comprising treating the wound with an ozone-oxygen mixture, characterized in that a “gas shaft” is created around the wound from an ozone-oxygen mixture with an ozone concentration of 2 μg / ml, by introducing ozone subcutaneously in a volume of 10-15 ml for every 5 cm of the length of the wound at a distance of 1-2 cm from the edges of the wound, the mixture is administered every other day for 5 days.

Images