RU2665947C1 - Method of treatment of necrotic enterocolitis - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to the field of surgery, and can be used to treat necrotic enterocolitis. Method comprises infusion therapy, complete parenteral nutrition, antibacterial therapy, respiratory therapy, decontamination of the intestine and introduction of 60,000 IU intravenously into 200 ml of isotonic NaCl solution of anti-gangrenous polyvalent horse serum in the infusion therapy, 1 ml for 5 minutes, the rest for 2 hours.EFFECT: use of the invention makes it possible to increase the effectiveness of treatment, to obtain a positive result on the 2–3 day of treatment in the absence of side effects.1 cl, 2 dwg, 3 ex

Description

The invention relates to medicine, namely to the field of surgery. Necrotic enterocolitis takes a leading place in the mortality structure of diseases of the gastrointestinal tract. In practice, necrotic enterocolitis is often diagnosed in the stage of peritonitis, complicated by intestinal necrosis. The number of patients with necrotizing enterocolitis is growing annually.

Analogs

A known method of treatment of necrotic enterocolitis: V.P. Nikulina, Z.M. Ozova, M.A. Godkov. Art. Therapeutic efficacy of Polyvalent Pyobacteriophage in the treatment of acute destructive pancreatitis. Magazine them. N.V. Sklifosovsky. No. 3, 2016.

Criticism of the analogue

The lack of Pyobacteriophage - does not always give positive clinical results in the later stages of inclusion in the treatment regimen. Other means must be used.

Prototype

As a prototype, we took the method described in the article by V.P. Nikulina, Z.M. Ozova, M.A. Godkov. “Therapeutic efficacy of Polyvalent Pyobacteriophage in the complex treatment of acute destructive pancreatitis” N.V. Sklifosovsky. No. 3, 2016.

Prototype criticism

The lack of Pyobacteriophage - does not always give positive clinical results, in the later stages of inclusion in the treatment regimen. The use of Pyobacteriophage does not lead to a decrease in zones of necrosis (ultrasound data of the abdominal cavity, CT, and laboratory results). Other means must be used.

The purpose of the invention

Increasing the therapeutic effect of antigangrenous polyvalent horse purified concentrated serum in the treatment of necrotic enterocolitis.

Improving the effectiveness of treatment of patients with necrotic enterocolitis.

The essence of the proposed invention as a method is as follows.

The proposed method consists in the following: as part of the traditional therapy of necrotic enterocolitis (infusion therapy, with full parenteral nutrition, antibacterial therapy, respiratory therapy, intestinal decontamination), 58 patients used antitoxic polyvalent purified horse-drawn concentrated serum - PGS. Release form - injection for 30000 ME (CL. Perfringens, CL. Oedematiens, CL. Septicum 10000 ME each). The main mechanism of action of antigangrenous serum is to neutralize microbial toxins, antibodies contained in serum.

Method: 60000 IU of anti-gangrenous serum, is administered intravenously dropwise, per 200 ml of isotonic NaCl solution. At the same time, 1 ml of the resulting solution - for 5 minutes, the rest of the volume - for 2 hours

Patients with necrotic enterocolitis, regardless of the stage of the disease, are invited to use anti-gangrenous serum intravenously as part of traditional therapy. When treating 58 patients with necrotizing enterocolitis, we used antigangrenous serum as part of traditional therapy. With the exception of 2 deeply premature small children, 56 were transferred with recovery to specialized departments. The therapy was carried out under microbiological control. In 87% of cases, blood culture gave a positive result for the Clostridia culture, culture directly from necrosis zones - in 95% of cases.

The specific implementation of the method

Example No. 1

Patient A. Age 1 month 10 days. DS: necrotic enterocolitis 1-2 tbsp. Hospitalized on the second day of the disease. According to the mother: vomiting of bile, bloating. On ultrasound - a moderately pronounced dilatation of the intestinal loops, a thickening of the intestinal wall. In analyzes of peripheral blood - anemia, neutropenia. In biochemical analyzes - hypopropenemia, hyponatremia. 1 dose was administered - 30,000 IU of antigangrenous serum on the 2nd day after surgery. He was transferred to the breast department on the 9th day in a satisfactory condition.

Example No. 2

Patient I. Age 5 months. Hospitalized on December 31, 2016. According to the mother: 3-fold vomiting with an admixture of bile, bloating and soreness in the abdomen. On a survey radiography of the abdominal cavity from 12/31/2016, there is an uneven bloating of the intestinal loops, interloop exudation. On ultrasound of the abdominal cavity - intestinal pneumatosis, interloop exudate. Operated on December 31, 2016 by DS DS: necrotic enterocolitis. Complex ileo-colonic invagination. Necrosis of the head of the ileum. 01/02/2017, as part of the infusion therapy, 60,000 ME PGS were introduced. The patient was transferred to the emergency surgery department on 09/09/2017 in a satisfactory condition.

Example No. 3

Patient M. Age 5 years. Hospitalized on January 29, 2017. Complaints of vomiting, abdominal pain, bloating. On a survey radiography of the abdominal organs - uneven gas filling, dimming areas, interloop exudation, fluid levels. On ultrasound b / p - from 01.29.2017, the loops of the intestines are expanded, thickened, swollen. In the right ileal region - a conglomerate of collapsed intestines. In the abdominal cavity - 300 ml of fluid. In blood tests, anemia, neutropelia. In biochemical analysis - hypoprotenemia, hyponatremia. 01/29/2017 Operation - resection of the ileum. Terminal ileostomy. The protocol of the operation is from 01/21/2017, the loops of a small intestine of a dark color are adjacent to the wound. The terminal ileum is dark in color with signs of necrosis. Aspirated 500 ml of serous effusion with a hemorrhagic shade. P / o DS: Inversion and necrosis of the ileum, peritonitis. 01/30/2017, 2 doses of 60,000 ME PGS were introduced. 02/05/2017, the patient was transferred in satisfactory condition to the specialized department.

Signs that distinguish from the prototype - according to the prototype method in the treatment of necrotic enterocolitis polyvalent serum was not used. The prototype used a polyvalent pyobacteriophage.

The proposed method allows to increase the effectiveness of treatment and to obtain positive results for 2-3 days of treatment in the absence of side effects and contraindications for the use of antigangrenous serum, which is confirmed by a statistical analysis of the prototype and the proposed method (table. 1, table. 2). The financial costs of treatment are reduced. We performed a retrospective analysis of the clinical and laboratory data of 37 patients admitted to the intensive care unit for the period 2007-2011. In the standard treatment regimen for necrotic enterocolitis, in the early and late periods, a polyvalent Pyobacteriophage was connected. Pyobacteriophage is a mixture of sterile filtrate phagolysates (E. Coli., PS. Aeruginosa., Clebsiella., Staphylococcus.) Manufacturer FSUE NPO Microgen MH Russia. Release form - bottles on 20 ml. Conventional dosage regimen: 20 ml per abdominal cavity, once, for 7-10 days. Of the 37 patients hospitalized in the ICU, in whose treatment regimen the Pyobacteriophage was connected, only 17 were transferred to specialized departments.

Information sources

1. Krasovskaya T.V., Kobzeeva T.N. Diagnosis and intensive care in neonatal surgery. Guidelines. Moscow. 2001 year

2. Karavaeva S.A. Surgical treatment of necrotic enterocolitis. The author is a doctor of medical sciences. St. Petersburg. 2002 year

3. Magomedov A.D., Patakhov S.P., Sharipov N.A. Guidelines. Actual problems of pediatric surgery. Republican scientific-practical conference with international participation. Makhachkala. 2001 year

4. V.P. Nikulina, Z.M. Ozova, M.A. Godkov. Art. Therapeutic efficacy of Polyvalent Pyobacteriophage in the treatment of acute destructive pancreatitis. Magazine them. N.V. Sklifosovsky. No. 3, 2016. - prototype

Claims (1)

A method for the treatment of necrotic enterocolitis, including infusion therapy, complete parenteral nutrition, antibiotic therapy, respiratory therapy, intestinal deontomization, and the introduction of intravenous infusion of 60000 IU per 200 ml of isotonic NaCl solution of antigangrenous polyvalent horse serum, 1 ml for 5 minutes, the rest volume for 2 hours

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