RU2719407C1 - Method for administering medicinal mixture in patients with deep vein thrombosis - Google Patents

Abstract

FIELD: medicine; pharmaceuticals.

SUBSTANCE: invention refers to pharmaceutical industry and medicine, namely to a method for administering a therapeutic mixture to deep vein thrombosis patients. Method of administering to patients with deep vein thromboses a medicinal mixture containing a glucocorticosteroid preparation, heparin and novocaine, by means of a syringe, pre-ultrasonography is used to determine the points of the most evident inflammation of the venous wall and paravasal tissue and under ultrasound control, 10 ml of the medicinal mixture produced by mixing 4 ml of dexamethasone, 5000 units of heparin and 20 ml of 0.25 % novocaine solution are introduced into the above places with a syringe at angle of 30–45 degrees.

EFFECT: above described method effectively reduces inflammation of venous wall, thrombosis and pain syndrome, promotes more rapid regress of thrombophlebitis symptoms and recanalization of venous lumen.

1 cl, 1 ex

Description

The invention relates to medicine, namely to vascular surgery, and can be used to treat acute deep vein thrombosis.

Closest to the claimed solution is a method of thrombolytic therapy, in which, to relieve inflammation of the venous wall, a medicinal mixture consisting of 50 IU of hydrocortisone, 5000 IU of heparin, 0.5 g of ampicillin, 10 mg of chymotrypsin, 150 ml of 0.25% novocaine solution is injected (see RF patent No. 2141315, IPC A61K 31/00, A61B 17/00, published on November 20, 1999).

However, this method has significant disadvantages:

- before the manipulation, the areas of the most pronounced inflammation of the venous wall and paravasal tissue are not determined, in which the development of connective tissue elements occurs with subsequent occlusion of the vein, where it is necessary to administer the drug mixture;

- the drug mixture is introduced empirically “blindly” over the projection of the thrombosed neurovascular bundle, which does not allow to achieve a high concentration of drugs directly in the affected area of the vein;

- the effect of the drug mixture is short-term, the half-life of hydrocortisone (the main anti-inflammatory component) is 110 minutes, and the duration of the biological effect is 8-12 hours, which requires repeated administration of the drug mixture;

- repeated administration of the drug mixture is necessary due to the short duration of action.

The technical task is to increase the effectiveness of therapeutic treatment of thrombosis by accurately identifying areas of inflammation and reducing the number of injections.

This object is achieved by the fact that in the method of administering to patients with deep vein thrombosis a drug mixture containing a glucocorticosteroid, heparin and novocaine, using a syringe, preliminary, using ultrasound, the sites of the most pronounced inflammation of the venous wall and paravasal tissue are determined and, under ultrasound control, to these places injected with a syringe at an angle of 30-45 degrees once 10 ml of a medicinal mixture containing 4 ml of dexamethasone, 5000 IU of heparin and up to 20 ml of a 0.25% solution of novocaine .

The technical result of the invention is to stop the inflammation of the venous wall, thrombosis and pain, contributing to a more rapid regression of the symptoms of thrombophlebitis and recanalization of the venous lumen.

The choice of the dosage form and its constituent substances is due to the fact that:

a) novocaine has a short analgesic effect for 0.5-1 hours, necessary for painless manipulation; b) dexamethasone - has a pronounced anti-inflammatory and desensitizing effect, a more prolonged effect compared to hydrocortisone, the half-life of dexamethasone (the main anti-inflammatory component) is 190 minutes, and the duration of the biological effect is 17-28 days; c) heparin at the indicated dose lasts 8 hours and is necessary to prevent the buildup of a blood clot in the vessel during manipulation; it begins to act from the moment of administration and during the time the drug mixture is present in the affected area, blocking the thrombin biosynthesis; decreasing platelet aggregation; inhibiting the activity of hyaluronidase.

In patients with deep vein thrombosis, an ultrasound examination of not only deep veins, but also of paravasal fiber is performed to detect places of its inflammation. A drug mixture is prepared by mixing the above components in a 20 ml syringe, without taking into account any sequence, in a ratio calculated on the basis of average therapeutic dosages of the drugs. The resulting mixture is injected paravasally once per course of treatment under ultrasound control by a puncture method at an angle of 30-45 degrees into the zones of the most pronounced inflammation of the venous wall and paravasal tissue, followed by ultrasound monitoring after 1 day, 3 days, 14 days, 1 month, 6 months. If the angle of injection of the syringe is less than 30 degrees, unsuccessful puncture is possible due to severe edema and subcutaneous fat, with an angle of more than 45 degrees, the risk of injury to the vein wall increases. If, with ultrasound monitoring, severe inflammation of the venous wall and paravasal tissue persists, the administration of the drug mixture must be repeated.

The method is as follows.

Upon receipt of a patient with deep vein thrombosis, an ultrasound examination of the deep veins and paravasal tissue is performed. The sites of the most pronounced inflammation of the venous wall and paravasal tissue are identified, which subsequently sprout elements of the connective tissue and lead to occlusion of the venous segment. Under ultrasonic navigation, a drug mixture is introduced into these places, consisting of 4 mg dexamethasone, 5000 U heparin, 0.25% novocaine solution up to 20 ml. Usually, the sites of the most pronounced inflammation are located in the area where the large venous tributaries flow into the main vein.

An example of the method:

Patient B., aged 67 years old, was hospitalized in the department of vascular surgery in Orel on 02/07/17 with complaints of bursting pain in the right lower limb to the level of the inguinal fold, sharp swelling of this limb, positive symptoms of Homas and Moses, cyanosis of the right lower limb , expansion of saphenous veins. Clinical diagnosis: deep vein thrombosis of the leg and thigh with a transition to the iliac vein, the duration of the disease is 9 days. 02/07/18. a thorough ultrasound examination revealed occlusal thrombosis of the popliteal and femoral veins. The most pronounced inflammation of the venous wall is located in the femoral vein slightly proximal to the inflow of the deep vein of the femur in the inguinal region and at the confluence of the tibial veins with the formation of the popliteal vein in the popliteal fossa. 4 mg of dexamethasone, 5000 IU of heparin, 20 ml of 0.25% novocaine solution were mixed in a syringe. After treatment of the inguinal region with an antiseptic (5% alcohol solution of iodine), 10 ml of the drug mixture was injected paravasally into the projection of the femoral vein under ultrasound guidance. The patient was turned on his stomach, the popliteal fossa was treated with an antiseptic, and under ultrasound navigation, 10 ml of the drug mixture was injected paravasally into the projection of the popliteal vein. After 1 day, a control ultrasound was performed. The patient notes a decrease in pain on the thigh, a decrease in edema of the right lower limb. A decrease in venous wall inflammation and paravasal edema has been reported. After 3 days, a control ultrasound was performed: inflammation of the venous wall and paravasal tissue is weak. After 14 days, a significant regression of the clinical symptoms of deep vein thrombosis was noted: the pain syndrome was stopped, swelling decreased by 2 times. During the control ultrasound, inflammatory changes in the venous wall and paravasal tissue are not recorded. Thrombotic masses in the lumen of the vein became less dense. The patient was discharged from the department with the appointment of rivaroxaban - an indirect anticoagulant drug, according to the instructions for its use. Examined after 1 month. There are no complaints, performs homework, notes a slight swelling of the right foot in the evening. During the control ultrasound, the presence of blood clots in the lumen of the deep veins of the right leg is not determined. Rivaroxaban is canceled, it is recommended to wear an elastic stocking.

In this way, with the informed consent of the patient, 10 patients with deep vein thrombosis of the lower extremities were treated. All patients registered a positive effect.

Thus, the proposed method allows to increase the effectiveness of treatment due to the introduction of the drug mixture under ultrasound navigation to the sites of the greatest inflammation of the venous wall and paravasal tissue, which prevents the development of connective tissue elements with subsequent occlusion of the vessel, reduces the frequency of administration of the mixture and, as a result, injection complications .

Claims (1)

A method for administering to patients with deep vein thrombosis a drug mixture containing a glucocorticosteroid, heparin and novocaine, using a syringe, characterized in that previously, using ultrasound, the sites of the most pronounced inflammation of the venous wall and paravasal tissue are determined and, under ultrasound control, a syringe is injected into these places under at an angle of 30-45 degrees, once 10 ml of the medicinal mixture obtained by mixing 4 ml of dexamethasone, 5000 IU of heparin and 20 ml of a 0.25% solution of novocaine.