RU27787U1 - System for the prevention of intestinal paresis - Google Patents

Abstract

System for the prevention of intestinal paresis, including a two-channel probe, a device for infusing blood substitutes and single-use infusion solutions, a container with a nutrient mixture and a dispenser, characterized in that the two-channel probe has free distal and proximal ends, the nutrient mixture is enriched with oxygen, and the dispenser mixture into the small intestine is located on the needle-duct of the container with the nutrient mixture.

Description

(LJ1EMA FOR PUFYLAKTAKI

Intestinal paresis

The utility model relates to medicine, primarily to abdominal surgery, and can be used to prevent the development of nasal-neural pgphesis of the intestine after nasal operations on (phganic cavity).

The problem of prevention of intestinal obstruction after onerations on the organs of the gastrointestinal tract is very urgent, since inhibition of its motor-evacuation function is observed in all patients operated on on the abdominal organs. Intestinal development is most often observed after emergency operations due to acute surgical diseases of the abdominal organs and their complications (destructive appendicitis with peritonitis, perforated gastric ulcer, destructive forms of nmcreatitis, mesenteric thrombosis, restrained hernias with necrosis of the intestine, etc.). In addition, intestinal H1phase often occurs in patients operated on for severe gastrointestinal bleeding, after large and traumatic surgical interventions, in cases of preoperative electrolyte shifts in the body, as well as in young, elderly, and senile patients and even severe concomitant diseases of the kidneys, cardiovascular system, liver and lungs. The development of intestinal H1phase sharply worsens the nornosis of the operation performed, contributes to the occurrence of adhesions in the fusiform cavity, the early sessile

МЖА61 N1 / 36

impassability of the pupil, leads to severe endogenous intoxication, I1fusheia of the functions of the liver, kidneys and other orgaps. In addition, PCs without intestines creates the conditions for translocation of the intestinal microflora through the intestinal wall into the peritoneal cavity, into the portal system of the liver, into the systemic cuvette, and T81 also into the upper sections of the alimentary tract 0. P. Makarenko et al. “Management of the postoperative period in patients with a surgical profile. - M .: Medicine. -1976. - S.157 -158; V.N.Chernov et al. “Portal and systemic bacteremia as a manifestation of the functional failure of the enteric barrier in acute intestinal obstruction - Vesti, chir. -1998. - t. 157. - No. 4.- S. 46 - 49).

The following methods are used to prevent postoperative intestinal P1physis of the intestine: stimulation of intestinal motility with medicaments, fougal decompression of the stomachs of the initial small intestine, prophylaxis of new kain blockade (perinephral, round ligament of the liver, intrathoracic and others), peridural polemic, correction of electrolyte disturbances the volume of circulating 1shove, decreased endotoxemia, hyperbic acid blood oxygenation of patients, reflexology (TP Makareiko et al., ibid., P. 157 - 158; P.V.11etrov, I.A. BRYUKHIN "Intestinal obstruction. - M.: Meditsia. 1989.- S. 72).

Enteral probe nitration with saline and monomer-salt nutrient mixtures also helps to prevent the development of P1phase after emergency operations on the abdominal organs (T. Spopova, Yu.N. Ga11perin, EC. Utesha1I7f. “Probe

nutrition in patients urgently inoculated on the organs of the abdominal ttt: Methodically rvkomendatsnn.- M.-1987.- S. 13-14).

In the native linguistics course, the Snobb for the treatment of post-inferior rifling of the intestine (A.S. No. 1197645, MF A 61 N1 / 36 publ. Bull. No. 46 of 1985), according to which the drug mixture is introduced into the retroperitoneal fiber through a microirrigator. The method is based on the interruption of natological nerve impulses from the intestine by blocking the celiac plexus. There are also known snobs based on electrical stimulation of the intestine. This is a "Snob of electrical stimulation of the motor activity of the gastrointestinal tract (AS No. 430861, MF A 61N 1/36, publ. Bulletin No. 21, 1974)" intestinal tract (AS No. 1243737, MF A 61 N 1/36, publ. bull. No. 26, 1986), "A method for electrical stimulation of the gastrointestinal tract in the nose-neration period (RF patent No. 200414, MF A 61N 1/36 , publ. Bulletin No. 37-38,1993). Also known is the "Method of stimulation of intestinal motility in the postoperative non-period (RF patent No. 2147899, MF A 61 N 1/36, publ. Bull. No. 12, 2000). The essence of this method is that in order to stimulate intestinal motility, patients are sampled from the peripheral vein, undergoing ultraviolet irradiation and additional oxygenation in the oxygenator and returning it to the portal system of the liver through a cannulated umbilical vein. The disadvantage of this method is the difficulty of its implementation: random cannulation of the umbilical vein, blood sampling from the peripheral vein for ultraviolet training and oxygenation. 1 In addition, availability

apparatus for ultraviolet irradiation of blood and oxygenator. All this narrows 1fug of patients who are able to conduct stimulation and intestinal motility in this way.

As you know, in the pathogenesis of postoperative intestinal paresis, circulatory hypoxia of tissues and, especially, the small intestine, leading to severe metabolic fluxes, is important (V.P. Petrov, NA. Eryukhin "(Intestinal obstruction.-M.: Medicine. 1989.- C.34) .In this regard, the improvement of oxygenation of the small intestine is essential in the prevention of postoperative intestines. This is proved by the fact that the use of hyperbolic blood oxygenation helps to restore intestinal motility in the postoperative period. e (N.I. Shulga, I.A. BVTYUKHIN, A.B. Trostinsky "HBO-therapy of postoperative complications in cancer patients. - In the book: Materials of the Fourth All-Russian Congress of Anesthesiologists and Resuscitators. M.-1994. S. 65 The disadvantage of this method is the need to place the patient in a bio-chamber. For this, the patients should be transported to the HBO therapy room and transferred to the camera, which can lead to impaired heart activity (lowering blood pressure, increased heart rate). In addition, the patient should be conscious, not have any mental symptoms, lung diseases, ENT organs and decompensated heart diseases. For HBO therapy, complex training and specially trained training are also required.

As a prototype of the claimed technical solution, a system for the prevention of postoperative intestinal paresis according to the RF patent No. 2029504 “Method of postoperative period management (МЖА61В17 / 00; А61М25 / 00.31 / 00, publ. Bulletin 1" GB 1995) was taken.

the system includes a two-channel probe, consisting of hawala for external decompression of the stomach and a channel for enteral probe ntania. During oneracin, a two-channel probe is installed in the upper part of the digestive canal so that the distal part of the canal for decompression is located in the lumen of the duodenum and stomach for the discharge of irrigation water from them, and the distal part of the canal for enteral probe threading is guided to the initial part of the small intestine. In a nosleoner in the patient’s nasal period, 2-4 hours after noperation, nth fluid begins to flow through the mouth but 30-60 ml per nriem every 10-20 minutes. At the same time, this liquid is poured into the stomach immediately but flows out to the tube for decompression of the stomach. Against the background of a thread of fluid through the mouth, the nutrient mixture is introduced into the small intestine through the second channel, intended for enteral probe threading. The disadvantage of this system is that it is not intended for a constant dosed supply of the nitrous mixture into the gut in the first 3 days after surgery, which is necessary to prevent intestinal tract. Firstly, the introduction of a nitrous mixture into the small intestine while drinking fluid through the mouth is possible only during the patient’s wakefulness. Secondly, in a commonly used infusion system (a device for infusion of blood substitutes and single-dose infusion solutions of HP-21-05 type), the nutrient mixture rate guard is located on the tube through which the nutrient mixture passes to the channel for enteral probe injection. This quite often leads to blockage of the tube with an amniotic mixture and the termination of the latter in the small intestine. In fetish, enter into thin

hshpechnik nutrient snes not hylisfoda so necessary

to eliminate hypoxia in the intestinal wall in the early nose

period. The indicated deficiencies are eliminated in the claimed technical

decision.

The technical task of the proposed utility model is the creation of a large system that would allow for a constant dosed supply of nitrous mixture into the small intestine for 3 days, enriched with oxygen at the rate of L, 1 liter per day at a rate of 15-20 calels per minute. The technical result is achieved by the fact that the system for the prevention of postoperative intestinal paresis contains a two-channel probe, a device for infusion of blood substitutes and single-use infusion solutions of type IIP-21-05, a container with a nutrient mixture and a dispenser. At the same time, the probe contains 2 intranasal tubes, one of which is made with the possibility of introducing it into the stomach, and the other into the patient’s small intestine. The free end of the first tube is installed above the tank for collecting wash water, and on the side surfaces of its distal end located in the stomach there are 2 side openings and one end. The free end of the second tube (for enteral tube feeding) using a device for the injection of blood substitutes and infusion solutions of single use is connected to a container in which there is an oxygen-containing nutrient mixture. The container is connected to a dispenser, which, due to the regulation of the air entering the container, ensures the continuous supply of oxygen supply through the tube for enteral probe feeding into the small intestine with a piece of pitaget mixture with sk (fost 15-20

1 minute kshel in an amount of 1-1.4 liters per day for the first 3 days after the option.

Detailed description of utility model and implementation

The system for the prevention of postoperative intestinal paresis includes (Fig. 1) a two-scalp probe (1), a device for infusion of blood substitutes and single-use infusion solutions (7), a container (9) with an oxygen-containing nitrous mixture (10) and a dispenser (12).

The two-channel probe (1) consists of 2 silicone tubes: one (2) with a diameter of 6 mm and a length of 1.0 m with additional lateral holes (4) 0.8 x 0.4 cm in size at a distance of 10 and 17 cm from the distal end, designed for the outflow of contents and washings from the stomach cavity (5); the second (nutrient) diameter of 4 mm and a length of 1.1 m, intended for the introduction of the nutrient mixture into the small intestine (6). Both tubes are connected to each other over the entire length, except for 5 cm of the proximal end, where the ends of both tubes are free for reliable connection with the extracorporeal part of the proposed system, and for 25 cm of the distal end of the tube (2) for free location in the stomach cavity (5) and thereby ensuring an adequate outflow of contents from the stomach. A two-channel probe is inserted into the upper section of the patient's pathogens during surgery. The free distal end of the tube (2) is placed in the cavity of the stomach (5), the other, nutritional (3), is carried out in the initial section of the small intestine (b). After option 4q) e3, the pipe (2) is washed (5). For this to her

The free outer end is injected with a 20 ml nipple containing Rnngvra solution into the stomach. Then, in reverse, the syringe syringe is sucked out of it. This is repeated 3-4 times, but convinced of a good navigation bridge (2), they are left open for the outflow of the contents of the stomach (5) into the container for collecting non-washed water (15). On a daily basis (every 2 hours) they check the passability of the tube (2) with the help of the same nifnz with Rninger's solution. Then, an oxygen-containing non-nutritive mixture (10) is filled into the device (7) for the introduction of blood substitutes and single-use infusion solutions. To do this, pierce the stopper of the container (9) with a needle through the air duct (11) and push the tip of the needle as deep as possible into the oxygen-containing non-compound mixture. A dispenser (12) is put on the tube of the needle-duct (11) so that the tube is not pinched and air can freely pass through it into the container (9). Then, a ngloi (8) device for injecting blood substitutes and single-wound infusion solutions (7) pierce the container stopper (9) so that the tip of the tuvule (8) is in the oxygen-containing nutrient mixture (10) near the stopper. After that, the container (9) with the oxygen-containing feed mixture (10) is mounted on a tripod and slightly lifting the stool (14) of the device for infusion of 1 substitute and infusion solutions (7) with the flow of the oxygen-containing nutrient mixture (10) fill the entire clearance of this device without air bubbles ( 7) immediately, with the dispenser (12), completely clear the lumen of the duct needle of the duct (11). Then the cannula (14) of the device for the infusion of 1 substitute and ipfusiope solution {ju (7) is connected to

,, -9- :.. ,

to the free probe probe (1) and begin the IODE JIJJ | IddOc6 holding tii (10) into the small intestine (6) / For this, the SHOROK (12) yiie;

 mmi- "oaiq c {nonaj (tlXH 1, capacity X and acid-containing; ayta 1"

it is possible to enter the device jibiB of multifusion solutions of dvdokr1ShoShS1f & less than 1 W t

jf / L - -: i --- ,. --Vg h, .--, .- t., -; - 1- .., t, -.- ,.: j .-- f: i.- V ti-tfi: r J fi. -A-L, .- r iVS ... v,.-.-.

the handset (3) has a two-channel: shndy4ts Vs about “1shch.; p: e the degree of clamping the pipe holders HJUibbJB d count the amount of infusion) set the speed of the drive (eeE1b | C11 | D4 carry (10) equal to 15-20 drop 1 ibutu: in tsh || p1ёSh1g carried out around the clock in tmevi first 3 days Jio

total dose 1.0-1.4 L per day: 1bp1 Iodically (E - in cyilti), patients are monitored for the presence of peristalsis of the jcyTeir abdominal cortex or enterographin. According to the Navy vganyu Shuzho .. peristalsis of the gut with 1 stultation and high jg enterogranma judge about the preservation of peristalsis of the intestine C :: and the absence of it.

Example 1. B-naya Vch, 64 g. (Ii.6. Fir Ш4) department of BSMP No. 1 of Restov-a-g-Doyiu n0 yellow $ g || rch "about intestinal bleeding. With (71goyaviv topper, a serious and general weakness, I am dizzy with tsfyada soberly, that’s TVV.

-. , - .-. . , - - ... .- f -:. . . . ,, v-. . .; -,. ,,.

coffee gushchv, vrv act defekashchvv color AD 12Sh9 RT. Art., impulse 86 in 1 mvvutu, 1 t of fvbrogastrosko vv 1 with a diameter of 1 cm in front of u to Щ1 ЩЩ | 1Ве | и (

the next day, bleeding was recovered. In this regard, the patient was operated on. One performed a resection of the stomach according to Billroth I. During the operation, a two-channel probe was performed in the lumen of the stomach and duodenum. One tube was placed in the stomach cavity to remove the contents and rinsing water. A second tube was passed into the lumen of the duodenum for the introduction of an oxygen-containing nutrient mixture. After surgery, through a tube located in it was washed with Ringer's solution. A good cross of the dunpa tube was revealed. Therefore, it left open the outflow of contents from the stomach. A device for infusing blood substitutes and single-use infusion solutions was mounted and filled with an oxygen-containing nutrient mixture. This device is connected to the end of the feeding tube and, by adjusting the degree of compression of the duct needle of the duct, the dispenser starts the introduction of an oxygen-containing nutrient mixture at a rate of 15 drops per 1 minute at the rate of 1.0 l per day. During abdominal auscultation during this period, the patient experienced weak intestinal peristalsis noises. When electroenterography (Fig. 2, pos. A), wave amplitudes of up to 2.3 mV were noted. The infusion of an oxygenated nitate mixture was continued on the second day after the operation. The peristasis of the gut was higher and weakened. Pa Electroperter about a gram wave amplitude remained within 2.6 mV (Fig. 2, pos. B). On the third day of the introduction of an oxygen-containing nutrient mixture, augmentation of intestinal motility was auscultatively detected, and waves with an amplitude of 4.1 mV were detected with electroenterophaphia (Fig. 2, item c). The Boshni began to independently exhaust gases, and on the 5th nine postoperative period a decorated chair appeared.

-11 Consequently, the phenomena of paresis of the knchechnok did not develop. Sick after 8

B-voy K-v, 37 years old (base unit number 1657) was admitted to the emergency department of the BSMP No. 1 of Rostov-on-Don due to exacerbation of gastric ulcer. He has a history of gastric ulcer for 14 years. 2 times there were bleeding. Marks pain in the epigastrium with nrradnacna in the lumbar region on the right. Pulse 78 in 1 minute, rhythmic blood pressure W / bO mm Hg During a fluoroscopy of the stomach, it was revealed that the vaginal section is deformed, and the contrast is evacuated from the gallbladder after after a short spasm of the pylorus. By its medial contour, a niche with a diameter of 1.5 cm is determined by a depth of OD FM. After preoperative preparation for 7 days, the patient underwent 2/3 resection surgery according to Billroth P in the modification of Hoffmeister-Finsterre. During the operation, a two-channel probe was inserted into the stomach, one tube of which was placed in the stump of the gallbladder, the other (nutritional) tube was passed through the gastroenteroanastomosis into the outlet loop of the skinny scab 20 cm. After the operation, the stump was washed with Ringer's solution through a tube located “in its lumen. A device for injecting 1 substitute and single-use infusion solutions was assembled and filled with an oxygen-containing nutrient mixture, then the aforementioned device and the skinny intestine were connected to the feeding tube continuously introducing the oxygenated nutrient mixture at a rate of 20 drops of 1 minute. The patient received 1.4 liters per day oxygenated nutrient mixture hour 3 consecutive days. In the first sutkn austsschtativno determined at p bowel istaltika

electroenterogime wave amplitude was within 2.4 willows (Fig. 3, pos. a). On the second day, pronounced intestinal motility was noted, and on electroepteroglyms, the amplitude of the wolves increased to 2.9 MB (Fig. 3, pos. B). For the second day’s coccyx, they started to independently exhaust gases; during electro-enterography, an amplitude of 3.6 mV was detected (Fig. 3, item c). On the fourth depot after the operation, an independent chair appeared. The postoperative period was uneventful. Sutures from the surgical wound were removed after 10 days. Thus, the development of intestinal fever was not observed.

Patient So, 46 years old, (i.b. 498) lowered the surgical department of the Rostov BSMP X "1 for peptic ulcer of the duodenum. The patient has signs of ongoing ulcerative bleeding: repeated black stool, pulse 96 in 1 minute, blood pressure 115/75 mm RT. Art. In this regard, he urgently operated. A resection of the stomach was performed according to Billroth P in the modification of Hoffmeister Finster. During the operation, a two-channel probe was inserted into the stomach. One of his tubes was installed in the lumen of the stomach stump for outflow of contents and lavage water from it, the second tube was drawn into the jejunum 25 cm below the gastroenterostomy for introducing the nutrient mixture. After the operation, the stomach stump was washed with Ringer's solution through the tube located in it and it was left open. Through the second tube of the probe, the introduction of a non-oxygen-containing salt nutrient mixture (Ringer's solution) was started, 20 drops in 1 minute, 400 ml 3 times a day for 3 days. On the first day after surgery, intestinal motility was weakened. At the electroenterogram (Fig. 4, pos. A), a reduced wave amplitude of 2.3 mV is determined. Navtsfy day

auscultatory intestinal motility was heard. When electroenterography, the amplitude of the waves remained reduced to 1.8 willows (Fig. 4, nos. B). Because of the occurrence of intestinal rifling phenomena, on the third day after surgery, intestinal motility was prescribed by gyneerbic oxygenation, and the next day, cerucal (2 ml 2 times subcutaneously). After the stimulation performed, intestinal motility began to recover (during auscultation, weak and then more active intestinal murmurs of peristalsis began to be detected). During electroenterography, the wave amplitude increased to 2.5 mV (Fig. 4, pos. C). Therefore, in this case, stimulation of intestinal motility was needed.

A system for the prevention of postoperative intestines was used in 73 patients. A clear success in preventing bowel development was achieved in 67 people. In b observations, the result was not due to the appearance of signs of acute pancreatitis (4 people) and the failure of the sutures of the duodenal stump (2 people) after operations for penetrating into the pancreas of giant duodenal ulcers. During the infusion of an oxygen-containing nutrient mixture into the small intestine, there was no H1fusability of the patency of the device for infusion of blood substitutes and single-use non-infusion media. The dispenser mounted on the tube of the needle-duct ensured the case dosing of the rate of the oxygen-containing nutrient mixture entering the thin

Claims (1)

System for the prevention of intestinal paresis, including a two-channel probe, a device for the injection of blood substitutes and single-use infusion solutions, a container with a nutrient mixture and a dispenser, characterized in that the two-channel probe has free distal and proximal ends, the nutrient mixture is enriched with oxygen, and the dispenser mixture into the small intestine is located on the needle-duct of the container with the nutrient mixture.