UA100923U - METHOD OF TREATMENT OF purulent wounds - Google Patents

Abstract

The method of treatment of purulent wounds is to create a sealed aerosol-drainage system over the purulent wound, which combines normoxic therapeutic compression with the simultaneous spraying of a drug aerosol under positive pressure, which is subsequently evacuated (if available) by evacuation.

Description

A useful model belongs to medicine, namely surgery, and can be used to treat a purulent wound.

The generally accepted method of treating purulent wounds is surgical treatment and systemic therapy, in the postoperative period an important role is given to the local drug treatment of purulent wounds under a bandage using combined drugs on modern hydrophilic bases (Shalimov 0.0. Modern drug treatment of wounds: departmental instructions / O.O Shalimov et al. // - K., 2002. - 35 p.).

However, the known method has a number of serious drawbacks that become especially acute in the first phase of the wound process - short-term and insufficient effectiveness of ointments, the need for a systematic change of ointment dressings in the wound, which increases the risk of intra-hospital infection, the impossibility of phased use of drugs, weak release of the active substance , inhibition of the growth of granulation tissue, toxic effect of ointments on tissues in the wound area, their systemic effect, which leads to a negative effect on the wound healing process.

A known method of treating nervous and ENT diseases with normoxic medical compression (NLC). In the proposed method, the NLC session is performed at a small positive pressure - up to 0.15 atm for 10-15 minutes. in a pressure chamber. The therapeutic effect of NLC consists in increasing the formation of biological energy in the form of ATP in every cell of the body and restoring the regulation of microcirculation. (Kazantseva N.V. Normoxic compression in the treatment of stroke / N.V.

Kazantseva // Journal of Neurology and Psychiatry. - 2014. - Mo 8. - b. 42-51; Troll V.G.

Barotherapy and interval hypoxic training in the treatment of sensorineural hearing loss / V.G. Troll, V.V. Vyshnyakov // Bulletin of Otolaryngology - 2009. - Mo 3. - P. 39-42).

Unlike oxygen therapy and hyperbaric oxygenation, NLC does not increase the content of dissolved oxygen in the blood plasma, is not accompanied by hyperoxygenation, and, accordingly, does not cause any harmful side effects.

However, this method is used in portable stationary pressure chambers of general effect, where patients who take drugs orally or parenterally (that is, the general effect of the drug on the body) is affected by positive pressure. However, there is no information in the available literature regarding the local application of NLC. There are many methods of managing a purulent wound in a controlled closed environment (Amiraslanov Yu.A., 1981; Kostyuchenok

B.M., 1986; Svetukhin A.M., 1997; 2006; I.V. Tsvetnenko et al., 1994; Glyantsev S.P., 2001;

V.A. Privalov, 2002), but none of them provides for the combination of NLC with the aerosol method of introducing drugs into a purulent wound, i.e., local simultaneous use of methods of drainage, spraying and sorption of the drug in the wound under positive pressure.

The prototype of the claimed method is unknown.

The useful model "Method of treatment of purulent wounds" is based on the task of increasing the effectiveness of complex treatment of purulent wounds by reducing the duration of the first phase of the wound process.

The task is solved by creating a hermetic aerosol-drainage system over the purulent wound, which combines normoxic medical compression with simultaneous spraying of an aerosol of medicinal substances under positive pressure, which is later evacuated to the outside (into a container) together with the exudate (if present).

The useful model is explained by the drawing, which shows the principle scheme of aerosol-drainage treatment of purulent wounds, where: 1- graduated container with liquid; 2 -- drainage tube;

C - hermetic chamber; 4 - connecting tube; 5- aerosol sprayer; b - connecting tube; 7 - compressor; 8 - wound cavity; 9 - soft tissues.

The method is carried out as follows. The nebulizer generates particles of the specified size of the medicinal substance, which through the drain hole of the caloreceptor or the hole in the antibacterial film enter the hermetic space above the wound. At the same time, excess pressure is created. A drainage tube is placed on the contralateral side of the calorimeter or in the lower extremity of the wound, under the adhesive base (at the bottom of the wound), as an option, the drainage tube is made through a separate incision in the skin in the case of large and deep purulent wounds. The tube is connected to an extension cord or directly to a container with liquid (a used vial of infusion solution with marked divisions). The volume of liquid (height) varies depending on the desired pressure of the aerosol above the wound. When the amount of liquid increases, the pressure of the aerosol in the wound increases. The excess pressure together with the exudate (if present) is evacuated into the container. In this way, we achieve long-term irrigation of the wound with a medicinal substance under high pressure and removal of excess aerosol together with wound exudate at a predetermined pressure value (by adding liquid to the container). When using two-component calorimeters, it is possible to revise the wound, perform necroctomies at any time, without removing the adhesive plate and drainage, and quickly resume the procedure.

The aerosol drainage system consists of the following components: a source of increased pressure - a compressor; variable aerosol sprayers that allow you to adjust the size of the particles (dispersion); airtight chamber above the wound with the function of protecting the surrounding skin; drainage system, which is represented by a polyvinyl chloride or rubber tube, an extension cord (if necessary) and a transparent container with graduated divisions.

To obtain an aerosol, a compressor inhaler (for example, a nebulizer) is used, with a compressor output pressure of 1.5 bar (Biaet Moma Vogea!Yi 400), and variable sprayers Rapidfly - 2 (ВЕ-2), which generates particles in two modes 0.8 -2 μm, and 2-10 μm, KE-4 with particles of 2.73 μm, and KE-6, the average particle size of 1.53 μm. The average pressure at the nozzle outlet theoretically reaches 0.55 bar.

To form an airtight space above the wound, you can use a calorimeter type

SoIoriabi (one- or two-component) with a drain hole that allows you to connect a sprayer (sealed with a reusable clamp). Before use, an outline of the wound is cut out in the adhesive base of the calorimeter, by transferring it from a transparent cellophane film, which is applied to the wound and outlined with a marker. Also, for large and deep purulent wounds, you can use an antibacterial adhesive film of the "Iorap" type, which is pasted along the contour of the wound with the subsequent cutting of a hole for the inlet connecting tube of the sprayer.

Advantages of the method: the speed of achieving a therapeutic effect, especially pain relief (when using local anesthetics); increasing the effectiveness of the drug due to uniform distribution over the entire surface of the wound, and therefore reducing the cost of treatment; absence of a toxic effect of the drug on tissues in the wound area, which is present in the case of the use of concentrated antiseptic agents, minimal systemic effect; treatment is carried out in a natural, moist environment (without excessive hydration or, conversely, dehydration); the possibility of gradually using different medicinal products without mixing them, which reduces the possibility of their mutual chemical inactivation; increased pressure promotes aeration of the wound, eliminates cell hypoxia and opens closed "pockets" in the wound; excess pressure "pushes out" the exudate, thus increasing the efficiency of drainage and accelerating | phase of the wound process; in addition to the effect on the pathological process, positive pressure promotes a constant flow of air from the inside to the outside and thereby prevents the penetration of microorganisms from the environment, i.e. intra-hospital infection of the environment, i.e. intra-hospital infection (in the case of using antibacterial air filters at the compressor inlet).

Example.

The patient, 67 years old, was hospitalized 10 days after the onset of the disease with the diagnosis: "Necrotic phlegmon of the left thigh. Infectious-allergic myocarditis. Diabetes mellitus, type 2, insulin-dependent, severe form in the stage of subcompensation. Diabetic ketosis. Ischemic heart disease. Atherosclerotic myocardiosclerosis, coronary sclerosis, aortosclerosis.

Hypertensive disease of Ii, 2nd century, risk 4. Hypertrophy of the left ventricle. Encephalopathy I". An operation was performed on the patient: "Opening and drainage of phlegmon of the left thigh, necrectomy". In the postoperative period (for 2 days) against the background of general treatment (antibacterial, detoxification, anti-inflammatory, insulin therapy), local treatment of the purulent wound with aerosol-drainage was started method. To obtain an aerosol, a Riajet Moma Vogea! 400 compressor nebulizer was used with a compressor output pressure of 1.5 bar and rapidfly-2 (AE-2) variable atomizers, which generated particles in the 2-10 micron mode. The following were used sequentially for spraying in the wound drugs: 0.25 95 solution of longocaine (5 ml) for the purpose of pain relief; a mixture of hydrogen peroxide: dexasan (1:3), which was alternated with spraying of chymotrypsin (0.01 g). Spraying was carried out twice a day for 15-20 minutes To create a hermetic space above the wound, a one-component open-type SoIoriazi-type calorimeter was used. The drain hole of the calorimeter allowed to connect a nebulizer sprayer that was sealed with a reusable clamp. Before use, the outline of the wound was cut out in the adhesive base of the caloreceptor, by transferring it from a transparent cellophane film, which was applied to the wound and outlined with a marker.

A polyvinyl chloride drainage tube (with a diameter of 5 mm) was passed through a separate hole of the caloreceptor to the distal site of the wound cavity.

After 4 days, the wound exudation decreased significantly (about 10-20 ml per day of serous secretions), which made it possible to proceed to the treatment of the I phase of the wound process and to complete the use of the aerosol-drainage method.

On the 7th day, secondary sutures were placed on the granulating wound, which were removed after 8 days - the postoperative wound healed with the formation of an elastic linear scar.

Claims (1)

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