RU2016577C1 - Method of treating purulent wounds and burns - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: this method prescribes applying rheopolyglucine solution preliminarily perfused via xenospleen to injured surface in amount of 1.0 to 1.5 ml per 1 cm of wound area. EFFECT: accelerated healing of wounds.

Description

 The invention relates to medicine, in particular to surgery, and can be used to treat extensive superficial and abdominal purulent, as well as burn wounds, including in septic conditions.

 A known method of treating infected wounds by exposure to the wound surface with ultrasound through a layer of a medicinal substance sprayed in the form of an aerosol.

 The disadvantage of this method is the high likelihood of complications, especially with concomitant pathological abnormalities (hypertension, coronary heart disease, cancer, hematological diseases, etc.). In addition, the ultrasound effect is limited in time (5-15 minutes), which does not give the desired effect in the presence of extensive wounds.

 A known method of local drug treatment of purulent wounds, which includes the application of the wound surface with an ointment based on polyethylene glycol (levosin, levomycol, dioxole, 5% dioxidine, quinifurine, etc.).

 The disadvantage of this method is a rather long period of treatment of wounds, especially extensive ones. The average wound healing period is 9-17 days.

 The purpose of the invention is the acceleration of the healing time of wounds. The achieved positive effect is a 5-12-day reduction in the hospital bed-day and a 5-6-fold reduction in the consumption of medicines.

 The essence of the method is as follows. In the treatment of purulent and burn wounds, including those complicated by septic conditions, abscesses and purulent drips, a general detoxification treatment (hemodez, polyglucin daily, 400-450 ml daily), protein solutions (albumin, plasma), antibiotic therapy in the form of antibiotics are carried out various antibacterial orientation of a wide spectrum of action. At the same time, an application is applied to the surface of the wound using a solution of reopoliglyukin previously perfused through the xenosepleen of the pig.

The consumption of xenoperfusate 1.0-1.5 ml per 1 cm ^{2 the} area of the wound. Applications are applied daily for 5-12 days, depending on the area of the wound and the virulence of the pathogen. At the same time, a granulation development rate of 2.5 cm ² a day is achieved on average, the degree of wound infection decreases by 40-50% within 2-3 days, and the effect of adsorption of toxins from the wound is also expressed. The use of reopoliglyukin as a solution during perfusion is due to its properties to restore blood flow in small capillaries, at the site of contact with perfusate. The consumption of xenoperfusate with applications less than 1.0 ml / cm ^{2 is} ineffective. Consumption in excess of 1.5 ml / cm ² does not increase the effectiveness of treatment, but increases the consumption of xenoperfusate. The duration of treatment with xenoperfusate less than 5 days does not give the desired effect, more than 12 days is not advisable due to the occurrence of addiction.

PRI me R 1. Patient H., 49 years old, for 4 months three times operated on the biliary tract. Due to the high post-traumatic stricture of the common hepatic duct, obstructive jaundice, purulent cholangitis, a transhepatic through drainage of the right and left lobes of the liver was performed with the formation of hepatoyunoanastomosis. A postoperative complication - an intestinal abscess with a breakthrough in the abdominal cavity, diffuse fibro-purulent peritonitis: sepsis - required relaparotomy, debridement and drainage of the abdominal cavity. Staphylococcus aureus was sown from the patient’s blood. Suppuration of the surgical wound with the divergence of its edges led to the formation of a deep purulent wound with profuse purulent discharge and the threat of intestinal fistula. Pseudomonas aeruginosa is sown from a detachable wound. Infusion detoxification therapy included intravenous administration of a glucose solution with insulin, hemodesis, alvesine, plasma, albumin, glutamic acid, vitamins C, group B. Antibiotic therapy - kanamycin, ampicillin, hetamycin. Applications for the purulent wound 6 x 5 cm in size were applied with a biostimulating substance, which was used reopolyglucin xenoperfusate obtained by perfusion of an isolated pork spleen. Reopolyglucin xenoperfusate was prepared as follows. In sterile conditions, immediately after the slaughter of the animal, the spleen was taken. After external washing of the spleen with furatsillin solution, the artery and spleen vein were cannulated with teflon catheters. Then they began to wash the vascular bed of the spleen with physiological saline 200 ml + 2500 units. heparin. Spleen delivered in solution "Euro-Collins" at + 4-1 ^{° C} in sterile plastic bags by putting them in a thermos with ice. Upon delivery of the spleen to the hospital, the spleen was additionally washed with physiological saline 100 ml + 2500 units. heparin, bandaged the vessels of the spleen throughout their entire length. Such a spleen is prepared for xenoperfusate. 1 l of reopoliglukin was passed through one spleen to obtain xenoperfusate. The resulting solution can be used for 10 days and stored at a temperature of + 4-1 ^o C.

In this patient, when treated with xenoperfusate, the area of the wound initially was approximately 30 cm ² . The daily consumption of xenoperfusate in the initial period was 1.5 x 30 = 45 ml. The duration of treatment was 12 days. The average wound healing rate was 2.5 cm ² . In the course of treatment on day 3, a decrease in purulent discharge, a wound cleansing was revealed. After the 5th day of applying applications with xenoperfusate, rejection of necrotic tissues, purification from purulent plaque, and growth of granulations were observed. After a 6-day use of rheopoliglukin xenoperfusate, juicy granulations of bright pink color appeared over the entire surface of the wound. On the 8th day, the marginal epithelialization of the wound began, and on the 12th day the wound was completely epithelized. Sowing from a separable wound did not give microflora growth. There were no complications or relapses.

 PRI me R 2 specific implementation of the method.

 Patient A., 50 years old, was hospitalized with a diagnosis of burns of the II-IIIa degree of the lower extremities, general septic state.

The condition at the time of admission was serious. Disturbed chills, a temperature of 39 ^{° C,} pain in the limbs. The area of the burn wound is 80.6 cm ² . Detoxification therapy was carried out (Ringer's solution, hemodesis, native plasma, albumin, glucose solution with vitamin C, insulin, alvesine) and antibacterial (penicillin, gentamicin, cefamizine, kanamycin). On the surface of the burn wound was applied with xenoperfusate reopoliglukin obtained analogously to example 1. The amount of xenoperfusate in the calculation of 1.0 x 80.6 cm ² was approximately 80 ml daily. The duration of treatment is 12 days.

The average wound healing rate was 6.8 cm ² per day. After 12 days, the burn wound was completely epithelized. To control the effectiveness of treatment, smears were taken, Staphylococcus aureus was seeded. On the 5th day, during microbiological analysis of a detachable wound, microflora growth was not detected.

 PRI me R 3. Patient B., 42 years old, was admitted to the surgical department with a diagnosis of post-injection abscess of the right buttock, right thigh. Worried upon admission, high fever, chills, soreness in the buttocks and thighs. Objectively, in the region of the right buttock, a seal of 10 x 12 x 3 cm with the phenomena of hypereminis, edema, fluctuation was determined, in the region of the right thigh, a seal of 5 x 8 x 0 cm with the same local changes. An abscess was performed. After that, from the first day, bandages with xenoperfusate were applied daily for 4 days. On day 3, complete removal of necrotic masses and growth of red juicy granulations was noted, and the general condition and temperature returned to normal. On day 5, the wound was completely epithelized. On the 7th day the patient was discharged to work. Staphylococcus aureus was sown from the wound on the first day. On the 3rd day, microbiological analysis of microflora growth separated from the wound was not detected. General antibacterial therapy was not carried out.

Claims (1)

 METHOD FOR TREATING PURULENT AND BURNING RAS, including applying a medicinal product to the wound surface, characterized in that, in order to accelerate wound healing, a solution of reopoliglyukin, previously perfused through xenosepleen, is used in a volume of 1.0-1.5 ml per 1 cm of the wound area .