RU2137506C1 - Implantation prophylaxis of purulent inflammatory complications in cardiac surgery - Google Patents

Abstract

FIELD: cardiac surgery. SUBSTANCE: method includes sterilization of textile clout and placing it into reservoir with saturated solution of alcohol-soluble antibiotic for 24-28 hr. Clout is then removed, dried, and immersed into 10% solution of medicine glue "Sulfacrylate" in high- purity acetone for 2-3 hr, after which it is dried until complete polymerization. EFFECT: prevented complications. 2 ex

Description

 The invention relates to medicine, namely to cardiac surgery and is intended for intraoperative prophylaxis of purulent-septic complications in patients with a high degree of risk of such complications.

 The prototype of the invention is a method of using textile pads in cardiac surgery for suturing (Cardiovascular surgery: Manual. / Auth .: V.I. Burakovsky, L.A. Bokeria; M .: Medicine, 1996, p. - 430).

 The disadvantage of this method is that the gaskets used for septic endocarditis can be a source of infection due to pronounced wick and absorption properties.

 The aim of the invention is the reliable prevention of purulent-septic complications of cardiac surgery, in which there is a need for implantation of additional textile materials in the form of spacers under the seams.

 This goal is achieved by the fact that textile pads are placed for 24 hours in a saturated alcohol solution of an antibiotic or a mixture of alcohol-soluble antibiotics, removed from it, dried in the open air, immersed in a 10% solution of Sulfacrylate glue in chemically pure acetone, then dried to complete polymerization of glue.

 The method of implant prophylaxis of purulent-septic complications in cardiac surgery is as follows. A standard textile flap for receiving gaskets for seams after sterilization by any conventional method is placed in a container with a saturated solution of alcohol-soluble antibiotic in 96% ethanol. The saturation concentration, as a rule, for erythromycin phosphate can be a 40% solution, for chloramphenicol succinate - 7%, tetracycline hydrochloride - 6% solution. A mixture of chemically compatible alcohol-soluble antibiotics in the concentration of their saturation can be used. The optimal exposure time is 24-48 hours, when the antibiotic impregnation of the tissue reaches the maximum possible for each type of material and does not increase further. The antibiotic-treated tissue is removed and dried in the open air at room temperature on sterile gauze wipes. Typically, the drying time does not exceed 10-15 minutes. After that, the flap is immersed in a 10% solution of sulfacrylate medical glue in chemically pure acetone for 2-3 minutes. An increase in the exposure time of a textile flap can subsequently lead to stiffness and brittleness. The flap is removed from the adhesive solution and dried on sterile gauze napkins until the glue polymerizes completely, which is determined by the appearance of a whitish film on the tissue and the absence of adhesion of this film to surgical gloves. A flap treated in this way can be used to make gaskets for seams immediately or placed in a sterile hermetic container, pharmacy bottle, Bix, etc., and stored until subsequent use without loss of antimicrobial properties for a long time.

 Example 1. During an operation to correct an interventricular septal defect under conditions of cardiopulmonary bypass, vegetations were detected from the right ventricle on the interventricular septum at the lower edge of the defect. Vegetation is removed mechanically, the area under the vegetation is treated with an antiseptic solution. The dimensions and anatomical features of the defect allow it to be sutured with U-shaped seams on the gaskets. Previously, a medical felt flap 3 x 3 cm in size, 1 mm thick, which was in the alcohol solution of a mixture of alcohol-soluble antibiotics of erythromycin (30%) and chloramphenicol (7%) for 24 hours, was removed, laid on a sterile gauze and 8 minutes after full evaporation of alcohol, transferred to a container with a 10% solution of sulfacrylate glue in chemically pure acetone. After a two-minute exposure, the flap was again laid out to dry on a napkin. After 3-4 minutes, a whitish film appears, when touched with a hand, the flap does not stick to the glove. From the flap prepared in this way, 4 gaskets of the required dimensions were made, which were used at the seams for the defect. The operation completed in the usual way. In the postoperative period, clinical and laboratory signs of manifestation of septic endocarditis were not noted. Discharged with recovery on the 11th day. During the follow-up examination after 6 months, the data of laboratory and clinical studies of endocarditis were not revealed.

 Example 2. In preparation for a planned operation, a patient with acute septic endocarditis with an aortic valve lesion and an established causative agent of infection (Pseudomonas aeruginosa sensitive to erythromycin), the medical felt flap was treated the day before as in example 1, but 40% erythromycin solution was used for impregnation in 96% ethanol, and after polymerization of the adhesive, the material is placed in a sterile pharmacy bottle with a ground stopper. After 2 days, during the operation, the treated flap was removed from a sterile container, 14 pads were made from it, which are used under the seams to fix the artificial prosthesis of the aortic valve. Postoperative course without complications. From the second day, the body temperature is subfibril, and on the 4th day its complete normalization. Discharged with recovery on the 16th day. During the follow-up examination after 1 month, data for the septic process were not revealed.

 The effectiveness of the proposed method of implant prophylaxis of purulent-septic complications in cardiac surgery has been studied and substantiated as part of a research plan for surgical suture and textile materials with antimicrobial activity of the NGO Bashbiomed, Ufa. A high antibacterial activity of textile pads treated by the proposed method in biological tissues under conditions of main blood flow was established, for which samples of the material were sutured into the aortic walls of laboratory animals with their subsequent removal at different times and the study of antimicrobial activity on standard bacteriological cultures. The term high level of antibacterial activity was 5-7 days with a trace effect of up to 9-10 days. This effect is achieved by the fact that the polymer fixation of the antibiotic in the textile tissue with subsequent biodegradation of the adhesive shell provides a prolonged portioned flow of the antibiotic into the implantation zone of the pad, and the presence of the polymer shell itself gives the pad the properties of pseudo monofilament, which significantly reduces their fit in the first hours and day of the postoperative period.

 This method is applied during 4 cardiac surgery operations in patients with manifestations of septic endocarditis. Postoperative purulent-septic complications were not noted in any case, while the prototype repeatedly noted prosthetic endocarditis. The method can be recommended when performing cardiac surgery with a high risk of purulent complications.

Claims (1)

 The method of implantation prevention of purulent-septic complications in cardiac surgery, including the use of implantable textile materials, characterized in that the textile pads are placed for 24 hours in a saturated alcohol solution of an antibiotic or a mixture of alcohol-soluble antibiotics, removed from it, dried in the open air, immersed in 10% - solution of sulfacrylate glue in chemically pure acetone, then dried until the glue polymerizes.