A method of treatment of injuries of the central nervous system
(57) Abstract:The invention relates to medicine, namely to intensive care and neurosurgery, and can be used for the treatment of acute toxic lesions of the brain, followed by endocrinologia. Carry out cleaning of the liquor in vitro by removal of cellular elements, sorption, filtration, sterilization it in closed loop mode. In addition carry out its cooling when passing them detoxifying device. Cooling of the liquor is carried out for 60 to 90 minutes before reducing the temperature of the liquor at the point of intake to 2-3°C. Then support the achieved temperature of the liquor during the entire cleaning cycle of the liquor within 12-17 hours At the rate of passage of the liquor through detoksiciruuschee device is 0.9 to 2.0 ml per minute. The method allows to effectively restore impaired function of the Central nervous system in acute toxic lesions of the brain, as well as to avoid additional toxic damage. 3 table. The invention relates to medicine, namely to intensive care and neurosurgery, and can be used for the treatment of acute toxic lesions of votes is recorded, meningitis and other).So far not developed treatment methods, combining hypothermia brain, providing antihypoxic and antiischemic effects and detoxification, aimed at reducing endotoxemia Central nervous system.The closest technical solution is a method of treating acute toxic lesions of the brain due to the purification of the liquor by removal of cellular elements, sorption, filtration, sterilization him in a constant closed loop mode with speed likvidatsii (A. C. the USSR N. 1500270, 1989, V. N. Pies, O. I. Soloviev, V. Century Peresvetov].The disadvantages of this method include: destruction of cellular elements of liquor without regard to the specific pathogenesis of acute toxic cerebral lesions, which, along with the detoxification of the liquor needed measures to reduce brain metabolism by hypothermia.In addition, the proposed method the rate of perfusion rate likvidatsii has insignificant effect of detoxification.Negative sides method applies an underestimation of the effects and disadvantages of the combined use of the methods of lycoriella is - improving the efficiency of treatment by combined use of extracorporeal detoxification of the liquor and hypothermia brain.This objective is achieved in that during the cleaning liquor additionally carry out its cooling when passing them detoxifying device. This method of treatment of injuries of the Central nervous system includes the treatment of the liquor with the concurrent execution of its cooling when passing detoxifying device. Cooling of the liquor is carried out for 60 to 90 minutes before reducing the temperature of the liquor at the point of intake to 2-3oC, then maintain temperature achieved during the entire cycle within 12-72 h, and the rate of passage of the liquor through a detoxifying device is 0.5-2.0 ml per minute.Comparative analysis of the prototype shows that the proposed solution is characterized by the fact that during the cleaning liquor perform its cooling when passing them detoxifying device. If this is the cooling of the liquor within 60-90 min before decreasing it at the point of intake to 2-3oC. Then reached temperature is maintained throughout the cycle of detoxification within 12-72 hours the Rate of passage of the liquor through a detoxifying device is 0.5-2.0 ml per minute.Cakewedding analysis of patent and literature the authors found, the proposed technical solution has features that distinguish it not only from heat but also from other technical solutions in this and related fields.Known methods of selective cerebral hypothermia [Soghomonyan S. A., Salolikin C. I., A. Lubnin Y. // Anesthesiology and resuscitation - 1996. - N. 2. - S. 90 - 92.]:
1. Cooling of the brain through the outer skin of the head.2. Extracorporeal cooling of blood flowing to the brain.3. Perfusion of cerebral ventricles chilled solutions.Cooling of the brain through the outer skin of head [Radushkevich C. L. Craniocerebral hypothermic perfusion crosslease fluid in terminal States. -Irkutsk. 1985. - S.] cannot solve problems at the local cooling of the brain, as it is a mediated way, and on its way cold factor meets at least two serious obstacles:
Bone formation in the skull with high thermal insulation properties;
The network of blood vessels with significant deploymeny potential.In cool blood apply large doses of anticoagulants, in connection with alogia and resuscitation - 1996. - N. 2. -S. 90-92].The most promising method of perfusion of the cerebral ventricles chilled saline solutions proposed Golovin A. P. [Golovin, A. P. // Bulletin of experimental biology and medicine. -1948, no.26, - N. 1. - S. 68 - 70]. However, for cerebral hypothermia used electrolyte solutions, which has toxic effects on brain tissue [Lataste x, Vandendriessche M, Castel J. P., F. Cohadon Etude d, a,um liquide cephalo - rachidien artificiel //Neurochrugie (Paris).- 1980.- V. 26.- N. 3.- P. 201-220.].In the available literature is not found ways where selective cerebral hypothermia is used, the cooling of the circulating liquor, thereby providing immediate hypothermia brain with the maximum physiology. Was not greeted and offered by us to enhance the recovery of Central nervous system function method combined use of hypothermia of the liquor and its detoxification by filtration or sorption. We offer modes allow you to increase the efficiency of treatment of patients with lesions of the Central nervous system.Consequently, the proposed tonic solution meets the criterion of "inventive step".This method can be used in neurosurgery and Rea is streammachine disease, and therefore, the method corresponds to the criterion "industrial applicability".The method is as follows. Is puncture and catheterization of the subarachnoid space in two points. The intake of liquor occurs through the overlying access, and reset after cooling and filtering (sorption) in the downstream catheter. The flow of cerebrospinal fluid in the filtration or sorption column and its movement through a closed circuit at a rate of 0.5-2.0 ml/min, at the expense of the vacuum created roller pump.Cooling and detoxification occurs through the passage of pathological liquor through a cooled detoxifying device that is placed in a hermetic refrigerating chamber. For cooling use plastic cooling chamber in which the refrigerant circulates. As the refrigerant used running water with a temperature equal to 6-8oC. After rehabilitation cleaned and chilled liquor via IV returns to the subarachnoid space via the underlying access. To control the temperature of the cooled liquor used temperature sensors, thermocouples which one entered into the lumen of the NTA, achieve a gradual reduction of the temperature of the liquor at the point of intake to 2-3oC for 60-90 minutes you Know that the most beneficial on the brain operates this level of hypothermia. Next, the achieved temperature is maintained constant during the entire cycle of liquorous. Thus the procedure is performed continuously for 12-72 hExample 1
Sick Hours, 40 years (N medical history 23707) received PAIR with dz: Severe traumatic brain injury. Fracture of the temporal bone on the left. Subdural hematoma on the left.At admission the patient's condition is extremely serious. Coma II Pupils S > D, the reaction of pupils to light is absent. Right-sided hemiparesis, to plegia in the leg. Bilateral symptom Babinski.Surgery for health reasons: osteoplastic trepanation of the skull to the left, deleting subdural hematoma (100 ml). After the operation was transferred to PETER on prolonged mechanical ventilation.In the absence of positive dynamics within days of a patient's resuscitation decided to spend prolonged lycoriella parallel hypothermia brain.The Protocol surgery
In aseptic conditions under locally the CSOs space in the interval L2-3. Lycoriella through the filter Kobe-400, placed in a sealed plastic chamber with a sampling of cerebrospinal fluid from the lumbar subarachnoid space and return in greater occipital tank. Speed liquorous 2 ml per minute. To column liquor intensely red, after slightly pink.Simultaneously with liquiritia started cooling filtration column temperature measurements drains cerebrospinal fluid from the large occipital tanks, which at the beginning of the procedure was $ 37,1oC. the temperature of the flowing water 10oC. After 60 min reduced the temperature of the flowing fluid to the 35oC. the temperature of the coolant is increased to 28oC. In this mode:
coolant temperature - 28oC;
the temperature of the flowing liquor 35oC;
speed liquorous - 2 ml / min;
the operation was carried out for 12 hoursPerformed measurements of CSF pressure: 1 h 180 mm of water.art., 3 h - 170 mm water.art., 6-th h - 120 mm of water.article.Analysis of CSF are shown in table 1.12 h after LF with hypothermia marked improvement in neurological situation, which resulted in mind coatline breath.Later the patient was discharged from hospital with minimal neurological deficit. Mild right-sided hemiparesis that do not have a significant impact on the movement of the patient. Opticheskih no violations. Intellectually saved.Example 2
Patient I. , 28 years old (N medical history 25843) received PAIR with RS: Right-sided pneumonia. Secondary purulent meningoencephalitis.At admission the patient's condition is extremely serious. The spoor. Pupils S=D, the reaction of pupils to light sluggish. Bilateral symptom Babinski.General analysis of cerebrospinal fluid for admission: lymphocytosis 3241106/l, protein - 2.85 g/L.In the absence of positive dynamics within 3 days, with a massive intravenous antibiotic therapy prolonged lioresalbuy parallel hypothermia brain.The Protocol surgery
In aseptic conditions under local anesthesia produced puncture and catheterization greater occipital tanks and lumbar subarachnoid space in the interval L4-5. Liquorice through the column with sorbent CKH-2k, placed in a sealed plastic chamber with a fence cerebrospinal fluid of greater occipital C column liquor turbid, after considerably more transparent.Simultaneously with liquiritia started cooling filtration column temperature measurements drains cerebrospinal fluid from the large occipital tanks, which at the beginning of the procedure was $ 38,0oC. the temperature of the flowing water 11oC. After 90 min, reduction of the temperature of the flowing fluid to the 35oC. the coolant Temperature is increased to 26oC. In this mode:
coolant temperature - 26oC;
the temperature of the flowing liquor 34-35oC;
speed liquorous - 0.5 ml per minute;
the operation was performed within 72 h, with minimal disruption to the change of the sorption column.By the end of the procedure, the consciousness of the patient has recovered to moderate stun. Adequate. Indicators of liquor are shown in table 2.After 8 days after admission the patient was withdrawn from the intensive care ward without neurological deficit on the aftercare and rehabilitation therapy.Just made 7 operations detoxification parallel hypothermia in 7 patients with severe traumatic brain injury (5 people) and purulent meningitis (2 patients). Efficiency Yes the P> Thus, the proposed method for the treatment of brain injuries allows more efficient to restore impaired function of the Central nervous system in acute toxic lesions of the brain, along with measures to reduce the metabolism of the brain must be active detoxification, which is achieved by the inclusion in the way of methods lycoriella or lioresalbuy. In addition, application for immediate cerebral hypothermia of autorequire avoids additional toxic damage of the CNS that will occur when using other fluids. Forced perfusion through the subarachnoid space of the cooled liquor in a continuous closed loop ensures constant hypothermia under temperature control.The proposed method can be used in clinical practice. A method of treatment of injuries of the Central nervous system, including cleaning of the liquor, characterized in that during the cleaning liquor additionally it is cooled by passing them detoxifying device, and the cooling of the liquor is carried out during which the temperature throughout the cycle for 12 - 72 h, and the rate of passage of the liquor through a detoxifying device is 0.5 - 2.0 ml per minute.
SUBSTANCE: method involves conducting bougie through the liver. Flexible tube is attached to its end and set in bile ducts. Flexible radio-opaque conductor is introduced through the flexible tube. The tube is removed. Draining tube is introduced along the conductor from porta hepatis to its diaphragmatic surface into the ducts to be drained.
EFFECT: reduced risk of traumatic complications.
SUBSTANCE: method involves puncturing pyogenic abscess cavity under ultrasonic control with draining tube left therein. Laparoscope connected to monitor unit is introduced into abscess cavity. One of introduced drains is set in upper point of the cavity and the other one in lower point. The abscess cavity is filled with ozonized solution to 2/3 of its volume and bubbled with ozone-oxygen mixture during 2-3 min changing the solution until it becomes transparent. The emptied cavity walls are treated from distance of 3-4 cm with laminar airflow heated to 38-40°C under pressure of 1-1.5 atm during 2-3 min. Next to it, the cavity walls are irradiated from distance of 2-3 cm with non-coherent red light during 2-3 min per each area.
EFFECT: improved safety conditions and healing quality.
FIELD: medical engineering.
SUBSTANCE: device has suction tube having lateral openings and irrigation tube. The irrigation tube is connected to jet-action atomizer. The atomizer is hollow collapsible cylinder with holes. Ultrasonic radiator having conductor to ultrasonic frequency oscillator is available in the cylinder. The radiator and conductor enable one to introduce ultrasonic oscillations into antiseptic solution.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves puncturing pyogenic cavity with trocar having blunt obturator via skin incision made outside of abscess boundary having length equal to arthroscope diameter. Then, arthroscope is introduced and the cavity is filled with physiologic saline. Pyogenic cavity revision is carried out under arthroscope control, irrigation cannula is set, constant water medium is created. Arthroscopic mill on shaver handle is introduced via another skin incision. Non-viable tissues are removed with stage-by-stage hemostasis using endocoagulator. The cavity is healed. Perforated draining tube is set under arthroscope control. Tube ends are brought out through pierces outside of the cavity and sutured to skin. Active suction of wound exudates is carried out using closed vacuum drain system in postoperative period. The drainage is removed when cleaning the wound from wound microflora and single sutures are placed.
EFFECT: enhanced effectiveness of treatment.
FIELD: medicine, abdominal surgery.
SUBSTANCE: the present innovation deals with treating patients in case of destructive forms of pancreatitis. One should lance a gastro-colic ligament, mobilize splenic and hepatic angles of large intestine, tighten a middle colic artery, descend mesenteric root cross-sectionally against a colon, dissect parietal peritoneum along the upper and lower edges of pancreas to withdraw it into abdominal cavity, remove necrotized tissues. Then one should apply a rubber balloon with drainage tubes along its upper and lower edges into omental cavity: one balloon's end should be withdrawn through median wound, another one - through contra-aperture being 5 cm below a costal arch along median axillary line. The method suggested enables to form adequate access to patient's pancreas.
EFFECT: higher efficiency of drainage.
6 dwg, 1 ex
FIELD: medical engineering.
SUBSTANCE: device has liquid-permeable porous lining that is to be placed on or in a wound, flexible plastic film having a set of holes distributed over its surface, liquid-impermeable film napkin and connection means. The porous lining has foamed polymer material having interconnecting cells. The plastic film makes contact with porous lining surface and is between wound surface and the lining when used. The film napkin is placed above the porous lining and is sticky along its perimeter to provide sealing in skin area surrounding the wound. The connection means passes through the film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. Another embodiment has removable wound bandage usable in particular for treating large wounds requiring draining fluids. It has the first porous lining, the second porous lining, elastomer envelope, film napkin and tubular connection means. The first liquid-permeable porous lining contacts the wound and has foamed lining having foamed material based on polymer built of interconnecting cells and isolated transverse holes. The elastomer envelope has the first and the second sheets of elastomer film soldered along their periphery and enveloping said foamed lining. Each of the first and the second elastomer film sheets has spaced-apart holes. The holes in the second sheet are justified with said spaced-apart holes in the first sheet. The second liquid-permeable porous lining is to be placed under the first porous lining. It has foamed polymer material having interconnecting cells. The liquid-impermeable film napkin is placed above the second porous lining. The first porous lining is placed above the wound. The film napkin is sticky along its perimeter to glue the napkin to skin area surrounding the wound. The tubular connection means passes through said film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. The third embodiment has the first elastomer film sheet having spaced-apart holes deviated from spaced-apart holes in the foamed lining. The second elastomer film sheet has spaced-apart holes adjusted to the spaced-apart holes in the foamed lining.
EFFECT: simplified usage; accelerated wound healing.
15 cl, 3 dwg
FIELD: medicine, surgery.
SUBSTANCE: one should perform decompression of Wirsung's duct with the help of silicone instrument or catheter in case of pancreatogastrostomy in the course of pancreatoduodenal resection. Moreover, the above-mentioned instruments should be fixed in anastomosis with one of the sutures in internal row, their free ends should be loosely located in the stomach and tightened to caprone ligature to be then withdrawn through patient's nose. In 7-10 d either silicone instrument or catheter should be removed due to pulling by caprone ligature. The innovation enables to decrease the risk in the failure of pancreatogastroanastomoses and post-operational pancreatitis.
EFFECT: higher efficiency of draining.
FIELD: medicine, surgery.
SUBSTANCE: at the end of the main stage of operation conducted one should perform paravertebral Novocain blockade by puncturing the sheath of m.erector trunci, the drainage should be introduced towards lateral edge of m.ilipsoas through paracentesis of lumbar area being about 1-2 cm above ilium's ala at the line made via the end of the 12th rib vertically up to ilium's ala. Retroperitoneal space should be, also, drained. The innovation enables to prevent purulent-septic complications and decrease the pain.
EFFECT: higher efficiency.
1 dwg, 2 tbl
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: uterine cavity should be drained in the course of operation, moreover, irrigator's distal end should be withdrawn through operation wound at anterior abdominal wall, and 2 h after the end of operation uterine cavity should be washed through irrigator with 400 ml of cooled 0.06%-sodium hypochlorite solution at perfusion rate being 200 ml/h, 6 times every 12 h up to 3-4 d; after each perfusion one should introduce 1 g kanamycin directly into uterine cavity, moreover, in case of availability of bacterioid and/or anaerobic flora in uterine cavity according to the results obtained due to pre-operational antibioticogram one should add 100 ml 3%-hydrogen peroxide solution into perfusion solution. The present innovation enables to efficiently sanitize uterine cavity due to intrauterine injection of antibiotics by taking into account antibioticogram performed at all stages of operative treatment.
EFFECT: higher efficiency of prophylaxis.
1 cl, 2 ex
FIELD: medical engineering.
SUBSTANCE: device has lateral holes and is manufactured from absorbable material like polydioxanon. The holes are diametrically arranged in two rows along the whole tube length in chessboard order in the first embodiment of the invention. The absorbable material of polydioxanon is manufactured as threads arranged as reticular mesh grid structure of 12-20 u/cm in building tube walls.
EFFECT: eliminated occurrence of pyo-inflammatory complications.
2 cl, 2 dwg