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 2-3C. 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 h

Example 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 hours

Performed 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.

 

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