Method of conservative treatment of lesions brain crush zone |
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IPC classes for russian patent Method of conservative treatment of lesions brain crush zone (RU 2169562):
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The method of treatment of autoimmune arthritis / 2169560
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The method of treatment of autoimmune arthritis / 2169560
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(57) Abstract: The invention relates to medicine, namely to neurosurgery and neurology. During the first three to five days of intravenous infusions of dopamine at a dose of 2.0 to 5.0 mcg/kg/min While dehydration therapy with 3-5 days on the background of the continuing infusion of dopamine introduction mannitol at a dose of 0.5 g/kg with the addition of 20-40 mg lasixa. The method allows to increase the effectiveness of the treatment. The invention relates to medicine, mainly to intensive care, and can be used in the treatment of lesions crush zone and edema - swelling of the brain. Known methods of intensive therapy foci crush zone brain based on the use of dehydrating therapy - the introduction of osmodiuretiki - mannitol or saluretics - lasix, furosemide. The known method of conservative treatment centers decomposition of the brain, including the introduction of mannitol (1). Mannitol is administered intravenously drip at the rate of 1.0 - 1.5 g/kg Infusion of osmotic diuretics causes a pronounced hypotensive effect, which is manifested in the decrease liquor and intravenous pressure. To ensure the dehydration of the tissue in regulacji water-electrolyte metabolism and cerebral blood flow; the safety function of the blood-brain barrier (BBB). Undamaged parts of the brain these factors manifest themselves more fully, creating preconditions for uneven dehydration in various parts of the brain. However, in areas of the brain with broken GEB osmodiuretiki increase vascular permeability and thereby facilitate the transfer of excess fluid in the tissue, which may exacerbate existing swelling - swelling of the brain. The known method of conservative treatment foci of the crush zone of the brain, including the introduction of saluretics (1). Lasix or furosemide administered intravenously or intramuscularly, fractional 40 - 60 mg Daily dose of 120 to 200 mg. In the treatment of brain edema by saluretics positive therapeutic effect is not due to the direct dehydrating action on the brain, and indirectly, by improving renal function. However, their use is the increased excretion of potassium ions, which can lead to heart disorder. The use of saluretics may be ineffective, as in the first two days after injury more pronounced phenomenon of swelling of the brain. Prototyperaptor the introduction of mannitol at the rate of 1.5 g/kg with the addition of 20 - 40 mg lasixe for prevention of the phenomenon of recoil" (2). As in the first two days after injury more pronounced phenomenon of swelling of the brain and only the third day growing phenomenon of swelling of the brain used a dehydration treatment using emoderation and saluretics is ineffective. The combined use of osmodiuretiki with saluretic not fixes:1. gross effect on brain tissue; 2. the inability to use from the first day after injury and surgery, as it does not eliminate the swelling of the brain, by reducing the BCC and disturbances of electrolyte balance affect the cardiovascular system; 3. the danger of repeated bruising. The invention is directed to a method of conservative treatment of lesions crush zone brain that combat edema - swelling of the brain with the maximum preservation of the structure of brain tissue and mechanisms of regulation of blood flow and metabolic processes. The method consists in the following. During the first three to five days of intravenous infusions of dopamine at a dose of 2.0 to 5.0 mcg/kg/min After days from start of therapy in the presence of persisting in the making "phenomenon returns" introduction mannitol is performed in conjunction with lasix dose of 20 40 mg. The inventive method differs from the prototype in that during the first three to five days to give intravenous drip of dopamine at a dose of 2.0 to 5.0 mcg/kg/min, and in the presence of persistent intracranial hypertension in the last day of the introduction of dopamine additionally use mannitol at a dose of 0.5 g/kg with the addition of 20 - 40 mg lasixa. The use of dopamine as a drug that has vasodilatory effect on the brain vessels, helps to restore the autoregulation of the cerebral blood vessels at lower values of the perfusion pressure of the brain. In damages of the GEB dopamine as a neurotransmitter prevents the swelling of the brain and, thus, contributes to the restoration of the BBB. In addition, dopamine stabilizes the perfusion pressure of the brain by increasing systemic blood pressure and improves renal blood flow and renal excretory function, which allows you to reduce the dose of mannitol. The method is as follows. Intravenously injected dopamine in a dose of 2 to 5 mcg/kg/min Criterion input dose is systemic arterial pressure, which should not exceed 150 mm RT. Art. In severe hypertension dose administered drug mo the of nerve cells. Therefore, after 3 - 5 days from the beginning of therapy on the background of the continuing infusion of dopamine intravenous mannitol, the dose of which is 2 to 3 times less common, that is, 0.5 g/kg Indication for early introduction mannitol is persistent intracranial hypertension. To avoid the "phenomenon returns" introduction mannitol produced in conjunction with lasix dose of 20 to 40 mg. The inventive method of conservative treatment of lesions crush zone brain developed and clinically tested in the clinic the Polenov research neurosurgical Institute them. A. L. Polenov in the treatment of 7 patients with lesions crush zone of the brain of different size, location and degree of intracranial hypertension during January-March 1996, All of these patients after therapeutic treatment were discharged home without surgical intervention in satisfactory condition. For comparison have data for 1995 To the clinic the Polenov research neurosurgical Institute named A. L. Polenov enrolled 16 patients with lesions crush zone of the brain, which was held conventional conservative treatment foci of the crush zone of the brain. Despite treatment, on the second day of 7 patients were operated on, on the fourth day prooperirovana home without surgical intervention in satisfactory condition. Provide examples of extracts from the history of the disease. Example 1 Patient D., 58, I. B. N 261 for 1996 Diagnosis: Closed craniocerebral injury. Brain contusion severe. Subarachnoidal hemorrhage. Foci crush zone posterior right frontal and temporal lobes. Alcohol intoxication. When applying the impairment of consciousness to the level of the spoor. Experienced spontaneous movement in the right extremities. To painful stimulus remained focused defensive reaction, the patient responded the voice, the rotation of the head. Left-side hemiparesis. Eyeballs are fixed in a neutral position. Photoreactive and corneal was absent. Meningeal symptoms are not present. Pathological stop signs. HELL 90-100/60 mm RT. Art. Ps 84 in 1 min. The series of computer tomograms (CT) on admission, the location of the ventricular system is symmetric relative to the centerline. Moderate deformation pole of the right lateral ventricle due to multiple small (2 - 3 cm3) foci crush zone posterior right frontal and temporal pain. The total volume of lesions 10 - 12 cm3. The medulla swollen. According to the claimed method in the first day from the date the camping at the level of up to 140 mm RT.article In connection with anemia were single-group blood transfusion blood in quantities of 500 ml. Diuresis volume was equal to the amount of fluid. On the third day since the introduction of dopamine was observed regression of cerebral and focal symptoms. The level of consciousness regressed to a deep stun. There is agitation. Swallowing is not broken. Face symmetrical. Deviation of the tongue there. Pupils D - 3 mm S - 2 mm, reaction to light on the right is missing, left weak. Corneal low D = S. was slightly limited mobility of the eyeballs in hand, rough paresis of upward gaze. Deep reflexes live D = S. loss of sensitivity pathological ankle symptoms, meninggalnya no symptoms. On the fourth day amid the continuing infusion of dopamine was held dehydration therapy with mannitol at a dose of 0.5 g/kg in combination with lasix dose of 40 mg, fractional. The vital functions of the body during therapy remained stable. After the treatment there has been regression of neurological symptoms. The patient is fully conscious, partially disoriented, not critical. Speech disorders no. The face is symmetrical. G is at his D = 3.2 mm S - 2 mm, reaction to light on the right was absent, left weak. Fully regressed left-side hemiparesis. Muscle tone is normal. Deep reflexes live D = S. Pathological spontaneous reflexes, loss of sensitivity of cerebellar symptoms are not present. On the control CT - ischemic area of the brain substance in the projection of the right frontal lobe - the outcome of the development of small diffuse lesions of the right frontal lobe. Offset median structures not. The patient was discharged in satisfactory condition home on the 18th day. Example 2. Patient, 50 years, and. b. N 336 1996. Diagnosis: Closed craniocerebral injury. Brain contusion severe. Foci contusion of the left frontal and temporal lobe. Subarachnoidal hemorrhage. When applying the impairment of consciousness to the level of the spoor. Psychomotor agitation. On the shout opens his eyes. To painful stimulus untargeted traffic. Of paresis and paralysis no. No speech function. Divergent strabismus. Pupils D = S - 3 mm, photoreactive weak. Corneal D = S low. Eyeballs are fixed in a neutral position. Pathological stop signs on both sides. On CT brain when the post is Ohm (V = 10 cm3and contusion lesions in the left frontal and temporal lobe. According to the claimed method in the first days from receipt initiated the introduction of intravenous dopamine drip at 5% glucose at a dose of 3 mcg/kg/min Diuresis volume was equal to the amount of fluid. On the following day since the introduction of dopamine was observed regression of cerebral and focal symptoms. The level of consciousness regressed to a deep stun. On the shout opens his eyes. Attempts to perform basic commands. Face symmetrical. Deviation of the tongue there. Pupils D = S, remains divergent strabismus. Of paresis and paralysis are not. On the second day since the introduction of dopamine the mind regressed to the level of moderate stun. Began to engage in verbal contact. The monosyllabic answers. The patient is disoriented, secretion. Without focal symptoms. On the fifth day since the introduction of dopamine sick in the mind. No complaints. Oriented. Several Africa. Speech disorders no. Pupils D=S. the Movement of the eyeballs in full. Violations of sensitivity there. Swallowing and foncia not violated. Appearances no. The vital functions of the body at the time of grated day phenomenon of intracranial hypertension regressed. On the control CT - shift of median structures no. Regression contusion. The patient was discharged home in good condition. The advantage of the proposed method of conservative treatment foci of the crush zone of the brain in severe traumatic brain injury is the expansion of the indications for conservative treatment of this pathology, as the use of dopamine improves cerebral blood flow and, consequently, restoring the autoregulation of the cerebral blood vessels at lower values of the perfusion pressure of the brain. Thus, when the damaged BBB dopamine as a neurotransmitter prevents the swelling of the brain, contributing to the restoration of the BBB. In addition, dopamine stabilizes the perfusion pressure of the brain by increasing systemic blood pressure. In this regard, conducting a dehydration therapy on the background of the ongoing infusion of dopamine possible with the use of mannitol at a dose of less common in the 2 to 3 times. Literature 1. Sirovsky E. B. Principles of intensive therapy of brain edema // J. UXO. neurosurgery them. N. N. Burdenko. - 1987 - N 4 - N-9 - 15. 2. Irger I. M. Neurosurgery. - M.: Medicine - 1982 - N-97 - 98 is the introduction of dehydration therapy, characterized in that on the first day, begin the introduction of intravenous dopamine drip at a dose of 2.0 to 5.0 mcg/kg/min, and a dehydration treatment is carried out with 3 - 5 days on the background of the continuing infusion of dopamine introduction mannitol at a dose of 0.5 g/kg with the addition of 20 - 40 mg lasixa.
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