Treatment of trophic ulcers |
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IPC classes for russian patent Treatment of trophic ulcers (RU 2170093):
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(57) Abstract: The invention relates to medicine and can be used for the treatment of trophic ulcers of lower extremities in people with advanced forms of the disease. On the surface ulcers daily dressings with active substance and then placed in an isolation cell at 50 - 60 min with the supply of the ozone-oxygen mixture. Within the first 5 to 15 minutes maintain a pressure of 2.5 kPa and in the next 5 to 15 minutes to create the negative pressure of 2.5 kPa. The session provided by 4 - 5 cycles with changes in pressure in the isolator. At the end of the session injected subcutaneously around the edge of the ulcer ozone-oxygen mixture in the amount of 40 - 60 cm3with ozone concentration of 2000 µg/l and intravenous ozoneresistant solution of sodium chloride daily until the end of treatment. Even before epithelialization as active substance use soaked in hypertonic solution of sodium chloride enterosorbent. Hypertonic solution of sodium chloride pretreated 25 - 30 min ozone-oxygen mixture with ozone concentration of 5000 µg/L. At the end of the session in the insulator on top of the enteric dressings with pre-saturated with ozone at a concentration of 4000 - 5000 µg/l with an antiseptic. After the emergence of e the ozone with a concentration of 5000 µg/l for 4 h vegetable oil. The method allows for the rapid suppression of the microflora of superficial and deep layers ulcers, rapid cleansing of the ulcer surface, to eliminate local tissue hypoxia. 2 C.p. f-crystals. The invention relates to medicine and can be used in particular for the treatment of trophic ulcers of lower extremities in elderly and senile patients with advanced forms of the disease. Modern methods of treatment of venous ulcers in all age groups of patients suggest a complex effect on the pathologic lesion of modern antiseptics, laser therapy [1], magnetic therapy [2], red light [3], etc. The presence of contamination trophic ulcers of mixed bacterial flora, with high virulence and resistance to most antibiotics, greatly complicates local treatment. The presence of severe local tissue hypoxia difficult reparative processes and increases the duration of treatment of trophic ulcers. Therefore, to shorten the period of treatment of trophic ulcers and partial elimination of the above disadvantages as a therapeutic agent applied ozone [4]. So, for the treatment of trophic ulcers of the lower con and serves ozone at a concentration of 1500-2000 mg/l for 15-20 minutes daily, pursuing the course of treatment of 15-20 procedures [5]. The closing of trophic ulcers in this way reaches 50-60%. And if on the surface long-existing ulcers large number guaino necrotic plaque impossible to carry out rapid cleansing of the wound surface from microbial cells and to provide a bactericidal effect of ozone on the depth of the affected tissues. The closest in technical essence and the achieved result selected by the authors as a prototype, is a method of treatment of wounds and ulcers, in which a pathological area placed in a detention center, include the mode of ozone therapy given parameters (24 μl/ml) with exposure time of 10 min, then include the aeration mode, conducting sessions daily until wound healing [6]. There is a method allows using bactericidal properties of ozone, the local suppression of pathogenic microorganisms at an early stage of the disease in groups of patients young and middle age. However, treatment of patients of elderly and senile age with advanced forms of the disease, and other pathologies, in particular violations of the arterial and venous circulation, in a known manner is ineffective. Poeticheskogo age with advanced forms of trophic ulcers of the lower extremities, which is not shown surgical treatment. The problem is solved in that in the known method of treatment of trophic ulcers, including pathological isolation zone from the environment and exposed to ozone, in accordance with the proposed technical solution, daily before the insulation on the surface of the ulcer dressings with active substance, then put it on 50-60 min frame plastic insulator, which serves the ozone-oxygen mixture and where within the first 5-15 min support pressure of 2.5 kPa, and in the next 5-15 min generate a vacuum of 2.5 kPa, realizing for the session 4-5 cycles of pressure change in the insulator, at the end of treatment in prison injected subcutaneously around the edge of the ulcer ozone-oxygen mixture in the gas phase up to 40-60 see cubic when the ozone concentration of 2000 ág/l, and carry out intravenous infusion etnonacional solution of sodium chloride daily until the end of treatment with saturating concentration of 3000 mg/L. Until epithelialization of the ulcer surface as the active substance use enterosorbent, which is kept in a hypertonic solution of sodium chloride, treated for 30 min ozone-oxygen mixture with the oxygen the LC with antiseptic, pre-saturated with ozone at a concentration of 4,000 to 5,000 µg/l, and after the appearance of epithelization as active substance use ozonated olive oil, processed by passing through ozone with a concentration of 5000 µg/l for 4 h Until epithelialization of the ulcer surface in the insulator serves the ozone-oxygen mixture with ozone concentration of 5000 µg/l, and after the appearance of epithelization the ozone concentration is maintained at the level of 1000 µg/l until the end of treatment. Application of dressings with enterosorbent, processed in a hypertonic solution of sodium chloride by passing through the ozone-oxygen mixture, greatly increase the antibacterial effect of sorbent on the wound, change in a positive way the actual reaction of the medium wounds, improve local blood oxygenation ulcers, which complicates vegetariana anaerobes, strengthen local anti-inflammatory effect of sorbent and to increase the speed cleanse the wound. The parameters of the processing mode enterosorbent chosen empirically. It was found that the ozone concentration less than 4000 µg/l significantly slows down the speed of the cleansing of the ulcer over the ysenia sorbent ozone. Ozone concentrations above 5000 µg/l and the processing time of over 35 min to maintain impractical. These data were controlled using bacteriological methods. Mode settings stay limbs with trophic ulcer in the insulator with different concentrations of ozone are also selected empirically. The ozone concentration of 5000 µg/l and the duration of the session ozonation less than 50 min, especially in the presence of microbial associations, led to incomplete rehabilitation of trophic ulcers and increased duration of treatment, and the reduction in the percentage of full recovery. These observations are confirmed by bacteriological and cytological studies. Fastest sterilization ulcer surface occurred at ozone concentration of 5000 µg/l, exposici in a plastic insulator for 50-60 minutes maintaining the concentration of 5000 µg/l in prison after reaching bacterialwaste ulcer surface was led to a slowdown in the rate of epithelialization of the ulcer surface. Therefore, the optimal daily rate of epithelialization (8-10%) was achieved when the ozone concentration of 1000 ug/l The parameters of pressure changes in the plastic frame insulator also picked up experience in microvessels according to the method. A negative pressure less than 2.5 kPa provides optimal draining ulcer surface on the depth of the lesions. The volume injected subcutaneously ozone in the gas phase around the perimeter of the ulcer is due to the fact that greater amount entered simultaneously, can cause temporary local ischemia of the layout area ulcers. The search for sources of scientific, technical and patent information, as well as the analysis of the selected materials have shown that there is no information about the treatment of trophic ulcers of the lower extremities of the proposed method. Therefore, the authors believe that this solution meets the criteria of paternopoli: "novelty" and "inventive step". Our proposed method is as follows:At the beginning of treatment to the surface of trophic ulcers impose a napkin, which was placed granular sorbent FAS-2 in the amount of 15-30 g (depending on the area of ulcer surface) of a layer thickness of 4-5 mm Enterosorbent was pre-treated with 500 ml of 10% solution of sodium chloride bubbling method the ozone-oxygen mixture with ozone concentration of 5000 µg/l for 30 minutes Changing dressings with the sorbent asustray tightness created by the imposition of the obturator above the location of the sores. This chamber through the gas of the traces connected to the generator of medical ozone on the one hand, and on the other hand to medical vacuum device to get it reduced pressure. With the third track, the camera was connected to manovacuummeter for registration of the change of pressure in it. Session outdoor ozone therapy was carried out for about 50-60 minutes twice a day. In this period of time every 10 min positive pressure in the chamber was replaced by the regime of vacuum for the next 10 minutes with residual ozone concentration of 5000 µg/l After removal of the camera on the ulcer surface superimposed over the enterosorbent bandage with ozoneresistant with an antiseptic solution (furatsilin, dioxidine, BALIS-2), which had been bubbling saturation of ozone at a concentration of 4000 mg/l within 30 minutes When expressed epithelialization ozone concentration was decreased to 1000 µg/l and a reduced pressure in the chamber within 3-4 days decreased to 0.5 kPa. With the full cleansing of the ulcer surface from purulent-necrotic strikes and the emergence of Mature granulation tissue, before epithelialization instead of enterosorbent after a session of outdoor ozone therapy was applied bandages from osherow is within 4 h In order to reduce local tissue hypoxia in the area of trophic ulcers were applied after each treatment ulcers ozone in a plastic insulator subcutaneous injection of ozone in the gas phase around the ulcer, away from the zone of infiltration by 1.5-2 refer to the ozone Concentration in the syringe does not exceed 2000 mg/l, and the volume of 60 cm cubic In addition to the specified local treatment of all patients from the first day until the end of the treatment received intravenously of 250.0 ml etnonacional solution of sodium chloride at a concentration of ozone 3000 µg/l daily to detoxify. This method was applied to the Nizhniy Novgorod regional clinical hospital for war veterans in 42 patients of elderly and senile age from 61 to 84 years. Of these women, 12 (35%), men 30 (65%). This number of patients with trophic ulcers appeared on the soil of venous insufficiency in 82%, 16% as a result of arterial insufficiency and 2% as a result of injuries. The duration of the ulcers from 2 to 30 years. In 8% of patients were previously plastic surgery of the skin, after which those terms were formed recurrence of ulcer. All patients are often treated with conventional methods. Estimated dynamics of the following indicators: speed is I complete epithelialization of the ulcer surface. As a result of treatment revealed that the cleansing of the ulcer surface came to 7-8 days, that is for 3-4 days earlier than conventional methods of treatment. The absence of bacterial growth when planting with ulcerative surface occurred at 6-7 day that for 3-4 days earlier than using modern local antiseptics. Drew my attention early and complete disappearance of pain (for 4-5 days), while conventional methods of conservative treatment the pain disappeared only to the end of treatment or after its termination. The rate of epithelialization in the process of treatment was increased to 12.5% per day, whereas according to the literature, when the conventional treatment it is no more than 8-9%. Complete epithelization of our patients came to 24-26 days after the start of treatment. A case history: Patient M., 73 years, history 101, participant of the great Patriotic war, he enrolled in the Regional clinical hospital for war veterans 27.06.94 with a diagnosis of trophic ulcers of the lower third of the left tibia on the background of venous insufficiency of the blood vessels. Atherosclerosis of vessels of heart and brain. Coronary heart disease (CHD III). Pneumosclerosis, pulmonary heart disease (DN-II). History: shrapnel wound in l the STI. Trophic ulcers first appeared in 1964, Repeated local treatment of venous ulcers has led to the closure of the ulcer for 2-3 months. In 1990 he formed two ulcer area of 12 square cm and 15 square see this time, despite continuous treatment, the ulcer was not closed and had a tendency to increase. Examination: the left leg is slightly enlarged, the skin crimson, to the middle third of the leg marked hemosiderosis blotches in the skin. Visible extended venous network, with expansion up to 0,8-1,0 see In the lower third of the left tibia on the inner surface of the two ulcer size 10 and 20 square see with irregular raised edges. The ulcer is covered with a grayish tinge and slidearray content. When planting detachable from the selected Staphylococcus, Streptococcus, Pseudomonas aeruginosa, are not sensitive to most antibiotics. The degree of microbial contamination was 107microbial cells in 1 g of tissue. Around ulcers expressed infiltrated inflammatory shaft width up to 2 cm around the perimeter. From ulcers comes putrid smell. The patient complains of pain and constant itching, distance on foot 200 meters. Treatment: on the first day held ligation, powerhoster.com FAS-2. The lower limb is placed in a frame camera, which was supplied to the ozone-oxygen mixture with ozone concentration of 5000 µg/l with periodic variation of pressure with excessive low. This procedure was conducted twice during the day, 55 minutes each. Ozonized sorbent was replaced after 8 hours the first day started intravenous drip of 250.0 ml etnonacional solution of sodium chloride, obtained by ozonation solution with ozone at a concentration of 3000 mg/L. Twice a day after ozone in the chamber subcutaneously around the ulcer surface was performed by subcutaneous injection of ozone in the gas phase. This treatment is carried out during the first 5-6 days. To 7 days ulcerative surface entirely cleansed from raids, inflammatory roller has decreased in 2 times, gone putrid smell, the pain disappeared on day 5, itching on day 6. In this period the number of microbial cells in 1 g of tissue was decreased to 102. In subsequent days the treatment of ulcers before a session of outdoor ozone was carried out ozoneresistant with furatsilina. Ambient ozone therapy was carried out on 55 minutes in tough reinforced plastic camera in pressed-vacuum mode when the ozone concentration of 1000 µg/L. asle. Epithelialization of the ulcer began with 11 days and ended on the 23rd day from the beginning of a comprehensive treatment. With 7 days with peptic ulcer surface was not inoculated pathogenic flora. The patient was discharged on day 24 with a bandage, which was removed 7 days after outpatient observation. Inspection 12 months: ulcer surface is closed, minor swelling, pain not worried about that distance on foot to 600-800 meters. Thus, the advantage of this method of treatment is as follows: - firstly, in the course of treatment quickly achieved suppression microflora superficial and deep layers ulcers, - secondly, there is a rapid cleansing of the ulcer surface from purulent-necrotic masses, - thirdly, in the treatment process eliminates local tissue hypoxia, which leads to a decrease swelling and rapid disappearance of pain, - fourthly, this method can cure trophic ulcer without the use of antibiotics and cost 3-4 times more profitable method of reconstructive and plastic surgery. The marked reduction of the patient stay in a hospital bed for 10-15%, - fifth, the proposed method allows to obtain a cure in 93-95% of cases, patients with long-term the of is the method of choice in the treatment of trophic ulcers in patients of elderly and senile age since that in this category of patients is difficult surgical treatment due to the presence of severe comorbidity. Sources of information: 1. Koshelev, C. N.,Glukhov E. I., In Charge Of L. N. Treatment WITH 2-laser trophic ulcers and nonhealing wounds. // News, hir. -1985. -N 2.- S. 55-58 2. Sukhotnik I., Comparative evaluation of the efficiency of the DC and AC magnetic fields in the treatment of trophic ulcers. // MPEI Vestnik, hir. -1990. N 6-S. 123-124 3. The Onuchin P., Treatment of trophic ulcers of different etiology and nonhealing wounds with low-intensity non-coherent red light, a photosensitizer is methylene blue. // Abstract. dis.Kida. the honey. Sciences.- Nizhny Novgorod, 1992. -S. 22 4. Wolf H. Das mediz. Ozon. Heidelberg, 1979 5. Rilling,S., Viebahn R. Praxis der Ozon - Sauerstoff-Therapie.-1985 6. A. S. USSR N 1832021, A 61 G 10/04, from 07.08.93 BI N p 1. Treatment of trophic ulcers, including pathological isolation zone from the environment and exposed to ozone, characterized in that on a daily basis prior to isolation on the surface of the ulcer dressings with active substance, then put it at 50 - 60 min in the insulator, which serves oonkilleroo mixture and where within the first 5 to 15 minutes support Alenia in the insulator, at the end of treatment in prison injected subcutaneously around the edge of the ulcer ozone-oxygen mixture in the amount of 40 - 60 cm3when the ozone concentration of 2000 µg/l and carry out intravenous infusion etnonacional solution of sodium chloride daily until the end of the treatment, and until epithelialization of the ulcer surface as the active substance use enterosorbent, which before use is kept in a hypertonic solution of sodium chloride, treated for 25 - 30 min ozone-oxygen mixture with ozone concentration of 5000 µg/l at the end of the session in the insulator on top of the enteric advanced dressings with pre-saturated with ozone at a concentration of 4000 - 5000 µg/l antiseptic, and after the appearance of epithelization as the active substance after a session isolation use of ozonized vegetable oil, processed by passing through ozone with a concentration of 5000 µg/l for 4 h 2. The method according to p. 1, characterized in that the quality of vegetable oil use olive oil. 5. The method according to p. 1, characterized in that, before the epithelialization of the ulcer surface served in the insulator ozone-oxygen mixture with koncentracija treatment.
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