The method of thermochemical treatment of burns and lesions of the respiratory tract

 

(57) Abstract:

The invention relates to medicine, to kombustiologiya, and can be used for treatment of burns and chemical lesions of the respiratory tract. Enter in the composition of infusion therapy drug superoxide dismutase in a dose of from 16 to 40 mg and alpha-tocopherol in a dose of from 100 to 300 mg on the background of the reorganization of the tracheobronchial tree, including reorganization of the tracheobronchial tree through the implementation of diagnostic and treatment bronchoscopy with local treatment with antiseptics and mukolitikami. This invention enhances the efficiency of the treatment of burns of the respiratory tract.

The invention relates to medicine, namely to anesthesiology-reanimatology and kombustiologiya, and can be used in the treatment of patients with inhalation injuries.

There are many ways of thermochemical treatment of burns and lesions of the respiratory tract, the main points of which are to provide access of air to the respiratory tract; the reorganization of the tracheobronchial tree in various ways, including the implementation of diagnostic and treatment bronchoscopy; conducting local drug therapy mukali is lnyh ways when bronchoscopy, intrabronchial the instillation of drugs with laryngeal syringe or transnasal catheter and in other ways), infusion therapy (Gerasimov, L. I., Loginov L. P., smolskiy, B., Diagnosis and treatment of burns of the respiratory tract. //Vestnik St.Petersburg University. surgery. - 1979.- So 123, 8. - S. 96-100; Carvajal H. F., Parkes D. H. Burns in children: Transl. from English. - M.: Medicine, 1990. - 510 S.; Kurbanov W. I. Thermal inhalation defeat at burnt: Diagnosis and treatment. Abstract. Diss. D. M. N. - M., 1994. - 36 S.; Abston S. E., Rutan ie, Aghop R. E. Treatment of burns. Inhalatory injury // robl. surg. - 1987. - Vol. 24, 6. - R. 370-384; DiVincenti F. C., Pruitt C. A., Recler J. M. Inhalation injuries // J. Trauma. - 1971, - Vol. 11, 2. - P. 109-117, etc.).

Common disadvantages of all the above methods are relatively low efficacy and high incidence of developing complications.

There is a method of treatment of burns of the respiratory tract, whereby to provide for efficient removal from the surface of the mucous membrane of products of incomplete combustion and accelerated healing before bronchoscopy carry out intravenous administration of unithiol and after the implementation of the reorganization of the tracheobronchial tree antiseptic solution and mucolytics are presented irradiate the affected poverhnostnom treatment of burns of the respiratory tract").

This method has the following disadvantages:

the method does not allow for the elimination of the action of reactive oxygen species generation, which is one of the main pathogenetic factors lesions of the tracheobronchial tree during inhalation injury;

for the implementation of the method requires the presence of the laser, which is not available in most medical institutions of the Russian Federation.

The closest to the essential features is the way in which part of the integrated drug therapy administered large doses of glucocorticoids (up to 3 g per day), administered by intravenous infusion, inhalation, and irrigation of the tracheobronchial tree (Boenko S. K., Polishchuk, S. A., Rodin Century. And. respiratory got burned. - Kiev: Health, 1990. - 136 C.; Kostyuchenko A. L., Gurevich, K. J., Lytkin M. I. Intensive therapy of postoperative complications. - St. Petersburg: Special literature, 2000. - 535 S.; Bernard, G. R., J. M. Luce, Sprung C. L, et al. High-dose corticosteroids in patients with adult respiratory distress syndrome // N. ngl. J. Med. - 1987. - Vol. 31. - R. 1565-1570).

The method has the following disadvantages:

the relatively low efficiency of the method is due to the fact that glucocorticoids do not have dialogue leads to lesions of the mucous membrane of the respiratory tract and lung parenchyma;

- the use of glucocorticoids is not possible to quickly restore the circulation and adequate gas exchange in the lungs;

- the use of large doses of glucocoticoids associated with the risk of some side effects.

The aim of the invention is to increase the efficiency of thermochemical treatment of burns and lesions of the respiratory tract due to the introduction in the complex therapy of drugs with the ability to destroy reactive oxygen species and products of lipid peroxidation.

Superoxide dismutase converts the superoxide anion radical to hydrogen peroxide, which is then destroyed by catalase and the enzyme system glutathione to water and oxygen. Thus, superoxide dismutase prevents the formation of more toxic compared to the superoxide anion-radical reactive oxygen species that damage macromolecules and cells. The introduction of drugs superoxide dismutase also reduces the intensity of the processes of lipid peroxidation. In addition, superoxide dismutase indirectly prevents thrombus formation, disruption of the kinin system, restores the permeability of microvessels and provides other f the ion-radical, that significantly improves pulmonary blood flow and gas exchange. Alpha-tocopherol has the ability to inactivate a different type of active forms of oxygen, singlet oxygen (Delta and Sigma), the resulting "jump" one of the electrons in the oxygen molecule to a higher energy level or as a consequence of the change of the spin of the unpaired electron. Thus, co-administration of antioxidants - superoxide dismutase person and alpha-tocopherol ensures the inactivation of the main types of active forms of oxygen and ensures the recovery of lung function.

Superoxide dismutase person is part of the drug Erised, manufacturing technology which was developed by employees of the State research Institute of highly pure biopreparations (, St. Petersburg). In appearance substance drugs is a white powder, hygroscopic, odourless. The substance is soluble in water and in 0.9% sodium chloride solution for injection. The drug is non-toxic, intravenous LD50is not installed. The use of the drug in clinical practice is permitted on the basis of a registration certificate 97-335-8 (VFS 42-2765-96), vidanov composition of drug therapy in patients with burns and chemical lesions of the respiratory tract administered drugs on the basis of human superoxide dismutase (drug Erised) in doses of from 16 to 40 mg per day of alpha-tocopherol in a dose of from 100 to 300 mg per day. In this case, preparations of human superoxide dismutase administered intravenously and through inhalation (using ultrasonic inhalers), and alpha-tocopherol, intramuscularly or orally. Intravenous preparations of superoxide dismutase add in solutions of crystalloids, glucose and amino acids and is injected intravenously; the speed is from 2.0 to 4.0 mg of enzyme per hour.

Clinical example. Patient a-WA J. G., 48 years old, and. b. 32081 was admitted to the hospital thermal lesions military medical Academy 15.03.1998, with a diagnosis of Combined injuries. Inhalation defeat pairs of methanesulfonamide, chlorine and hydrochloric acid. Chemical burn of acid reagent 18% / I-IIIA degree Linden, torso, upper and lower extremities. Chemical eye burns acid reagent I-II degree. Blast trauma. Multiple shrapnel blind wounds of soft tissues in both legs. From the past history of trauma: the victim was in remedies (filter mask, plastic apron, rubber gloves) and samples were taken from the reactor, in which at a temperature of +70oWith happened chlorination of intermediate products of the synthesis dioksidina. There was an explosion of the reactor. The victim poured hot Himicheskaya stripped off his gas mask, resulting received inhalation defeat. First aid - wash burn wounds running water for 30 minutes. In the clinic thermal lesions delivered after 1 hour from the moment of injury.

The patient complains of pain in wounds, in the sense sore throat, coughing, a large number of mucous sputum. In the initial examination: skin, upper and lower extremities swollen, hyperemic. In the legs there are numerous blind shrapnel wounds. If fibrobronchoscopy made at 11 h 30 min found the following: in the oral cavity and larynx - pronounced edema, hyperemia of mucous, parts whitish-gray color. The glottis is narrowed, thickened vocal cords. The trachea is hyperemic, there are also lots of pale gray. Made mucosa irrigation with 5% sodium bicarbonate solution. Made toilet burn wounds imposed aseptic bandage.

Produced puncture and catheterization of the right femoral vein by the Seldinger started infusion therapy. The patient entered 90 mg prednisolone intravenously, and in the tracheobronchial tree of 100 mg of hydrocortisone. Since 18 hours later, 7 hours after admission), was performed intravenously at the rate of 2 mg per hour (just to the end of the first day the patient received 34 mg of the drug). During the first days twice was carried out by intramuscular injection of alpha-tocopherol (1 ml of 30% aqueous solution). In the following days Erised was injected intravenously from the calculation of 12 mg per day. When performing medical diagnostic bronchoscopy on the following day, it was determined that multiple erosions and submucosal hemorrhages on the background hyperemic mucosa, was diagnosed with erosive endotrophic. Further for trauma smooth, was discharged in good condition after 69 days after injury.

The method of thermochemical treatment of burns and lesions of the respiratory tract, including the reorganization of the tracheobronchial tree through the implementation of diagnostic and treatment bronchoscopy with local treatment with antiseptics and mukolitikami, as well as the implementation of infusion therapy, characterized in that the composition of infusion therapy the drug is administered superoxide dismutase in a dose of from 16 to 40 mg and alpha-tocopherol in a dose of from 100 to 300 mg.

 

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