The way to prevent septic complications in the postoperative period |
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IPC classes for russian patent The way to prevent septic complications in the postoperative period (RU 2191014):
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(57) Abstract: The invention relates to medicine, in particular to surgery, and can be used for prophylaxis of septic complications in the postoperative period. For 30 min before surgery injected Mexidol in the dose of 100 mg for 3 days after surgery Mexidol injected intramuscularly at the same dose every 12 hours Method eliminates the use of antibiotics. This increases the efficiency of prophylaxis of purulent-septic complications. The invention relates to medicine, namely to methods of prophylaxis of septic complications in the postoperative period after surgical treatment of various diseases. The problem of prevention of wound infection in General surgery and gynecology explained by the significant spread of purulent-inflammatory diseases, reduced immunological reactivity and growth allergization of the population, changes in the species composition of the microbial flora, increased resistance of microorganisms to a wide range of antibiotics and antiseptics. There is a method of prophylaxis of septic complications in the postoperative perlego process and is 5-7 days (A. I. Strukov and other Acute diffuse peritonitis. M.: 1987, S. 228-229). In the preoperative and postoperative periods in parallel with the antibiotic therapy used diffusion therapy. The lack of antibiotics as prophylaxis of septic complications in the surgical treatment is the increasing resistance of microorganisms to antibiotics, reduced immunity, the development of allergic reactions in patients. Known closest to the claimed method of treatment and prevention of inflammatory diseases of the abdominal cavity, including postoperative antibiotic therapy, consisting in the fact that in the process of treatment is additionally injected Mexidol in a dose of 100-200 mg/ml 3-4 times daily for 3-4 days (RF patent 2039557, IPC a 61 K 31/44, publ. 20.07.95). However, the known method does not allow to exclude the use of antibiotics, which leads to the manifestation of the known adverse effects of antibiotic therapy. The invention solves the problem of exclusion of the use of antibiotics, and increase the effectiveness of prophylaxis of septic complications in the postoperative period after surgical treatment. To put nnom period, includes introduction to the patient Mexidol, Mexidol injected dose of 100 mg 30 min before surgery and for 3 days after surgery intramuscular injection of the same dose every 12 hours The method is as follows. After the establishment of clinical diagnosis and preparation for surgery, 30 minutes before surgery, the patient intravenously administered 100 mg of Mexidol, followed by the introduction of Mexidol intramuscular injection of the same dose every 12 hours for 3 days. The method eliminates the antibiotics and to prevent associated allergic, immunologic, and other complications compared with the known method and to improve the effectiveness of prophylaxis of purulent-septic complications. Clinical trials of the proposed method were conducted as follows. All patients were divided into two groups - primary and control. The study group included patients treated with Mexidol - 274 patients, 101 of which were made of the operation of the laparotomic access, 23 - vaginal, and other 150 patients in this group operations are performed using laparoscopic surgery. The control were 256 patients who prophylactic used antibio is - laparoscopically. When forming the main and control groups were taken into account, the ratio of operations of open and minimally invasive access to these groups operations from both groups were represented equally. Patients of the main group for 30 minutes before surgery were injected intravenously with 100 mg of Mexidol. Within 3 days early postoperative period Mexidol was injected intramuscularly in the same dose every 12 hours Patients in the control group, for 30 min prior to surgery, were injected intramuscularly antibiotics - cefuroxim 0.75 g, claforan 1 g every 8 h, gentamicin 0.8 g every 8-12 hours In the early postoperative period antibiotic therapy was continued for 3-4 days. Suppuration of wounds (wound dehiscence, redness and swelling on the skin during wound channel) patients of the main group was not observed. Patients of the control group, despite the preventive antibiotic therapy, local purulent-inflammatory complications was observed in 3.7% of cases. The same picture is observed in the study of pain. 90% of patients of the main group pain to palpation in the surgical wound II. In the control group to 7-day pain on palpation was still present in 56% of patients. In the postoperative period all patients were studied temperature reaction. Among the patients of the main group once a temperature of 37.5 degrees on the first day after surgery was observed in 15% of patients, up to 38 degrees in 3% of patients. On the 3rd day after the operation, the temperature returned to normal in all patients of the main group. A control group of patients whose treatment was carried out with the use of antibiotics, temperature 37.5-38 degrees was noted in 22% of patients at 3-day is in 19% of patients, on the 7th day - in 5% of patients. Thus, the use of Mexidol in the postoperative treatment by the proposed method contributes to the reduction of the period of liquidation of posttraumatic local violations, prevents the development of septic complications stimulates the reparative process, and helps restore the structure and performance of the microcirculatory system of the soft tissues. The invention is illustrated by examples. Example 1. Patient C., 52 years old, was admitted to the clinic due to multiple fibroids with submucosal localization of one of the nodes in op the process in the pelvis, posthemorrhagic anemia. Were performed laparoscopy, a total of adhesions, total hysterectomy with appendages. For 30 min before surgery the patient is intravenously introduced Mexidol in the dose of 100 mg followed by Mexidol intramuscular injection of the same dose every 12 hours for 3 days. Temperature response in the postoperative period is not marked. The blood in the first day:GB-100 g/l; L-8,5; ESR-9. On the fifth day: GB-107 g/l; L-5,2; ESR-20. Example 2. Patient K., aged 47, was admitted to the Department regarding multiple fibroids 12 weeks centripetally growth of one of the nodes, epithelial dysplasia of the cervical canal, posthemorrhagic anemia. Conducted laparotomy transverse suprapubic incision, hysterectomy with appendages. Mexidol introduced in example 1. Temperature response in the postoperative period is not marked. The blood in the first day: GB - 100 g/l; L - 9,0; ESR-6. On the fifth day: GB - 109 g/l; L - 6,7; ESR-18. Healing by first intention. Example 3. Patient K., 51 years old, was admitted to the Department regarding diffrece process in the pelvis 3-4 degree, posthemorrhagic anemia. Performed laparoscopy, a total of adhesions, supracervical hysterectomy with appendages, appendectomy. Mexidol introduced in example 1. Temperatura response in the postoperative period is not marked. The blood in the first day: GB - 92 g/l; L - 4,2; ESR-15. On the fifth day: GB - 98 g/l; L - 4,5; ESR-26. Healing by first intention. Example 4. Patient R., aged 77, was admitted to the hospital with a diagnosis of diabetic wet gangrene of the left foot. Performed amputation of the left femur at the level of the middle third. Mexidol impose on the scheme, as in example 1. Temperature response in the postoperative period is not marked. The blood in the first day: GB - 110 g/l; L - 12,5; ESR-15. On the fifth day: GB - 100 g/l; L - 7,0; ESR-10. Sutures were removed on the 10th day, healing by first intention. Example 5. Patient D. , 76 years old, was admitted to the hospital with a diagnosis of diabetic wet gangrene stump of the right foot. Performed amputation of the right tibia at the level of the middle third. Mexidol impose on shemales blood in the first day: GB - 105 g/l; L - 15,0; ESR-10. On the fifth day: GB - 25 g/l; L - 10, 0mm; ESR-15. Sutures were removed on the 10th day, healing by first intention. Example 6 (control). Patient M., 46 years old, was admitted to the Department regarding multiple fibroids in combination with adenomyosis and endometrial hyperplasia. Conducted laparotomy transverse suprapubic incision, supracervical amputation of the uterus with appendages. In terms of prevention of postoperative complications was received gentamicin 80 mg 2 times a day, and then connects ampicillin 1 g 4 times a day due to the formation of postoperative infiltration of the anterior abdominal wall with long subfebrile temperature, which lasted 12 days. Blood test: The first day GB - 113 g/l; L - 10,1; ESR-11. Sixth day GB - 110 g/l; L - 5,3; ESR-20. The fourteenth day GB - 105 g/l; L - 6,7; ESR-45. Example 7 (control). Patient M., aged 35, was admitted to the Department regarding multiple fibroids 14 weeks, scar deformation and endocervicosis cervix. Conducted laparotomy transverse suprapubic incision, the extirpation of the uterus without appendages. Blood test: The first day GB - 113 g/l; L - 10,7; ESR-10 Sixth day GB - 107 g/l; L - 8,1; ESR-61 The fifteenth day GB - 105 g/l; L - 4,9; ESR-42 Example 8 (control) Patient I., 43 years old, was admitted to the Department regarding multiple fibroids with submucous localization of one of the nodes, posthemorrhagic anemia. Conducted laparotomy transverse suprapubic incision, supracervical amputation of the uterus without appendages. In terms of prevention of postoperative complications was obtained cefamezin 1 g 2 times a day. Thermal response is normalized to the 6th day. Blood test: The first day GB - 90 g/l; L - 10,1; ESR-14 The fifth day GB - 85 g/l; L - 4,7; ESR-18 Healing by primary intention. The way to prevent septic complications in the postoperative period, including the introduction of the patient Mexidol, characterized in that Mexidol injected dose of 100 mg for the first 30 min prior to surgery and then within 3 days after surgery intramuscular injection of the same dose every 12 hours
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