A method for the treatment of reversible ischemia inter-intestinal anastomoses in peritonitis

 

The invention relates to medicine. A method of treatment of reversible ischemia inter-intestinal anastomoses in peritonitis with sequential intravenous nicotinic acid at a dose of 0.3 mg/kg of body weight and oxygendemanding of perftoran in a dose of 6 ml/kg every 30 min 3 times a day for 4-7 days. The method allows to stably maintain the level of blood flow and oxygenation in the inter-intestinal anastomoses. table 2.

The invention relates to medicine, in particular to surgery,and can be used for the treatment of ischemic disorders in the inter-intestinal anastomoses with peritonitis.

The known correction method microcirculation intestine (see methodological recommendations - Violations of bioenergy intestinal wall in acute intestinal obstruction, Makhachkala, 1990), namely, that with the help of microirrigation connected to the root of the mesentery, in 4-5 days 2 times enter the warm mixture consisting of ATP, cocarboxylase, heparin, hydrocortisone, broad-spectrum antibiotic, a 0.25% solution of novocaine in Pharmacopeia valid doses prior to the clinical well-being. The effectiveness of treatment is enhanced by lowering veroyatnostei known method is the lack of dynamic monitor monitoring the microcirculation of the colonic wall. In addition, co-administration of 6 drugs contrary to the order of the Ministry of health of the Russian Federation 328. In this scheme, the use of antibiotics is considered inappropriate, as it does not affect the microcirculatory bed. If we take into account the pharmacokinetics of heparin is used to prevent blood clots, the medication should be 4-6 hours, as after 6 h heparin is excreted from the body. ATP and kokarboksilaza currently recognized as drugs of unproven efficacy, because they act only at the moment of introduction, and both drugs increase the action potential and metabolism, and novocaine, included in the composition of a medicinal mixture, reduces the action potential and metabolic processes, therefore, the drugs are pharmacological antagonists. In addition, the complex of these drugs is polypragmasia and dangerous allergic reactions.

The well-known technique for drug prevention of insolvency zone inter-intestinal anastomoses by insufflation through introduced into the lumen of the anastomosis microirrigation 2%-aqueous solution of papaverine hydrochloride in a dose of 0.15 mg/kg and 0.5% solution of novocaine as a prototype.

The disadvantages of this method is the inability to use the solutions of 2% papaverine hydrochloride and 0.5% novocaine in asthma and in patients with systemic hypotension, because exacerbated the severity of their initial state. Solutions imposed previously by dissolving them in a 0.9% NaCl-200,0 by local insufflation, there is no guarantee that the exact dosage and full pharmacological action of drugs. The introduction of therapeutic solutions through the probe is not effective when disturbed absorption of the intestines (malabsorption syndrome) when the inevitable peritonitis syndrome, intestinal failure.

The essence of the invention lies in the fact that according to the method of treatment of reversible ischemia inter-intestinal anastomoses in peritonitis consistently intravenous nicotinic acid at a dose of 0.3 mg/kg of body weight and oxygenated perftoran in a dose of 6 ml/kg every 30 min 3 times a day for 4-7 days.

Using the proposed method helps to stimulate microcirculation in the area of inter-intestinal anastomosis with peritonitis, including the blood flow in the arteries, capillaries, postcapillary venules, and veins, which only in combination define ischemia, jizeng of perftoran in a dose of 6 ml/kg of body weight. Sequential use of drugs by the claimed method allows to obtain after intravenous nicotinic acid, at a dose of 0.3 mg/ kg weight fast positive hemodynamic effects due to the expansion of peripheral blood vessels and improve oxygenation of the tissues without significant effect on Central hemodynamics. Introduction after 30 min oxygendemanding of perftoran in a dose of 6 ml/kg of body weight stabilizes the volume of circulating plasma during peritonitis, improves blood rheology, gas-transport function of erythrocytes and plasma, helps to maintain hemicircular in extended nicotinic acid vessels suture strip inter-intestinal anastomosis with peritonitis due to systemic mechanisms. In addition, oxygenated perftoran as plazmozameschayuschie solution with gas transport function reduces intracellular acidosis and interstitially swelling, improves oxygenation in ischemic anastomosis sites of the intestinal wall, promotes the healing of the inter-intestinal anastomosis with peritonitis. Thus sequential intravenous nicotinic acid and oxygendemanding of perftoran stimulates energy potential of cells and improves tissue regeneration. The method of control, medicinal substances, nicotinic acid and oxygenated perftoran, successively introduced into the bloodstream, are the means of prevention and treatment of ischemic disorders in the inter-intestinal anastomoses due to edema, acidosis, blood stasis, microthrombosis, hypotension, vascular spasm in the early postoperative period in patients with resection of the gut in the presence of peritonitis. The method is efficient because oxygenated perftoran and nicotinic acid have a positive effect on hemodynamics small intestines and anastomoses with peritonitis: a pharmacological effect of nicotinic acid is a quick and relatively short, oxygendemanding of perftoran is slow and much more long lasting, which enables to stably maintain the level of blood flow and oxygenation in the inter-intestinal anastomoses in the postoperative period.

The method is as follows. Intravenous solution of nicotinic acid in a dose of 0.3 mg/kg of body weight, pre-diluted in 200.0 ml of saline, 30 min after injection of nicotinic acid on physiological solution intravenously injecting oxygenated perftoran in a dose of 6 ml/kg of body weight to stabilizatsionnye. In experiments on dogs studied the effect of oxygendemanding of perftoran and nicotinic acid in the bloodstream intact guts and suture zones of the strips 1 and 2-row anastomoses side-to-side with peritonitis. Peritonitis was obtained by the method of skeletization segment of the small intestine length 10.0 cm during laparotomy under intravenous clipsrobin anesthesia and subsequent exposure within 24 hours of the Experimental series to study the effects of "oxygendemanding of perftoran on the blood flow to the gut and zone 1 - and 2-row anastomoses performed in 10 dogs. Hemodynamics were studied using the intraluminal probe pulsatory by the method of H. M. Segal (1984). The measurements were carried out immediately after the formation of the anastomosis at relaparotomy, and after 30, 60 and 120 min after intravenous oksigenirovannykh of perftoran in a dose of 6.0 ml/kg of body weight. The research results are reflected in table 1.

In the control plot the amplitude of the pulse wave (AR) tended to increase after 30 min and increased significantly by the end of the first hour after infusion of perftoran. The effect of the positive effects remained within 2 h of observation. Maximum (ADM), minimum (Admp) arterial and venous (P venous pressure and the intact intestine in 1 - and 2-row anastomoses after 30 min after injection oxygendemanding of perftoran AR increased significantly, that testifies to improve circulation in the area of research. The impact oxygendemanding of perftoran was consistently increased by the end of 1 and 2 h, as evidenced by a significant increase in AR suture in the bands of both types of anastomoses. Systemic arterial pressure remained stable.

Investigation of the solution of nicotinic acid, administered at physiological solution at similar peritonitis occurred immediately after the imposition of anastomoses, then after 15 and 30 min after drug administration at a dose of 0.3 mg/kg of body weight. Dynamics of parameters of blood flow in the small intestine, 1 - and 2-row anastomoses are reflected in table 2.

In the intact intestine most hemodynamic effects registered in 15 min after injection: AR significantly increased from 2.450,12 to 4.320.6 mm, a Reliable increase in AR, ADM, ADP, reducing R veins kept for 30 min In the anastomoses of both types remained similar dynamics improve blood flow in areas of research interest seam strips anastomoses.

Example: the Patient K. ,71 years old, diagnosis: adenocarcinoma of the descending part of the colon, 3 B stage. Eforming inter-intestinal anastomosis summed probe for decompression and intraluminal pulsatory. If pulsatory zone inter-intestinal anastomosis showed a significant decrease in the amplitude of the pulse to 0.5-1.0 mm Started the complex of therapeutic measures in the proposed method, namely, intravenous introduced a solution of nicotinic acid in a dose of 0.3 mg/kg in saline and oxygenated perftoran in a dose of 6 ml/kg every 30 minutes 3 times a day for 6 days. The outcome of the treatment is the cure.

Claims

A method for the treatment of reversible ischemia inter-intestinal anastomoses in peritonitis, which consists in the application of hemodynamic drugs, characterized in that sequentially intravenous nicotinic acid at a dose of 0.3 mg/kg of body weight and oxygenated perftoran in a dose of 6 ml/kg every 30 min 3 times a day for 4-7 days.

 

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