The processing method of the abdominal cavity in the peritonitis

 

(57) Abstract:

The invention relates to medicine, in particular to surgery, and can be used for the treatment of abdominal cavity with peritonitis. The initial inflammation is treated with a stream of the medicinal aerosol using high-frequency insufflation. The rate of 1-1 .5 l/min, frequency 100-120 cycles of 1 min, a pressure of 25-40 mm RT.art., within 5-7 minutes Number of sessions 6-9. The composition of the aerosol includes oxygen, local anesthetics, antiseptics, antibiotics, fibrinolitiki, glucocorticoids, immunomodulators, antihistamines. When fibrinous exudate medicinal aerosol consists of oxygen, local anesthetics, antiseptics, fibrinolitikov and antihistamines. When fibrinous-purulent purulent exudate from oxygen, local anesthetics, antiseptics, corticosteroids, immunomodulators, antibiotics, and antihistamines. The method prevents the spread of infection in the abdominal cavity. This increases the effectiveness of the treatment. 2 C.p. f-crystals.

The invention relates to medicine, in particular to abdominal surgery, and can be used in clinics surgical profile.

Known sposoben of liquid through the drainage, located in podrebarac, with the assumption that she, washing the abdominal cavity, will be discharged through the drainage of the abdominal cavity in the pelvis /Veronese, I., Aunts R. A., Flowing abdominal lavage in the treatment of peritonitis. Surgery, 1980, 9, S. 58-61; Radionov centuries, Leman, P. , Lavage of the abdominal cavity in the postoperative period in diffuse purulent peritonitis of appendiceal origin. Surgery. 1985, 9, S. 99-102/.

2. Hypothermic perfusion - abdominal lavage large quantities of cold solution /up to 30 liters per day/, liquid washing of the abdominal cavity, independently discharged through the drainage from the pelvis /Tatishvili, G , Tamazashvili T. M., Tevdoradze I. D., Abdominal hypothermia in the treatment of postoperative peritonitis. Bulletin of surgery, 1985, 12, S. 139-142/.

3. Hyperthermic perfusion - abdominal lavage is carried out with a solution with a temperature of 40-41 degrees /Deryabin I. I., Lysonic M. N., Peritoneal dialysis, M, Medicine, 1991, s 168/.

4. Introduction and extraction of fluids to wash the abdominal cavity during laparoscopy /Petrov, C. I., Sitkin A. P., Prolonged postoperative rehabilitation of the abdomen using a laparoscope at the races is the infection may spread to more distant areas of the abdomen.

2. Low efficiency of peritoneal dialysis due to the fast formation in the abdominal cavity channels, due to the loss of the threads of fibrin and the formation of adhesions, fragmenting it, that does not give us the ability to bring the full course of treatment, limits in addition, the ability of the required number of sessions.

3. Leaching of a flowing fluid of a large number of protein and electrolytes from the body, which leads to the development gipoproteinemii and disturbances of water and electrolyte metabolism.

4. The need for each session peritonialnogo dialysis of a large number of /from 13 to 15 to 30 liters per day/ expensive medical solutions /Karimov W. I., Tursunov K. N., Asrarul A. A. and other Efficacy of peritoneal dialysis, intestinal lavage and enteral enteral feeding in treatment of diffuse diffuse purulent peritonitis. Methodical recommendations, Tashkent, 1984, 14 S./.

As a prototype for closest to the technical nature of our chosen method of treatment of the abdominal cavity in the peritonitis /EN 2154505 C1, 20.08.2000/. How is the impact on mesotheli abdominal medicinal mixture consisting of oxygen, local anesthetics, antispy drugs. Medicinal mixture is injected in the form of an aerosol using high-frequency insufflation with a speed of 3 l 1 min for 10-15 min, under a pressure of 70 mm RT.art., when the number of sessions from 9 to 20.

The disadvantage of this method, selected as a prototype are:

- the need to install additional drainage causes damage (irritation) of the peritoneum and as a consequence further spikeblackfang;

- the spread of drug aerosol with a speed of 3 l 1 min occurs almost throughout the abdominal cavity, which leads to irritation unmodified sections of mesothelia and wypadaniu advanced exudate, which in the future may be the cause of adhesions;

- high pressure 70 mm RT.art., used for distribution of medicinal aerosol, limits the mobility of the diaphragm, which may lead to the disturbance of the lung (hypostatic pneumonia);

- procedure duration (10-15 minutes) that causes unpleasant subjective feelings because of the limited mobility of the patient (nausea, feeling of fullness in the abdomen and shortness of breath).

All the above mentioned disadvantages of the prototype does not allow to effectively use it when Mecosta processing method of the abdominal cavity in the treatment of peritonitis limited /local/ localization that is achieved by eliminating additional irritation unmodified areas of the peritoneum, preventing spread of infection in the abdominal cavity, prevention of adhesions, as well as by reducing treatment time.

The problem is solved in that limited area of the abdominal cavity in peritonitis, i.e., the initial inflammation, process stream medicinal aerosol consisting of oxygen, local anesthetics, antiseptics, antibiotics, fibrinolitikov, glucocorticoids, immunomodulators and other antihistamines with a high-frequency insufflation with a rate of 1-1 .5 liters with a frequency of 100-120 cycles of 1 min for 5-7 min, under a pressure of 25-40 mm RT.art., the number of sessions from 6 to 9.

When the inflammation has fibrinous bleed and have exudate, the medicinal aerosol consists of oxygen, a local anesthetic, an antiseptic, fibrinolytic and antihistamine drug, and with fibrinous-purulent purulent exudate - oxygen, local anesthetic, antiseptic, glucocorticoid, immunomodulator, an antibiotic and antihistamine drug.

The method is as follows. After setting the Oia, starting after 3-4 hours after surgery, the abdominal cavity insufflated medicinal aerosol /2/ depending on the content /fibrinous oxygen, a local anesthetic, antiseptic, fibrinolytic and an antihistamine; fibrinous-purulent purulent - oxygen, a local anesthetic, an antiseptic, a glucocorticoid, an immunomodulator, an antibiotic and an antihistamine/. The number of sessions /6-9/ depends on clinical and laboratory data. As criteria of control over the course of the inflammatory process and level of adhesions apply immunoassay methods blood tests.

Insufflation exercise mounted by the installation of two devices - ultrasonic generator ALBEDO and high-frequency apparatus VASILEK-1.

This takes into account the size of the inflammation, the optimal allowable increase of pressure in the abdominal cavity and the processing speed of the site peritoneum medicinal aerosol.

High frequency insufflate medicinal aerosols is sick moderate and severe severity.

Medicinal compositions for maximum efficiency include the following components - 1% solution of novocaine 5,0, blocks of intermicrobial), provide a bactericidal effect on pathological microorganisms, fibrinolizin - 10,0 /150%/ - provides for the dissolution of the threads of fibrin, preventing the development of adhesions in the abdominal cavity, prednisolone 0.5 ml /15 mg/ - glucocorticoid hormone inhibits the growth of fibroblasts, reduces inflammation of the peritoneum, suprastin or diphenhydramine 1.0 ml - antihistamines reduce the sensitization of the body, immunofan - immunomodulator has local and General immunokorrigiruyuschy effect, the oxygen - creates some of the gas layer in the area of inflammation, preventing, thus, the development of adhesions, reduces the response of the peritoneum to mechanical irritation, provides oxygenation of the cells.

High frequency insufflate medicinal aerosol with a rate of 1-1 .5 l/min, for 5-7 min at a pressure of 25-40 mm RT.art., frequency 100-120 cycles of 1 min at the direction of the jet spray to the area eliminated the source of the inflammation improves local blood circulation, makes it possible to handle a limited section of the abdominal cavity. Eliminates the possibility of the spread of infection and possible complications. It proved bench trials and experimental is spalania is carried out within 2-3 days of the session, depending on the severity and stage of peritonitis. The age and comorbidities of the patient does not limit the time and the number of ongoing sessions.

The procedure does not affect the condition of the patient and is not aggravating.

Examples from clinical practice.

1. Patient B. , 39 years old, medical history, 10883, was admitted to the hospital in serious condition with a diagnosis of acute appendicitis /gangrenous-perforating appendicitis, abscess pelvic, local peritonitis/.

12.06.2000, in an emergency procedure performed appendectomy and drainage of the abdominal cavity. Immediately after the operation two successive days was carried out high-frequency insufflate medicinal aerosols (VCIL). Just spent 6 sessions for 5 minutes On each session has trashdolls of 4.5 ml of drug solution and 11 liters of oxygen with a pressure of 25 mm RT. tbsp. at a rate of 1 l/min and a frequency of 100 cycles of 1 min discomfort during procedures VOILA the patient had not experienced. The drains are removed on the second day. High frequency insufflate medicinal aerosols was conducted against a background of complex treatment. The postoperative course without complications. The wound healed by first intention. The patient was discharged in good with the bed-day.

2. Patient G., 43 years old, medical history, 8633, was admitted to the hospital on an emergency basis in a serious condition with a diagnosis of gangrenous-perforating appendicitis /retrocecal location Appendix/ local peritonitis.

Surgery - appendectomy, abdominal drainage well-established technique. In posleoperatsionnom period were VOILA /just completed 7 sessions/. The drains are removed on the 3rd day. Parameters of high-frequency insufflation of medicinal aerosols - frequency of 110 cycles of 1 min, a pressure of 35 mm RT.art., the rate of 1.3 l/min, the flow rate of drug aerosol 6 ml per session for 6 min, 13 liters aerosols. VOILA was conducted against a background of complex treatment without objective and subjective deterioration of the General condition of the patient. The wound healed by first intention. The postoperative period without features. In satisfactory condition discharged for outpatient monitoring by the surgeon. Dates of stay in the hospital for 10 days.

3. Patient K., 64 years. History 10718, was admitted to the hospital in case of emergency: 07.06.2000, in serious condition with a diagnosis of acute appendicitis, peritonitis.

Diagnosis after surgery gangrenous cholecystitis. Secondary flegmonoznih of appendic the cholecystectomy, abdominal drainage well-established in the clinic technique.

In the postoperative period were VOILA /frequency of 120 cycles of 1 min at a pressure of 40 mm RT.article and its rate of 1.5 l/min Flow rate of 15 liters of oxygen per session, 7 ml of drug solution for 7 minutes

A total of 9 sessions over 3 days. VOILA was conducted on the background of the treatment without deterioration of subjective and objective parameters. The postoperative period without complications. The wound healed by first intention. The patient in a satisfactory condition prescribed under the supervision of a surgeon on a residence. The patient was in the hospital 12 days.

Examples of the treatment of peritonitis in the method prototype.

1. Patient S. , 41 years old, medical history, 2005, was admitted to the hospital 31.01.2000, in case of emergency with a diagnosis of gangrenous-perforating appendicitis, unlimited local serous-fibrinous peritonitis. Urgently Nizhneserginsky access performed appendectomy, sanation of abdominal cavity. Set - transverse drainage tube in the region mesogastric and 2 drainage tubes through the right and left iliac region) summed up to the pelvis. After surgery through the drainage tube t is each session 60 ml of drug compound and about 30 liters of oxygen. The aerosol was fed under a pressure of 70 mm RT.article with a speed of 3 liters in 1 min). During VOILA into the abdominal cavity and within a few hours after it was noted a feeling of bloating arching character, nausea, increase General weakness and difficulty in breathing. Drainage installed in the pelvis on the left, on the 2nd day ceased to function. Complex treatment of peritonitis has been accepted way. The patient within four days of continued fever. The wound healed by first intention. The chair is irregular, it was necessary to stimulate bowel function. 15.02.2000 was discharged to outpatient treatment. Duration of treatment was 15 bed-day.

2. Patient W. , 47 years old, medical history, 5600, was admitted to the hospital 22.03.2000, in connection with perforating duodenal ulcer, unlimited local serous-fibrinous peritonitis. Urgently 22.03.2000, surgery - laparotomy and closure of the ulcer 12 duodenal ulcer, sanation of abdominal cavity, drainage of the abdominal cavity. In the postoperative period for 4 days was carried out high-frequency insufflate medicinal aerosol - 17 sessions. With the 4th day marked the flow of fluid from the abdominal cavity, in addition to drainage of labor is proizoshlo suppuration of postoperative wounds in the area of standing drainage (in the right iliac region). Within 8 days in the postoperative period was a persistent dry cough. Conducted a comprehensive treatment according to the standard technique. Long remained the symptoms of intoxication. The wound healed by secondary intention. The patient was discharged on the 16th day outpatient treatment. At hospital discharge and after 1 year from the time of the transactions complained of discomfort, occasional bloating, irregular bowel movements, which is an indirect indication of the development of adhesive disease.

On this way /high frequency insufflate medicinal aerosols/ has been the treatment of the abdominal cavity 38 patients with limited inflammation. Of them women - 21, 17 males ranging in age from 17 to 86 years. The cause of peritonitis were acting appendicitis, O. pancreatitis, O. cholecystitis and perforated gastric ulcer. All patients in the postoperative period complications from abdominal cavity was not.

This method allows you to more effectively handle local inflammatory lesion in the abdominal cavity, reduces the treatment time for 4-8 days by improving local blood circulation and eliminate the possibility of infection, as well as additional irritation unmodified sections of mesothelia peritoneum. Zaya and peritonitis by high-frequency insufflation medicinal aerosol consisting of oxygen, local anesthetics, antiseptics, antibiotics, fibrinolitikov, glucocorticoids, immunomodulators, and antihistamines, characterized in that insufflation carried out directly to the site of initial inflammation with a rate of 1-1 .5 l/min for 5-7 min at a pressure of 25-40 mm RT. Art. with a frequency of 100-120 cycles of 1 min in the amount 6-9 sessions.

2. The method according to p. 1, characterized in that in the presence of fibrinous exudate medicinal aerosol consists of oxygen, local anesthetics, antiseptics, fibrinolitikov and antihistamines.

3. The method according to p. 1, characterized in that in the presence of fibrinous-purulent purulent exudate medicinal aerosol consists of oxygen, local anesthetics, antiseptics, corticosteroids, immunomodulators, antibiotics, and antihistamines.

 

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FIELD: medicine, surgery, coloproctology.

SUBSTANCE: one should introduce gelatin-based colloids: gelatinol or gelofusin and crystalloids at 1:1 ratio at total volume of 40-50 ml/kg patient's body weight daily; additionally, since the 2nd to the 7th d after operation it is necessary to conduct enteral nutrition in the form of hypercaloric mixtures by increasing their volume at higher rate of injection starting from 25 ml/h/kg body weight on the 2nd and 3d d up to 100 ml/h on the 6th-7th d. The present innovation enables to improve nutrition of intestinal endothelium, decrease pathogenic and conditionally pathogenic microflora, prevents appearance of postoperational intestinal paresis and restores its function in more shortened terms.

EFFECT: higher efficiency.

1 ex, 3 tbl

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