The treatment for frostbite of the extremities of high degrees in directives and early jet periods

 

(57) Abstract:

The invention relates to medicine, to kombustiologiya, and can be used to treat frostbite of the extremities of high degrees in directives and early jet periods. Daily determine the blood levels of anti-thrombin III and its content 61-75% enter 300-400 ml cryoplasty, when the levels of anti-thrombin III 51-61% enter 400-500 ml cryoplasty, when the level of anti-thrombin III 50% and less than impose 500-800 ml cryoplasty; bioplasma, heated to 40C, enter in the first three days after admission and after 12 hours; thereafter bioplasma, warmed up S injected once a day during the acute period. This invention contributes to the reduction of treatment time due to the dosed application of cryoplasty compensating antithrombotic potential of the blood, which, in turn, improves microcirculation in the affected limb segments, reduces spontaneous platelet aggregation, reduces necrosis.

The invention relates to medicine, in particular to combustology.

Pathogenetically reasonable methods of treatment frostbitten, in addition to General and local warming and other methods konserwatywnego disseminated intravascular coagulation (DIC blood). Most researchers agree that the basis of the destruction of tissue exposed to low temperatures, are disorders in the microvasculature. Already in directiony period develops a condition that is characterized by thrombosis at the microcirculatory level, leading to malnutrition and tissue necrosis. In this regard, anticoagulant therapy with heparin pathogenetically substantiated (Varies B. C., Kochemasov C. H., starlings Y. R. Local damage by cold. - L.: Medicine, 1991. - 192 S.; Kotelnikov B. N. Frostbite. - M.: Medicine, 1988. - 256 S.; Muresan R. I., Smirnov, S. C. Frostbite of the extremities. -M.: Medicine, 1984. - 112 C.). However, evaluation of the use of heparin in the treatment of frostbite is ambiguous. First, hearingcare conducted when platelet aggregation was completed and microcirculatory path already irreversibly blocked by blood clots. Secondly, hearingcare appoint without regard to the content in the serum of anti-thrombin III (AT III), which is a cofactor heparin and frostbite progressive decreases rachodes on the inactivation of clotting factors in the process of development ice of blood. (Barkagan the legislative Assembly Hemorrhagic diseases and syndromes. M.: Medicine, 1988. - 409 S.) Podoba annoying hindrance, which complicates the implementation slim "treatment of tactical algorithms" in the treatment of frostbite, thereby dictating the need for the development of complex pathogenetic programs anticoagulant therapy secretly flowing local ice blood Ottaway tissues of patients with severe cold injury.

The known method using cryoplasty if frostbite of the extremities, proposed by Rubinstein I. Murasama and S. C. Smirnov, by injecting thawed plasma reconvalescent at a dose of 50-100 ml with an interval of 1-2 days (frostbite of the extremities. - M.: Medicine, 1984, S. 62).

However, this method is completely unsuitable for the treatment of patients with frostbite of the extremities in the stage of hypercoagulation directives and early reactive periods, as proposed dose and frequency of injection does not compensate for deficiency of AT III and can only be used in cases of intensive forms of bacteremia and generalized infectious process late reactive period.

The closest to the proposed method for the treatment of patients with frostbite of the extremities in directives and early jet age is a way of applying cryoplasty for the treatment of DIC blood, PR is cryoplasty in the initial dose of 600-800 ml, with repeated transfusions 300-400 ml every 6-8 hours. In the following days, the dose is 400 to 800 ml in 8-12 hours. To enable input from a plasma AT III at the beginning of each infusion (phase hypercoagulability) intravenous 5000-7500 units of heparin. (Barkagan the legislative Assembly Hemorrhagic diseases and syndromes. - M.: Medicine, 1988, S. 409).

This method does not provide sufficient warming of the tissues from the inside, especially in coreactive the period when frostbite combined with General hypothermia, and the introduction of excessive doses of cryoplasty excluding deficit AT III makes the method prohibitively expensive.

The present invention is to increase the efficiency of treatment of patients with General hypothermia and frostbite of the extremities in directives and early jet periods, the reduction of treatment time due to the dosed application of cryoplasty, compensating antithrombotic potential of the blood, which improves microcirculation in the affected limb segments, reduces spontaneous platelet aggregation, reduces necrosis.

The task is achieved by the fact that in directiony and early reactive treatment periods frostbite of the extremities high degrees inkjet, parenteral waded daily. At level III AT 61-75% enter 300-400 ml cryoplasty, at levels of AT III 51-60% enter 400-500 ml cryoplasty, level III AT 50% or less enter 500-800 ml cryoplasty. Warmed up to the 40S bioplasma imposed in the first three days of receipt within 12 hours later, once a day, warmed up S, in the acute period.

The novelty of the present invention is that when the level of AT III in the blood 61-75% to compensate for antithrombotic potential blood type 300-400 ml cryoplasty, at levels of AT III 51-60% enter 400-500 ml cryoplasty, level III AT 50% or less enter 500-800 ml cryoplasty. Bioplasma enter the first three days of receipt for 12 hours, heated to 40C, thereafter once a day, warmed up S, during the acute period.

Such temperature cryoplasty is optimal and biophysicist reasonable (logical) for uniform recovery of blood flow in frozen tissues. Introduction warmed up to the 40S cryoplasty in addition to external warming and provides internal utorevenue tissues, thereby expediting the recovery of microcirculation.

Application of cryoplasty in treatment otmaro is through compensation components, supporting antithrombotic potential of blood, and restoring antiprotease activity of plasma. Timely and informed use of cryoplasty containing all the necessary components of the blood coagulation system, promotes the elimination of hemodynamic disturbances, improves haemorheology, microcirculation in the affected limb segments, reduces spontaneous platelet aggregation, reduces toxicity. It is known that for effective action of heparin in the blood must contain at least 80% AT III. Its decrease below 60% corresponds to a hypercoagulable state, and at a concentration of AT III 50% and below increases the risk of spontaneous thrombosis. When the secondary (acquired when frostbite) deficiency of AT III develops severe thrombotic condition characterized by venous and arterial thrombosis and thromboembolism. By reducing the level of AT III below 30% of patients die from pulmonary, and heparin have no significant anticoagulant activity. Moreover, heparin without regard to the content in the serum AT III threatens secondary "rebound" of blood clots, which explains the inefficiency of heparin therapy in the early jet age taugeh with, it would seem, has been restored blood flow. This problem is solved by providing a method of arresting ice blood by compensation deficit AT III.

The method is as follows. After diagnosis: frostbite of the extremities of III-IV degree, combined with the General hypothermia or without it, in directiony or early reactive periods, on the background of General warming streams of warm air by the "Wind" is one of catheterization of peripheral veins. Previously affected limb segments are insulated with insulating covers. Infusion therapy is carried out by known circuits in combination with warmed up to the 40S cryoplasty. The determination of AT III in the blood is carried out daily.

When the levels of AT III 61-75% enter 300-400 ml cryoplasty, at levels of AT III 51-60% enter 400-500 ml cryoplasty, level III AT 50% or less enter 500-800 ml cryoplasty. Bioplasma injected heated to 40C in the first three days of receipt after 12 hours, further heated to S once a day during the acute period.

This tactic worked in the experiment, as currently implemented in clinical practice 333 Military clinically the results have been traced for up to 1 year. Complaints patients did not show.

Example 1.

Patient M., 38 years old, delivered at the casualty Department of a coach, "Ambulance" with signs of General hypothermia and frostbite of upper and lower limbs. On the eve fell into the hole and independently reached a settlement within 6 hours in wet clothes and shoes at an ambient temperature of minus 25C.

When entering a serious condition, drowsy, lethargic, rectal temperature of +35C. Brush and lower third of the forearm, as well as the foot and the lower third of the tibia, cold to the touch, in a state of rigor Mortis, do not respond to painful stimuli. The test of Billroth-Radaeva from the injection site comes serous discharge, in the fingers of the obtained dry puncture". On the overview thermograms revealed suppression of infrared radiation on the type of "amputation" from the level of the lower third of the forearm and the lower third of the tibia. The coagulation tests revealed reduced levels of AT III - 52%.

Diagnosed: General hypothermia. Adinamicheskoy stage. Frostbite of the hands and feet of III-IV degree. Directiony period.

The patient is placed in the intensive care unit, where after isolation of the upper and lower extremities warm is orogeny.

From the time of admission and after 12 hours from the start of treatment introduced in 800 ml of warmed up to the 40S cryoplasty. The content of AT III to the end of the first day was 65%, which required the introduction of cryoplasty at a dose of 500 ml twice. thermograms were observed strengthening of infrared radiation in the region of the hands and feet, leaving the levels of "amputation" in the toe area. On the third day the level of AT III was 72%. Put 300 ml of cryoplasty with an interval of 12 hours.

On the background of therapy swelling of the affected tissues was moderate. Preventive surgical intervention was not performed.

Over the next five days level III AT ranged 71-82%. Dose warmed up S cryoplasty was 300 ml once a day.

Dry necrosis was formed to ten days from the time of the injury at the level of the base of the toes, the median and the ungual phalanges of the hands, requiring surgical treatment.

The patient was discharged with improvement, with normal AT III. Viewed through 6 months. Walks with a limp, serves himself.

Example 2

Patient G., aged 34, delivered to the Department of thermotrauma a coach, "Ambulance" with signs of General hypothermia and atorage without shoes.

When receiving drowsy, slow speech, chills, pale skin, the presence of "goose skin", the rectal temperature of 34C. Foot cyanotic, cold to the touch, do not respond to painful stimuli, thick consistency for the type of rigor Mortis. From places prick the test of Billroth-Radaeva after the massage, soft tissue depart microguide. Review thermogram clearly reveals the suppression of infrared radiation from the level of the middle third of both feet. According to the coagulation registered a decrease of AT-III to 63%.

Diagnosed: General hypothermia. Adinamicheskoy stage. Frostbite of the feet of the III degree. Directiony period.

In the emergency Department after isolation of the lower extremities uniform insulating covers initiated a General warming of the patient flow of warm air by the "Wind". In a comprehensive program of infusion therapy in the initial dose, parenteral, inkjet introduced 350 ml of warmed up to the 40S cryoplasty with re-infusion at a dose of 300 ml after 12 hours.

By the end of the first day in the previously insensitive segments of the lower limbs had gone numb, appeared paresthesias. The affected area turned pink. Swelling of the affected tissues starovlach noticeable intensification of infrared radiation in the feet.

On the following day when the indicators AT III 71% of transfused twice 300 ml of cryoplasty. By the end of the third day performance AT III was 74%, which required a double injection of 300 ml of cryoplasty.

In the future, for three days the level of AT III was 75-80%. Conducted introduction warmed up S cryoplasty at a dose of 300 ml once a day.

The indices of coagulation bravely returned to normal on the 6th day.

The patient was discharged with recovery. Viewed through 8 months. No complaints. Works at the same place.

Application of cryoplasty in the complex treatment of frostbite of the extremities is the treatment secretly flowing ice blood, corregira disorders of hemostasis through compensation components that support the antithrombotic potential of the blood and restoring antiprotease activity of plasma. Timely and informed use of cryoplasty containing all the necessary components of the blood coagulation system, promotes the elimination of hemodynamic disturbances, improves haemorheology, microcirculation in the affected limb segments, reduces spontaneous platelet aggregation, reduces intoxication.

In some cases offer therapy with Ciu in the affected limb segments, making the lesion is available for antibiotics, drops the extension of the zone of destruction by insufficient vascularized tissues, significantly accelerates the repair and recovery of patients.

The method is simple and easy to use in clinical practice, in particular in the case of mass simultaneous receipt of the victims with the General hypothermia and frostbite of the extremities of high degrees.

The treatment for frostbite of the extremities of high degrees in directives and early jet periods by jet injecting heated cryoplasty and heparin, characterized in that daily determine the blood levels of anti-thrombin III and its content 61-75% enter 300-400 ml cryoplasty, when the levels of anti-thrombin III 51-61% enter 400-500 ml cryoplasty, when the level of anti-thrombin III 50% and less than impose 500-800 ml cryoplasty; bioplasma, heated to 40C, enter in the first three days of receipt and within 12 hours; thereafter bioplasma, warmed up S, enter once per day during the acute period.

 

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