Method and means for treating the cases of pyoinflammatory diseases of soft tissues

FIELD: medicine; medical engineering.

SUBSTANCE: means is composed of spherical and close-to-spherical 500-3000 mcm large microgranules. Microgranule matrix has at least one cross-linked polymer and fillers. The cross-linked polymer is taken as sodium alginate, or gelatin, or pectin, or carraginan, or agar-agar, or sodium salt of carboxycellulose, or copolymer of acrylic acid and butylacrylate, or their mixtures. The fillers are hyperosmolar, antiseptic, anesthetic and, when required, antioxidant compounds. Method involves placing microgranules into pyoinflammatory lesion focus through postoperative or fresh wound. Wound cavity space is filled with microgranules to not more than one-half of its volume. Then the wound is drained and covered with antiseptic bandage. The granules and bandage are changed once a day during 2-3 days.

EFFECT: enhanced effectiveness of treatment; prolonged drug concentration support in wound.

6 cl,1 tbl

 

The invention relates to medicine, in particular to surgery, and can be used for the treatment of purulent-inflammatory diseases of soft tissues.

Known coating for wounds and method thereof (RU # 2091082, A 61 L 15/30, 1997). The coating is monoclonal film made of fluorine-containing rubber and a water-soluble polysaccharides of plant origin, are taken in certain amounts. The coating is prepared by mixing a latex of fluorinated rubber and an aqueous solution of the polysaccharide to a homogeneous state, the distribution of the mass on a flat surface and drying.

It is known for the treatment of RAS (RU # 2115436, A 61 L 15/24, 1995). The tool is made of copolymers of vinyl alcohol, vinyl acetate and vinylpyrazine in powder form with a particle size of 10-1500 μm and contains a drug selected from the group of: an antimicrobial drug, a proteolytic enzyme or local anesthetic agent.

There is a method of treatment of infected wounds (RU application No. 94033866/14 And 61 To 39/106, 1994). The method consists in the surgical and mechanical wound debridement, drainage and irrigation, restoration operations, local drug therapy. Washing is carried out once with an aqueous solution of bilastine with a concentration of 0.25 to 0.8 person-doses/ml for 3-5 days, and the local is medicamentosa therapy is carried out by applying to the wound dressing with an aqueous solution of bilastine the same concentration 24-48 hours for 5-8 days.

It is known that for local treatment of purulent wounds in the phase of exudation used substances with hyperosmolar properties to create conditions conducive to the outflow of wound from the wound in a bandage (a Wound and wound infection, guidelines for physicians edited Migasena, Bmostacedo. M.: Medicine, 1990, s). Among hypertonic solutions, has received the most widespread, well-known 10% solution of sodium chloride. The method was first scientifically substantiated in 1890 Maerianske and studied in experiment and clinic A.E.Wright. (Pods V., Grigoryan A., Postyshev VK Purulent wound, M, Medicine, 1975, p. 166-168).

The disadvantages of these funds can be attributed to the short duration of effect due to dilution of wound exudate and fast drying of Turunc (2-3 hours)that requires frequent changes of dressings (not less than 3 times a day).

There is a method of local treatment of purulent wounds using granular sorbents based on chemically cross-linked polymers, such as Glavina (Theory and practice of local treatment of purulent wounds edited Bmezine. Kiev: Health, 1995, s-177).

The main disadvantages are low or moderate osmotic properties of the sorbents, as well as the fact that the maximum sorption occurs in the first minutes of contact with exudate and subsequently significantly reduced, which also required the re-dressings during the day.

Task, which is aimed at solving of the invention are to reduce the period of the basic periods of wound healing, reduction of terms of hospital treatment of patients with purulent-inflammatory diseases of soft tissues due to the prolonged maintenance of the necessary concentration of the drug substances in the wound.

The task is solved as follows.

For the treatment of purulent-inflammatory diseases of soft tissues contains a polymer and represents the microspheres, the matrix which is formed from at least one reticulated polymer selected from the group comprising sodium alginate, gelatin, pectin, carrageenan, agar-agar, sodium carboxymethyl cellulose, copolymer of acrylic acid and butyl acrylate and mixtures thereof, and fillers, representing hyperosmolar, antiseptic, anesthetic, and if necessary, an antioxidant substance, with the following ratio of components, wt.%:

Matrix:

The specified mesh polymer 11,0-29,0,

Fillers:

hyperosmolar 70,0-80,0,

antiseptic 0,5-5,5,

anesthetic 0,5-2,5,

antioxidant 0,05-1,0,

while pellets are made in a spherical or close to spherical shape size 500-3000 μm.

As hyperosmolar substances the product contains sodium chloride (NaCl), or the magician who Oia chloride (MgCl 2), or sea salt. As an antiseptic substances the product contains dioxidine or nitazol. As of anesthetics, the product contains lidocaine, or trimekain, or piromekain in the form of hydrochloride. As antioxidant substances the product contains olifen, or Karmazin, or emoxipin.

The method of treatment of purulent-inflammatory diseases of soft tissues using the above tools on a background of antibacterial, anti-inflammatory, desensitizing and detoxification therapy differs in that the microspheres are placed through or postoperative fresh wound in purulent-necrotic lesion, filling them no more than half of the volume of the cavity wounds, then drain, cover aseptic dressing, and the dressing change and produce granules once a day for 2-3 days.

The proposed tool (MICPEL) is a free-flowing powder of the microgranules. In turn, the microspheres consist of a polymeric matrix and functional fillers, which primarily include salt, creating local hyperosmolar effect in inflammatory lesion, as well as anesthetic and antiseptic substances both together and separately. Granules obtained by granulating these compounds one of the known methods, followed by drying and sterilized is in securitization. The application of the aforementioned components in granular, and not in the native state gives the overall effect of prolonged action of the prisoners in the granule active components, primarily salts. In addition, you can program the speed of separation of the components (salts) from the granules into the wound by changing the quantitative ratio between the salt and the polymer matrix, as well as the change in the degree of crosslinking of the polymer matrix, which is confirmed by the study of the kinetics of excretion of salt from the granules by changing its concentration in the external solution phase in vitro. The use of the polymer composition of microgranules of anesthetics reduces pain threshold or even eliminates pain syndrome.

The tool MIKOL contribute through postoperative or fresh wound directly in the home purulent inflammation or wound. As the impregnation of microgranules, introduced into the wound, the exudate complex substances included and their composition, diffuses into the hearth, thereby maintaining the high osmotic pressure compared to the interstitial fluid and blood plasma. This provides the centripetal direction of movement of tissue fluid from the perifocal area directly in purulent cavity, and further drains in a bandage, contributing to the accelerated withdrawal from inflamed and swollen adjacent tissues of excess fluid and IU is aboliton, reduces swelling. Thereby improve the conditions for the recovery of microcirculation in the area of inflammation, stimulates the fresh items humoral and cellular immune systems, as well as increasing the concentration of the drug, administered parenterally and from the bloodstream. The action of microgranules is adjusted over time by cross-linking of the polymer in the formed granules that helps provide uniform diffusion of trace elements for at least 24 hours. In addition, the microspheres have the ability to absorb a significant amount of wound Exo - and endotoxins contained in wound exudate and provide a hemostatic, analgesic and antiseptic

Studies of physico-chemical and medicinal properties allow us to conclude that, by combining polymer microspheres with different content of substances and the degree of crosslinking can be adjusted in time action hyperosmolar component that allows you to provide a uniform rate of its diffusion in the environment for at least 24 hours. Having stable chemical bonds cross-linking of the chains of the polymer granules are able to maintain a stable form that at low their mutual adhesion allows you to stand out from the wound exudate to easily enter stand the LC formed by spaces between them. This distinguishes it from the known analogues, which form on the surface of the wound a continuous layer of gel, and creates the fundamental advantages at purulent inflammatory process, characterized by generally abundant exudation. Treatment with Mikola conducted in the first phase of the inflammatory process until the complete cessation expressed exudative manifestations in the festering wound.

Method of treatment using Mikola conducted against the backdrop of total antibacterial, anti-inflammatory, desensitizing and detoxification therapy. Microspheres are applied to a fresh wound or placed in a necrotic lesion, filling them about half the volume of the cavity of the wound or ulcer. Then the cavity is drained by any of the methods available, close aseptic dressing, and the dressing change and produce granules once a day for 2-4 days. In cases characterized by extremely abundant exudation, which is determined by the degree of impregnation of the bandage discharge from the wound, bandaging change Mikola can be performed two times a day. Range of therapeutic actions can be extended by additional introduction of a granule of any medications. The tool can be used both in stationary and field conditions. Of particular importance may be the use of the drug is in emergencies and terrorist acts at the stage of skilled care in medical institutions of the Ministry of defense, Ministry of emergency situations, as well as in outpatient and inpatient levels of medical institutions of the Ministry of health involved in the treatment of purulent-inflammatory complications of injuries of different localization. MIKOL allows to improve the results of treatment, to reduce the number of septic complications of mechanical and gunshot injuries, to reduce the period of rehabilitation of sick and injured, as well as the work of medical personnel in the course of their treatment in the surgical departments of the Ministry of health, Ministry of defense, Ministry of emergency situations.

The invention is explained by examples. In the table structures MIKOL, which conducted the treatment of patients with purulent-inflammatory diseases of soft tissues.

Example 1. Patient N., 34 years old, was admitted for acute odontogenic limited osteomyelitis of the mandible 36 tooth complicated by cellulitis of floor of mouth. The General state of moderate severity. After opening and drainage on the day of receipt under General anesthesia of the left submandibular and podozriteljnogo spaces sick in purulent-necrotic lesion were placed MIKOL No. 1 in the amount of filling of a purulent cavity half. Postoperative wound drained two tubular Winternitz the drains. On the dressings that are made daily 1 times a day, ran fractional washing wounds through the drains of 0.02% chlorhexidine. Thus swollen granules, which were in the wound during the day, easily washed out, and a new portion MIKOL similar volume was placed in the wound. Conducted antibacterial, anti-inflammatory, desensibiliziruyuschee and detoxification therapy. As a result, by the beginning of the second day after surgery, the patient returned to normal body temperature. Gnetaceae from the wound stopped on the 3rd day, the wound was cleansed from areas of necrosis, which allowed us to remove the tubular drains and go to the local application of wound healing agents (Actovegin-gel). On the 4th day in the wound appeared visible foci of granulation tissue. Planimetrically amount of postoperative wounds decreased from 12.4 cm3to 5.6 cm3to the 6th day. On the 6th day imposed early secondary seams. The duration of inpatient treatment was 8 days.

Example 2. Patient S., 33, entered regarding adenomegaly right sacilotto area. When receiving an operation of opening and drainage of adenomegaly. Local treatment was carried out using MIKOL No. 2, which was filled in postoperative wound 1 time per day, approximately half of the cavity of the abscess. In addition, we have conducted a total antibacterial and anti-inflammatory treatment. Cultorum the day marked the termination of exudation, the cavity was cleansed from necrotic tissue. Cytological study of the transition to a regenerative stage was marked by 4 days of treatment, from which topically applied traditional healing tools. Reduction wounds twice as determined by planimetric study, came to the 5th day of treatment and was 5.99 cm3. On postoperative wound imposed early secondary seams on the 6th day of treatment.

Example 3. Patient W., 41, was treated for acute odontogenic limited osteomyelitis of the mandible, complicated by cellulitis of the left submandibular region. After the operation of opening and drainage of cellulitis were carried out by local treatment using MIKOL No. 3. During bandaging, which was performed 1 time per day, purulent cavity through the tubular drains washed antiseptics, have been introduced to the microspheres, which fills its volume by about half. The following ligation of the swollen microspheres, sorbera wound. They are easily removed from the wound during dressing changes when washing the wound with antiseptics through the tubular drains, then into the cavity superimposed fresh portion MIKOL. In addition, he conducted a General antibacterial and anti-inflammatory treatment. In the treatment of exudative phenomena stopped on 2nd suck is, allowing on the 3rd day of treatment to remove the tubular drainage and move on wound healing ointment dressing. Cytological study of the regenerative type cytograms were determined on the 4th day. Measured planimetrically reduction wounds twice, came on the 5th day. On the 6th day of treatment imposed early secondary suture.

Example 4. Patient 3., 30. Came on a bilateral non-consolidated fracture of the mandible in the area of 36 and 44 teeth, complicated by cellulitis of the left submandibular region. The operation of opening and drainage of cellulitis, immobilization of the mandible nazemnymi tires Vasiliev premaxillary rubber traction. Local treatment of postoperative wounds were performed MIKOL No. 4, which was filled with purulent cavity half its volume with the imposition of aseptic dressings. Frequency of change - 1 time per day. In the treatment of exudative processes cropped on the 3rd day, the infiltration of the soft tissues disappeared by the 5th day. Starting with 4 days of treatment switched to local application of wound healing drugs (Actovegin-gel). The transition of the cytologic picture of degenerative-inflammatory-type regenerative were observed on the 5th day. The amount of wounds on the second day was 10.3 cm3on the 6th day of 4.8 cm3. Postoperative wound healed by second intention for 12 days the am from the start of treatment. Consolidation of the fracture of the mandible in the future was uneventful.

Example 5. Patient L., aged 30, was treated for acute odontogenic osteomyelitis of the mandible from the 48 tooth complicated by cellulitis of floor of mouth. The operation of opening and drainage of the left and right submandibular, sublingual and podozriteljnogo cellular tissue areas. At the time of surgery, the patient was noted abundant purulent discharge gray color with a fetid odor. The soft tissues of the floor of mouth deathly changed, signs of myositis, fasciitis. On the background of the General treatment of locally applied MIKOL No. 5 by filling them with purulent-necrotic cavities on the dressing, which was carried out 2 times a day after wound dialysis antiseptics. A day after the surgery and treatment of finely granulated polymer odor from the wound was not determined, significantly reduced the number of wound. The amount of purulent cavities planimetrically amounted to 41.6 cm3. After three days of purulent-necrotic processes are stopped, the wound is cleansed, exudative processes cropped. Tubular drains removed, locally initiated the application of topical dressings. Cytological picture to the 5th day of treatment began to acquire the characteristics of the regenerative type, appeared determined macroscopically granulation. The volumes of the cavities to the 6th day amounted to 23.5 cm 3imposed early secondary seams, bringing the wound edges. Was discharged for outpatient treatment on the 10th day after the operation.

The proposed tool MIKOL allows you to clean inflammatory lesion from purulent-necrotic tissue and helps to reduce perifocal edema and infiltration, as well as relief of pain with purulent-inflammatory diseases. The tool can be used both in stationary and field conditions.

1. For the treatment of purulent-inflammatory diseases of soft tissues containing polymer, characterized in that it is a micro-granules, the matrix which is formed from at least one reticulated polymer selected from the group comprising sodium alginate, gelatin, pectin, carrageenan, agar-agar, sodium carboxymethyl cellulose, copolymer of acrylic acid and butyl acrylate and mixtures thereof, and fillers, representing hyperosmolar, antiseptic, anesthetic, and, optionally, antioxidant substances, with the following ratio of components, wt.%:

Matrix:

The specified mesh polymer 11,0-29,0,

Fillers:

hyperosmolar 70,0-80,0,

antiseptic 0,5-5,5,

anesthetic 0,5-2,5,

antioxidant 0,05-1,0,

when this pellet is made in sferica the coy or close to the spherical shape of the size 500-3000 μm.

2. The tool according to claim 1, characterized in that as hyperosmolar substances contains sodium chloride (NaCI), or magnesium chloride (MgCl2), or sea salt.

3. The tool according to claim 1 or 2, characterized in that as an antiseptic substances contains dioxidine or nitazol.

4. The tool according to claim 1, characterized in that as anesthetics contains lidocaine or trimekain, or piromekain in the form of hydrochloride.

5. The tool according to claim 1, characterized in that as antioxidant substances contains olifen, or Karmazin, or emoxipin.

6. The method of treatment of purulent-inflammatory diseases of soft tissues with the use of the tool according to claim 1 on a background of antibacterial, anti-inflammatory, desensitizing and detoxification therapy, characterized in that the microspheres are placed through or postoperative fresh wound in purulent-necrotic lesion, filling them no more than half of the volume of the cavity wounds, then drain, cover aseptic dressing, and the dressing change and produce granules once a day for 2 -3 days.



 

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FIELD: medicine; medical engineering.

SUBSTANCE: means is composed of spherical and close-to-spherical 500-3000 mcm large microgranules. Microgranule matrix has at least one cross-linked polymer and fillers. The cross-linked polymer is taken as sodium alginate, or gelatin, or pectin, or carraginan, or agar-agar, or sodium salt of carboxycellulose, or copolymer of acrylic acid and butylacrylate, or their mixtures. The fillers are hyperosmolar, antiseptic, anesthetic and, when required, antioxidant compounds. Method involves placing microgranules into pyoinflammatory lesion focus through postoperative or fresh wound. Wound cavity space is filled with microgranules to not more than one-half of its volume. Then the wound is drained and covered with antiseptic bandage. The granules and bandage are changed once a day during 2-3 days.

EFFECT: enhanced effectiveness of treatment; prolonged drug concentration support in wound.

6 cl,1 tbl

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