Method for increasing efficiency in treating inflammatory diseases of uterine adnexa

FIELD: medicine, gynecology.

SUBSTANCE: the present innovation deals with isolating erythrocytic mass, then one should introduce a half of daily dosage of prescribed antibiotic into "Hemacon" container with erythrocytic mass at exposure of 20 min in thermostat at 22 C followed by re-infusion for female patient. Therapy course consists of 3-5 seances conducted in a day or two, in intervals between courses a patient is prescribed for antibiotic as intramuscular injections at conventional daily dosage. The method enables to decrease the expenses of medicinal preparation per therapy course and prevent the necessity of operative interferences.

EFFECT: higher efficiency.

3 ex

 

The invention relates to medicine, namely gynecology, to increase the effectiveness of pharmacotherapy of inflammatory diseases of uterine appendages (VSPM).

In the treatment VSPM in recent time, there are two directions - conservative and surgical. For nonoperative treatment of a wide Arsenal of drugs, among which an important place is occupied by antibacterial drugs. However, their clinical efficacy is often insufficient due to the severity of infection, deep structural changes in the affected tissue, the complexity of optimal treatment regimens and the introduction of antibiotics, and that, in turn, forced to resort to surgical intervention. The latter leads to prolonged hospital stay of patients in the postoperative period requires a significant economic costs for surgical intervention and subsequent administration of drugs. In addition, surgical treatment VSPM often leads to disruption of the functional structure of the female genital organs with possible disability of the patient (Shigaku A.N., Podzolkova NM Suppurative inflammation of the uterus. M, Medicine, 1996,. 6-7).

In the treatment VSPM also use the methods in medicine, including l the academic plasmapheresis, however, plasmapheresis procedure is usually combined with traditional methods of introduction of antibiotics (Summary A.N., Podzolkova NM Purulent inflammatory diseases of the uterus. M, Medicine, 1996,. 228-229).

Closest to the proposed invention is a method of treatment, which consists in drawing blood from the patient, the procedure, plasmapheresis with in vitro modification of erythrocyte mass (EMEM) antibiotics with subsequent introduction into a patient (G.M. Protopopov, S.V. Vlasov, V. M. Kreines. Reinfuse cell mass of the blood after incubation with the antibiotic in the treatment of uncomplicated pneumonia in children. Efferent therapy. 1998, So 4. No. 4. S. 47-50). However, the described method is used in pulmonology for the treatment of uncomplicated pneumonia in children.

Using in vitro modification of blood corpuscles antibiotics in gynecology for the treatment VSPM is not known.

The technical object of the present invention is to provide a method of increasing the effectiveness of treatment VSPM to reduce the number of surgical interventions and optimizational antibiotic therapy.

The problem is solved by the selection of erythrocyte mass and return it to the patient, while in the container Gamecon" with erythrocyte mass injected half of the daily dose of n is meant sick of antibiotic exposure time of 20 minutes in an incubator at 22°C and subsequent reinfuse the patient, treatment includes 3-5 sessions held after 1-2 days, the intervals between which the patient receives an antibiotic in the form of intramuscular injections in the usual daily dosage.

The method is as follows.

Under aseptic conditions from the cubital vein of a patient using a plastic container Gamecon" 500/300 ml samples were taken 400 ml of whole blood, with the aim of substitution, the patient is injected with 0.9% sodium chloride solution 300 ml drip.

"Gamecon" centrifuged in a centrifuge RS-6 mode 2900 rpm for 10 minutes. Then in the container with erythrocyte mass (after elimination of plasma) was injected half of the daily dose of assigned patient antibiotic with exposure time of 20 minutes in an incubator at 22°C and subsequent reinfuse the patient.

The proposed method for the treatment of inflammatory diseases of the uterus includes 3-5 sessions in vitro modification of blood corpuscles antibiotics in dosage form for intravenous administration, in accordance with antibiotikogrammou, with an interval between sessions of 1 to 2 days under the control of the levels of total protein, ostrofsky protein and weight peptides of the serum level of circulating immune complexes (CIC), indices of coagulation, blood count. In those days, when the session extracorporal Inoi modification of blood corpuscles antibiotic does not hold the patient receives an antibiotic in the form of intramuscular injections in the usual daily dosage.

Example. 1. BT, 28, No. East. 7873, was admitted to the gynecological Department No. 1 of the Municipal health institutions, Voronezh Municipal clinical hospital № 9 (ambulance)" 21.03.02, with a diagnosis of Exacerbation of bilateral chronic adnexitis.

At admission (21.03.02,) had clinical signs of chronic inflammatory diseases of uterine appendages (pain in the lower abdomen with irradiation in the lumbar region, purulent discharge from the genital tract, tictacti and tenderness of the uterus during a gynecological examination), in smears from the vagina, cervical canal and the urethra on flora and purity revealed scant coccal flora in the background of several high number of cells (10-25 in the field of view), there were changes in the biochemical analysis of blood (increasing the level of the CEC to 57 UNITS, medium-sized molecules to 0,299 ED, C-reactive protein to 2 UNITS).

The patient was assigned to therapy, including provocation by a gonovaccine conventional scheme with the subsequent application of the method of in vitro modification of the formed elements of blood gentamicin (taking into account the sensitivity to it St. epidermidis identified bacteriological examination of sowing of the cervical canal and on the background of provocat and with the interval between sessions 1-2 days N 3.

On a background of treatment, the patient had expressed positive dynamics of clinical status: stopped purulent discharge from the genital tract, decreased soreness and infiltration of the uterus during a gynecological examination, in smears from the vagina, cervical canal and the urethra on flora and purity of the white blood cell count decreased to unit-5-6 in the field of view, bacillary flora became abundant, there was a normalization of biochemical parameters (the level of the CEC declined to 22 UNITS, medium-sized molecules to 0,197 ED, C-reactive protein to 0 ED).

At discharge from hospital (12.04.02,) showed complete clinical regression of the inflammatory process and elimination of the pathogen bacteriological examination.

Example 2. Patient B.L., aged 22, No. East. 5481, was admitted to the gynecological Department No. 1 of the Municipal health institutions, Voronezh Municipal clinical hospital № 9 (ambulance)" 01.03.02, with a diagnosis of Exacerbation of bilateral chronic adnexitis.

At admission (01.03.02,) had clinical signs of chronic inflammatory diseases of uterine appendages (purulent discharge from the genital tract, tictacti and tenderness of the uterus during a gynecological examination), in smears from the vagina, cervical canal and

the urethra on flora and purity detection is but an increased number of cells

(40-60 per field).

The patient was assigned to therapy, including provocation by a gonovaccine conventional scheme with the subsequent application of the method of in vitro modification of the formed elements of blood gentamicin (taking into account the sensitivity to it St. epidermidis identified bacteriological examination of sowing of the cervical canal in the background of provocation) with the interval between sessions 1-2 days N 5.

On a background of treatment, the patient had expressed positive dynamics of clinical status: stopped purulent discharge from the genital tract, decreased soreness and infiltration of the uterus during a gynecological examination, in smears from the vagina, cervical canal and the urethra on flora and purity of the white blood cell count decreased to 2-5 in the field of view, bacillary flora became rich.

At discharge from hospital (20.03.02,) showed complete clinical regression of the inflammatory process and elimination of the pathogen bacteriological examination.

In the examples of the side effects of therapy were observed.

Example 3. This method was applied in 10 patients with WSPM. The average exchange rate dosage of gentamicin was 0,98 ± 0,076 g (by the usual method of introducing 1,36 ±0,103 g), which was significantly lower (p less than 0.05).

Thus, the positive effect featur is imago way is to increase the effectiveness of treatment VSPM, because of therapeutic effects of the sessions in vitro modification of the formed elements of the blood with the use of antibiotics, which gave the ability to potentiate the pharmacological effect of drugs.

The proposed method of increasing the effectiveness of treatment VSPM allows to reduce the consumption of the drug on the course of treatment and to prevent the need for surgical interventions in the treatment VSPM.

The way to increase the effectiveness of therapy of inflammatory diseases of the uterus, including the allocation of erythrocyte mass and return it to the patient, characterized in that the container Gamecon” with erythrocyte mass injected half of the daily dose of assigned patient antibiotic with exposure time of 20 min in an incubator at 22°C and subsequent reinfuse the patient, the treatment includes 3-5 sessions held after 1-2 days, the intervals between which the patient receives an antibiotic in the form of intramuscular injections in the usual daily dosage.



 

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