Method for treating acute purulent inflammation in serous cavity

FIELD: medicine.

SUBSTANCE: method involves introducing perfluoran bubbled with ozone-and-oxygen mixture with given ozone concentration of 3000 mkg/l during 15 min.

EFFECT: restricted peritoneal inflammation.

 

The invention relates to medicine, namely to surgery, and is intended for the treatment of acute purulent inflammation of the serous cavity.

It is known that for treatment of purulent peritonitis in clinic and experiment applies the blood substitute “Perftoran”, which is considered to be multifunctional drug (Grechaninov, Amoloben, Agusan, VMS and Usseglio, 2000; Remegio, Amoloben, Aoommnub, Acelchiersi, M.-E. A. Askerov, 2001 and others). The effect in this case, as the authors state, is achieved by the activation system faguoqitirute cells in peritoneal fluid and stimulation of immune organs, and also, to some extent, cytoprotective, membrane and sorption properties of perftoran.

It is also known that ozone therapy is used as an effective method of rehabilitation of the abdomen in experimental peritonitis and for the treatment of patients with diseases of the abdominal cavity, complicated by peritonitis.(Iaarabene and Sevastova, 1997; Sevastova and coauthors, 2000; Neubecker and coauthors, 2000 and others).

In particular, the proposed Grosskirchheim with co-authors “Intraperitoneal perfusion of perftoran in the treatment of patients with widespread purulent peritonitis” (introduction to the peritoneal cavity is 100-150 ml of perftoran before wound closure), according to the authors, allows the isit the necessity of repeated readjustment of the abdomen by 44% and mortality - 5.2% and that 48 hours after the initial treatment in patients treated with perftoran, compared with control, decreases in 2 times the number of aerobic microorganisms, the new blend of fibrin with 85 0 to 33, 3% and almost disappear anaerobes (“Surgery”, 2000, No. 9. - p.8-10).

The disadvantage of this method of treatment is that the perftoran introduced into the peritoneal cavity resulting in drainage tubes after 2 hours, maybe a few to enhance the migration of macrophages and adsorbiroval part toxins. The effect of the perftoran is limited in time and from the abdomen absorbed only a small part of it that may not have a significant cytoprotective and membrane-stabilizing effect on the damaging toxins in the tissue cells.

In addition, the perftoran not it has antiseptic properties, and therefore there is a need in the prior traditional rehabilitation methods.

A PROTOTYPE of the proposed method of treatment is “Ozone therapy of widespread peritonitis in the early postoperative period (Bpicture and co-authors, “Surgery”, 1997, No. 3 p.36-41).

To study the effectiveness of sancturay drugs for the treatment of widespread purulent peritonitis, the authors have created a model 40 of laboratory animals (white rats weighing 180-20 g).

After the development of peritonitis, as judged by clinical manifestations, all animals were divided into two groups (20 animals) and control and basic. Treatment of experimental peritonitis was performed according to the following procedure: at the height of clinical manifestations, on average, after 24 hours from the moment of initiation of peritonitis, under ether anesthesia puncture method produced a single leaching sanitation of the abdominal cavity (in animals the main group - a fresh furatsilina 1:5000, saturated immediately before use ozone-oxygen gas mixture with ozone concentration of 4-6 mg/l in a volume of 0.7 ml per 1 g of body weight ) to clean the wash water, after which the animals were injected in the abdomen and rectal on 1 cm3the ozone-oxygen gas mixture based 0,048 mg of ozone per 1 g of body weight. Subsequently twice with an interval of 12 hours of injection was repeated, replacing intraperitoneally the introduction of gas at the ozonized physiological solution (0.9% sodium chloride solution) with the same concentration of ozone. Animals of the control group for the sanation of abdominal cavity, the authors used not ozonated, but treated with oxygen with the same exposure furatsilina 1: 5000, and then the oxygen and saline solution in the same as that of the main group of animals, volume. During treatment twice privilegeny animals from the experiment (time after 24 and 48 hours from the moment of initiation of peritonitis) determined the number of microorganisms in the internal organs (liver and heart). While in animals the main group after 24 hours from the start of treatment was noted a significant decrease (up to single colonies) level of microbial contamination of the internal organs, while animals in the control group it remained the same. Rats in both groups after 2 hours after the start of treatment has been registered by reducing the number of cells mainly by lymphocytes (animals of the control group - 21.2%). Such a reaction is typical of stress, as the authors state, when ozone was less pronounced. After 24 hours from the start of treatment in animals main groups, according to them, was a significant decrease in blood leukocytes at the expense of all forms, including stab, whereas the animals of the control group in the blood is preserved and marked leukocytosis, and a characteristic band offset.

Criticism prototype

1. Ozonation of water furatsilina. Research conducted by employees of the Department of General surgery, medical faculty, Russian state medical University and city clinical hospital №13, Moscow (Laberca L.A. and coauthors, 2000), show the inexpediency of ozonation solutions of antiseptics: furatsilina, rivanol, chlorhexidine, dioksidina connection with the change in their physico-chemical properties and blockade their antibacterial action.

2. The use of very small is Nikich amounts of ozonated solution 1 cm3where the concentration and amount of dissolved ozone is negligible.

3. A lot of stages carried out medical procedures (inefficient, taking into account research Loubere et al., wash sanitation ozonated furatsilina, and intraperitoneal rectal insufflation of ozone-oxygen mixture, followed by double injection into the peritoneal cavity of ozonized physiological solution.

4. In the prototype there is no survival of animals in the control and main groups; research conducted within the first 2 days, and therefore not tracked long-term results, respectively adhesions, which is usually a complication of purulent inflammation of the peritoneum.

Thus, in the literature there is no information about the possibility of using ozonated of perftoran, although there is evidence of high solubility and stability of ozone in organofluorine compounds, in particular in “Performanceline” (Sedlabanki and Der, 2000).

The aim of the present invention is to develop a method of treatment of acute purulent inflammation of the serous cavity.

This goal is implemented by the rehabilitation infected serous cavity barbotirovany within 15 minutes, the ozone-oxygen mixture with perftoran with a given ozone concentration 3000 mg/L.

For ozonation per the Tauran used ozonator “Medozons - BM AOT - N-01-APR-91” (company JSC “ Arzamas instrument plant”).

The INVENTION

Proposed as a method of the invention is as follows.

On the background of acute purulent inflammation of the serous cavities hold its reorganization ozonated for 15 minutes (bubbling) ozone-oxygen mixture with perftoran with a given ozone concentration 3000 mg/L.

In acute peritonitis for intraperitoneal administration of ozonized perftoran rat put his head down under chloroform anesthesia or latch Neelikon (1971). The skin of the abdomen Caudalie navel take a fold perpendicular to pierce the abdominal wall, then in the direction of the folds needle (to avoid damage to the needle of the internal organs).

Proposed for the treatment of acute experimental fecal peritonitis in white rats to use 2.5-3.5 ml of ozonated perftoran at the rate of 1.5 ml per 100 g weight of the animal.

The use of ozonated of perftoran in the specified quantity ensures the sanitation of the abdomen with acute fecal peritonitis.

Depending on the severity of the inflammatory process and timing of peritonitis the procedure can be repeated but not sooner than 48 hours.

A method of treating at a later time (24 hours or more) development of peritonitis can be recommended to set the CNS with antibacterial therapy.

The developed method can be applied in an acute purulent inflammation of the serous cavities of different locations (acute purulent pleurisy, arthritis, peritonitis).

COMPARATIVE analysis of the CHARACTERISTICS of the PROTOTYPE AND the present INVENTION

In the proposed method as a medium for dissolving the ozone-oxygen mixture is used perftoran, in which ozone is more soluble and stable than in the physiological solution. In the method prototype as a medium for dissolving the ozone-oxygen mixture is used saline solution.

SPECIFIC EXAMPLE

Excerpt from the laboratory journal of the Department of human anatomy.

To study the effectiveness of ozonated of perftoran for the treatment of acute purulent inflammation of the serous cavities created a model of acute fecal peritonitis according to the method of Remanika (1965) the introduction of 5% fecal suspension in physiological solution at a ratio of 1 ml per 100 g weight of the animal at 72 white rats weighing 140-160 g

Experimen held at the sanatorium “K pool - Atar” of the Republic of Dagestan on 20 and 21 April 2002

Ozonation of perftoran or saline conducted by bubbling their ozone-oxygen mixture in the laboratory of the sanatorium on the ozonizer “Medozons - BM AOT - N-01-APR-91” (company JSC “Arzamas instrument plant”).

20.04.0, Under glafornil anesthesia in the peritoneal cavity is entered 5% fecal suspension, after which the rats are divided into individual cells in series:

I series (12 rats) In the peritoneal cavity is entered 5% fecal SVES and immediately saline.

II series (12 rats). In the peritoneal cavity is entered ozonated saline solution immediately after the injection of fecal suspension (1 control group).

III series (12 rats). In the peritoneal cavity is entered ozonated perftoran immediately after the injection of fecal suspension (1 main group) 21.04.02,

Series IV (12 rats). In the peritoneal cavity is injected ozonized physiological solution on the background of the 24-hour fecal peritonitis (2 control group).

V series (12 rats). In the peritoneal cavity is injected ozonated perftoran on the background of the 24-hour fecal peritonitis (2 core group).

Saline or perftoran was injected into the peritoneal cavity at the rate of 1.5 ml per 100 g weight of the animal.

On the same day, i.e. 21.04.02, under chloroform anesthesia withdrawn from experiment 3 rats from I, II and III series.

Opening the abdominal and thoracic cavities taken brushstrokes-prints, then made a thorough inspection and then seized the mesenteric limfaticheskie sites, areas of the jejunum and ileum with lymph node and spleen for histopathological investigated who I am. All material fixed in 10% neutral formalin.

On the same day, the remaining rats (I-V series) in individual cells taken in the vivarium of the Department of human anatomy of Dihomogamma.

With 22.04.02, 28.04.02, i.e. after 24, 48, 72 hours and 7 days remaining rats as deduced from experiment, as described above.

Brushstrokes-prints from the pleural and peritoneal cavities and blood from the right ventricle stained by Romanovsky - Institute for cytological study.

Histological material was investigated with appropriate wiring, fill in the blocks, making sections and paint them with hematoxylin-eosin, according to Romanovsky - Institute methyl green and Pronina, and sections of the small intestine is also alcian blue.

Comparative analysis of the results of the experiments showed:

1. In the case of intraperitoneal administration newtoniana saline with fecal suspension develops a picture of diffuse peritonitis, and all rats killed at 4-7 days of peritonitis.

2. With the introduction of ozonated saline solution immediately after intraperitoneal injection of fecal suspension, the phenomenon of diffuse peritonitis less pronounced; the majority of rats peritonitis is limited by the appearance of fibrin plaque, minor adhesions and 2-3 encysted pustules between the loops of the intestines and on the lower surface the displacement of the liver on the 2nd and subsequent days. Survival of rats for 4-7 days about 83%. In smears-prints from the abdomen there are single microbes, many leukocytes and macrophages.

3. With the introduction of ozonized perftoran immediately after the introduction of fecal mist diffuse peritonitis in rats has hardly developed, limited to the 2nd and last day summanen in the form of slight 1-2 small round lesions in the folds of the seal without adhesions. While the survival rate of rats is 100%. In smears-prints no free flora, there are foamy macrophages and leukocytes.

4. If you enter the ozonized physiological solution on the next day i.e. in 24 hours after injection fecal suspension, develops detailed picture of diffuse peritonitis in most rats; 50% of them die for 4-7 days. Violated rheological properties and blood clotting (if decapitate in chloroform narcosis follows approximately 1-2 ml dark bystrooborachivaemy blood).

In smears-prints from the abdomen and pleural sinuses notes free coccal flora and Escherichia coli.

5. If you enter the ozonized perftoran on the following day, ie 24 hours after intraperitoneal injection of fecal suspensions, picture of diffuse peritonitis was only about 17% of the animals. Another 17% of the animals at 2-3 days found encysted small GN is ilnicki between the folds of the seal, adhesions or no, or they are very gentle, which are easily destroyed when moving loops of bowel. The remaining 66% of the animals fibrin plaque on the peritoneum is not defined, pleural sinuses without features. In smears-the fingerprints of microbial flora is not detected; the density of cells is significantly lower, but among them the vast majority of macrophages with foamy cytoplasm (perforatae”) and monocytes. Survival of animals about 83% (1 rat died on 3 and another one on the 5th day of peritonitis).

The USEFULNESS of INVENTIONS

The result is a clear positive effect of the ozonized perftoran and benefits before ozonated saline solution for the treatment of acute fecal peritonitis was confirmed not only by the picture of the development of peritonitis in the dynamics, but also on the results of cytological and histological examination of recovered material.

The method is tested twice on white rats with acute experimental fecal peritonitis.

Perftoran, in contrast to saline, has sorption, cytoprotective and membrane-stabilizing properties. (Krupkin V., Moroz V.V., Pisarenko L.V., Khomenchuk A.I., 1997).

Perftoran stimulates peritoneal macrophage phagocytes and regional immune organs, i.e. the first line antimicrobial protection peritoneal cavity when Periton is those BORN Askerhanov et al., 2000; Rahimov, P.M. et al., 2001).

Perftoran improves haemorheology, microcirculation (Rahimov D.M., 1999), is also a good carrier of oxygen and carbon dioxide.

The ozone-oxygen mixture, “dissolved” perftoran, has a more prolonged action (physiological solution, ozone rapidly decomposes, after 30 minutes, its concentration is reduced by 50% or more (petaev N.A. et al., 2000)).

Ozonated perftoran the most effective within the first hours of peritonitis, which can prevent the spread of inflammation in the peritoneum, even when his single intraperitoneal injection.

Ozonated perftoran delay the development of purulent pleurisy, which almost 34% of the cases observed in rats on days 2-3 fecal peritonitis in the treatment of ozonated physiological solution and 83% without treatment.

The method of treatment of acute purulent inflammation of the serous cavities, which consists in the rehabilitation of this cavity barbotirovany for 15 min sankilotai with a mixture of perftoran with a given ozone concentration 3000 mg/L.



 

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