Method for treating craniocerebral trauma

FIELD: medicine, neurology, traumatology, neurosurgery.

SUBSTANCE: the present innovation deals with treating acute craniocerebral traumas (CCT). Since the first hours of therapy it is necessary to perform intravenous drop injection of 2-ethyl-6-methyl-3-hydroxypyridine succinate per 200 mg twice daily in case of severe degree of disease and per 200 mg once daily in case of average and light degrees of the trauma. The method provides detoxication effect in acute period of CCT due to recently established antitoxic action of the preparation suggested , that is accelerated degradation and withdrawal of toxic metabolites out of cerebrospinal liquid.

EFFECT: higher efficiency of therapy.

3 ex, 3 tbl

 

The present invention relates to medicine, namely, neurology, traumatology, neurosurgery. It can be used in the treatment of acute traumatic brain injury.

Please note that oxitetraciclina succinate and 2-ethyl-6-methyl-3-hydroxypyridine succinate are one and the same substance. Both names priemlema, but we believe that the latter name is more appropriate (str radar 2004).

Traumatic brain injury is accompanied by the accumulation of cerebrospinal fluid (CSF) which are toxic to the Central nervous system of metabolites resulting from the degradation of brain tissue and hemorrhage in the subarachnoid space. With the advent of CSF medium molecular oligopeptides of oxygenated hemoglobin, bilirubin and serotonin bind violation of the tone of the cerebral vessels and cerebral ischemia. Thus, promising in the treatment of brain injury is detoxification CSF.

There is a method of treatment (I) acute traumatic brain injury, selected as a prototype, which includes the basic principles of evidence-based medicine, which consists in the correction of intracranial pressure, cerebral edema, prevention of seizures under dynamic observation neuroimaging methods. As treatment applied osmodiuretiki (mannitol, Resolume is), barbiturates (thiopental sodium, phenobarbital), corticosteroids (dexasone). This prototype also has disadvantages: long-term treatment, low efficiency, high cost of treatment, high risk of fatal outcome in acute degree (heavy stream) traumatic brain injury because it does not consider autointoxication brain toxic metabolites.

The invention solved the problem of reducing mortality, reducing the duration of treatment and time of hospitalization, improve patient outcomes while reducing cost.

This problem is solved by the fact that in acute severe traumatic brain injury from the first hours of treatment prescribed intravenous drip 200 mg 2-ethyl-6-methyl-3-hydroxypyridine succinate in saline solution, and frequency of administration depends on the severity. In heavy 2 times a day, with light and medium - 1 time per day.

The detailed implementation of the method. The method is based on the well-known fact increased antioxidant and lipoic action of the active substance 2-ethyl-6-methyl-3-hydroxypyridine succinate. The drug promotes the preservation of structural and functional organization of biomembranes, performance of transport of neurotransmitters and improve synaptic transmission. Is increased compensatory activation aerobes the glycolysis and decreased inhibition of oxidative processes in the Krebs cycle during hypoxia with an increase in the content of ATP and creatine phosphate, activation energosintezirutuyu of mitochondrial function, stabilization of cell membranes.

The authors it was experimentally proved toxic effect of the drug, which was manifested by accelerating disintegration of blood cells in CSF (mainly erythrocytes and their toxic metabolites: hemoglobin, oxyhemoglobin, hemosiderin). Also noted a more rapid elimination from CSF under the influence of the drug, which explains its antitoxic effect. Clinical effects of the drug 2-ethyl-6-methyl-3-hydroxypyridine succinate implemented, according to our data, by reducing the multifaceted manifestations of edema, ischemia, hypoxia, cephalalgia; patients quickly recovered the lost functions of the Central nervous system.

The method is performed in the following sequence. A patient with acute traumatic brain injury severe from the first hours of treatment prescribed 2-ethyl-6-methyl-3-hydroxypyridine succinate 200 mg in 200 ml of saline, intravenously 2 times a day. The drip is set in the morning and in the future, after 12 hours in the evening.

On the second or third day see a decrease in the degree of impairment of consciousness. Patient from a coma goes into the spoor. Continue treatment. 10 day fix the clarification of consciousness, reduction of meningeal and cerebral syndromes, smoothing the focal neurologic the tion of symptoms, reorganization of the CSF.

It was found that on the 20th day of treatment the patient begins to sit up in bed to go to the toilet with the accompanying, partly to maintain herself.

The patient in a state of moderate or mild severity of acute traumatic brain injury, prescribe intravenous drip 200 mg 2-ethyl-6-methyl-3-hydroxypyridine succinate 200 ml of saline 1 time per day.

On the second day, as a rule, mark the stabilization of consciousness of the patient. On average, on day 14 of treatment record almost complete disappearance of headaches. Restored cognitive function. The patient maintains itself. Under the supervision of a practitioner physical therapy leaves the chamber office on a walk.

Then the patient will be discharged to a rehabilitation center or at home with the implementation of outpatient treatment, including recommended further drug 2-ethyl-6-methyl-3-hydroxypyridine succinate.

In the case of severe and moderate acute craniocerebral trauma, the presence of residual corresponding to this description, repeat the treatment within 6 months to the steady improvement of the patient's condition.

Example 1. Sick And s M.P., 36 years. Diagnosis: gunshot wound of head fracture of the right parietal bone, brain contusion, lung-subarachnoid hemorrhage. Coma 1. On the background of the Russian Academy of Sciences the e conducted urgent therapy to the patient from the first hours of treatment prescribed 200 mg of 2-ethyl-6-methyl-3-hydroxypyridine succinate 200 ml fishriver intravenously 2 times a day.

Already at day 2, the patient was observed dynamics of full human consciousness: from coma 1 to light spoor. The patient opens the eyes of the challenge, can one word answer: “Yes”; “No”. Remains rough paresis of the left limbs.

On the 12th day from the beginning of treatment the patient has fully recovered. Clear consciousness. Decreased degree of paresis with 2 to 4 points. 21 days - sick in the mind and memory. Can sit with support. Sitting on the bed, can easily serve themselves. Remains mild depressive syndrome. However, there is interest in life, manifest positive emotions. After 2.5 months was discharged to a rehabilitation facility.

After 6 months the patient was recommended to undergo re-treatment with 2-ethyl-6-methyl-3-hydroxypyridine succinate on the proposed and previous methods. See the restoration of the lost functions. Psycho-emotional condition is satisfactory. Restored limited working capacity.

Example 2. Patient T s., 42. Diagnosis: acute closed craniocerebral injury, brain contusion. Massive subarachnoid hemorrhage. The spoor.

In hospital, diagnostic plan held an urgent lumbar puncture. Verified the diagnosis of subarachnoid hemorrhage. After therapy, conducted by emergency medical help is, from the first hours of treatment prescribed 200 mg of 2-ethyl-6-methyl-3-hydroxypyridine succinate 200 ml of physiologic saline intravenously, twice a day. On the second day note the decrease of the degree of impairment of consciousness from spoor to stun. Note the decrease meningeal and cerebral syndromes.

On the seventh day decreased the severity of paresis with 3 to 4 points. In the analysis of CSF noted a decrease in the number of erythrocytes with 14258 to 303 and osmolarity with 304 246.

Patient T s in consciousness, a moderate cephalalgia and easy meningeal syndrome.

On the 14th day - clear consciousness, remains mild hemiparesis to 4.5 points, can sit up in bed, simply to maintain itself.

After 1 month the patient is in satisfactory condition was discharged to a rehabilitation center. After six months, patients received rehabilitation treatment is proposed and investigated earlier method. Restored the ability to work, focal neurological symptoms no. There are moderate psychoemotional disorders.

Example 3. Patient M-VA., 49 years. Diagnosis: acute closed craniocerebral injury, brain injury of moderate severity.

Admitted to the hospital. The patient is prescribed 200 mg of 2-ethyl-6-methyl-3-hydroxypyridine succinate in saline solution intravenously 1 time per day.

On day 2 of treatment the patient was released from the spoor. N is observed a clear consciousness, but still lack of coordination (cerebellar symptoms and autonomic dysfunction. The patient spent 30 days in hospital and was discharged in satisfactory condition. Patient 4 months will re-treatment 2-ethyl-6-methyl-3-hydroxypyridine succinate previous method and rehabilitation.

Treatment outcomes observed that the patient recovered socio-psychological status. Working at your previous job. Further, the patient had not sought medical help for neurologists.

The effectiveness of the method

The method of using 2-ethyl-6-methyl-3-hydroxypyridine succinate in the first hours of treatment can effectively and quickly to stop the intoxication, which in turn reduces the degree of impairment of consciousness (on a scale Glazgo), reducing musculoskeletal disorders (on a scale NIH), and further the degree of disability (Barthel scale), the accelerated release of impairment of consciousness, and this allows a significant improvement in therapeutic process:

1. Reduced mortality in the treatment of acute severe traumatic brain injury;

2. Declining terms of rehabilitation of the CSF, which leads to a faster reduction of concomitant manifestations of brain injury (edema, ischemia, cephalalgia);

3. Reduced time of treatment of acute heavy, medium and light craniocerebral trauma;

4. Stand who agrees effectiveness of the treatment and reduces the cost of bed-days in hospital for patients with acute traumatic brain injury.

Table 1.

Treatment of acute severe traumatic brain injury. Hospital.
Methods of treatment of acute head injuryThe number of patientsMortalityThe treatment timeThere are residual effects (in % from number of patients treated)
Abs.in %
Prototype method1488659%2.5 months.93%
The proposed method1565334%2,0 months.87%

Conclusions: in the treatment by the proposed method reduced mortality, reduced treatment time, less pronounced observation residual phenomena (Table 1).

Table 2.

The dynamics of rehabilitation of cerebral spinal fluid (CSF) in patients with acute severe head injury
The timing of lumbar puncture1-2 days6-8 days
TreatmentThe number of patientsErythrocytes OsmolarityErythrocytesOsmolarity
Abs.in %Abs.in %Abs.in %Abs.in %
Prototype method (traditional treatment)8216342±6300100302±16,31009417±22357,6297±12,298,3
The proposed method (using drug) on the background of traditional treatment9114342±4951100304±17,21007295±116,050,86248± and 11.381,57

Table 2 shows that with the proposed method using 2-ethyl-6-methyl-3-hydroxypyridine succinate on the background of traditional treatment there has been a more rapid resorption of red blood cells, and consequently, hemoglobin, oxyhemoglobin, hemosiderin, which are toxic for CSF. The decrease in the osmolarity and the accelerated disintegration of blood cells in the CSF is manifested in the clinic in the form of reduction of edema, ischemia, cephalgia.

Conclusions: in the treatment by the proposed method is observed more rapid and effective rehabilitation of the CSF, which leads to b is more rapid restoration of the lost functions of the Central nervous system.

Table 3.

Treatment of acute medium and light craniocerebral injuries.
TreatmentThe number of patientsThe incoordinationNeurosis-like disordersAutonomic disordersThe treatment time
Abs.in %Abs.in %Abs.in % 
Prototype method655585%5787%4772%4 weeks
The proposed method483981%3063%3165%3 weeks

Conclusions: the treatment by the proposed method is more efficient, less long-term time and less costly (table 3).

Literature

1. Pathogenesis, diagnosis and treatment of traumatic brain injury and its consequences./Antonopoulou, Lubriderm, A.a.potapov etc. //Ukr. The matters. Neurosurgery them. Burdenko. - 1994. No. 4. - P.18-25.

2. Butakov S.M. Vascular and tissue changes in contusion foci of brain in acute PE is the iodine traumatic brain injury with varying degrees of impaired consciousness. // 's lives.-the honey. expertise." 1993. - T.36. No. 2. - P.12-15.

3. Clinical guide. Volume II, Chapter 7 /Under the editorship of Academician A.N. Konovalov, Professor Lublijana, ATV): the Antidoron, 2001.

The method of treatment of acute traumatic brain injury), characterized in that the first hours of treatment intravenous drip 2-ethyl-6-methyl-3-hydroxypyridine succinate dose of 200 mg 2 times per day with severe and 1 time per day 200 mg for moderate and mild injuries.



 

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