Method for treating purulent meningitis

FIELD: medicine, anesthesiology-resuscitation, infectology, detoxication.

SUBSTANCE: the innovation suggested interrupts infectious-toxic shock, moreover, after that it is necessary to prescribe peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg. Then one should sample patient's blood to obtain leukocytes to be washed and diluted in 0.9%-NaCl solution, activated due to incubation with immunophan and intravenously injected for a patient. Then comes peroral intake of Reaferon-EC-Lipint at the dosage of 10000 - 15000 U/kg once daily for 5 d. The innovation enables to decrease the number of complications and lethality due to decreasing immunodeficiency.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

 

The invention relates to medicine, namely to anesthesiology and intensive care, Infectology and methods of detoxification, can be used in the treatment of purulent meningitis of different etiologies.

There is a method of treatment of purulent meningitis in infectious diseases, which is regulated by the decree No. 375 of the Ministry of health of the Russian Federation dated December 23, 1998, which are as follows: relief of infectious-toxic shock, antibiotic therapy, hormonal therapy with corticosteroids, anti-inflammatory, desensibiliziruyuschee, diuretic therapy.

The disadvantage of this method is that it does not account for emerging infectious patients T cell-immune deficiency and inhibition of phagocytic activity of neutrophils and macrophages, and does not include in the comprehensive treatment of immunomodulators (Annunciation SV, Bodybuilder I.A., Zubov J.E. et al. Bacterial infection and immunodeficiency as key factors that determine the nature of the course and outcome of chronic inflammatory diseases of the Central nervous system//Medical immunology. - 2002. - V.4. No. 2. - S-230).

Closest to the present invention is a Method for the prevention and treatment of sepsis in Ozegovich patients (Patent No. 2123341, a 61 K 35/14, 38/08, 20.12.1998).

The task of the invention is to increase the efficiency Leche is of purulent meningitis.

The task reach that patient later after edema infectious-toxic shock, before blood sampling prescribe oral IFN-EU-Lient dose 10000-15000 U/kg and intravenously administered washed and diluted activated Imunofan leukocytes, then patients are taking oral IFN-EU-Lient dose 10000-15000 IU/kg once daily for 5 days.

The method is as follows: a patient with purulent meningitis after cupping infectious-toxic shock prescribe oral Reate-Ron-EU-Lient dose 10000-15000 U/kg, followed by a session in vitro treatment of cells with Imunofan. The blood from a vein of the patient is carried out in a number of 400-500 ml Vials eksponirovannoi and heparinised blood centrifuged 15 min with a speed of 2000 rpm, after which the plasma exposium. In a sterile vial collect leukocyte film and diluted with NaCl 0.9% as - 200-250 ml and environment 199-200250 ml, red blood cells return to the patient, is injected into the vial Imunofan 75-125 mcg 1×109cells; the resulting solution is incubated for 90 min at 37°C, then centrifuged 15 min with a speed of 2000 Rev/min, the vials are removed solution to leukocyte film, further leukocytes washed 3 times with sterile 0.9% NaCl - 390-485 ml, washed leukocytes diluting the NaCl 0,9% - 50-100 ml of intravenous drip infusion to the patient. Subsequently the patient takes oral IFN-EU-Lient dose 10000-15000 IU/kg once daily for 5 days.

Comparison of results of treatment experienced (IFN-EU-Lipitor and in vitro treatment of cells with Imunofan) and control (by known means) groups (table 1) shows that the use of IFN-EU-Lipina with in vitro treatment of cells with Imunofan reduces the duration of treatment, to reduce the total number of complications and reduce mortality of patients with purulent meningitis of different etiologies.

Table 1
Group, nBed-day, days.Complications, %Mortality, %
Control, 50 patients36,2

±1,28
88,0

±4,0
24,0

±3,03
The study, 50 patients21,4

±1,33

<0,001
32,0

±3,41

<0,001
10,0

±2,45

<0,001

Clinical example 1.

Patient A. 20 years. Diagnosis at admission: purulent meningitis, toxic shock II Art.

By the end of 1 day the patient came out of shock: T=38,9°AD=120/70 mm Hg,

CVP=50 mm Hsub> 2O, HR=102 ADV min, NPV=22 min, SBP=2 sec, the diuresis was 30 ml/h, consciousness - stun (13 points on the scale of Glasgow), cerebrospinal fluid lymphocytosis 16200/ml, protein cerebrospinal fluid - 4,63 g/l, LII=12,8; immunoregulatory index=0,81; phagocytic index of 11.0, given the condition of the patient, him oral assigned IFN-EU-Lient 10,000 IU/kg (5 days)and conducted the session in vitro treatment of cells with Imunofan. After drawing blood from a vein of the patient in 400 ml vials eksponirovannoi and heparinized blood was centrifuged 15 min with a speed of 2000 rpm, after which the plasma was expositives. In a sterile vial was going leukocyte film and was divorced with 0.9% NaCl to 200 ml and the environment 199-200 ml, red blood cells returned to the patient in a bottle was introduced Imunofan 75 mcg 1×109cells; the resulting solution was incubated for 90 min at 37°C, then centrifuged 15 min with a speed of 2000 Rev/min, the vials were removed solution to leukocyte film, further leukocytes 3 times washed with sterile 0.9% NaCl - 390 ml, washed leukocytes were diluted with NaCl 0,9% to 50 ml and intravenous drip poured patient.

After the session a comprehensive immunotherapy on day 7: T=36,5°With the clear consciousness (15 points according to the scale of Glasgow), cerebrospinal fluid lymphocytosis 4 cells/ml, protein cerebrospi the individual liquid - 0.26 g/l, LII=0,5; immunoregulatory index -1,67; phagocytic index - 36, septic complications was not.

Clinical example 2. Patient C. for 45 years. Diagnosis at admission: Purulent meningitis, toxic shock II Art.

The post-shock is very severe, consciousness - spoor (10 points on a scale Glasgow), T=39,5°AD=120/70 mmHg, heart rate=120 ADV min, CVP=90 mm H2O URS=3 sec, diuresis 45 ml/hour, cerebrospinal fluid lymphocytosis 14800/ml, protein cerebrospinal fluid - 5,12 g/l, LII=11,4; immunoregulatory index=0,6; phagocytic index 9,0, given the state of the patient, her oral assigned IFN-EU-Lient 13000 thousand IU/kg (5 days) and conducted the session in vitro treatment of cells with Imunofan. After drawing blood from a vein of the patient in the amount of 450 ml vials eksponirovannoi and heparinized blood was centrifuged 15 min with a speed of 2000 rpm, after which the plasma was expositives. In a sterile vial was going leukocyte film and was divorced by the 0.9% NaCl - 225 ml and environment 199-225 ml, red blood cells returned to the patient in a bottle was introduced Imunofan 100 g 1×109cells; the resulting solution was incubated for 90 min at 37°C, then centrifuged 15 min with a speed of 2000 Rev/min, the vials were removed solution to leukocyte film, further leukocytes 3 times of washing and sterile 0.9% NaCl - 435 ml, washed leukocytes were diluted with NaCL 0,9% - 75 ml intravenous drip transfusion of the patient.

After the session: T=36,8°With the clear consciousness (15 points according to the scale of Glasgow), cerebrospinal fluid lymphocytosis 7 cells/ml, protein cerebrospinal fluid - 0.31 g/l, LII=1,1; immunoregulatory index=1,2; phagocytic index 28, septic complications was not.

Clinical example 3. Patient S. 49 years. Diagnosis at admission: Purulent meningitis, toxic shock Art. III

The state of admission: the condition is very severe, consciousness, coma (8 points on the scale of Glasgow), skin and visible mucous membranes pale, T=38,0°S, MTBF more than 3 seconds. The vesicular breathing, wheezing none, NPV=26 in minutes Heart tones are deaf, single extrasystoles, pulse weak filling, heart rate=140 ADV min, AD=75/40 mm Hg, CVP neg. The abdomen is soft, painless. No urine. After the release of the patient from shock: consciousness coma (8 points on the scale of Glasgow), T=39,8°, pale skin, URS more than 5 seconds. Breathing hard, single dry rales, NPV=30 minutes Heart tones are deaf rhythmic HR=124 ADV min AD=110/50 mm Hg, CVP=100 mm H2O urine output of 20 ml/h, LII=13,5, cerebrospinal fluid lymphocytosis 17100/ml, protein cerebrospinal fluid - 4.61 in g/l, immunoregulatory index=0,7; phagocytic index of 8.0, given the condition of the patient, him oral assigned IFN-EU-Lient tis IU/kg (5 days) and conducted the session in vitro treatment of cells with Imunofan.

After drawing blood from a vein of the patient in a quantity of 500 ml bottles with eksponirovannoi and heparinized blood was centrifuged 15 min with a speed of 2000 rpm, after which the plasma was expesially. In a sterile vial collected leukocyte film and diluted with 0.9% NaCl to 250 ml and the environment 199-250 ml, red blood cells returned to the patient in a bottle was introduced Imunofan 125 mcg 1×109cells; the resulting solution was incubated for 90 min at 37°C, then centrifuged 15 min with a speed of 2000 Rev/min, the vials were removed solution to leukocyte film, further leukocytes 3 times washed with sterile 0.9% NaCl - 485 ml, washed leukocytes were diluted with NaCl 0,9% - 100 ml of intravenous drip transfusion of the patient.

After the session T=36,7°With the clear consciousness (15 points according to the scale of Glasgow), cerebrospinal fluid lymphocytosis 6 cells/ml, protein cerebrospinal fluid - 0.24 g/l, LII=0,7; immunoregulatory index=1.3; phagocytic index 32, septic complications was not.

The proposed method allows to reduce the duration of treatment, to reduce the total number of complications and reduce mortality of patients with purulent meningitis of different etiologies.

The method of treatment of purulent meningitis, including the relief of infectious-toxic shock, characterized in that it further after edema shock is Aulnay prescribe oral Reaferona-EU-Lient dose 10000-15000 IU/kg, then make the blood of the patient, get his white blood cells, washed, and diluted them with 0.9%NaCl, then leukocytes activated by incubation with Imunofan and intravenously administered to the patient, then perform oral administration Reaferona-EU-Lient dose 10000-15000 IU/kg once daily for 5 days.



 

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