Method for treating intestinal deficiency in patients with acute abdominal surgical pathology

FIELD: medicine, surgery.

SUBSTANCE: one should perform Novocain blockade presacrally before operation and not less than one time after operation. Solution for blockade is being a 200 ml 0.25%-novocaine solution supplemented with 1.0 g antibiotic and 40 mg low-molecular heparin. The method enables to improve motor-evacuatory intestinal function, conduct microbiocenosis correction of small intestine, decrease the risk of the development of enterogenic purulent-septic complications, improve microcirculation and hemostasiological profile in mesenteric vessels of small intestine and its wall.

EFFECT: higher efficiency of therapy.

1 ex, 3 tbl

 

The invention relates to medicine, namely to methods for treating intestinal failure in patients with acute abdominal surgical pathology (complicated by acute cholecystitis, acute destructive pancreatitis complicated by acute appendicitis, acute obstructive small bowel obstruction).

There is a method of treatment of intestinal failure in patients with acute abdominal surgical pathology (acute pancreatitis and acute peritonitis) (see A.V. Vishnevsky, A.A. Vishnevsky Novocaine blockade and oil-balsamic antiseptics as a special kind of pathogenetic therapy. // Izdat. Academy of Medical Sciences of the USSR. - Moscow. - 1952. - C-51), consisting in doing after surgery perirenal procaine blockade.

The disadvantage of this method is low efficiency of treatment of patients using this method. The application of the known method is associated with complications due to the fact that the blockade perform based only on the qualifications and experience of the surgeon, without proper monitoring of damage to other organs. The result may wound the needle parenchyma of the kidneys, colon, spleen or vessels such as the renal arteries or inferior Vena cava.

In addition, the treatment is carried out only once after the operation, while excluding the Chen preoperative prophylaxis of intestinal failure due to what perirenal blockade patients tolerate extremely difficult, there is no possibility of multiple its recurrence in the postoperative treatment.

Use only novocaine for the implementation of the blockade is limited only by its ganglioblokiruyuschimi action. There is a risk of suppurative complications in the blockade.

In the remote period in patients undergoing perirenal blockade, in 40-50% of cases develops sclerosis perirenal fat;

For the most part put novocaine remains enclosed in perirenal adipose tissue not having the desired effect on the mesentery of the small intestine and, therefore, the colon;

The present invention more easily, reliably and efficiently solves the problem of treatment of intestinal failure in patients with acute abdominal surgical pathology.

The technical result consists in increasing the effectiveness of treatment. Implementation of the proposed method of the blockade can improve bowel function, including motor-evacuation function, to adjust the microflora of the small intestine to reduce the risk of developing interagency purulent-septic complications, improve microcirculation and hemostatic profile in the vessels of the mesentery of the small intestine and its walls, with the responsible oxygenation and metabolism in the enterocytes.

Ability to re-run the blockade before surgery and in the postoperative period can improve the effectiveness of the treatment.

Running the blockade multicomponent solutions containing procaine, antibiotic and low molecular weight heparin, provides comprehensive protection zone of the blockade, has a bactericidal effect on allochthonous microflora of the small intestine, provides anticoagulant effect with a pronounced antithrombotic, and very importantly, long-term therapeutic effect to 20 hours.

The proposed method of treatment is safe, simple, and available for use by the surgeon of any qualification.

This technical result is achieved in that in the method of treatment of intestinal failure in patients with acute abdominal pathology, consisting in doing after surgery, the multicomponent novokainovy blockade, blockade perform the addition before surgery and after surgery at least once, and the solution for the blockade to 200 ml of 0.25% solution of novocaine add 1.0 g of antibiotic and 40 mg of low molecular weight heparin.

A method for the treatment of intestinal failure in patients with acute abdominal pathology is as follows.

To prepare the solution for blockages in sterile conditions in a bottle with 200 ml of 0.25% solution Novo is ain add 1.0 g of antibiotic and 40 mg of low molecular weight heparin. As antibiotic use cefobid or Fortum, as well as low molecular weight heparin - therapy.

Blockade perform the before operation and one or more times in the postoperative period, which in the rectum enter the second finger of the left hand and fumbled the coccyx (os coccyges). After two processing locations vcol 2% alcohol solution of iodine, under the tip of the coccyx injected a needle length of 10 cm and a syringe injected 20 ml of the solution prepared for the siege under the supervision of a finger, which prevents injury to the rectum. Novocaine detaches the rear wall of the rectum that you can feel with a finger of the surgeon. Needle conduct towards the promontory of the sacrum to a depth of 8-9 cm and enter the remaining dose of novocaine. Removing the needle, place vcol is treated with iodine.

After running the blockade novocaine distributed under the retroperitoneal tissue up, washes plexus sacralis and plexus hypogastricus, envelops the root of the mesentery of the small intestine.

The way has proved highly effective, cheap, easy to implement, eliminating the risks and complications that occur in the prototype.

After blocking all the patients showed improvement of motor-evacuation function of the intestine, which received confirmation when conducting electrogastrography and ultrasonography gastrointestinal tract (GIT). When microbiologic the x-ray study of the contents of the small intestine normalization species spectrum of bacterial populations. The frequency of septic complications (sepsis, peritonitis, abscesses of the abdominal cavity, festering wound, phlebitis, pneumonia, pleurisy) is reduced by 20-35%. In the group of patients with the blockades were observed thrombohemorrhagic complications (generalization of DIC, thrombosis of the pulmonary artery and veins of the extremities, bleeding - nasal, uterine, hemorrhoid).

In table 1, 2, 3 shows the indicators of the effectiveness of the treatment of intestinal failure in patients with acute abdominal surgical pathology of the proposed method.

Clinical example

To illustrate this example. Patient D., 38 years old, medical history N15341, enrolled in MUS KB No. 25 11.10.02. 2045with complaints of acute pain in the epigastrium and podrebarac who wore "herpes" character, bloating, nausea, uncontrollable vomiting, bringing relief. The patient believes himself for 20 hours, when for the first time suddenly developed severe pain in the epigastrium and podrebarac, radiating to the left of the rib-vertebral angle, joined bloating. The pain didn't abate after administration of analgesics and antispasmodics. The last 4 hours began to grow, weakness, increased sweating.

Objectively: a serious condition. The skin and sclera of the eyes slightly icteric. HELL 120/80 mm Hg, pulse 114 in 1 min. Language with the Khoi, the back is lined with white-brown patina. Belly swollen, palpation sharp pain in the epigastrium, where not clearly defined infiltration. In the right upper quadrant is palpated tight, painful liver, protruding 2 cm under the costal arch. Symptoms Ortner, Murphy and George-Mussi negative. Positive symptom Mayo-Robson and Kera. Peristalsis unit in the lower divisions is determined by the noise of lapping". Symptoms of peritoneal irritation negative. The sum of the liver was 24.9%, kidney - 23,2%, which corresponds to hepatorenal syndrome I tbsp. of gravity.

The hemostasis was observed activation of blood coagulation by the type of stage I of DIC: time rekaltsifikatsii was 158, APTT - 35 C. platelet Aggregation was 52.1%. Thrombin time is reduced to 15 C. the Fibrinogen was increased to 6.43 g/l Concentration of AT-III was decreased to 72.6%. Actually, the patient was reduced and was $ 26.4 minutes

Ultrasound hepatobiliopancreatic zone: Pancreonecrosis, the fluid in the stuffing bag and abdomen, more on the right flank. Biliary hypertension.

Ultrasound of the gastrointestinal tract: the diameter of the small intestine is 38 mm, the wall thickness of 4.5 mm Folding of the mucosa expressed peristalsis on separate sections of the ramp. It is noted in the small intestine intraluminal depot is licensing fluid, positive symptom "stagnation" of the stomach. Fluid in the abdominal cavity. Conclusion: the patient syndrome, intestinal failure.

Conclusion electrogastrography: marked reduction of the total strength of the electrical signal to 3.5 Áv by reducing the relative electrical activity of each Department of the digestive tract in 2-3 times. Duodeno-gastric and gastro-kalitesi reflexes almost was not determined. Also reduced 3.5 times the ratio of the comparison, determining propulsive ability of the gastrointestinal tract, at the level of transition 12 duodenal ulcer in skinny and iliac in thick. Cadence impulsatsii all GI of oregana 3-4 times and completely out of balance relative to each other.

Clinical diagnosis: Sterile pancreatic necrosis. Ametabolic. Enzymatic peritonitis. Intestinal failure. Obstructive jaundice. Hepatorenal syndrome I tbsp. of gravity.

Given the clinical and laboratory data, interogations and sonographic changes of the gastrointestinal tract, evidence of intestinal failure in the standard preoperative preparation included the multicomponent novocaine blockade (200 ml 0.25% solution of novocaine + 1.0 g of fortune and 40 mg of Clexan).

When you examine the patient after 4 hours was a decrease bloating due to heavy discharge of gases, disappeared pathologically the noise, appeared weakened peristalsis.

When the control electrogastrography based on a significant improvement in all indicators. So the total power of the electrical signal is increased to 5.2 Áv, and the relative electrical activity of all GI in 1-1,5 times. Were determined duodeno-gastric and gastro-kalitesi reflexes. Propulsive ability of the gastrointestinal tract increased in 1,5-2 times. Cadence impulsatsii all GI increased in 1-2 times.

Ultrasound of the gastrointestinal tract was determined: the diameter of the small intestine is 29 mm, the wall thickness of 4.0 mm Folding of the mucosa remained pronounced, appeared weakened peristalsis, the ramp was not determined. Decreased the number of intraluminal deposition of fluid, a symptom of "stagnant" stomach was not determined.

From hemostasis was noted significant improvements. Markers for stage I, DIC has ceased to register. So time rekaltsifikatsii increased to 178 sec, APTT - up to 41 seconds. Platelet aggregation decreased to 23.7%. Thrombin time was increased to 32 sec. Fibrinogen decreased to 4.08 g/l AT-III increased to 84.3 percent. Actually, the patient improved and was 16,6±1,1 minutes

Summary measure of liver function after 6 hours of hospital stay increased to 27.2 ed, kidney - 26,5%

Those who are not less than despite an 8 hour intensive therapy of the underlying disease, the patient remained clinical and sonographic picture of sterile pancreatic necrosis, metobolite, biliary hypertension. Prognostic criterion severity of acute pancreatitis on a scale Ranson corresponded to 4 points. The patient underwent surgery for urgent reasons.

Under endotracheal anesthesia, the patient assisted surgery way through the gastrocolic ligament examined the pancreas, where in the field the head of the pancreas diagnosed local hemorrhagic pancreatic necrosis. The small intestine is inflated to 32-34 mm, hyperemia, wall thickened. The mesentery of the small intestine moderately edematous. Peristalsis is weak, on the wall of the intestine small plaque easy to remove fibrin. Made sanitation and drainage stuffing bags, abdomen, imposed cholecystostomy. Drained the round ligament of the liver and inguinal lymph node on the right for subsequent injections of drugs.

Postoperative diagnosis: Sterile pancreatic necrosis. Ametabolic. Enzymatic peritonitis. Intestinal failure. Obstructive jaundice. Hepatorenal syndrome I tbsp.

In the postoperative period at 1 and 2 days were fulfilled the multicomponent procaine blockade with the same letters of drugs.

Already on the 2nd day of the postoperative period, the patient disappeared bloating, appeared distinct peristalsis, became himself the individual to leave Gaza.

If electrogastrography, executed on the 2nd day after the operation, based on a significant improvement in all indicators. So the total power of the electrical signal is increased to 7.8 mV. Relative electrical activity of the stomach and duodenum 12 came almost to normal. Clearly defined duodeno-gastric and gastro-kalitesi reflexes. Propulsive ability of the digestive tract was reduced only at the expense of the large intestine. Cadence impulsatsii all GI relative to each other has been restored.

Ultrasound of the gastrointestinal tract was determined: the diameter of the small intestine - 25 mm, wall thickness of 3.8 mm Folding of the mucosa is not expressed, peristalsis distinct. Intraluminal deposition of the liquid not the symptom "stagnant" stomach negative.

From hemostasis showed normalization of all parameters. Time rekaltsifikatsii increased to 194 sec, APTT - to 54 C. platelet Aggregation was decreased to 18%. Thrombin time was increased to 34 sec. Fibrinogen decreased to 3,66 g/L. AT-III remained at the same level - 84%. Actually, the patient improved and was 12±1.0 min

Sick on the 3rd day was transferred from the intensive care unit, state of moderate severity, interesest of the skin and sclera of the eyes had vanished completely recovered intestinal peristalsis, was learning the insistent chair. On the 5th day hepatorenal syndrome has ceased to register. Hemostatic profile is normalized. Drainage from the gallbladder removed in 14 days. The healing of wounds per prima. The patient was discharged in good condition on the 16th day of receipt in the hospital.

Table 1.

Influence mnogokomponentnoi the procaine blockade on coagulation parameters and protivosvertawate in patients with acute abdominal surgical diseases complicated with intestinal failure (n1without the blockade; n2- blockade)
IndicatorsQty

n1-142

n2-104
Before surgeryAfter surgery
1-2 days3-4 days5-6 days
Time rekaltsifikatsii, sblockade216±8*186±12*218±22*204±12*
without siege145±7128±6112±10176±14
Activated partial thromboplastin time, secblockade52,8±2,9*50,6±4*54,3±6*of 56.4± 4
without siege44,6±332,5±334,5±446,5±3
Prothrombin index, %blockade84,4±382,6±2,3of 83.4±1,883,2±2,4
without siege92,6±488,5±2,982,2±281,2±2
Thrombin time, secblockade34,6±1,4*27,2±2*32,3±2*30,6±2*
without siege22,3±1,220,9±221,5±326,7±3
Fibrinogen,

g/l
blockade4,6±0,2*5,1±0,1*3,6±0,2*2,5±0,2*
without siege5,8±0,46,6±0,56,2±0,15,9±0,2
Antithrombin 10%blockade82,4±4,1*70,4±3*75,2±3*78,3±2*
without siege65,8±12,157,4±258,2±161,3±2
Spontaneous platelet aggregation, %blockade22,6±1,8* 36,3±4*24,7±2*16,6±2*
without siege46,4±2,858,6±376,5±548,4±3
Fibrinolytic activity of blood, minblockade12±2*14±1*12±2*13±1*
without siege20±226±218±1,816±1,5
Note - * - shows degree of significant differences between groups of patients with held blockages and without blockages;

Table 2.

The effect of the multicomponent procaine blockade on sonographic picture of the digestive tract in patients with acute abdominal surgical diseases complicated with intestinal failure (blockades - 62; without blockades - 44)
Sonographic signsBefore surgeryAfter surgery
1-2 days3-4 days5-6 days
blockadewithout siegeblockadewithout siegeblockade/td> without siegeblockadewithout siege
The diameter of the small intestine, mm21,5±1,228,4±1,324,6±1,132,5±1,023,7±0,930,7±1,222,1±1,526,3±1,2
Wall thickness, mm3,5±0,34,5±0,23,7±0,25,1±0,23,8±0,25,2±0,23,6±0,14,4±0,2
Folding was slit. shell:

- not expressed

- pronounced
not pronouncedpronouncednot pronouncedpronouncednot pronouncedpronouncednot pronouncednot pronounced
Peristalsis

- norm

- weakened

- matimop.
Normaweakweakmatimop. or noweakmatimop. or noNormaweak
no
Nutripro. depositing liquid:no nononono
no

-
The symptom of "stagnant" stomach " :nonononono
no

-

Table 3

The effect of the multicomponent procaine blockade on the amplitude of the bioelectric potentials of the gastrointestinal tract in patients with acute abdominal surgical diseases complicated with intestinal failure (blockades - 62; without blockades - 44)
OptionsDepartment of digestive tractBefore surgeryAfter surgery
1-2 days3-4 days5-6 days
SIEC (Áv)blockadecent to 8.85±1,4*are 5.36±0,7*to 6.19±1,1*7,94±0,9*
SIEC (Áv)without blockade7,63±1,33,53±0,4a 3.87±0,84,88±0,5
ZAO (Áv) with blockade the stomach

Buy

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paddos.

thick
2,15±0,2*

0,38±0,04*

0,42±0,05*

0,94±0,08*

4,96±0,3*
1,54±0,2*

0,29±0,03*

0,28±0,03*

0,66±0,07*

2,59±0,2*
1,71±0,2*

0,32±0,04*

0,36±0,03*

0,72±0,08*

is 3.08±0,2*
1,96±0,2*

0,34±0,03*

0,37±0,02*

0,78±0,05*

4,49±0,2*
The EAC has been (Áv)without blockadestomach

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paddos.

thick
1,85±0,3

0,18±0.02

0,22±0,03

0,84±0,06

4,54±0,4
1,04±0,2

0,09±0,01

0,13±0.02

0,39±0,03

1,88±0,2
1,09±0,1

0,10±0.02

0,14±0.02

0,42±0.04

2,12±0,1
1,28±0,2

0,15±0.02

0,19±0,01

0,53±0,03

2,73±0,2
COP (Áv)blockadestomach

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paddos.
5,65±0,2*

0,90±0,1*

0,44±0,02*

0,18±0,3*
5,32±0,1*

1,03±0,01*

0,42±0,01*

0,25±0,01*
5,34±0,1*

0,88±0,01*

0,50±0,01*

0,23±0,01*
5,76±0,2*

0,91±0,02*

0,47±0,02*

0,17±0,02*
COP (Áv) without blockadestomach

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paddos.
10,2±0,3

0,81±0,1

0,26±0.04

0,18±0,2
11,5±0,3

0,69±0,07

0,33±0.04

0,20±0,02
10,9±0,4

0,71±0,06

0,33±0,03

0,19±0,02
8,53±0,3

0,78±0,05

0,35±0,03

0,19±0,02
CU (Áv)blockadestomach

Buy

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paddos.

thick -
3,57±0,6*

0,92±0,1*

1,22±0,2*

2,17±0,3*

7,99±0,5*
1,25±0,1*

0,30±0,04*

0,41±0,06*

0,81±0,09*

2,36±0,2*
1,89±0,2*

0,54±0,08*

0,72±0,1*

1,23±0,1*

to 3.92±0,2*
3,24±0,3*

0,76±0,09*

1,12±0,1*

1,96±0,2*

7,16±0,4*
CU (Áv)without blockadestomach

Buy

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paddos.

thick
3,26±0,6

0,87±0,1

1,09±0,2

1,99±0,3

6,84±0,5
1,18±0,1

0,32±0.04

0,39±0,06

0,77±0,09

2,44±0,2
1,24±0,2

0,35±0,08

0,43±0,1

0,92±0,1

2,56±0,2
2,02±0,3

0,52±0,09

0,61±0,1

1,08±0,2

3,80±0,4
COMPOUNDS - the total power of the electrical signal;

EOS - relative electrical active is th

COP - coefficient comparison;

KR - coefficient of rhythm

Note - * - shows degree of significant differences between groups of patients with held blockages and without blockages;

A method for the treatment of intestinal failure in patients with acute abdominal surgical pathology: acute complicated cholecystitis, acute destructive pancreatitis complicated by acute appendicitis, acute obstructive small bowel obstruction, consisting in doing after surgery procaine blockade, characterized in that the blockade perform the addition before the operation and at least once after the operation, and the solution for the blockade to 200 ml of 0.25% solution of novocaine, add 1.0 g of antibiotic and 40 mg of low molecular weight heparin.



 

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1 cl, 2 ex

FIELD: medicine, anesthesiology, surgery.

SUBSTANCE: in preoperational and early postoperational periods after planned and urgent operations one should intramuscularly inject adrenogangliolytics: benzohexonium 0.18 - 0.22 mg/kg, droperidol 0.078 - 0.083 mg/kg and obzidan 0.016 - 0.022 mg/kg thrice daily; moreover, the time for their introduction after operation depends upon the type of anesthetic preparation applied to carry out spinal anesthesia, that is: if one applied lidocaine as local anesthetic the above-mentioned adrenogangliolytics should be introduced 2 h after the end of operation, and if marcaine was applied as local anesthetic - 3 h after the end of operation. The innovation enables to prevent disorders of central and peripheral hemodynamics at carrying out spinal anesthesia in perioperational period.

EFFECT: higher efficiency.

FIELD: medicine, orthopedics, traumatology.

SUBSTANCE: one should perform blockades in crossing points of vertical line located along anterior surface of the inferior third of patient's shin at equal distance against median and lateral ankles and the line connecting supramalleolar areas, and, also, in crossing points of vertical line and horizontal one that connects the tops of ankles to improve the accuracy of injections made.

EFFECT: higher efficiency of conservative therapy.

1 dwg, 1 ex

FIELD: medicine, surgery, anesthesiology, traumatology, orthopedics.

SUBSTANCE: before operation one should perform premedication by prescribing individual dosages of tranquilizers and analgesics followed by subarachnoidal anesthesia by applying anesthetizing preparations being 2-3 segments higher against the site of operation, moreover, anesthetizing preparations should be introduced simultaneously into subarachnoidal space and the quantity of anesthetic introduced should not exceed 75% against the standard dosage. The present innovation provides reliable protection before operation and raise the development of tolerant impact of adaptation processes to higher power, improves the flow of postoperational period by preventing the development of postoperational pain syndrome, catabolic reaction and immunosuppression.

EFFECT: higher efficiency.

1 ex, 2 tbl

FIELD: medicine, anesthesiology.

SUBSTANCE: as the values of anesthesiological efficiency one should apply temperature alteration in area of local anesthetic's action and at decreased temperature by 0.6 C and more one should conclude upon efficiency of anesthesia; moreover, the temperature in area of anesthetic injection should be measured not earlier than 2 min after its injection. The present innovation enables to objectively evaluate the efficiency of infiltration anesthesia followed by its correction in the course of operative interference.

EFFECT: higher accuracy of detection.

1 cl, 2 ex

The invention relates to medicine, operative gynecology, anesthesiology and can be used for anesthesia in cosmetic surgery for vulva in women
The invention relates to medicine, obstetrics, and can be used for the treatment of discoordination labor

The invention relates to medicine, anesthesiology, surgery, orthopedics and traumatology and can be used for plexuses anesthesia of the lower extremity

FIELD: medicine, resuscitation.

SUBSTANCE: one should obtain the values on head's vertical position, pulmonary ventilation, efforts coming to organs of controlling and parameters of cabin's hermetic nature. A transport driver should get the information on irregular extreme situation, one should supply 100% oxygen. In case of acute respiratory insufficiency at the background of spontaneous respiration, in case of acute pain, high heart beating or gunshot wound it is necessary to perform additional electrostimulation of the muscles that actively participate in respiration act, with amplitude-frequency-modulated triangular series of impulses at impact duration being 1.5-2.0 sec at pause being about 3-4 sec. Moreover, electrostimulation should be combined with anesthesia performed due to automatic injection of medicinal preparation into biologically active point Tan'-Chzhun along with the intake of therapeutic dosage of an antiaggregant, a thrombolytic, a nitropreparation, beta-adrenoblocking agent and low-molecular heparin. Automatic pharmacoinjection should be conducted manually as a transport driver desired, and in critical situation - due to distance-controlled operation; moreover, injection should be fulfilled perpendicularly for the depth not exceeding 0.5-0.6 cm. The innovation increases the number of preparations applied in extreme situations to rescue a transport driver.

EFFECT: higher efficiency of rescue activity.

3 cl, 1 dwg

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