Method for preventing complications during high-risk operations in small children at motor apparatus pathology and syndrome of increased thymus gland

FIELD: medicine, pediatrics.

SUBSTANCE: in small children at syndrome of increased thymus gland degree 1-3 one should prescribe prednisolone and eubiotics simultaneously, and at degree 2-3 it is necessary to prescribe immunomodulating agents, additionally. The innovation provides increased anti-infectious immunity and inspecific body resistance due to efficient correction of hormonal state in this group of children.

EFFECT: higher efficiency of prophylaxis.

2 cl, 1 ex

 

The invention relates to medicine, in particular to the prevention of complications in children up to three years with pathology of the musculoskeletal syndrome enlarged thymus gland.

Known way to prevent intra - and postoperative complications in children with hyperplasia of the thymus gland by means of prednisolone therapy in the preoperative period under any operative intervention with prophylactic dose of 0.5-1 mg/kg / day (see Maiakovskii, pediatric endocrinology, Moscow, 1982 s-347).

However, this method is taken as a prototype, is unidirectional and only offers replacement therapy hypofunction of the adrenal cortex and does not affect all parts of the pathological process. In addition, in the implementation of this method does not take into account disturbances in the immune system, changes in the functional activity of lymphocytes and water-electrolyte balance. Preparation for surgery patients is delayed in time and does not ensure the prevention of all postoperative complications.

The task of the invention is the correction of hypofunction of the adrenal glands with increased anti-infective protection and nonspecific resistance of the organism, elimination disorders of cellular and humoral immunity by targeted activation of T-cell immunity, interferon, and it is recchi composition of the intestinal microflora in children during and after surgery in high-risk congenital pathology of the musculoskeletal system on the background of the syndrome enlarged thymus gland.

This problem is solved due to the fact that if the child has signs of syndrome enlarged thymus gland 1-3 degrees simultaneously prescribed prednisolone and eubiotics, and when the second and third degree additional immunomodulators. Syndrome enlarged thymus gland first degree prednisolone is administered in the morning in the preoperative, operative and post-operative days in the dose of 0.7-0.9 mg/kg syndrome enlarged thymus gland in the second degree and planning operations in high-risk prednisolone intramuscularly for two days in cooperationon period, on the day of surgery and two days after surgery at a dose of 1.0-1.5 mg/kg, and when the syndrome enlarged thymus gland of the third degree, the dose of prednisolone was increased to 1.6 to 2 mg/kg with the simultaneous introduction of immunomodulators: taktivina dose of 3 mcg/kg subcutaneously for two days before surgery and two days after her or licopid in a dose of 0.5 mg twice a day sublingually. From the date of receipt of the patient is prescribed eubiotics: bifidum-Lactobacterin 3-5 doses 3 times a day or BL-complex 3-5 ml once a day, Linex, 1 capsule 2-3 times a day for 7-10 days.

A method for preventing perioperative complications in children is as follows. For the admission of children under three years of age with congenital disorders of musculoskeletal system conducted for the I surgical intervention conduct a thorough clinical and radiographic examination. Upon detection of clinical signs of the syndrome enlarged thymus gland, increase cardio-timico-thoracic index on the chest x-ray all children spend preoperative preparation. Children with the syndrome enlarged thymus gland first degree in one day before surgery, on the day of surgery and one day after the operative intervention is introduced a solution of prednisolone in the dose of 0.7-0.9 mg/kg / day. intramuscularly. Hyperplasia of the thymus gland in the second degree and planning high-risk operations, such as open reduction of congenital dislocation of the hip, including the reconstruction of the pelvic and femoral joint components, Mineralni corrective osteotomy, osteotomy of the pelvis according to the method of Edinburgh, exercise introduction in the preoperative period for two days, on the day of surgery and for two days after surgery solution of prednisolone at a dose of 1-1 .5 mg/kg intramuscularly unlike conventional schemes, in accordance with which it is prescribed only to operations at a dose of 0.5-1 mg/kg without phasing, with simultaneous the purpose of the immunomodulator - taktivina dose of 3 mcg/kg subcutaneously for two days before surgery and two days after her or licopid in a dose of 0.5 mg twice a day sublingually. Syndrome enlarged thymus gland of the third degree, the dose of prednisolone increased the up to 1.6-2 mg/kg From the date of receipt of the patient is also prescribed eubiotics: bifidum-Lactobacterin 3-5 doses 3 times a day or BL-complex 3-5 ml once a day, Linex, 1 capsule 2-3 times a day for 7-10 days.

As for the additional use of immunomodulators, taktivin - drug thymus glands, normalizes the T-system of immunity, stimulates the production of cytokines, the functional activity of stem gemopoeticheskoi cells, T-cells, as well as osteoinduction.

Likopid - is a synthetic analogue of glycopeptides bacterial wall, has a high immunomodulatory activity and stimulates anti-infective immunity.

Linex, bifidum-Lactobacterin, LP-complex-eubiotics, which contain microorganisms that are part of the normal intestinal microflora, participate in the development of immune reactions of the child due to the constant stimulation of self-antigens and the development of immunological tolerance.

With this combination of conventional methods with the use of immunomodulators, eubiotics used depending on the degree of enlargement of the thymus gland, a new comprehensive approach to the preoperative preparation and postoperative management of infants with the syndrome enlarged thymus gland.

Clinical PR the measures. Patient C., 3 years, enrolled in the Department of pediatric orthopedics NIETO 17.11.03 about residual subluxation of the hips. Accompanying diseases: anaemia, iron deficiency, normocapnia, mild syndrome enlarged thymus gland, delayed physical development. On examination, the child is lethargic, pale, pasty, wasting and reduced muscle tone, reflexes decreased, tachycardia, sympathicotonia. Physical development is low, disharmonious. On radiographs of the chest a second degree of increase of the thymus gland, cardio-timico-thoracic index of 0.40. Treatment: iron supplements - sorbifer 50 mg per day. within 30 days, Mezim-Forte 1 tab. 3 times a day for 10 days, Linex 1 caps. 2 times per day. within 20 days, Likopid 0.5 mg 2 times per day. within 10 days. Two days before surgery - prednisolone 15 mg/m daily in the morning on the day of surgery and two days in the postoperative period. 28.11.03 operation: mineralna corrective osteotomy and pelvic osteotomy in Saltaire. During surgery, hemodynamics: heart rate, blood pressure within normal limits. The postoperative period was uneventful, with no complications.

Thus, the proposed method operates simultaneously on all sides of the pathological process in the preparation of the child with disorders of musculoskeletal system on the background of Sindh who Ohm enlarged thymus gland to surgery. The method leads to the prevention of acute insufficiency of the adrenal cortex during and after the operation, but also enhances anti-infective protection of the body, the normalization of water-electrolyte balance with optimization of adaptive capabilities of the organism, which reduces the number and severity of intra - and postoperative complications.

1. The way to prevent complications during high-risk operations in children of early age with disorders of musculoskeletal system and syndrome enlarged thymus gland by corticosteroids, characterized in that if the child has signs of syndrome enlarged thymus gland 1-3 degrees simultaneously prescribed prednisolone and eubiotics, and when the second and third degree - additional immunomodulators.

2. The way to prevent complications during high-risk operations in children of early age with disorders of musculoskeletal system and syndrome enlarged thymus gland according to claim 1, characterized in that the syndrome enlarged thymus gland first degree prednisolone is administered in the morning in the preoperative, operative and post-operative days in the dose of 0.7-0.9 mg/kg of body weight, syndrome enlarged thymus gland in the second degree and planning operations in high-risk prednisolone intramuscularly within two days the preoperative period, on the day of surgery and two days after surgery at a dose of 1.0-1.5 mg/kg of body weight, and when the syndrome enlarged thymus gland of the third degree, the dose of prednisolone was increased to 1.6 to 2.0 mg/kg and used during the same time period with simultaneous introduction with the increase of the thymus gland, second and third degree immunomodulators: taktivina at a dose of 3.0 mg/kg of body weight subcutaneously for two days before surgery and two days after her or licopid in a dose of 0.5 mg twice a day sublingually.

3. The way to prevent complications during high-risk operations in children of early age with disorders of musculoskeletal system and syndrome enlarged thymus gland according to claim 1, characterized in that from the date of receipt of the patient is prescribed eubiotics: bifidum-Lactobacterin 3-5 doses 3 times a day or BL-complex 3-5 ml once a day, Linex, 1 capsule 2-3 times a day for 7-10 days.



 

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