Method for treating sepsis

FIELD: medicine.

SUBSTANCE: one should carry out antibacterial and infusion therapy. Moreover, additionally, after compensating the volume of circulating blood during infusion therapy one should intravenously inject 30 thousand IU antigangrenous polyvalent equine serum by drops per 200 ml isotonic NaCl solution: the first 1 ml solution should be injected for 5 min, the rest volume - for 1-1.5 h. The innovation suggested enables to optimize immunocorrecting therapy without sensitizing patient's body.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl


The invention relates to medicine, namely: intensive care, surgery, urology and gynecology.

Sepsis is a generalized inflammatory response of the host to excessive microbial load, caused not so much by the circulation in the blood of living organisms, how much excess blood gets of structural components and molecules of microbial origin from natural colonization (Navalmorales). Sepsis often called germs of the patient in the hospital (Vdelali).

Developed many effective treatments for sepsis: drainage foci localization and reproduction of microbes, antibiotic therapy in combination with aminoglycosides, detoxification methods through action on the main excretory organs, inhibitors of proteolysis (trental, gordox), respiratory support (humidified oxygen, mechanical ventilation), ultraviolet irradiation, immunostimulirutuyu therapy.

High mortality of patients with septic shock in the ICU, on average, 40% of the total mortality, (Vdelali)is the problem causing the search for new approaches to the treatment of sepsis. Extensive injuries. surgery, immunosuppressive therapy, unjustified antibiotic therapy, intoxication violate used, i.e. dynamic equilibrium Mick is Flory human and microorganism, violation of the colonization resistance of microbes. Abnormally proliferating in other ecological niches of microbes actively produce toxins. (Averoes). Even with a high level of reactivity of the microorganism and active phagocytosis intoxication, haemodynamic instability, each of these factors separately, especially in combination leads to translocation into the blood, the reticulo-endothelial system and connective tissue conditionally pathogenic microbes and their metabolites. In the treatment of this pathology is the drug "Pentaglobin".

"Pentaglobin" is intravenous immunoglobulin that binds endotoxin microbes.

"Pentaglobin" in high titer present antibodies to gram-negative bacteria. Early appointment of Pentaglobin, with gram-negative sepsis and septic shock, increases the survival of patients.

Dose Pentaglobin - 3-10 ml per kg per day, 3 days in a row/drip (causal and pathogenic therapy school, (Aromance, Lectures on topical issues of Pediatrics, 2002).

Contraindications to the drug "Pentaglobin":

1. You cannot enter with a high serum creatinine level, i.e. in renal failure.

2. The introduction of Pentaglobin can negatively affect the action of live vaccines against viral diseases.

Side effects, who may be on the introduction of Pentaglobin: chills, fever, headache, nausea, vomiting.

Documented cases of aseptic meningitis after the introduction of Pentaglobin.


As a prototype we have used a method of treating intestinal sepsis normal human immunoglobulin (application instructions approved by the Ministry of Health of the Russian Federation 23.04.02 year).

Normal human immunoglobulin is an immunologically active protein fraction, the active principle of which is the immunoglobulins of different specificity. The drug has also nonspecific activity, increasing the resistance of the organism.

Biological and immunological properties - neutralization of microbes and their toxins, antibodies contained in the immunoglobulin.

Route of administration: intramuscularly, intravenously. Maximum input single dose of 0.2 ml per kg of body weight, repeated administration through 24-72 hours.

The disadvantages of the prototype can be attributed to the fact that it is unstable to decomposition under the influence of bacterial protease, does not always produce the desired clinical result, the status of sepsis in patients may progress, it is necessary to use other means.

The essence of the proposed method as the invention is as follows.

As part of infusion therapy, the most severe, in the prognostic plan b is determined as being. it is proposed to use protivomigrenoznoe polyvalent equine serum - ASG.

Since 1967 CBC is used for emergency seroprevelance in military field conditions and traumatic injuries in the home in violation of the integrity of bone tissue. Application instructions approved by the head of the main Department of health care Ministry of health USSR 14.11.1988,

The main mechanism of action protivomigrenoznoe polyvalent equine serum is reduced to binding and neutralization of Exo - and endotoxins microbes antibodies contained in the serum.

Way. 30 thousand ME protivomigrenoznoe polyvalent equine serum is injected into/drip, 200 ml of isotonic NaCl after filling volume of circulating fluid. The first 1 ml for 5 min, the remaining capacity for 1-1,5 hours.

In our practice, ASG entered 23 surgical and 9 somatic patients with multiorgan failure. All patients except one surgery in satisfactory condition transferred to the relevant Department.


All patients who entered protivomigrenoznae polyvalent equine serum, in the next few days showed positive: improved reaction to external stimuli, normalized body temperature, while ately peripheral blood, biochemical parameters, patients were allowed paresis of the intestine.

Examples of specific implementation method.

1. Case history No. 2087.

26.02.04. Delivered patient with complaints: anxiety, bloating. fever, vomiting.

From the anamnesis: operated 16.02.04, Operation: dezinformatsia intestine. Diverticulectomy. A serious condition. The pale. Microcirculatory disorders. Toxic-exsicosis II Art. the probe from the stomach goes - stagnant stomach contents of green. In the tests: Hb - 88 g/l, L - 5,4·109, ESR - 55 mm/h

26.02.04, relaparotomy. Resection Powszechny intestine. Postoperative diagnosis: multiple perforations, diffuse purulent peritonitis, infectious gastroenterocolitis, infectious and toxic hepatitis. Toxic cordic.

In the analysis of increased t/aminase, (ALT - 1,4 AST - 1,6) Thymol turbidity test (1,6%) protein Total of 45.5 g/l In the analysis of peripheral blood lymphocytosis - 42, leukocytes - 13,2·109, ESR - 46 mm/h In the urine traces of protein, leukocyte count to 20 in sight bacteria.

Treatment was conducted. Respiratory support, antibiotics, selective decontaminate, cardiotonic, hepatoprotectors, perebrannoe introduction lidocaine, inhibitors of proteolysis, immunostimulirutuyu therapy (immunoglobulin - normal human 3 doses of 27, 28, 29 Feb the Ala). On the background of therapy continued intoxication. Tachycardia. Paresis of the intestine - probe departs from the stomach intestinal discharge. 02.03.04, with the composition of infusion therapy, on the 5th day operations transferred ASG/drip.

5.03.04, the State of moderate severity. Started enteral feeding. 10.03.04, the Patient is in satisfactory condition transferred to the relevant Department. A comparative analysis of the peripheral blood before and after the introduction of PACS is reflected in the table.

2. Case history No. 374.

Sick And born in 2001 (2 years 5 months) delivered in the ICU 11.01.03, in a very severe condition of CRH, Gudermes.

From the anamnesis: sore 5 days. The disease began with fever up to 38.5 C. anxiety. The patient, CRH, Gudermes, to suppress heat production, inside and externally appointed Apple essence (in a dilution of 2 teaspoons per Cup of water), aspirin1/2TB., ampicillin. Planning: menadione, nicotinic acid, calcium gluconate, hormones in the dose of 20 mg/kg / day (1295 mg). At the time of admission in the ICU patient in a coma I expressed dyspnea mixed body temperature - 38,8°, tachycardia, microcirculatory disorders, paresis of the intestine. On the radiograph - ocharovatelnye shadows. Liver and spleen were enlarged. No urine.

In the analysis of peripheral blood leukocytes 49,10, l, limonene (3-4 in p the Le view - the result of immunosuppression) the infusion of large doses of hormones. Coagulation on the Moravica 1 minute, 30 seconds, thrombocytopenia, anemia. In the biochemical analysis of blood - increased grantability (ALt, Ast - 1.2 mmol/l). Urea - 13 mmol/l In the urine are all leukocytes, protein. Locally lower extremity purple-bluish color on both limbs (R. 3×4 cm), bubbles with clear content.

Diagnosis: 11.01.03, Chemical burns of the oropharynx, esophagus, pneumonia, toxic hepatitis, toxic kordic, coma. Thrombosis of the lower extremities. Sepsis.

Against the backdrop of ongoing respiratory support (mechanical ventilation), antibiotic therapy, heparin therapy (500 IU/kg), after the restoration BCC, physiological solution introduced ASG 1 dose (30 thousand ME) 2 times with an interval of 24 hours. On day 3 after 2 injections improved reaction to external stimuli, normalized body temperature and peripheral blood, stabilized hemodynamics. Was sanitize foci of infection. In satisfactory condition of the patient is directed, in Moscow for autotransplantation.

3. Case history No. 11293/545.

17.10.2003. Patient a, age 1 year, 1 month delivered from the Central district hospital (n midwives) complaints: abdominal pain, vomiting, fever to 38.9°, bespokoit is O. On the day of treatment in the analysis of blood leukocytes of 19.2·109/l; Hb - 112 g/l; signs of systemic inflammation.

In the analysis of urine protein - 3.5 g/l erythrocytes, leukocytes entirely, bacteria +++.

17.10.2003, Surgery: laparotomy. Revision of the abdominal cavity. Pyelostomy left. Postoperative diagnosis: congenital hydronephrosis on the left on the basis of narrowing pyeloureteral segment. Conservative: Ampioks 500 mg 3 times a day; Reopoliglyukin; fresh Frozen plasma, 10% glucose, trental, analgesics.

23.10.2003 year - on the sixth day after the operation, the condition worsened; vomiting 3 times. Fever - 39°With tachycardia. HR - 168 beats per minute. Locally: belly swollen, tense, painful on palpation. Drainage from the abdominal cavity departs purulent discharge, in the field of wound infiltration. During inspection of the wound - dirty-hemorrhagic fluid.

23.10.2003, Operation: lumbotomy. Resection of the pelvic-ureteric segment. Pyeloureterostomy. Nephroscope. Postoperative diagnosis: congenital stenosis paleorecharge segment. Hydronephrosis. After laparotomy, parametric, urinary numb. Peritonitis.

25.10.2003, the Patient is pale, the temperature of 37.8°C. Vomiting, persistent microcirculatory disorders. Locally: abdominal pain, the phenomenon of paresis of the intestine, the probe of the stomach stagnant detachable.

In the analysis of urine protein 0.3 g/l, leucocytes, erythrocytes. Visually: the urine is concentrated, mixed with erythrocytes. UD. the weight of urine 1023. Patient 25.10.2003, intravenous, drip ASG. 1 dose (30000 thousand IU).

27.10.2003 normalized body temperature, stabilized hemodynamic parameters, has allowed paresis of the intestine. The patient is in satisfactory condition transferred to the relevant Department.

When using CBC with curative intent, in the complex treatment of patients with sepsis positive results in 30 patients in the absence of side effects in the coming days after injection.

Signs, distinctive features of the prototype:

in the treatment of intestinal sepsis this drug was not used.

The usefulness of the proposed method is as follows:

- to achieve a stable, fast, a positive result from one or 2 injections ASG, already on the 2nd, 3rd day observed clinical and laboratory results;

- optimization of immune-correcting therapy without sensitization of the patient;

- shorter hospital stay heavy patients;

- the absence of contraindications to the drug;

- resistance to cleavage by bacterial toxins and enzymes.

Show is whether peripheral blood and t - reaction before and after the introduction of PACS
t body38°38°38°38°39°38°38°
Days after surgery2345678

A method of treatment of sepsis caused by intestinal infection, which consists in the carrying out of antibacterial therapy, characterized in that in the treatment of sepsis in the composition of infusion therapy, the patient is injected 30 thousand IU protivomigrenoznoe polivalent the Noah horse serum intravenously in 200 ml of isotonic NaCl after filling volume of circulating fluid, the first 1 ml injected for 5 min, the remaining capacity for 1-1,5 hours


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