Method for detecting indications for hyperbaric oxygenation (hbo) at treating patients with acute ischemia of limbs after fractures of long bones

FIELD: medicine, traumatology.

SUBSTANCE: the present innovation deals with providing individual approach in necessity to prescribe the course of HBO in patients with acute ischemia of limbs after fractures of long bones. One should detect partial pressure of gas in tissues of an affected limb before HBO seance, moreover, it is necessary to detect partial pressure of carbon dioxide due to noninvasive technique being distally the lesion level both before and 3 h after a pilot HBO seance to compare their values and at availability of the increase in the values of partial pressure of carbon dioxide in tissues against the values before HBO seance by 30 mm mercury column, and more one should conclude upon the usefulness of carrying out the course of HBO therapy.

EFFECT: higher accuracy of detection.

2 ex

 

The invention relates to medicine, in particular to methods for determining indications for hyperbaric oxygen therapy, and can be used in the treatment of trauma patients.

One of the contraindications to the use of HBOT in the treatment of severe traumatic injury is the predicted no effect from the use of HBOT.

Known quality criterion for predicting the effectiveness of HBOT on the basis of conjunctival biomicroscopy. If after the first session of HBO has a positive orientation of qualitative parameters of microcirculation in visual assessment of microvascular bulbar conjunctiva, then it is a major improvement of clinical and functional parameters, and overall clinical outcome HBO regarded as positive (Dr. I.P., Lototsky M., Levchuk A.L., Brodzyanskiy SCI Hyperbaric oxygenation in military surgery / Hyperbaric. Fiziol. and medicine, 2001. No. 3. - S. 14-26.).

However, using this criterion, it is impossible to estimate the local response of damaged tissues.

A well-known criterion for the treatment of hyperbaric oxygenation in trauma patients based on invasive determination of oxygen partial pressure (po2in the muscles in the damage zone. Recommended Bratina course of hyperbaric oxygen therapy patients have pO2more than 2 mm Hg, while working electrode is introduced into the hematoma between the joints to a depth of 15-20 mm (Afrasiab, Nravidca. Hyperbaric oxygenation in the treatment of fractures / Of Saratov University. Samara branch, 1991. - 133 pages).

However, in the treatment of patients with acute lower limb ischemia after long bone fractures by Ilizarov method positive effect of courses of HBO was achieved and when pO2was zero.

The present invention is to develop a method for the diagnosis indications for treatment of hyperbaric oxygenation in trauma patients with acute limb ischemia after damage, allowing to determine the feasibility of treatment with hyperbaric oxygenation.

The problem is solved in that in the method of determining indications for hyperbaric oxygenation in the treatment of patients with acute lower limb ischemia after fractures of long bones, including the determination of the partial pressure of gas in the tissues of the injured extremity before the session HBO, determine the partial pressure of oxygen and carbon dioxide is a non-invasive method distal to the level of injury before and 3 hours after the session HBO, compare their values, and in the presence of increasing values of partial pressure of carbon dioxide in the tissues consider is Ino values to session HBOT for more than 30 mm Hg treatment prescribed hyperbaric oxygenation when values of the partial pressure of oxygen in the tissues is less than 2 mm Hg

The present invention is illustrated in a detailed description of the method of determining indications for hyperbaric oxygenation in the treatment of patients with acute lower limb ischemia after fractures of long bones, and specific examples of its implementation.

The method is as follows.

In the study method transcutaneous polarographic patient determine the partial pressure of oxygen and carbon dioxide when installing the sensor on the intact skin of the investigated limb distal to the level of damage before the session of HBO. Followed by a test session HBO even if the value of the partial pressure of oxygen in the studied tissues was less than 2 mm Hg, and 3 hours after the end of the re method transcutaneous polarographic determine the partial voltage of the gases in the skin of the affected limb distal to the level of the fracture. Compare the values of partial pressure of carbon dioxide, and in the presence of increasing its value in the investigated tissues after the trial session of HBO relative to the values obtained before the session GCE, more than 30 mm Hg, treatment hyperbaric oxygenation is considered reasonable.

Clinical example, issue the log method.

Patient S., 13 years old (case History No. 31759) was treated about the effects of the massive direct road trauma. In the postoperative period, despite the ongoing comprehensive General and local treatment, has built an extensive necrosis of the skin and soft tissues of the lower leg from knee to ankle, rolling on the rear foot, with exposure of the tibial diaphysis with three sides. Was necrectomy soft tissue tibia osteosynthesis leg and foot by Ilizarov with the aim of creating favorable conditions for the elimination of defects and in wound healing of soft tissues. Thus, there has been a replacement of defects of all tissues, however, formed ankylosis of the ankle joint. When this soft tissue over the level of the knee joint to the ankle joint scar changed, ankylosis in the Shin-ankle joint in a vicious position (equinus feet 150°).

To set foot in a functionally advantageous position the patient the operation was performed - closed osteosynthesis of the right foot and tibia by Ilizarov and hinge osteotomy of the talus, as well as hellotime by Bayer. In operation, during insertion of the foot to the corner 105°marked acute circulatory disorders of the forefoot, so the foot is returned to its original position. Started medicamentosa therapy, aimed at improving the trophic limb, vicious setting foot decided to resolve gradually.

After surgery, the toes of cyanotic, cold to the touch. Tactile sensitivity is weakened on the rear foot, not on your fingers. Ripple peripheral vessels in the foot is not defined on photoplethysmogram arterioles of the fingers of the right foot, the oscillation amplitude was not registered. Method transcutanous polarographic partial pressure Rho2in the tissues of the foot was zero Rho2=38 mm Hg Status regarded as the presence of occlusion a.tibialis post., a.tibialis ant., pronounced signs of hypoxia of the tissues of the foot. The patient was assigned to the treatment hyperbaric oxygenation. 3 hours after the test session the study of partial pressure of gases in the skin of the rear foot. Method transcutannay polarographic partial pressure Rho2. in the skin of the dorsal surface of the foot were equal to zero, the partial pressure of carbon dioxide RNO2increased, reaching values of 150 mm Hg

Comparison of the values of partial pressure of carbon dioxide before and after HBOT session. Revealed the presence of increasing values of partial pressure of carbon dioxide in the investigated tissues after the trial session of HBO relative values to session HBO on 112 mm Hg Course of treatment is hyperbaric oxygenation was considered shown and continued.

After the treatment hyperbaric oxygenation method transcutannay polarographic registered partial pressure Rho2in skin tissues dorsal surface of the foot 20 mm Hg, hypercapnia tissues decreased - RDF2equal to 54 mm RT. According to PPG with all fingers of the right and left foot were recorded amplitude photoplethysmogram more than 20 mm Patient within 14 days after the operation started, the elimination of equinus foot deformity with a rate of 0.25 mm 3-4 times a day.

8 days since the beginning of the elimination of equinus foot deformity in a patient with clinical signs of ischemia of the skin on the foot was missing.

Clinical example No. 2.

Sick,, 45 years old (case History No. 40501) was admitted to the hospital with ischemia of the leg and foot in the fire-shot wounds of the left tibia with bone defect of the tibia and the damage of the main arteries of the leg. When entering the skin of the leg and foot is cold to the touch, cyanotic color, the pulse on peripheral arteries of the foot was not determined. After the necessary tests have been carried out surgical treatment of gunshot fracture with fixation of the fragments of the tibia by Ilizarov. After the operation, the pulsation of the vessels were not found on photoplethysmogram arterioles palileo stops the oscillation amplitude were not registered. Method transcutannay polarographic partial pressure Rho2in the tissues of the foot was equal to zero, RNO2=1 mm Hg

The patient continued conservative therapy of ischaemia of the leg, supplemented by a course of hyperbaric oxygenation. 3 hours after the test session, a study was conducted in partial pressure of gases in the skin of the rear foot. Method transcutannay polarographic partial pressure Rho2in the skin of the back surface was equal to zero, the partial pressure of carbon dioxide RNO2was 2 mm Hg

A comparison was made between values of partial pressure of carbon dioxide before and after HBOT session, resulting in a detected increase in the values of the partial pressure of carbon dioxide in the investigated tissues after the trial session of HBO relative values to session HBO 1 mm Hg On the basis of this it was concluded that it was not the course of hyperbaric oxygenation. However, the patient received 10 treatment sessions of hyperbaric oxygenation. Despite treatment, the patient was clinically observed pattern of gangrene of the limbs with a clear line of demarcation, which required the amputation of the leg at the level of the top of the third and appeared to confirm the inappropriateness of course hyperbaric oxygenation.

Thus, the usage of the proposed method allows for an individual approach in need of treatment hyperbaric oxygenation in patients with acute ischemia after fractures of long bones of the extremities.

The method of determining indications for hyperbaric oxygenation in the treatment of patients with acute lower limb ischemia after fractures of long bones, including the determination of the partial pressure of gas in the tissues of the injured extremity before the session HBO, characterized in that to determine the partial pressure of carbon dioxide is a non-invasive method distal to the level of injury before and 3 h after the trial session of HBO, compare their values and in the presence of increasing values of partial pressure of carbon dioxide in the tissues relative to the values before the session GCE 30 mm Hg or more is considered advisable to pursue a course of HBO treatment.



 

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