Method of complex therapy in early age children with cytomegalovirus and locomotor system pathology in case of planned surgery

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to orthopedics and can be used for complex therapy in children of early age with cytomegalovirus and locomotor system pathology in case of planned surgery. For this purpose 10 days before taking patient to hospital 1 capsule of eubiotic "Bifiform" is introduced three times a day. Since the day of hospitalisation introduction of the medicine is continued in dose 1 capsule two times a day during 7-10 days. Two days before the operation immunomodulator "Viferon" is introduced in dose 1 suppository a day rectally. 30 minutes before the operation antibiotic "Ceftriaxon" is introduced intravenously in dose 15-20 mg/kg. After operation introduction of "Ceftriaxon" is continued for 2 days. Day dose of "Viferon" is increased to three suppositories every 8 hours during three days. After that it is introduced in dose one suppository per day every second day during 10 days.

EFFECT: elaborated regimen of therapy ensures prevention of post-operation complications, favours faster normalisation of blood parametres and reduction of index of leukocyte intoxication in post-operation period.

 

The present invention relates to medicine, in particular to methods of complex therapy in infants with cytomegalovirus, and pathology of the musculoskeletal system during routine surgeries.

The known method, including the introduction of antibiotics to children for 30 minutes prior to surgery (see EHarmony. Features pharmacokinetics of cephalosporins with routine orthopedic surgery in children. Abstract of Diss. for UCST CMN, Vladivostok, 2007, p.20).

However, this method does not take into account the fact that the increased risk of infection in patients is associated with severe pathology of the musculoskeletal system, requiring surgical intervention, often traumatic and time-consuming, involving massive blood loss and severe violations of the mechanisms of antibacterial protection of the body, especially in children during the first three years of life, among which the infection cytomegalovirus infection, leading to immunosuppression of the child's body, reaches 50%.

As a prototype of the selected method, which consists in injecting a immunomodulator cycloferon simultaneously with the antibiotic in the preoperative period (see Wedshare, Moskalski, Ohangaron. Immunomodulators in orthopedics. Moscow, 2006, s-408).

However, the known method does not allow to influence all parts of the pathological process, does not account for disturbances in the immune system caused by the persistence of cytomegalovirus in the body of the child, does not ensure prevention of postoperative complications.

The task of the invention is the prevention of postoperative complications, increased anti-infective protection and nonspecific resistance of the organism, elimination disorders of cellular and humoral immunity through the activation of the interferon system and correction of the composition of the intestinal microflora in young children with orthopedic disorders.

This problem is solved due to the fact that in the method, including the appointment of immunomodulatory and antibacterial agents, as immunomodulating funds designated suppositories "Viferon" 1 candle per day rectally two days before surgery, after surgery, increase the daily dose to three candles every 8 hours for three days, and then assign one suppository once a day every other day for 10 days, 30 minutes before surgery intravenous antibiotic "Ceftriaxone" in a dose of 15-20 mg/kg and continue its introduction within 2 days after surgery, 10 days before admission to the hospital designate eubiotic "Bifiform" one capsule three times a day, but from the day of admission to hospital - one capsule twice a day for 7-10 days.

The way to the complex therapy in infants with cytomegalovirus and pathology of locomotor apparatus with planned surgical intervention is as follows. 10 days prior to elective surgery the child as an outpatient appoint eubiotic "Bifiform" 1 capsule 3 times a day, as from the date of admission to the hospital, 1 capsule 2 times a day for 7-10 days. Two days before the operation, the child rectally administered suppositories "Viferon" dose 150000 ME once a day in the evening. In the postoperative period prescribed 150000 ME three times a day every 8 hours for 3 days, then 1 suppository (150000 ME) 1 time per day every other day for 10 days. On the day of surgery for 30 minutes before surgery intravenous antibiotic "Ceftriaxone" once in a daily dose of 15-25 mg/kg and continue his introduction to the same dose within 2 days after the operation.

Clinical example. Patient C. 3 years, IB. No. 219153, he enrolled in the Department of pediatric orthopedics NIETO 5.09.08, congenital bilateral clubfoot (during treatment). The first hospitalization was in 2005 at the age of 10 months, however, operative treatment was delayed because the child was ill ORVI with obstructive syndrome. In General, the analysis of blood erythrocytes - 3.4 million, hemoglobin - 101 g/l, lake. - 4,6%, stab neutrophils - 1%, segmented neutrophils - 38%, lymphocytes - 37%, monocytes - 5%, eosinophils - 19%, ESR - 2 mm/hour (anemia mild, neutrophiles, eosinophilia). According to PCR diagnostics allocated cytomegalovirus. Yes the major chest x-ray, the child has the syndrome enlarged thymus gland.

Child 1 pregnancy 1 term labor in the head previa, score on a scale of Apgar score of 8, weight at birth 2620, a growth of 48 cm (intrauterine hypotrophy of the fetus). Was seen by the neurologist with perinatal CNS damage, suffered double-obstructive bronchitis.

The second hospitalization at the age of 11 months. also ended with a statement of the child over SARS.

Third hospitalization at the age of 1 year and 1 month. 10 days before hospital admission outpatient patient was assigned Bifiform" 1 capsule 3 times a day. Since admission to the hospital the child received "Viferon" 150000 ME once a day for 2 days before surgery, 3 days after surgery 150000 ME 3 times a day every day, then dose 150000 ME in a day for 10 days, "Bifiform" - 1 capsule 2 times per day. 30 minutes before surgery injected 200 mg of Ceftriaxone, then the same dose was used for another 2 days. Received iron supplements (ferrules) and Mezim-Forte 1 tab. 2 times a day, prednisolone in a dose of 10 mg/m: one day before surgery, on the day of surgery and one day after surgery. Operation performed: analgesicsratio the right foot by Ilizarov, 4 months: analgesicsratio left foot by Ilizarov. Postoperative wound healing by primary intention, SARS child was not sick. Wipes the n home in satisfactory condition.

The method applied in 42 patients aged 2.5 months to 3 years with such diseases of musculoskeletal system, such as congenital hip dislocation, congenital clubfoot, congenital planovalgus deformity of the feet and other

In the study of indices of hemo-grams, immune status, leukocyte index of intoxication in children receiving this scheme adjuvant therapy, in contrast to receiving standard therapy, characterized by a more rapid trend towards normalization of blood counts and reduced leukocyte index of intoxication in the postoperative period.

In any case, was not observed postoperative infectious complications.

The method of complex therapy in infants with cytomegalovirus and pathology of locomotor apparatus when the planned operational intervention improves anti-infective protection of the body by passive and active influence on the immune system, reduces the frequency of acute infectious diseases in the period of inpatient treatment to prevent postoperative infectious complications and to shorten the period of stay of the patient in the hospital.

The method is used in children of early age with the first days of life, has low cost, is simple to use, non-invasive way BB is the origin of immunomodulator and eubiotics and high etiopathogenetic efficiency.

The method of complex therapy in infants with cytomegalovirus and pathology of locomotor apparatus when the planned operational intervention by assigning immunomodulatory and antibacterial agents, characterized in that as an immunomodulating funds designated suppositories "Viferon" 1 candle per day rectally two days before surgery, after surgery, increase the daily dose to three candles every 8 hours for three days, and then assign one suppository once a day every other day for 10 days, 30 minutes before surgery intravenous antibiotic "Ceftriaxone" in a dose of 15-20 mg/kg and continue its introduction within 2 days after surgery, 10 days before admission to the hospital designate eubiotic "Bifiform" one capsule three times a day, but from the day of admission to hospital - one capsule twice a day for 7-10 days.



 

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