Method of intestinal distention preventing in patients with widespread peritonitis

FIELD: medicine.

SUBSTANCE: invention belongs to medicine, notably to surgery and resuscitation, and can be used as intestinal distention preventing method in patients with widespread peritonitis. For this purpose on Th10-12-LI vertebrae level mixture of medications is injected subdermally. Mixture consists of 6 ml of 0.5% marcaine solution, 16 IE of lydasum, 0.5 ml of 0.05% proserin. Injection is made once a day for five days.

EFFECT: method allows preventing the intestinal distention by affecting the spinal cord nervous structures, which form abdominal and mesenteric plexus, promoting its metabolism and motility recovering.

1 ex

 

The invention relates to medicine, namely to surgery, and can be used as a method of prevention and treatment of paresis of the intestine during the widespread peritonitis.

There is a method of prevention and treatment of paresis of the intestine during the widespread peritonitis, which uses standard intensive therapy, including extended epidural anesthesia. The disadvantages of this method should recognize the potential complications: hypotension, postfunctional headache, low back pain and discomfort, excessive spread of spinal anesthesia, which is manifested by anxiety, nausea, paralysis of the intercostal muscles, lack of air movement - weakening voice, epidural hematoma, complications associated with catheter (vascular or subarachnoid position, the cutting portion of the catheter needle) [1]. Through an epidural catheter limited selection of drug combinations, in particular a neostigmine methylsulfate.

The proposed method does not have these complications and difficulties in the production and use advanced combinations of drugs.

The technical result of the invention is improving the efficiency of treatment of patients with disseminated peritonitis by affecting nerve education of the spinal cord, forming the splanchnic and brig Ichnya plexus resulting in the reduction of swelling nerves and plexuses, restore metabolism of the nervous structures and contributes to the correction and restoration of motor skills. This provides a layered effect on the nervous system - as regional and system, which results in a more pronounced and prolonged therapeutic effect.

The method consists of subcutaneous injections at the level of Th10-12-L1vertebrae performed with the patient in the horizontal position on the side" with the belly knees and bent back. Bony landmarks were the spinous processes of the vertebrae. Palpation was determined by the midpoint between the spinous processes of adjacent vertebrae, where he made an intramuscular injection with a needle. The introduction of needles was carried out parallel to the spinous processes of the vertebrae. The injections were performed subcutaneously at a depth of 1-2 cm, which depended on the severity of the subcutaneous fat. The amount of drug compound was 7-8 ml and was administered in two points of adjacent segments of the spine. The mixture was prepared immediately before the procedure. Injections were performed 1 time per day for 5 days. Drugs included in the drug mixture into a chemical reaction does not take.

Part of the complex drug mixtures included:

6 ml of 0.5% solution of marcaine - mestone teshirogi the drug;

- 16 UNITS lidz is an enzyme that increases tissue and vascular permeability, facilitating the movement of fluids in the interstitial spaces; reducing the swelling of the tissue [2];

to 0.5 ml of 0.05% solution of neostigmine methylsulfate (Neostigmine the methyl sulfate) - synthetic anticholinesterase agent (neostigmine), reversible blocking cholinesterase, leads to the accumulation and enhancing the action of acetylcholine on the organs and tissues and restoration of neuromuscular conduction, causes a decrease in heart rate, increases the secretion of glands (salivary, bronchial, sweat and blood) and increases the acidity of gastric juice, increases the tone of the smooth muscles of the intestine (increases peristalsis and relaxes sphincter), tone of skeletal muscles [2].

The basis of this method of treatment was neurotropic effect of complex mixtures of drugs on the nervous education of the spinal cord, forming the celiac and superior mesenteric plexus.

The proposed method is easy to perform, availability, and efficiency.

To assess the effectiveness of the proposed method was conducted clinical observations on 49 patients with ulcer disease complicated by perforation, widespread peritonitis at the age of 42,94.3 years. All prescription perforation exceeded 6 hours. The amount of interference: the closure part the dispensing orifice, decompression of the gastrointestinal tract, sanitation and drainage of the abdominal cavity. According to the testimony patients underwent intensive therapy in terms of SAR. Depending on the applied methodology all patients were divided into 2 clinical group.

The comparison group (n=32) consisted of patients who received standard intensive care.

The main group (n=17) - along with the standard therapy used subcutaneous neuroborreliosis injection (STUMPS).

Evaluation of the treatment results was performed according to the following algorithm:

- auscultatory appearance of intestinal peristalsis;

- the dynamics of change and the timing of normalization of leukocytosis;

- the emergence of an independent chair;

- early enteral nutrition;

- gastric probe "probe losses."

When using the proposed method of treatment time normalization of leukocytosis was 6,520,27 days against 7,450.21 days only with standard therapy. The emergence of an independent chair has been through to 3.580,17 and 4.09 to0.12 days with standard therapy. The abbreviation "probe loss through gastric tube <300 ml/day. fell from 3,590.16 to 2,710.14 days, restoration of peristalsis, contributing to full enteral nutrition, were 2.240,1 (2,560,09) day.

Thus, the study suggests that h is about the use of subcutaneous neuroborreliosis injection in treatment of widespread peritonitis encourages earlier recovery of bowel function and a smooth postoperative period.

Clinical example:

Patient N. 51. Received in the receiving Department of the MUSES "BCHB", Berdsk 14.04.2007 with a diagnosis of peptic Ulcer complicated by perforation.

Peritonitis. From the anamnesis: a long time suffering from gastric ulcer. 1-2 times per year exacerbation of the disease. Undergoing treatment antiulcer drugs. Last exacerbation 1.5 weeks ago. On admission the patient's condition is severe. In consciousness, adequate. Abdomen tense, palpation sharp pain. Symptom Shchetkina-Blomberg positive. After preoperative preparation is taken for the operation. Operations: perforation of stomach ulcers. Common serous peritonitis. Performed suturing of the defect, sanitation, drainage of the abdominal cavity. Appointed Cefoperazon at a dose of 1.0 g 3 times per day, intravenous metronidazole 500 mg intravenously 3 times a day. Conducted antiulcer therapy, infusion-detoxification therapy. Duration of antibiotic therapy was 7 days. From the first day was held subcutaneous neuroborreliosis injection at the level of Th10-12-L1vertebrae (five days in two points). By the end of the course there was a clear positive dynamics: on the 6th day there was a mild leukocytosis, restoration of peristalsis, contributing to a full-fledged enterain the e power, had for 2 day, 5 day removed the probe, independent chair appeared towards the end of the 3 days. Adverse reactions are not registered. Discharged from the hospital under the supervision of a surgeon and therapist's place of residence.

References

1. Jedward Morgan Jr., Maged S. Michael. Clinical anesthesiology: book 1-I / ed. 2nd, Rev. - Lane. from English. - M - SPb.: Publisher BINOM Nevsky Dialect, 2008. 400 C., Il.

2. Register of medicines of Russia radar encyclopedia of medicine. - 15th vol./ editor-in-chief Glaskowsky. - M.: "radar - 2007", 2006. - s.

Method of prevention of paresis of the intestine during the widespread peritonitis, wherein subcutaneously at the level of Th10-12-L1vertebrae administering a mixture of 6 ml of 0.5%aqueous solution of marcaine, 16 UNITS lidz, 0.5 ml of 0.05%neostigmine methylsulfate, injection is carried out 1 time a day for 5 days.



 

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