Method of treating purulent wounds of soft tissues

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to purulent surgery, and can be used in treatment of patients with purulent wounds of soft tissues. For this purpose antibacterial and immune therapy are carried out. Immunotherapy is performed in the following way. Blood is sampled from patient, by plasmapheresis leukocyte cell mass is obtained from it and cultivated with 1 000 000 Units of interleukin -2 and 200 ml of NaCl 0.9% solution for 60 min at temperature 37°C, with further centrifugation. After that, obtained complex of cytokins is introduced uniformly subcutaneously symmetrically at distance 1.0 cm from wound edges until infiltration bank in volume 10-80 ml with 10 ml of solution per each 5 cm of wound length is created. Introduction is performed on the 1-st, 3-rd and 5-th day of post-operative period.

EFFECT: method makes it possible to increase efficiency of said pathology treatment due to local enhancement of non-specific immune response in region of infection focus.

1 ex

 

The invention relates to medicine, namely to the fields of surgery, and can be used in the treatment of patients with purulent wounds.

To do this, perform the surgical treatment of purulent wounds, then enter the complex autologous cytokines subcutaneously in the region of a wound received in the amount of 70-80 ml during the incubation of interleukin-2 for 60 minutes at 37°C with leukocyte cell mass obtained by plasmapheresis. The obtained volume of the complex cytokine evenly subcutaneously enter symmetrically at a distance of 1.0 cm from the wound edges to create infiltration of the shaft in the amount of 10-80 ml 10 ml for every 5 cm long wound in the 1st, 3rd, and 5th day post-operative period.

There is a method of treatment with interleukin-2 in advanced bacterial infections (German patent No. 3910011, AK 37/02, 1990). In this way the introduction of Il-2 intravenously, subcutaneously, intraperitoneally, intramuscularly leads to increased non-specific cellular response that will reduce the number of bacteria in the peritoneal cavity and reduction of endotoxins in the blood plasma. The method according to the patent may be used by injection of interleukin-2 in a dose of 1-3,5·106U/kg in the postoperative period, the state after a serious injury, a common gram-positive and gramatical the second infection, peritonitis.

However, these methods use of cytokines is their rapid elimination, which requires the use of cytokines in high doses, which can lead to significant adverse toxic reactions.

There is a method of adaptive immunotherapy for the treatment of patients with purulent-septic processes (Patent RU №2098125 C1, A61K 38/20, AK 38/00), which emit mononuclear cells, cultured them with interleukin-2 and return parenteral patient, and available purulent cavity is washed with a solution containing a combination of cytokines obtained by culturing mononuclear cells with inteleukin-2.

This method is only used in combination with intravenous and not used as an independent method only local citicentre. The method of preparation of the complex autologous cytokines requires high technical support and material costs, as well as the time factor.

The low permeability of the drug in the washing, requiring higher concentrations of the drug, frequency and duration of application, as well as increasing treatment time.

There is a method of treatment of purulent wounds, including pre-treatment of the wound with antiseptic and subsequent introduction into the wound drug superlymph (heterologous complex the natural cytokines, obtained from cultures of stimulated peripheral blood leukocytes) timagenes in a volume ratio of 1:10, once in the first, second, third, seventh, fourteenth and twenty-first day through the direction of the inner surface wounds drugs from the calculation of 0.1 ml of 1 cm wound (Patent RU №2228763 C1, A61K 38/19).

In this way local citicentre used for the treatment of purulent wounds heterologous complex of cytokines, which are less specific for each individual organism.

Also the disadvantage of this method is the need for removal of necrotic tissue, as pre-processing is carried out wounds only antiseptic, also when this method is used six times the introduction of the drug, and to achieve the treatment of purulent wounds should use thymogen.

The present invention is improving the efficiency of treatment of patients with purulent wounds by enhancing non-specific immune response and immunological reactivity in the nidus of infection.

The problem is solved by a method for the treatment of purulent wounds of soft tissues, including the surgical treatment of purulent wounds, antibiotic therapy, immunotherapy.

To conduct immunotherapy collect blood from a patient, get out of it when plasma is the leukocyte apheresis cell mass. Cell mass cultured with 1 000 000 Units of interleukin-2 and 200 ml of 0.9% NaCl for 60 min at 37°C, followed by centrifugation. Enter the complex of cytokines evenly subcutaneously symmetrically at a distance of 1.0 cm from the wound edges to create infiltration of the shaft in the amount of 10-80 ml 10 ml for every 5 cm long wound, 1st, and 3rd and 5th day post-operative period.

The novelty of the invention:

For immunotherapy collect blood from a patient, get out of it in plasmapheresis leukocyte cell mass. Cell mass cultured with 1 000 000 Units of interleukin-2 and 200 ml of 0.9% NaCl for 60 min at 37°C, followed by centrifugation.

- Enter the complex of cytokines evenly subcutaneously symmetrically at a distance of 1.0 cm from the wound edges to create infiltration of the shaft in the amount of 10-80 ml 10 ml for every 5 cm long wound, 1st, and 3rd and 5th day post-operative period. The subcutaneous route of administration, in contrast to intravenous, intramuscular and the application allows you to quickly create a higher concentration of the drug in the area of interest, which considerably increases the efficiency of action. The drug is injected directly into the area of the hearth surgical infection, which is formed of the local immune response and increase the immunological reactivity. Unlike injections inside the wound, the needle is not in contact with purulent wound surface.

The set of essential features in the available literature was not found, therefore the invention conforms to the criterion "novelty". For the first time in surgical practice applied local cytokine therapy of purulent wounds of various etiologies using subcutaneous injection in the region of purulent wounds of complex autologous cytokines as a result of stimulation of leukocyte mass interleukin-2.

The method can significantly improve the results of treatment of patients with purulent complications of postoperative wounds.

The combination of medical data manipulation allows to avoid additional surgical action in respect of purulent wounds, additional medicines, improve treatment outcomes, economic efficiency by reducing the consumption of drugs, reduce the length of hospitalization and disability, period of hospitalization, earlier recovery of physical activity.

The method is as follows.

When the identification of purulent wounds of various etiologies, after performing the surgical treatment of wounds, destination antibiotic therapy, is the introduction subcutaneously in the area of the wound to create infiltration shaft complex is autologinid cytokines, obtained in two stages, the first of which plasmapheresis 150 ml of patient's blood get leukocyte cell layer by double centrifugation, and incubated on the second received-cell mass with 1 000 000 IU of Il-2 for 60 min at 37°C, followed by centrifugation as before and the allocation of 70-80 ml of the supernatant layer containing a complex of autologous cytokines. Residual cell mass is disposed. The resulting complex of cytokines evenly subcutaneously enter symmetrically at a distance of 1.0 cm from the wound edges to create infiltration of the shaft in the amount of 10-80 ml 10 ml for every 5 cm long wound, 1st, and 3rd, and 5th day post-operative period.

The method of preparing complex autologous cytokines:

In "Gamecon" is a fence 150 ml of the patient's blood. The blood is centrifuged at 3700 rpm for 20 minutes and Then is removed from the system the plasma, so that over the erythrocytes remained leukocyte layer, and then produce centrifugation in the same mode and remove the supernatant, leaving the same leukocyte layer. In the obtained cell mass add 1 000 000 UNITS of interleukin-2 and 200 ml of saline solution NaCl 0,9%, incubare for 60 min at 37°C. Next centrifugum in the same mode and the distribution is eating the supernatant layer at 70-80 ml sterile vials, and the remaining cell mass recycle.

To further carry out the introduction of the received complex cytokines evenly subcutaneously symmetrically at a distance of 1.0 cm from the wound edges to create infiltration of the shaft in the amount of 10-80 ml 10 ml for every 5 cm long wound, 1st, and 3rd, and 5th day post-operative period.

Clinical case 1: Female, K., 57 years old (case history No. 1318). Entered the emergency surgical Department at CCH 1, core 31.03.2009 11:35 diagnosed with:

JCB. Acute calculous cholecystitis.

Companion: IHD. Stenocardia. FC I. CCI I. history 10 years ago on the treatment of thrombembolic pulmonary artery.

The state of moderate severity due to pain and inflammatory syndromes, pronounced abdominal pain syndrome in the right hypochondrium and epigastrium, locally positive symptoms of peritoneal irritation, low-grade temperature 37.7°C, stable hemodynamics, tachycardia no, leukocytosis blood to 13.3 billion/L.

In the biochemical analysis of blood hyperbilirubinemia: total bilirubin - 44.4 mmol/l, direct-faction - 14.4 µmol/L. of Hyperamylasemia there is no blood. Other values were within normal limits. ECG: sinus Rhythm, a single atrial extrasystoles, electrolyte disorders

The above complaints within 48 hours. History of tmichael rise of body temperature up to 40°C.

Diagnosis at admission was never in doubt. On abdominal ultrasound: gall bladder up to 108 ml, wall 0.4-0.5 cm, multiple concretions from 0.2 to 1.0 see Signs of biliary hypertension is not detected. The complex conservative therapy within 6 hours, including procaine blockade, infusion therapy, antispasmodics, ineffective. Preoperative preparation. Prevention thrombolites complications. Given the presence of comorbidity and the ineffectiveness of conservative therapy, for health reasons 31.03.09. Operation: Cholecystoenterostomy local access under local anesthesia.

Intraoperatively detected friable infiltrate in the right upper quadrant, consisting of the gallbladder, the edges of the liver and omentum. Dedicated gall bladder with a volume of 100 ml, the wall sharply infiltrated and thickened to 0.6 cm at the opening of the lumen of the bladder comes purulent bile, made cholecystectomy. The volume of operative intervention for health reasons.

Dignos after surgery: ECB. Acute calculous cholecystitis in loose infiltrate.

Further treatment in the emergency surgical Department, correction of the treatment of comorbidity, antibiotics: Cefazolin 2.0×3 times a day/m, Metrogylum 100 mg × 2 times a/m for the first 3 days, washing cholecystostomy 2 times a day.

The state remained stable, moderate fever in the first 3 days after surgery. Hyperleukocytosis in the General analysis of blood were observed, biochemical parameters within normal limits. On the 13th day marked the failure of cholecystostomy with leakage of bile into the dressing for revision of wound suppuration not.

On the 16th day revealed a festering wound.

15.04.09. Surgery: Cholecystectomy through a mini-approach, companionway, drainage of the abdominal cavity. Excision wound edges. Local cytokine therapy.

Diagnosis after surgery: ECB. Chronic cholecystitis. After cholecystectomy. The festering wound.

Intraoperative gallbladder selected from adhesions, subserous cholecystectomy combined method. Also identified suppuration of postoperative wounds: expressed infiltration during the breeding wound edges musculoaponeurotic layer, seeding from a wound, the wound edges excised, the wound is sutured closed. Intraoperative introduction cytokine suspension proposed method.

The postoperative period without features. Was performed a second procedure subcutaneous injection of complex autologous cytokines in the range of postoperative wounds: 17.04.09, 19.04.09.

Antibiotics: Cefazolin 2.0×3 times a day/m, Metrogylum 100 mg × 2 times a/m during the first 3 days after the last operation.

During the first 3 days subfebrile body temperature, which corresponds to the process at the given pathology, then the normalization temperature. 22.04.09 - swab removed, complications were found.

18.04.09 at 30.04.09 - signs of sepsis post-operative wound was not detected. The indicators of the General analysis of blood biochemical indices of the blood within normal limits.

30.04.09 stitches removed, the patient was discharged in good condition.

Thus, the use of the proposed method of local cytokine therapy can significantly improve the results of treatment of patients with purulent complications of postoperative wounds.

The method of treatment of purulent wounds of soft tissues, including the surgical treatment of purulent wounds, antibiotic therapy, immunotherapy, characterized in that for immunotherapy collect blood from a patient, get out of it in plasmapheresis leukocyte cell mass, cultivate it with 1 000 000 Units of interleukin-2 and 200 ml of 0.9% NaCl for 60 min at 37°C, followed by centrifugation and injected the resulting complex of cytokines evenly subcutaneously symmetrically at a distance of 1.0 cm from the wound edges to create infiltration of the shaft in the amount of 10-80 ml 10 ml for every 5 cm the length of the wound, in the 1st, 3rd, and 5th day post-operative period.



 

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