Method of treating pyoinflammatory complications in patients with critical ischemia of lower extremities based on local administration of perftoran

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to purulent surgery, and can be used for treating patients with critical ischemia of lower extremities. For this purpose, standard medical therapy is additionally combined with single-step wound layered infiltration of soft tissues by Perftoran at 3 cm from wound edges in dose 10-15 ml if the wound is localised on a feet, and 40-50 ml if the wound is localised on a leg or a hip every second day in amount 8-10 procedures.

EFFECT: method allows reducing length of treatment and managing pain syndrome, accelerating wound cleansing and healing in higher intensity of repair processes ensured by constant maximally effective active Perftoran concentration in the wound zone.

1 ex

 

The invention relates to medicine, in particular to methods of treatment of patients with critical ischemia of the lower extremities.

The overwhelming majority of patients with critical ischemia of the lower extremities are purulent-inflammatory complications and the incidence of these complications increases, which significantly lengthens the duration of treatment, worsens the course and prognosis of the disease, and progression of purulent inflammation significantly increases the risk of limb amputation and postoperative mortality.

Currently therapy of patients with critical ischemia of the lower extremities in the presence of purulent-inflammatory complications include various types of reconstructive surgeries, local treatment of wounds (how agressively to debride) and conservative treatment, which consists in the application of antiseptic solutions, ointments, enzymes that are not always effective in the treatment of purulent-inflammatory complications.

Other methods of treatment of purulent-inflammatory complications include mechanical methods of purification of RAS (pulsating jet, ultrasonic, vacuum drainage). (Purulent surgery, 2003 gpod amended Erohina E.A., Bergeland, Challapampa, str-257, 779-787). The disadvantages of these methods can be considered that require expensive equipment, which is not available in each clinic. In addition to the CSO, with this equipment it is usually at a great distance from the vascular compartment and requires the transportation of patients to perform the procedures that adversely affects their status.

There is a method of treatment of patients with obliterating atherosclerosis of the lower extremities in the stage of ischemia by a multiple of intraarterial perfusion with perftoran. Perfusion is carried out simultaneously in the femoral artery of the affected limb is once per day in the amount of 150.0 ml using an automatic dispenser, the treatment course is 8 to 10 of perfusion (Grechaninov, Amechazurra, Messagerie, Subchief. The use of emulsions of perftoran in treatment of critical ischemia of lower extremities // Angiology and vascular surgery - 2007. No. 4. - Pp.33-37).

The disadvantage of this method, selected as a prototype, is that there are technical difficulties at the puncture stenotic (atherosclerosis) of the femoral artery, the probability of injection of arterial thrombosis, the risk of bleeding with the development of the hematoma, the possibility of damage to the femoral vein, the need for automatic dosing.

The objective of the invention is to develop a simple and universal method for maximum concentration of the drug in approximately the wound area, prevention of complications specific to parenterale the introduction of the drug, prevention of suppurative complications of amputations, as well as for treatment of purulent-inflammatory complications in patients with critical ischemia of the lower extremities.

According to the invention the task is solved in that in the method of treatment of patients with critical ischemia of the lower extremities in the presence of purulent-inflammatory complications after the standard treatment regimen is layered coloradia infiltration of the soft tissues of the perftoran. Injections are performed in compliance with the rules of asepsis of several Ukolov, departing 3 cm from the wound edges. The location of the points Ukolov and quantity of the drug is determined by the anatomical localization of the wound, the severity of the soft tissue component. The localization of the wound in the foot simultaneously injected 10-15 ml of perftoran on leg and thigh - 40-50 ml of perftoran. Injections are performed in a day the total number of 8-10 procedures that allows to maintain a constant, the maximum effective concentration of perftoran in coloradoi zone. Dosage of perftoran and duration of its application has been tested in practice and are the best.

The efficacy was assessed on the dynamics of clinical symptoms, biochemical and coagulation of blood counts were conducted assessment of pain and local thermometry. All patients were determined cell is a bacterial composition of wound, studied the dynamics of wound healing, the area and depth of the wound, the nature and quantity of discharge, the volume of the affected limb, the dynamics of the ankle-brachial index. All patients underwent laser Doppler plumeria with the definition of the integral index of microcirculation.

As a result of the treatment was rapid subsidence of the inflammation, decrease pain, reduce dose used analgesics. There was a trend to active cleansing wounds, reduction of the first phase of wound healing. Was determined by the intensive growth of granulations, resulted in shorter time to close the wound secondary suturing. Early wound closure is favorably affected the functional and cosmetic results of treatment.

Example 1. Patient M., 68 years old, he enrolled in the Institute of emergency for cardiovascular Department with a diagnosis of atherosclerosis of vessels of lower extremities, occlusion of the superficial femoral artery to the left, necrosis I and II of the toes of the left foot, critical ischemia of the left lower extremity.

The patient underwent surgery: femoral-popliteal bypass, necrectomy in the amount of assertequal I and II of the toes of the left foot. In addition to standard conservative treatment is applied to the local introduction of perftoran 10 ml (8 procedures). On the 4th day marked the cleansing of wounds, increased bleeding tissue, which allowed to impose secondary seams. The patient was discharged on the 16th day after the operation with the formation of lasting scar. At the control examination after 6 months the patient has no complaints, the scar is smooth and painless.

The proposed method can speed up the cleansing and healing of wounds, to strengthen the intensity of reparative processes in patients with critical ischemia of the lower extremities, to reduce the number of amputations and mortality in pyo-inflammatory complications.

According to scientific-technical and patent literature there is no information about the treatment of patients with critical lower limb ischemia, acute purulent-septic inflammation, with local application of perftoran, therefore, the claimed invention meets the criterion of "significant difference".

The method of treatment of purulent-inflammatory complications in patients with critical ischemia of the lower extremities by standard therapy, characterized in that it further held coloradia layer infiltration of the soft tissues of the perftoran at a distance of 3 cm from the edges of the wound, simultaneously, at a dose of 10-15 ml with the localization of the wounds on the foot and 40-50 ml at localization in the leg and thigh, through the night, in the amount of 8-10 treatments.



 

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