Pm zinatullin's method of determining optimal volume of infusion therapy for injured in frostbites in state of alcoholic intoxication
SUBSTANCE: invention relates to narcology, and can be used in treatment of patients with frost bites, who are in the state of alcoholic intoxication of different severity. For this purpose determined are: degree of frostbite, area of affection, degree of alcoholic intoxication, physiological needs of organism and pathological loss during a day. After that, volume of infusion therapy is calculated by formula: V=(CfsxS)+(CfxSVIT)+PN+PL, where: V is volume of infusion therapy, in ml; Cfs is coefficient of frost bite severity: 1.0 in case of I and II degree frost bites; 2.0 in case of III-IV severity degree frost bite; S is area of affected surface, in cm2; Ca is coefficient of alcoholic intoxication severity: 0.5 in case of mild degree, 0.75 in case of medium severity; 1.0 in case of severe degree; 1.5 - in case of alcoholic coma; SVIT is standardised volume of infusion therapy, in case of alcoholic intoxication equal 2500 ml per day: PN stands for physiological needs of organism for a day, in ml; PL stands for pathological loss within a day, in case of I and II degree frost bites constituting 500 ml; in case of III and IV degree frost bites constituting 1000 ml.
EFFECT: method ensures adequate and differentiated carrying out infusion therapy in said category of patients, taking into account degree of alcoholic intoxication, which contributes to prevention of "mutual aggravation" syndrome, minimisation of hemostasis and microcirculation, as well as prevention of encephalopathy of complex genesis, alcoholic psychosis, including cases after carrying out necrotomy and fasciotomy.
The invention relates to medicine, namely to surgery, trauma and addiction.
Frostbite continue to be an important issue during peacetime and wartime. In the structure of surgical patients receiving inpatient treatment in the Russian Federation, the amount of 0.07%in burn units 4,5-7,0% of the total number received. Mortality from cold injury is 3.6-5%, the disability with deep frostbite is from 15 to 80% of sufferers. Most often affects men in working age, 90% of victims come in drunk.
Frostbite is a local lesion cold skin and lower fabrics. Tissue necrosis is not due to the direct effects of cold and disorders of blood circulation: spasm, and in the reactive period - palsy vessels (capillaries, small arteries, slowing blood flow, stasis of blood corpuscles, blood clots. In subsequent join morphological changes in the vascular wall: swelling of the endothelium, plasma soaking endothelial structures, the formation of necrosis, and then the connective tissue and obliteration of the vessels. Thus, tissue necrosis when frostbite is secondary, and the development continues in the reactive phase frostbite. Changes in the blood vessels due to othmorojeni is create a background for the development of obliterating diseases, trophic disorders.
Most often, in 95% of cases, frostbite exposed limbs, as when it is cooled in them faster circulation.
Within Britain there are two periods: directiony (hidden), and reactive. Directiony period lasts from several hours to several days before warming and restore circulation. Reactive period starts with the warming of the affected organ and restore circulation. Distinguish between early and late reactive periods. Early reactive period lasts 12 hours from the start of warming, is characterized by impaired microcirculation, changes in the vessel wall, hypercoagulation and the formation of thrombus. Late reactive period comes after early and is characterized by the development of necrotic changes and infectious complications. It is characterized by intoxication, anemia, hypoproteinemia.
Constriction of blood vessels of the skin due to the subjective feeling cold, so when they expand, for example in the case of alcohol, the perception of cold decreases and even disappears, but the development of frostbite occurs faster.
The concept of the syndrome of "mutual aggravation" is used in the diagnosis and treatment of frostbite with concomitant somatic pathology or combined injury. This is due to the fact that patients have a combination of several forms of diseases or diagnoses. Diagnosis of such conditions, the treatment of frostbite and their consequences is an important issue for specialists in surgical and trauma unit.
Owing to the relevance and frequency of getting frostbite in intoxicated varying degrees it became necessary to use the conventional chetyrehstennoy classification of alcoholic intoxication.
When mild intoxication there is a pleasant feeling of warmth, relaxation. The mood is unstable, often euphoric feeling of contentment, comfort and desire to communicate with others. People are talkative and boastful, saying loudly, quickly, easily moving from one topic to another, do not listen to others, try to attract attention. Movement is choppy, but less accurate. Attention is easily distracted. Thinking becomes less logical, difficult comprehension of the surrounding. The quality of work that requires concentration, deteriorating, but your people overestimate. Tends to jokes, sermons. Increased appetite, disinhibited sexual desire. Mild intoxication signs correspond to minor changes in mental activity - isolation, slow response, VSP is livoti, demonstrative reactions, attempts dissimulatio, euphoria, emotional instability, difficulties in concentration, otvlekaemost, increased vegetative-vascular reactions (redness of the skin and mucous membranes, injectionist sclera, increased sweating, tachycardia). Some irregularities in the motion field, the possible changes of gait, staggering when walking with quick turns, instability in sensitized and simple Romberg, inaccuracy in the small movements and coordinatory samples, horizontal nystagmus when looking to the side, a positive test Tadena, the smell of alcohol from his mouth, a positive chemical reaction to alcohol.
When the average degree of intoxication it is blurred (dysarthria), wobbly gait, swaying when standing, changes dramatically handwriting. Attention turns with difficulty, intellectual processes are slowed down, there perseverative, thinking is determined by random associations. Euphoria often followed by irritability, anger, resentment and scandals surrounding them. Often nausea and vomiting. In the following some of the events I remember vaguely. When the average degree is dominated by evidence of marked changes in mental activity (behavior involving violation of social norms, incorrect assessment of the situation and, lethargy, agitation aggressive or autoaggressive actions and inadequate speech, euphoria, dysphoria, impaired coherence of thoughts, fragmented statements, elements of perseverative, slow and depletion of associations); vegetative-vascular disorders (hyperaemia or blanching of the skin and mucous membranes, increased heart rate, breathing, fluctuation of blood pressure, sweating, salivation, dilated pupils, weak photoreactive; musculoskeletal and neuromuscular disorders (severe dysarthria, instability when standing or walking, a clear violation of coordination of movements, decreased tendon reflexes and pain sensitivity, horizontal nystagmus; the sharp smell of alcohol from his mouth; positive chemical test for alcohol).
Severe intoxication is expressed clinical picture growing stun. May be a separate shouting, indistinct murmur; to be almost impossible. The stun goes into deep sleep soundly (spoor), and often, and to whom. Drunk falls asleep in an uncomfortable position and inappropriate places, often incontinence of urine and feces, life-threatening vomiting (the possibility of aspiration of vomit). Signs of intoxication severe - severe mental disorder (disorders of orientation, sharp is aterogennosti, drowsiness, low accessibility contact with others, lack of understanding of the meaning of questions, fragmentary meaningless statements); expressed vegetative-vascular disorders (tachycardia, hypotension, breathing hoarse due to the accumulation of mucus in the mouth and nasopharynx, paleness of skin and mucous membranes, sweating, in some cases, involuntary urination, weak reaction of pupils to light; severe musculoskeletal and neuromuscular disorders (inability to stand and perform a targeted action, the inhibition of tendon reflexes, decreased corneal reflex, sometimes spontaneous nystagmus); the sharp smell of alcohol from his mouth; positive chemical tests ethyl alcohol. In the blood, usually more than 3 deg./PA alcohol.
Alcoholic coma is diagnosed in the absence of signs of mental activity (unconscious, no reactions at ambient); severe impaired autonomic regulation of the cardiovascular system (kollaptoidnoe state, involuntary urination and defecation, breathing disorders), severe neuromuscular disorders (sharp decrease of muscle tone, lack of pain, corneal, tendon reflexes, in some cases, pathological reflexes, hyperkinesia); the sharp smell of alcohol; the alcohol concentration in the rovi more than 3-4 degrees./PA. (http://lib.druzya.org/deviant/.view-delaru-deviant.txt.1.html; http://szpa.ru/library/norubs/62485/index.html).
Treatment of frostbite in the first place, provides for the restoration of disturbed blood circulation, microcirculation recovery, treatment of local lesions, prevention and treatment of infectious complications. Use of conservative and surgical treatment methods. The main place in the conservative treatment is infusion therapy. Different schemes, methods in conducting therapy with the use of infusion-transfusion environments depends on the period of frostbite, depth and area affected.
Conservative treatment of frostbite is as follows. In coreactive period, when there are persistent spasm, increase blood viscosity and aggregation of blood cells, use of intra-arterial and intravenous infusion of drugs, normalizing, metabolic processes: reopoligliukina, eagleman, 10% dextran solution and 5% mannitol solution 0.9% sodium chloride solution. Antispasmodic: a 2% solution of papaverine - 2 ml, 1% solution of nicotinic acid to 2 ml in a mixture of 10 ml of 0.25% solution of novocaine injected intraarterially. Thrombosis prevention injected heparin at a dose of 20000 to 30,000 DB. This therapy is still in the early jet age - the first 12 hours after warming the limbs. In early intoxication stood in infusium environments include blood detoxification steps - gemodez, neocomiensis, crystalloid solutions. In addition to intra-arterial and intravenous infusion of heparin it is injected subcutaneously at 5000 UNITS every 6 hours.
In the late reactive period in connection with the development of necrosis, intoxication, accession infectious complications are applied detoxification drugs, components of blood, immunological preparations, preparations for parenteral nutrition. As antibiotics used antibiotics, bacteriophages, chemical antiseptics [http://neonatology.narod.ru/surgery/otmorozheniya.html].
The known method minimized the introduction of drugs intraarterially, including single injection into the femoral or brachial artery 20-40 ml of the combined solution containing: Heparin 10000 IU; Niacin 1% 1-2 ml; Contrical 5000 DB; Procaine 0.5% of 15-20 ml; Aminophylline 2,4% 5 ml Efficacy of treatment is assessed by increased temperature of the extremities and the reducing zone cyanosis and pallor, the restoration of microcirculation.
When nevladenie technique and the inability intraarterial administration of drugs in massive influx of victims shows the introduction of drugs in the fiber space of the hands and feet. With the defeat of the lower extremities mixture is injected under the Achilles tendon. If frostbite brush the mixture is injected through mega Lavie intervals in the deep middle space of the Palmar surface. The composition of the mixture for one-introduction to fiber space: Heparin 10000 IU; Novocaine 5% 30 ml; Hydrocortisone 40 mg [Kotelnikov VP Frostbite. - M.: Medicine, 1988. - 256 S.].
Known way to treat frostbite of the extremities of high degrees in directives and early jet periods, characterized by the fact that daily determine the blood levels of anti-thrombin III and its content 61-75% enter 300-400 ml cryoplasty, when the levels of anti-thrombin III 51-61% enter 400-500 ml cryoplasty, when the level of anti-thrombin III 50% and less than impose 500-800 ml cryoplasty; bioplasma, heated to 40°C, enter in the first three days after admission and after 12 hours; thereafter bioplasma, warmed to 37°C, injected once a day for the acute period. This invention contributes to the reduction of treatment time due to the dosed application of cryoplasty compensating antithrombotic potential of the blood, which, in turn, improves microcirculation in the affected limb segments, reduces spontaneous platelet aggregation, reduces necrosis [patent RU 2235545, 2004].
Known way to treat frostbite of the extremities, including the imposition of insulating bandages, pain relief, antibacterial, anticoagulant, vasodilator and symptomatic therapy, hyperbaric. the s in the chamber, and after a session of hypobaric hypoxic stimulation carry out the compression of the affected limb to create a venous stasis and conduct regional introduction 0.2 g acetylcholine-chloride in 10 ml of 2%solution of novocaine [patent RU 2242225, 2004].
The prototype of the invention is a method of determining the optimal volume of infusion therapy for frostbite, namely, that calculate the severity index frostbite (ITO) in conventional units, namely the amount of any finger equal to 1 unit, lesions to the medial third of the metacarpal bones in the hand and metatarsal bones in the foot - 10 units, all brushes and a half feet - 20 units, all of the foot - 40 units, if the person acted in adinamicheskoy stage total cooling, to the computed index added 15 units, stuporous - 30 units, convulsive - 45 units. The optimal volume of infusion therapy (V) is calculated by the formula: V=(ITO×M×h):3+1000,0; and M is the weight of the patient in kilograms; h - the growth of the patient in meters. The method allows to determine the optimal amount of liquid for intravenous injection, which helps to improve blood circulation in the affected tissues, reduces endogenous intoxication [patent RU 2262306, 2005].
However, the method allows to determine the volume of infusion therapy for intravenous administration only directives and the beginning of reactive period Otmar the taxpayer. This method does not take into account the degree and depth of lesion, size of the lesion is determined in arbitrary units, does not take into account pathological losses associated with the holding of necrotomy and fasciotomy, physiological needs of the organism, as well as comorbidity, caused by alcoholism.
The task of the invention is to develop a method for determining the optimum volume of infusion therapy for frostbite patients with varying degrees of intoxication.
The technical result is the prevention of the syndrome of "mutual burdening", minimization of disorders of hemostasis, circulation, relief of excessive, withdrawal symptoms, prevention of encephalopathy complex Genesis, alcoholic psychosis, including after necrotomy and fasciotomy.
The proposed method of determining the volume of infusion therapy for frostbite in intoxicated as follows. To calculate the volume of infusion therapy determine the area of damage in cm2the degree frostbite, the degree of intoxication, the physiological needs of the organism in ml and abnormal loss in ml per day. Then calculate the volume of infusion therapy according to the formula:
V - volume infusion tera is AI, in ml;
Cat - severity ratio frostbite: 1,0 for frostbite I and II degree; 2,0 for frostbite III and IV;
S - the area of the damaged surface, in cm2;
Ka - severity ratio of alcohol: 0,5 is mild, with an average of 0.75 degree; 1.0 when severe; 1.5, if the alcoholic coma;
SOIC - standardized volume of infusion therapy in alcoholic intoxication, equal to 2500 ml per day of infusion solutions;
OP - physiological needs of the body during the day, in ml;
PP - pathological loss during the day, components for frostbite I and II degree 500 ml; III and IV degree 1000 ml.
Pathological losses associated with frostbite, determine the degree frostbite. Frostbite I degree: immediately after cessation of exposure to the cold and warming patients complain of a burning pain in the affected area with cold, itching sensation, feeling colotla develop hyperesthesia and paresthesias. Affected skin is red, swell up, the swelling often is in the nature of pastoznost. Swelling in some cases extends not only to tissue exposed to direct cooling, but adjacent to them. Especially pronounced swelling occurs on the face, ears, foreskin. Swelling and pastos tissue usually diminish after 5-8 days, the process ends with an extensive salusan the eating surface layers of the epidermis.
Frostbite II degree causes significant pain, an unpleasant feeling of tension fabrics. Bubbles appear within 2-3 days after the defeat, sometimes later - on during the first week of the jet age. Localization of bubbles in the area of injury, their number, the sizes may be different. They rarely are formed on the Palmar and plantar surfaces, and if you have in these areas, they usually are smaller than the rear feet or hands. The content of bubbles depending on the concentration of fibrin may be liquid or gelatinous. On bottom of the bubble fibrin accumulates in the form of a plaque, evenly covering the intact basal (germ) layer of the epidermis on the entire surface of the damaged retinal strata. The color content of bubbles yellowish. Edema in the frostbite II extent, captures a vast area, including and not subjected to direct cooling. The surface of the bubbles is very fragile and in many cases destroyed spontaneously or careless movements of the patient.
Thus, reversible processes for frostbite I and II have a pathological loss in the amount of 500 ml per day.
Frostbite III degree is accompanied by severe pain, which in some cases are radiating in nature. Loss of sensation in the area and the destruction continues in the early jet age, most often it occurs in zones, subsequently undergoing necrosis. The skin of the affected area remains cold, takes bluish coloration of formed bubbles are filled with hemorrhagic content. The pulse in the foot (or wrist) weakens or disappears, which is associated with increasing voltage tissues due to severe swelling.
At the end of the first week the swelling begins to subside, and there are clearly demarcated areas of darkened microtiterplate tissues. When joining a purulent infection swelling continues to grow. Demarcation of reparative processes significantly slowed down. With the development of dry gangrene is formed a scab, which appears after 2-3 weeks, and found underneath the surface is covered with granulation tissue. The period of resorption and rejection of necrotic tissue, epithelialization granulating surface flow in a few weeks with the formation of a deep scar. In rare cases there is a partial or complete rejection of the body (nose, ears, penis).
Frostbite of the fourth degree. At the beginning of reactive period swelling develops on the area exceeding the area of direct cooling. Necrosis may occur in the type of wet gangrene or in the form of mummification tissues. The latter form omerta the Oia develops mainly in the defeat of the fingers. During the process of rejection of necrotic tissue, development of granulation, epithelialization and scarring very long. Thus, the demarcation of the zone of ossification in the defeat of the fingers occurs within 2-4 weeks, and the necrosis extended to diaphyse bones, in some cases, ends only after 2-3 months [http://www.ordodeus.ru/Ordo_Deus9Otmorozhenie_B_M_E.html].
After opening the bubbles and the necro or fasciotomy in the postoperative period is marked abundant serous, serosanguineous discharge from wound surfaces requiring multiple dressings, treatment of the affected surfaces and replace the lost fluid volume [patent RU 2392878, 2010].
Thus, irreversible processes for frostbite III and IV have a pathological loss of 1000 ml per day.
Calculation of physiological needs is: from 1 to 10 kg to 100 ml of fluid per day; 11-20 kg - 50 ml; 20 kg - 10 ml (body weight 70 kg, physical demand will be: 10×100+10×50+50×10=2000 ml) [http://www.medmoon.ru;http://ochilds.narod.ru/0192.html].
The volume of infusion therapy in the treatment of alcohol intoxication of varying degrees of alcohol is accepted for 2500 ml per day of infusion solutions. This volume is taken as the indicator of SUIT - standardized volume of infusion therapy in alcoholic intoxication (Guide to the psychiatrist the AI. Ed. Gavrosh, 2 so, T.II. - M.: Medicine, 1988. - 640 S.; Thermal and radiation burns: a Guide for physicians. Ed. Ligerzero, Higashino. - Ed. 2nd, Rev. and supplementary): JSC "Publishing house Medicine", 2005. - 384 S.).
Example 1: determine the volume of infusion therapy if frostbite of both clusters I and II degree for adult victim by weight 70 kg, height 170 cm, size of the lesion 4% of the body surface, which corresponds to 680 cm2when alcohol medium according to the proposed method by the formula:
will be presented as follows:
V=(1,0×680 cm2)+(0,75×2500 ml)+2000 ml+500 ml, V=5055 ml,
1.0 - coefficient of gravity accounting I and II degree frostbite,
680 cm2- the area of the damaged surface,
0,75 - severity ratio of alcohol with an average degree;
2500 ml - SOIC per day;
2000 ml of a physiological need for a person weighing 70 kg and height 170 cm,
500 ml - pathological loss due to the swelling and blistering with serous content.
Example 2: determination of the volume of infusion therapy if frostbite on both feet III and IV in alcohol (severe according to the formula: V=(cat×S)+(Ka×SOIC)+OP+PP,
will be presented as follows:
V=(2,0×1000 cm2)+(1,0×2500 ml)+2000 ml+1000 ml, V=7500 ml,
where a 2.0 ratio of gravity with regard to III and IV degree frostbite,
1000 cm2- the area of the damaged surface, 1,0 - severity ratio of alcohol to severe;
2500 ml - SOIC per day;
2000 ml of a physiological need for a person weighing 70 kg and height 170 cm,
1000 ml - pathological loss due to the apparent swelling and blistering with serous-hemorrhagic content.
The volume of infusion therapy is calculated on the day and can be reduced with self-filling of physiological needs.
Example 3. Patient L., aged 47, was admitted to the burn Department MBUS GKB №18 of Ufa with a diagnosis of Frostbite I-II degree of brushes 4% and III-IV degree stop 5%, a total of 9%(5%). Alcohol intoxication severe. Received after 12 hours of injury.
Calculation of the volume of infusion therapy per day was performed according to the formula: V=(cat×S)+(Ka×SOIC)+OP+PP.
Defined volume of infusion therapy if frostbite abate brushes I and II degrees and stop III and IV, which were:
V=1,0×680 cm2+2,0×1000 cm2V=2680 ml,
1.0 - coefficient of gravity accounting I and II degree frostbite of the hands,
680 cm2- the area of the damaged surface of the brush,
a 2.0 ratio of gravity with regard to III and IV degree frostbite of the feet;
1000 cm2- the area of the damaged surface of foot;
Then determined the volume of infusion therapy when al is ogolna intoxication severe. 1,0×2500 ml, V=1,0×2500 ml, V=2500 ml,
1.0 - factor to the severity of intoxication is severe, 2500 ml - SOIC per day;
2000 ml of a physiological need for a person weighing 70 kg and height 170 cm,
1500 ml (500+1000) - pathological loss due to the swelling and blistering with serous-hemorrhagic content for frostbite I-II, III-IV degrees.
The volume of infusion therapy is the sum of the volumes of infusion therapy if frostbite brushes (680) and stop (2000), SOIT with alcohol severe (2500 ml), physiological needs (2000 ml), which is common for the patient, as well as the amount of pathological losses for frostbite brushes (500 ml) and stop (1000 ml), and equal 8680 ml per day(2680+2500+2000+1500).
After operations (wavy and contour fasciotomy on both feet) taking into account the fact that the patient fulfilled the physiological needs of their own, the calculation of the volume of infusion therapy was performed within 5 days by the formula: 2680+2500+0+1500, volume amounted 6680 ml per day. On 6-15 day in connection with epithelialization of frostbite brushes and self-renewal of physiological needs calculation of the volume of infusion therapy was performed with regard to the defeat of the stop III-IV degree by the formula: (2680-680)+2500+0+(1500-500), volume amounted to 5500 ml per day. From 16 to 21 days in connection with epithelialization of frostbite, samostojatel the essential filling of physiological needs and pathological losses, and mild alcohol intoxication volume of infusion therapy according to the formula: 0+2500+0+0 decreased to 2500 ml the Patient was discharged in a satisfactory condition for 30 days with preservation of the upper and lower extremities.
In the available sources of medical research and patent information by the authors was not found an identical way to determine the optimum volume of infusion therapy for patients with frostbite in a state of alcoholic intoxication considering the area of the lesion, the degree frostbite, the physiological needs of the body and pathological losses during the day, as well as the degree of alcoholic intoxication. Thus, the claimed invention meets the criterion of "Novelty".
The authors proved that the proposed method of determining the optimal volume of infusion therapy for patients with frostbite in intoxicated by the formula, including the size of the lesion, the severity ratio frostbite, physiological needs of the body and the pathological loss during the day, as well as the coefficient of gravity of alcohol and standardized volume of infusion therapy in alcoholic intoxication, provides an adequate infusion therapy in all periods of frostbite patients with varying degrees of alcohol OPI the care, prevention of the syndrome of "mutual burdening", minimization of disorders of hemostasis, circulation, relief of excessive, withdrawal symptoms, prevention of encephalopathy complex Genesis, alcoholic psychosis, including after necrotomy and fasciotomy. Thus, the claimed invention meets the criterion of "Inventive step".
In this way were treated 12 patients with frostbite in a state of intoxication in MBUS GKB №18 of Ufa. In all cases, was achieved this technical result.
The proposed method is easily reproducible in the hospital, and when it is achieved the specified technical result. Thus, the claimed invention meets the criterion of "Industrial applicability".
The method for determining the volume of infusion therapy for frostbite in patients with varying degrees of intoxication, characterized by the fact that determine the degree frostbite, the area of damage, the degree of intoxication, the physiological needs of the body and the pathological loss during the day, and then calculate the volume of infusion therapy according to the formula:
where V is the volume of infusion therapy, ml;
Cat - severity ratio frostbite: 1,0 for frostbite I and II degree; 2,0 when Otmar the assets III and IV degree;
S - the area of the damaged surface, cm2;
Ka - severity ratio of alcohol: 0,5 is mild, with an average of 0.75 degree; 1.0 when severe; 1.5, if the alcoholic coma;
SOIC - standardized volume of infusion therapy in alcoholic intoxication, equal to 2500 ml per day;
OP - physiological needs of the body during the day, ml;
PP - pathological loss during the day, components for frostbite I and II degree 500 ml; for frostbite III and IV 1000 ml
SUBSTANCE: invention relates to medicine, namely to resuscitation and intensive therapy and can be used in treatment of hemorrhagic shock of I, II and II degree of severity. Method of hemorrhagic shock treatment. For this purpose, assessment of degree of hemorrhagic shock severity is carried out, and in case of hemorrhagic shock of 1 degree of severity in the programme of infusion therapy included are: crystalloid solution of isotopic sterofundin in dose 3000 ml per day and 4% colloidal solution of modified gelatin in volume 1000 ml per day, in case of hemorrhagic shock of II degree of severity - 1200 and 2500 ml respectively, in case of hemorrhagic shock of III degree of severity - 1200 and 3500 ml respectively.
EFFECT: method makes it possible to improve results of treating patients with hemorrhagic shock at pre-hospital and hospital stages due to reduction of risk of electrolyte and acid-alkaline disorders.
SUBSTANCE: invention refers to medicine, namely resuscitation and may be used for prevention of severe complications in surgical management of massive and submassive blood loss with continuous haemorrhages. That is ensured by the intraoperative intravenous drop-by-drop introduction of Perftoran 2-4 ml/kg following mechanical arrest of the continuous haemorrhages. With underlying restorable blood volume, higher body oxygenation with eliminated nitrogen oxide inhalation. Rheamberyn is introduced in an average therapeutic dose at the end of the operation and on the first three postoperative days.
EFFECT: invention provides higher effectiveness of infusion-transfusion management, improved clinical course of the operative and postoperative period, reduced percentage of complications and mortality.
SUBSTANCE: invention refers to medicine. What is prescribed is taking a beverage made of soluble granulated magnolia-vine extract. The beverage 250 ml is taken before a dip for 20 days three times a day.
EFFECT: use of the declared method enables unfavourable changes of water and electrolyte metabolism in divers.
SUBSTANCE: invention refers to medicine. What is prescribed is a beverage made of soluble granulated magnolia-vine extract. The beverage 250 ml is taken before a dip (compression in a vacuum chamber) for 20 days three times a day.
EFFECT: method is high-effective for prevention of compressed-air disease in divers.
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to medicine and pharmacology and represents the use of water-soluble hybrid macromolecular compounds: O-(3-(3,5-di-tert-butyl-4-hydroxyphenyl)propionyl)-(1→6)-α-D-glucan, polyethylene glycol bis-3-(3,5-di-tert-butyl-4-hydroxyphenyl)-propionate as agents improving survival rate in wound shock.
EFFECT: invention provides the extended range of products applied in therapy for wound shock.
4 ex, 1 tbl
SUBSTANCE: invention relates to medicine, namely to combuistology, resuscitation and intensive care, narcology and can be used in patients in state of drug intoxication with use of desomorphine. For this purpose determined are patient's body weight, degree of drug intoxication expression and physiological needs of organism during a day. After that volume of deintoxication-infusion therapy is calculated by formula: V= Cdix(CsxBW)+ PN, where V is volume of infusion therapy, in ml; Cdi - coefficient of drug intoxication expression: 1.0 in case of changed reactivity to drug substance; 1.5 - in case of presence of psychic dependence (obsessive attraction); 2.0 - in case of presence of physical dependence (compulsive attraction); 2.5 - in case of abstinence syndrome; Cs is coefficient of somatic aggravation with use of desomorphine, equal 0.2; BW is patient's body weight in grams; PN is physical needs of organism during a day, in ml.
EFFECT: method makes it possible to ensure adequate infusion therapy in patients with different degree of expression of drug intoxication with desomorphine.
SUBSTANCE: invention relates to medicine, and is intended for stimulation of intestinal peristalsis in early post-operation period in patients with cancer of esophagus and cardial part of stomach. Plasma-substituting solution "Mafusol" is introduced enterally. "Mafusol" is additionally introduced parenterally in quantity 800-1200 ml per day.
EFFECT: method makes it possible to restore intestinal peristalsis on first-second day after operation.
FIELD: medicine, pharmaceutics.
SUBSTANCE: declared invention refers to chemical-pharmaceutical industry, and concerns a plasma-substitute compound with the rheological and hemodynamic properties on the basis of a block copolymer of ethylene oxide and propylene oxide, and hydroxyethylstarch, and using it in medicine and cosmetology.
EFFECT: preparing the plasma-substitute compound with the improved rheological and hemodynamic properties of mixed two active ingredients: the surfactant proxanol - the block copolymer of ethylene oxide and propylene oxide of molecular weight 1 to 20 kDa and the hemodynamic agent hydroxyethylstarch of molecular weight 40 to 200 kDa in the ratio of 1/1 to 10/10 respectively with an acceptable electrolyte solution.
10 cl, 8 ex
SUBSTANCE: invention refers to medicine, namely to purulent surgery, and may be used in treating patients with folliculitis and furuncles. For this purpose, at first forceps are used to remove an inflammation cone cover. A syringe is used to aspirate the purulent-necrotic mass. Before bandaging, the inflammation region is treated with the preparations Polcortolon or Oxycort.
EFFECT: method provides a cosmetic effect ensured by prevented formation of a hard hypertrophic scar due to elimination of punctures and incisions.
SUBSTANCE: invention refers to medicine, particularly anesthesiology and intensive care, and can be used for treating multiple-organ-failure syndrome in the patients who underwent cardiac surgeries. That is ensured by evaluation of the risk factors of developing multiple-organ-failure syndrome. Their absence enables standard intensive care. If within 12 hours after the cardiac surgery there are observed acute reduced cardiac output and reduced ejection fraction with the combined introduction of adrenaline and dobutamine appeared to be ineffective, differentiated interventional therapy of multiple-organ-failure syndrome is performed with using a calcium-sensitising agent taken among the cardiac support. The presence of haemodynamic criteria of acute lung injury combined with systemic inflammation response, prolonged renal replacement therapy in continuous veno-venous hemofiltration is performed. It is combined with a simultaneous complex of respiratory kinesiological rehabilitation with differentiated selection of a respiratory support method. On the forth day of artificial pulmonary ventilation, puncture-dilatation tracheostomy is performed.
EFFECT: method provides predicting a risk of developing multiple-organ-failure syndrome in a given category of patients at the early stage following the surgery.
SUBSTANCE: invention relates to medicine, namely to ophthalmology, and can be used for inducing posterior detachment of vitreous body. For this purpose 0.1 ml of miniplasmin solution is introduced endovitreally in 4 mm from limb. Preliminarily before introduction, solution of buffer salts up to pH values of 6.8-8.0 with osmolarity 280-320 mOsm to concentration of miniplasmin in solution 1 mg/ml is added into miniplasmin, mixed, heated to temperature 37°C and kept at said temperature for from 5 to 15 minutes.
EFFECT: method ensures reduction of toxic impact on retina and vitreous body, improvement of proteolytic properties of miniplasmin and, therefore, more complete detachment of vitreous body with reduction of interference trauma.
SUBSTANCE: invention refers to medicine and may be used to improve the adaptation possibilities and to correct the psychofunctional state in the patients with harmful working conditions. That is ensured by recommending a relaxed or partial load or motion state. Health food from Diet No.5, intake of low-mineralised (3.7 g/dm3) low-carbonate sulphate-hydrocarbonate sodium-calcium mineral water of 'Slavyanovskaya' source (Zheleznovodsk mineral water), 3.3 g/kg of body weight (200-250 ml) per one intake, 45 minutes before meals, 3 times a day. The patient takes baths with mineral water of the same composition at water temperature 36-37°C for 15 minutes, every second day, in the therapeutic course consisting of 10 procedures. The aromatherapy-assisted psychological autotraining sessions are prescribed for 14 days. Furthermore, Adaptol is prescribed for 14-day intake in a dose of 500 mg 3 times a day.
EFFECT: invention provides an improved adaptation, autonomic regulation, peroxide homeostasis, digestive functions, mental and emotional status of the patients exposed to the adverse effects of environmental factors due to the integrated treatment.
5 tbl, 3 ex
SUBSTANCE: invention refers to medicine, namely urology, and may be used for treating suppurative septic complications of prostate adenoma. For this purpose, with underlying administering antibiotics, ozonised saline solution in the concentration of 3 to 6 mg/l in the amount of 200 to 400 ml is additionally intravenously administered; the therapeutic course is 3-5 injections depending on the patient's state. Besides, ozonised saline solution in the concentration of 5 to 8 mg/l is injected into the bladder in the preoperative preparation period, and from the second postoperative day, saline solution is introduced drop-by-drop in the amount of 400.0 ml daily five times with a two-way flushing system.
EFFECT: method enables reducing the risk of urosepsis, eliminating intoxication and accelerating postoperative wound healing of a BPH bed by anti-inflammatory, detoxification, analgesic action, improved blood rheology and microcirculation, increased local immunity with activated regenerative and reparative processes.
2 tbl, 1 ex
SUBSTANCE: invention relates to medicine, namely to traumatology, oncology, pulmonology and surgery, and can be applied for treatment of pleurisy. For this purpose immediately after removal of exudate from pleural cavity into it introduced is wide-spectrum antibiotic and intravenously introduced is amikacin, after 10 minutes patient does 5 forced inhalations and exhalations with 3-minute intervals. After 10 minutes chest is subjected to electrophoresis with potassium iodide solution, which after day is alternated with solution of calcium chloride, with anode being placed into the space between scapular and midaxillary line at the level of 4-th rib to lower edge of rib arc. After finishing each session strips of capsicum plaster are stuck on back around shoulder-blades from both sides for one day, not less than 3 times.
EFFECT: method makes it possible to improve results of treatment and reduce development of complications by fast arrest of disease with adequate anti-inflammatory therapy and sanitisation of pleural cavity.
SUBSTANCE: invention relates to medicine, namely to surgery, and can be used in surgical treatment of patients with multilocular echonococcosis of liver. For this purpose transcutaneous drainage of cyst with further aspiration of its content is performed. After that, scolicide preparation is introduced. As scolicide preparation with 3-minute exposure 1% introduced is water solution of sodium hypochlorite in volume equal 1/3 of volume of aspirated liquid. After that, cyst content is re-aspirated. Procedure is repeated until "pure" aspirated liquid is obtained three times.
EFFECT: method makes it possible to ensure adequate and least traumatic treatment of said pathology without application of X-ray control due to application of definite sequence of techniques, as well as use of scolicide preparation, destroying envelopes of daughter echinococcal cysts.
SUBSTANCE: invention relates to medicine, namely to neurosurgery and traumatology. During surgery, which is realised from front access, installation of two catheters into epidural space is performed. Installation of catheters is performed by means of needles through separate punctures. Punctures are made with 2-3 cm indent from lateral edge of operation wound. Catheters are installed onto dura mater of spinal cord under and above its injury, orienting them in caudal and cranial directions. After that, operation wound is sutured. In post-operative period perfusion of spinal cord with 0.9% of sodium chloride solution, cooled to temperature +5÷8°C, is performed by means of installed catheters at rate 40-60 drop/min until temperature of solution, flowing out of epidural space, reaches +9÷11°.
EFFECT: method makes it possible to reduce risk of development of post-operative complications.
2 cl, 1 ex
SUBSTANCE: invention relates to medicine, namely, to vascular surgery and anesthesiology, and can be applied in surgical treatment of varicose disease of lower extremities with application of endovasal laser coagulation of veins. For this purpose paravasal infiltration of tumescent solution is realised. As such, cooled to 6-7C0 ozonised 4-5 mkg/l physiological solution is introduced. Introduction is carried out under continuous ultrasonic navigation into fascial sheath of coagulating vessel and hypodermic cellular tissue.
EFFECT: method makes it possible to ensure reduction of expression of post-operative pain syndrome, as well as prevent development of local inflammatory complications due to vein spasm and neutralisation of warming up of cellular-tissue structures at the moment to laser exposure.
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to an agent exhibiting nootropic action. The declared agent contains calcium chloride, sodium chloride, ferric sulphate (II), zinc sulphate, chromium chloride (III) and potassium bromide in certain proportions.
EFFECT: invention provides normalisation of the CNS function ensured by nootropic action.
1 tbl, 4 ex
SUBSTANCE: invention refers to medicine and aims at prevention of complications following the intestinal operations, at prevention of intestinal anastomotic leak, ischemic disorders in enteroenteroanastomosis in periotonitis, acute intestinal obstruction. There are involved the intra- and immediate postoperative introductions of hydroxyethyl starch (HES) 130/0.4 and balanced polyionic crystalloid solutions in ratio 1:3. The volume is gradually reduced to achieve the volume 3 times less than the initial one by the 7th day.
EFFECT: method enables reducing a probability of postoperative intestinal anastomotic leak.
SUBSTANCE: invention refers to medicine, namely surgery, and may be used for treating patients with trophic ulcers. That is ensured by the sequential intravenous drop-by-drop introduction of a mixture containing 5% glucose 200 ml, 0.5% Novocaine 50 ml, 25% magnesium sulphate 5 ml; that is followed by the introduction of a mixture containing 0.9% normal saline 200 ml, 2% pentoxifylline 5 ml and the introduction of a mixture containing rheopolyglucin 200 ml, 5% ascorbic acid 5 ml, 1% nicotinic acid 1 ml.
EFFECT: method enables stimulating trophic wound healing ensured by improved microcirculation and clinical course of metabolic processes.
SUBSTANCE: invention relates to medicine, in particular, to cardiology and rehabilitative medicine. Pace of training walk, calculated by mathematical formula, is determined. For this purpose calculated are: pace of training walk, number of steps per minute, metabolic equivalent of oxygen consumption, metabolic units; excessive weight of patient's body, unit fractions, length of patient's step. Patient performs training walk taking into account calculated pace.
EFFECT: method makes it possible to increase quality of rehabilitation of chronic heart failure patients, reduce terms of work capacity recovery and terms of staying on sick list, as well as to reduce time of hospital phase of treatment.
3 ex, 2 dwg