Gizatullin's method of determining optimal volume of infusion therapy for injured in frostbites in state of narcotic intoxication after application of dezomorphin

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to intensive therapy and narcology, and can be used in treatment of patients with frostbites, who are in the state of narcotic intoxication of different severity. For this purpose determined are: area of affection, degree of frostbite, degree of narcotic intoxication, physiological needs of organism and pathological loss during a day. After that, volume of infusion therapy is calculated by formula: V=(Cfs×S)+(Cn×MVDIT)+PN+PL, where: V is volume of infusion therapy, in ml; Cfs is coefficient of frostbite severity: 1.0 in case of I and II degree frostbites; 2.0 in case of III-IV severity degree frostbite; S is area of affected surface, in cm2; Cn is coefficient of narcotic intoxication severity: 1.0 - in case of changed reactivity to narcotic substance; 1.5 - in case of psychic dependence (obsessive attraction); 2.0 - in case of physical dependence (compulsive attraction); 2.5 - in case of abstinence syndrome; MVDIT is minimal volume of disinfection infusion therapy in case of application of dezomorphin, equal to 1250 ml of infusion solutions per day; PN stands for physiological needs of organism during a day; PL stands for pathological loss during a day, constituting 500 ml in case of I and II degree of frostbites and 1000 ml in case of III and IV degree of frostbites.

EFFECT: method ensures adequate and differentiated performance of infusion therapy in said category of patients taking into account degree of narcotic intoxication, which contributes to prevention of "mutual aggravation", minimisation of disorders of hemostasis, microcirculation, as well as prevention of encephalopathy of complex genesis, including carrying out necrotomy and fasciotomy.

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The present 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 young people in working age, survivors arrive intoxicated by consumption of psychoactive substances, in particular desomorphine.

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 from which orogeny. Changes in the blood vessels due to frostbite create the background for the development of obliterative disease, trophic disorders.

Desomorphine drug addiction is one of the types of drug addiction new wave, based on craft production desomorphine, which in the criminal environment is called "crocodile". Wide dissemination of this medico-social phenomenon received after 2000, so the average age of modern desomorphine addicts is 24-25 years old, has a tendency to involve young people, students. Especially rapidly began to spread after 2005, taking the nature of a hidden pandemic. Consumption level in Russia, the share of homemade desomorphine in total quickly rose to 25-28%, ranking second after heroin (55-58%). Among all types of injuries the influence of drugs or addictive behaviors of drug addicts, there are frostbite. The treatment of such victims requires considerable effort and expense.

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 prior to sogliani and restore blood circulation. Reactive period begins, since 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. When the use of narcotic substitutes, in particular desomorphine is dulling protective reactions of an organism, decrease in the sensitivity can reach full anesthesia, resulting in victims do not mark the onset of frostbite of the extremities.

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 is akih States, treatment of frostbite and their consequences is an important issue for specialists in surgical and trauma unit.

In addition, the problem that remains is the determination of the volume and qualitative composition of IV fluids in the treatment of patients with frostbite and especially patients intoxicated by consumption of psychoactive substances. Such patients develop the syndrome of "mutual burdening", there are risk factors for the development of encephalopathy complex Genesis in the use of narcotic substitutes and currents frostbite. The severity of clinical manifestations in individuals who have a history of drug surrogates, in particular desomorphine greatly exceed those that can be in other types of intoxication. No criticism to the severity of the condition in a condition of narcotic intoxication leads to late hospitalization, which leads to complications in the treatment of frostbite.

Drug addiction is characterized by the presence of a number of symptoms that can occur by changing the duration and frequency of use and quality of use of psychoactive substances and/or drug substitutes. The main evaluation criteria of the course of addiction are: a) the syndrome of altered reactivity to narcotic substance; b) a syndrome of mental zavisimost and; C) the syndrome of physical dependence.

Syndrome of altered reactivity changes in the course of the disease, because it changes its constituent symptoms: a form of consumption, tolerance, a form of intoxication. In the concept of a syndrome of altered reactivity include: changing patterns of use, change tolerance (endurance), the disappearance of protective reactions in overdose and changing forms of intoxication. This characteristic is undergoing changes at the initial stages of drug use and surrogates. Regular intake of the drug causes in a healthy person certain dysfunction, especially in the early stages of its use. Systematic drug, against which possible mental and physical comfort, testifies to the changed reactivity to this drug. As the appearance of other signs of illness, while deepening the mechanisms of addiction anesthesia becomes continuous. Systematic anesthesia is now forced. The mechanisms that support it, in the clinic are expressed symptoms of craving, withdrawal syndrome, externally visible condition is a high tolerance. In some forms of the drug form of abuse becomes a cyclical nature (stimulants). The ability to regularly taking svidetelstvo is, the tolerability of the drug has increased.

The rise of drug tolerance may also be considered as a manifestation of the changed reactivity. The tolerance on the height of the disease exceeds original, physiological 5-10 times (barbiturates), 8-12 times (sedative), 100-200 (opiates) shows that the body of a drug addict takes a fatal dose of the drug.

The disappearance of protective reactions observed shortly after the start of the regular anesthesia. Protective reactions are manifested in the form of a gag reflex (alcohol), initial itching (opiates), profuse sweat, hiccups, salivating, eyes, feelings of lightheadedness, nausea. Reduction, and then the disappearance of protective reactions indicates the transition of the body to a new level of response, which is still high doses now are non-toxic, do not require protection.

Changing forms of intoxication appears when formed systematic drug, once established high tolerance and disappeared protective reaction to an overdose. This symptom last time belonging to the syndrome of altered reactivity and develops on the background of already existing other abuse syndromes. This coincides with a drop tolerance. Increase dose not give the expected effect, which reflects the development process of abuse depending what.

The psychological dependence syndrome include mental - obsessive desire for the drug and the ability to achieve mental comfort in intoxication. Mental attraction is expressed in constant thoughts about the drug, lifting the mood in anticipation of the reception, depression, dissatisfaction in the absence of drug. Often the attraction is accompanied by the struggle of motives. In combination with Intrusive thoughts about the drug that gives us grounds to call the psychic libido obsessive. If compulsive attraction dictates the behavior of the patient, mental, obsessive determines the mood, the emotional background. In my over obsessive desire wavy. It is not expressed, if necessary rhythm anesthesia observed without delay, in this case, the resulting attraction is satisfied immediately. It may be temporarily suppressed major conflict due to anesthesia, hospitalization of the patient, any emotionally strong passion, not related to the drug. Attraction is exacerbated when unpleasant experiences, meetings with friends, addicts, talking about drugs.

The desire of the patient to the drug is not specific. It may be satisfied by any other narcotic substance. So drug addicts in remission can change the form of the drug, leading to the development of poly-drug abuse.

P is gradually marketservice begins to realize only under the influence of drugs, his mental health is satisfactory. This mental comfort in the intoxication of their exclusivity and different from the mental comfort in the intoxication of that observed in healthy subjects. If a healthy person can enjoy and experience the mental comfort in some situations, the addict only when the drug is taken.

The syndrome of physical dependence include: 1) physical (compulsive) attraction; 2) the ability to achieve a state of physical comfort in intoxication and 3) withdrawal syndrome.

Physical (compulsive) attraction, one of the well-known signs of drug addiction, is expressed in the irresistible desire to anesthesia. Desire reaches high intensity, displacing even such vital desire, like hunger and thirst. From obsessive compulsive attraction differs not only in its intensity, but also the fact that is able to subdue all the content of consciousness in the present moment, leaving no other, not related to anesthesia. Compulsive craving not only determines the attitudes and affective background, it dictates behavior, suppresses and eliminates conflicting motives and control. Compulsive attraction determines the behavior of patients, the motivation of their actions. When compulsively all aimed at finding drug and overcoming obstacles to this. In addition, compulsive attraction, characterized by autonomic manifestations in the form of expansion of pupils, hyperhidrosis (excessive sweating), dry mouth, hyperreflexia, tremor, even when those drugs for which the tremor is not typical. We can distinguish three types of compulsive desire: 1) arising out of intoxication; 2) included in the structure of the abstinence syndrome; 3) arise when drunk.

Symptom the ability to achieve the state of physical comfort intoxication can be distinguished by analogy with the symptom of ability of achieving a state of mental comfort during intoxication. Almost simultaneously with the development of compulsive desire light period (no intoxication) the patient is convinced that his health improves only if the intoxication, and without drugs he no longer feels happy and healthy. Out of the anesthesia patient Nabran, hard working, feeling bad, thoughts scatter. This condition is accompanied by a desire varying degrees of severity. Taking some individually the required dose, the addict experiences and mental and physical comfort, although this dose is still insufficient for the occurrence of euphoria. This dose is referred to as necessary to meet the needs.

Even more obvious indicator that outside Nar is alizatsii satisfactory functioning of the addict is not possible, is the withdrawal syndrome. The withdrawal syndrome does not develop in all forms of drug addiction. For example, if you abuse some psychodysleptics the formation of the disease is limited to compulsive urges. Is formed gradually, at different times in the various forms of drug addiction. Occurs after the breakage of anesthesia after a certain period of time after the last dose of the drug (from a few hours for alcohol to 20-24 h at opiomania and cachesize). The full formation of the withdrawal syndrome is defined by the private form of the drug. Slow withdrawal syndrome is formed with alcoholism, but rather when cachesize, even faster - by the abuse of drugs and stimulants, the shortest time - when ophiomyia.

Withdrawal syndrome consists of phases that appear consistently and regularly over time. This time sequence is visible as when observing a particular case, withdrawal syndrome and when the gradual analysis of its formation in the disease process. Withdrawal syndrome presents with symptoms that can be divided into two groups: the mental symptoms and vegetative symptoms, somatoneurological. In the picture abstinence proportion of psychopathological symptoms and vegetational vary, which is determined by the shape of the Nar is Omani. For example, prominent psychiatric symptoms when taking sleeping pills, vegetarische - by deprivation of hashish and opiates. The difference is determined also by long standing disease. Portable status abstinence at the beginning of the disease and in the end it different.

The withdrawal syndrome is an indicator formed a physical dependence on the drug. This condition is characterized by the need for the constant presence of the drug for a relatively normal functioning of the body, now at a different quality level. Adapted to the constant level of intoxication of the organism in the absence of the drug gives the first signal that need a regular dose of the drug. Occurs compulsive craving importance of vital necessity for the patient (http://www.psynow.ru/index.php?option=com_content&view=article&id=4:2010-01-15-16-18-12&catid=11:-2&Itemid=16).

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 thevisitor period 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, normalizes metabolic processes: reopoligliukina, eagleman 10% solution of dextran and 5% solution of mannitol in 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 UNITS. This therapy is still in the early jet age - the first 12 hours after warming the limbs. In early intoxication in the composition infusium environments include blood detoxification action - 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, BA is teriophage, 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 IU; 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 the interdigital 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 level maintained what I 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., is introduced into the first three days after admission and after 12 hours; thereafter bioplasma, warmed to 37°C, injected once a day during 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 oxygenation 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 a condition the 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 frostbite. This method does not take into account the degree and depth of lesion, size of the lesion is determined in arbitrary units, also 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 an adequate infusion is therapy in all periods of frostbite patients with different severity of anesthesia at the use of desomorphine.

The technical result is the prevention of the syndrome of "mutual aggravation, prevention encephalopathy complicated Genesis of psychosis after surgery.

The proposed method of determining the volume of infusion therapy for frostbite in intoxicated when drinking desomorphine as follows. To calculate the volume of infusion therapy for frostbite in a condition of narcotic intoxication depends on the area of damage in cm2the degree frostbite, the severity of anesthesia - the presence of a syndrome of altered reactivity to narcotic substance, psychological dependence syndrome (obsessive desire), syndrome of physical dependence (compulsive craving and withdrawal symptoms, 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=(cat×S)+(KN×MODIT)+OP+PP,

where:

V - volume of infusion therapy, 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, cm2;

KN - factor severity anesthesia: 4,0 - by altered reactivity to narcotic substance; 1,5 - mental depend on the STI (obsessive desire); a 2.0 in the presence of physical dependence (compulsive desire); 2,5 - opioid syndrome;

MADIT - the minimum amount of detoxifying infusion therapy when used desomorphine, equal to 1250 ml of infusion solution in a 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; 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 desquamation of the superficial layers of the epidermis.

Frostbite II degree causes significant pain, an unpleasant feeling of tension fabrics. Bubbles appear within 2-3 days after the lesion, can be the later 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 affected area continues in the early jet age, most often it is observed in the zones, subsequently undergoing necrosis. The skin of the affected area remains Ho is one, 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 of ossification develops mainly in the defeat of the fingers. During the process of rejection of necrotic tissue, development of granules of the Nations, epithelization 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 intoxication with the substance use and/or desomorphine with different degrees of severity of anesthesia is accepted for 1250 ml per day of infusion solutions. This volume is taken as the indicator MADIT - the minimum amount of detoxifying infusion therapy for substance use and/or mesomorph is on.

Example 1: determine the volume of infusion therapy if frostbite of both clusters I and II degree. For the adult victim by weight 70 kg, height 170 cm, size of the lesion 4% of the body surface, which corresponds to 680 cm when used desomorphine syndrome of altered reactivity according to the proposed method by the formula:

V=(cat×S)+(KN×MODIT)+OP+PP,

will be presented as follows:

V=(1,0×680 cm2)+(1,0×1250 ml)+2000 ml +500 ml, V=4430 ml.

where

1,0 - coefficient of gravity accounting I and II degree frostbite,

680 cm2- the area of the damaged surface,

1.0 to rate the severity of anesthesia with altered reactivity to narcotic substance,

1250 ml minimum volume of detoxifying infusion therapy when used desomorphine,

2000 ml of a physiological need for a person weighing 70 kg and height 170 cm

500 ml - pathological loss.

Example 2: determination of the volume of infusion therapy if frostbite on both feet III and IV degree at the use of desomorphine when there is physical addiction (compulsive desire) by the formula: V=(cat×S)+(KN×MODIT)+OP+PP,

will be presented as follows:

V=(2,0×1000 cm2)+(2,0×1250 ml)+2000 ml +1000 ml, V=7500 ml.

where:

a 2.0 ratio of gravity with regard to III and IV degree frostbite,

1000 cm2square stand is eidenai surface,

a 2.0 ratio severity anesthesia in the presence of physical dependence (compulsive desire),

1250 ml minimum volume of detoxifying infusion therapy when used desomorphine,

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 F., 27 years old, was admitted to the burn Department MBUS GKB №18, Ufa with a diagnosis of Frostbite I-II degree of the face and brushes 7%. Drug intoxication with the presence of physical dependence. Entered 4 hours after injury.

Calculation of the volume of infusion therapy per day was carried out at the frostbite of both clusters I and II degree for adult victim by weight 70 kg, height 170 cm, the area of damage 7% of body surface, which corresponds to 1190 cm2when used desomorphine with the presence of physical dependence according to the proposed method by the formula:

V=(cat×S)+(KN×MODIT)+OP+PP,

will be presented as follows:

V=(1,0×1190 cm2)+(2,0×1250 ml)+2000 ml +500 ml, V=6190 ml.

where:

1,0 - coefficient of gravity accounting I and II degree of ammo is ogene,

1190 cm2- the area of the damaged surface,

a 2.0 ratio severity anesthesia in the presence of physical dependence,

1250 ml minimum volume of detoxifying infusion therapy when used desomorphine,

2000 ml of a physiological need for a person weighing 70 kg and height 170 cm

500 ml - pathological loss.

Calculation of the volume of infusion therapy after 5 days was conducted with regard to self-replenish the patient's physiological needs, according to the formula: 1190+2500+0+500, volume amounted 4190 ml per day. On 7-14 day calculation of the volume of infusion therapy made with regard to the elimination of defeat brushes I-II degree by the formula: 0+2500+0+0, the volume of 2500 ml per day. From 15 to 21 days in connection with independent filling of physiological needs and pathological losses, epithelialization of frostbite and mild narcotic intoxication volume of infusion therapy according to the formula: 0+1250+0+0 decreased to 1250 ml. Patient was discharged in a satisfactory condition for 24 days with brushes and relief of withdrawal phenomena without the development of psychosis.

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 narcotic op is anemia in the use of desomorphine considering the area of the lesion, degree frostbite, the physiological needs of the body and pathological losses during the day, the degree of anesthesia, a minimum amount of detoxifying infusion therapy with drugs. 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 when drinking desomorphine according to 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 the degree of anesthesia, the minimum amount of detoxifying infusion therapy with drugs, allows to adequately provide infusion therapy in all periods of frostbite patients with different severity of anesthesia, ensures the prevention of the syndrome of "mutual burdening", prevention of encephalopathy complicated Genesis of psychosis after surgery.

Thus, the claimed invention meets the criterion of "Inventive step".

In this way were treated 7 patients with frostbite in the state narcotics the CSOs intoxication by drinking desomorphine in MBUS GKB №18, 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 anesthesia characterized by the fact that determine the degree frostbite, size of the lesion, the severity of anesthesia, physiological needs of the body and the pathological loss during the day, and then calculate the volume of infusion therapy according to the formula:
V=(cat×S)+(KN×MODIT)+OP+PP,
where V is the volume of infusion therapy, ml;
Cat - severity ratio frostbite: 1,0 for frostbite I and II degree; 2,0 for frostbite III and IV degree;
S - the area of the damaged surface, cm2;
KN - factor severity anesthesia: 1,0 - by altered reactivity to narcotic substance; 1,5 - if psychological dependence (obsessive desire); a 2.0 in the presence of physical dependence (compulsive desire); 2,5 - opioid syndrome;
MADIT - the minimum amount of detoxifying infusion therapy when used desomorphine, equal to 1250 ml of infusion solutions is the 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



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and intensive therapy, and can be used in treatment of patients with frostbites. For this purpose degree of frost bite severity, area of affection, physiological needs of organism and pathological loss during a day are determined. After that, volume of infusion therapy is calculated by formula: V-C×S+PN+PL, where: V is volume of infusion therapy, in ml; C is coefficient of frost bite severity: 1.0 in case of I and II degree frostbites; 2.0 in case of III-IV degree frostbites; S is the area of affected surface, in cm2; PN stands for physiological needs of organism during a day, in ml; PL stands for pathological loss during a day, in ml.

EFFECT: method ensures elimination of hemostasis and microcirculation disorders in pre-reactive period, as well as in early and late reactive periods due to carrying out adequate infusion therapy with optimal volume of solutions.

3 ex

FIELD: medicine.

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.

3 ex

FIELD: medicine.

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.

1 ex

FIELD: medicine.

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.

2 ex

FIELD: medicine.

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.

1 ex

FIELD: medicine.

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.

1 ex

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

FIELD: medicine.

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.

1 ex

FIELD: medicine.

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.

4 ex

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

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to pharmaceutical industry, particularly to an agent for vaginal douche in the first phase of treatment of bacterial vaginosis. The agent for vaginal douche in the first phase of treatment for bacterial vaginosis, which represents a powder containing kitchen salt, citric acid, dry extract of chamomile (Matricaria chamomilla L) and sorbitol in the specific ingredient percentage.

EFFECT: agent allows reducing the length of the treatment of bacterial vaginosis and promotes normalising the natural vaginal flora.

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to pharmaceutical industry, particularly to an agent for vaginal douche in the first phase of treatment of thrush (vaginal yeast). The agent for vaginal douche in the first phase of treatment for thrush (vaginal yeast), which represents a powder containing kitchen salt, baking powder and dry extract of chamomile (Matricaria chamomilla L) in the specific ingredient percentage.

EFFECT: agent is effective for vaginal douche in the first phase of treatment of thrush (vaginal yeast), eliminates the risk of a local allergic reaction.

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and intensive therapy, and can be used in treatment of patients with frostbites. For this purpose degree of frost bite severity, area of affection, physiological needs of organism and pathological loss during a day are determined. After that, volume of infusion therapy is calculated by formula: V-C×S+PN+PL, where: V is volume of infusion therapy, in ml; C is coefficient of frost bite severity: 1.0 in case of I and II degree frostbites; 2.0 in case of III-IV degree frostbites; S is the area of affected surface, in cm2; PN stands for physiological needs of organism during a day, in ml; PL stands for pathological loss during a day, in ml.

EFFECT: method ensures elimination of hemostasis and microcirculation disorders in pre-reactive period, as well as in early and late reactive periods due to carrying out adequate infusion therapy with optimal volume of solutions.

3 ex

FIELD: medicine.

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.

3 ex

FIELD: medicine.

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.

3 ex

FIELD: medicine.

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

FIELD: medicine.

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

FIELD: medicine.

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.

FIELD: medicine.

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.

1 ex

FIELD: medicine.

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

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and intensive therapy, and can be used in treatment of patients with frostbites. For this purpose degree of frost bite severity, area of affection, physiological needs of organism and pathological loss during a day are determined. After that, volume of infusion therapy is calculated by formula: V-C×S+PN+PL, where: V is volume of infusion therapy, in ml; C is coefficient of frost bite severity: 1.0 in case of I and II degree frostbites; 2.0 in case of III-IV degree frostbites; S is the area of affected surface, in cm2; PN stands for physiological needs of organism during a day, in ml; PL stands for pathological loss during a day, in ml.

EFFECT: method ensures elimination of hemostasis and microcirculation disorders in pre-reactive period, as well as in early and late reactive periods due to carrying out adequate infusion therapy with optimal volume of solutions.

3 ex

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