RU2000788C1 - Method for treatment of self-poisoning - Google Patents

Abstract

The invention relates to medicine, in particular to intensive care The method consists in that for the treatment of endogenous intoxication, along with traditional infusion-transfusion detoxifying and antibacterial therapy, an additional 0.03 - 0.06% solution of sodium hypochlorite is added intravenously dropwise in a volume equal to 1/10 of the volume of circulating fowl If necessary, nmnostig / ul nodolt 0.03% solution, if necessary, enhance detoxification 0.06% solution prpparat

Description

The invention relates to medicine, in particular to intensive care and resuscitation, and relates to the treatment of patients with endogenous intoxication syndrome in various forms of peritonitis and pancreatic necrosis,

In conjunction with the traditional infusion-transfusion, antibacterial and correlative intensive care, T is performed for intramuscular detoxification, including forced diuresis, evacuation of gastrointestinal contents, intestinal stimulation, immunotherapy, etc. If the measures taken are not effective enough, extracorporeal detoxification methods are involved: hemosorption, plasmosorption, lymphosorption, plasmophoresis. EKDPS, UV irradiation of blood, etc.

The prototype of this method of treating patients with endogenous intoxication syndrome is the extracorporeal connection of donor xenosepleen (EKDS) and the introduction of splenic perfusate. Xenosplen perfusion and the introduction of splenic perfusate have been found to be effective in increasing the immunological reactivity of the patient’s body in the presence of intoxication, and in reducing the general and immunological resistance of the organism with high resistance of the microflora inoculated to antibiotics.

ECPDS consists in actively taking the patient's blood from a vein by means of a roller pump for perfusion and pumping it through the communication system into the spleen, and then returning the patient to another vein. Xenosplenoperfusion involves the stimulation of immunoreactive systems, in particular T-lymphocytosis and neutrophilic phagocytosis, as well as the sorption of microbes and toxins by the spleen tissue itself.

A xenose-spleen donor perfusate is prepared by passing a rheoglucucin solution in a dropwise droplet manner through the spleen and then administered intravenously to the patient. These biostimulation methods along with traditional methods of treatment contribute to an increase in initially lower immunological parameters: the number of T-lymphocytes increases, the immunoregulatory index is normalized (T-helper: T-suppressor ratio) (Surgical sepsis. Abstract, 2nd All- Yu.Conf. Tula, 1989. Co-author N.M. Fedorovsky V.K.Gostishchev, A. B. Tsypin, A. A. Makarov, A. Yu. Polonsky, G. A. Vit zev).

However, xenosplenoperfusion and the introduction of splenic perfusate have a whole

A number of shortcomings, which are primarily associated with the complexity of the fence, conservation and transportation of the spleen. In addition, anaphylactic reactions are possible, especially with repeated sessions, when the patient’s blood comes in contact with foreign antigens of the formed elements and pig spleen tissue,

The aim of the invention is to find a method of treating patients characterized by simplicity of technical solution, low cost, high efficiency and with a minimum of side effects.

5 The method is carried out as follows. Sodium hypochlorite (NaCIO (obtained by electrolysis of a 0.9% sodium chloride solution in an electrochemical setup) is administered intravenously

0 EDO-4. External use of NaCIO in surgical practice has long been known. Having the expression of antiseptic, bactericidal and non-political deystvii, NaCIO is widely used in purulent surgery in the treatment of wound infection, in thoracic and abdominal surgery for the rehabilitation of cavities (E.A. Petrozen, V.I. Sergienko, G.K. Kulaev, A.K. Martynov, Yu.M. Lopukhin, O.V. Dubinkin,

0 V.M. Bensman. Sodium hypochlorite for the treatment of purulent wounds. Herald of Surgery 1991 No. 1). In the United States, the drug is available as an official solution for external use called Deikin. Decision

5 of the pharmacological committee of the Ministry of Health of the USSR No. 718 of 3.04.91 on the basis of a decision by the toxicological commission of the farm. Committee of September 7, 1990 and the conclusion of the Carcinogenic Substances Committee on December 6, 1990. Electrochemically prepared NaCIO is approved for iv use.

Infusion of a 0.03% and 0.06% NaCIO solution is carried out in catheterized central veins

5 (subclavian, lumbar, femoral) with a speed of 6-8 drops / min in an initial dose of 400 ml under the control of the level of volemia (NT no more than 40%), hemostasis vr. ev, cr. not higher than 15 min, the level of glycemia (blood glucose not lower than 5 mmol / l). Indication for the use of the drug is a pronounced syndrome of endogenous intoxication, accompanied by an increase in blood levels of medium molecules, toxic metabolites

5 bacterial origin, tissue breakdown products, microcirculation and hemorheology disorders, as well as immunodeficiency. The end result of the therapy is evaluated according to the clinical picture (overall health, skin cancer

integument, temperature reaction, NPV, hemodynamic indicators, intestinal motility), by the degree of intoxication (LII, ECA, KShchS indicators, level of average molecules, liver enzymes), by immunogram (absolute number of lymphocytes, percentage of T-lymphocytes, ratios T-helpers: T-suppressors, ATP in lymphocytes). The criterion for the duration of therapy is the degree of intoxication (with a decrease in intoxication to the first degree, drug administration is stopped).

 Being a donor of atomic oxygen, and in connection with this good oxidizing agent, NaCIO reliably models the monooxygenase system of the liver operating on cytochrome P-450. It also activates microsomal oxidation in lymphocytes, micro- and macrophages, which is confirmed by an increase in ATP in lymphocytes and activation of phagocytosis. The effect of NaCIO on cellular immunity is regarded as immunomodulating. It is noted that the use of NaCIO at a concentration of 300 mg / l has an immunostimulating effect. At the same time, the number of T-lymphocytes increases, the imbalance in the system of regulatory cells is eliminated, and ATP in the lymphocytes increases. The use of NaCIO at a concentration of 600 mg / L and higher does not change the immune status and does not cause immunosuppression. Thus, for immunization, it is advisable to use NaCIO at a concentration of 300 mg / L. 600 mg / L NaCIO can be used to oxidize toxic metabolites, tissue breakdown products.

Sick N., 33 g., Medical history No. 13552, was admitted to the surgical department 23 GKB 12/22/91 with a diagnosis of acute pancreatitis. The patient was given a conservative infusion, antispasmodic, antienzyme therapy with a slight positive effect. 12/23 marked deterioration. Pallor of the skin, acrocyanoe appeared, moderate shortness of breath - NPV 24 per minute, increased tachycardi - HR 120 beats. in min .. paresis of the gastrointestinal tract, peritoneal symptoms. When laparoscopy in the abdominal cavity detected hemorrhagic effusion, On the same day the patient made laparotomy. During revision of abdominal organs: hemorrhagic pancreatic necrosis, pancreatic cyst, secondary cholecystitis. Omenentobursocystotomy, cholecystectomy, choledochotomy, drainage of choledochae, subhepatic space, retroperitoneal space, abdominal cavity were performed. On the 3rd day of the operation, the intensive care unit showed signs of endogenous intoxication syndrome, with

5 objective examination: sick in the creation, in la, inhibited. The skin is pale with a cyanotic hue, acrocyanoe. Shortness of breath, NPV - 26 per min. Tachycardi, heart rate 110-112 bpm. The abdomen is swollen, peristalsis is not heard, stagnant contents enter the probe from the stomach.

0 For a day on a catheter received 700 ml of concentrated urine.

During laboratory examination: LII 5-3; urea 7.6; creatinine 154; bilirubin total 36 mmol / l; Alt 51; ACT 172; pH 7.55; PC02 27.8; p02 89.9; BE + 2.7; Hb 90 g / l; NTRP; ECA 26.5.

5 Immunogram: absolute lymphocyte count 480 / μl; Phone 48%; T-helpers: T-suppressors 2.0; ATP in lymphocytes 3.3 eq / l (deficiency of immunocompetent cells).

0 nar do with infusion corrective

therapy in a volume of 4 l, antibacterial therapy, infusion of a 0.06% FJaCIO 400 ml solution into the right subclavian oena was carried out at a speed of G-8 drops / min. Across

5 2 hours after NaCIO transfusion, the patient is more active, the skin is rosy, acrocyanosis, dyspnea, tachycardia decreased. After intestinal stimulation, peristalsis appeared, the gases moved away.

0 days laboratory shifts were noted: LII 1,2; ECA 33 g / l; urea 5.2; creatinine 115; bilirubin total 11 mmol / l; ApT 16; ACT 32; pH 7.51; pC02 35; p02 95.0; BE + 4.5; H93 / L; NT 34.

about in the immunogram: abs.h.lf. 1050 / μl; Tlf 43%; helper suppressors 1.4; ATP in LF 2.5 meq / l (imbalance in the system of regulatory cages against the background of deficiency of T-helper cells). In the following days, the syndrome of endogenous intoxication did not increase above grade I. Against the background of the therapy, positive dynamics were noted. On the 10th day after the operation, the patient was transferred about hir.otd. in a relatively satisfactory condition. On the 32nd day she was discharged home in satisfactory condition.

Sick S., 65 years old, medical history 11998. Received 11/17/91 in the department. 23 GB in severe condition with a diagnosis of acute

0 appendicitis, peritonitis. On the operation: gangrenous appendicitis, diffuse purulent peritonitis. Appendectomy, removal of the small intestine diverticulum, sanitation, and abdominal drainage were performed. AT

5 parts rean. patient's condition. Clinic of moderate si looma

endogenous intoxication. The skin is pale. Moderate tachycardi, heart rate - 100-108 bpm. The abdomen is slightly swollen, peristalsis is not heard.

During laboratory examination: LII 1.6; ECA 36 g / l; urea 4.9; creatinine 112; bilirubin total 13 mmol / l; Alt 20; ACT 30; pH 7.48; pCO2 35.00; p02 89.2; BE + "2.8, Hb 108 g / l; NT50.

Immunogram: abs. 440 / μl; Tlf 47%; helpers suppressors 0.6; ATP in lf. 5.5 meq / L (deficiency of immunocompetent cells, imbalance in the system of regulatory cells with the predominance of T-suppressors over T-helpers.

On the second day after the operation, along with the corrective infusion, antibacterial therapy, after hemodilution and bringing HT-a to 42, infusion of a 0.03% NaЈIO 400 ml solution in the right subclavian vein was performed at a rate of 6-8 drops / min.

After that, the clinical picture and lab indicators changed slightly.

0.06% solution at a dose of 800 ml 0.06% solution at a dose of 200 ml 0.03% solution at a dose of 400 ml

The 0.03% NoCIO solution at a dose of 400 ml has the greatest immunostimulating effect. Moreover, in the case of deficiency of immunocompetent cells on the first day after NaCIO infusion, the absolute number of lymphocytes increases by 30-40%. the number of T-lymphocytes is 25-28%, the ATP content in lymphocytes is 20%, the ratio of immunoregulatory cells is normalized. Deficiency of T lymphocytes with increased ATP synthesis in them is a prognostically unfavorable sign and, as a rule, cannot be corrected with NaCIO. A 0.06% NaCIO solution at a dose of 400 ml does not affect the immunological status, and at a dose of 800 ml it can cause immunosuppression. However, a 0.06% NaCIO solution has a more pronounced detoxifying effect, as it is able to oxidize toxic metabolites, tissue breakdown products, and middle molecules. And this is reflected in the positive dynamics of the clinical picture, normalization of LII, an increase in ECA, a decrease in the concentration of nitrogenous toxins, and bilirubin. medium molecules, liver enzymes

Biochemistry and KShchS: LII 1,4; ECA 34 g / l; urea 4.8. creatinine 111; bilirubin total 12 mmol / l; Alt 23: AcT 45; pH 7.51; pCO2 30.4; p02 90.0; BE + 1.7; Hb 123 g / l; NT 44.

However, positive shifts appeared in the immunogram: abs.h.p.9999 / μl; T-60%; helpers: suppressors 0.8; ATP in lf. 7 meq / l

In the following days, against the background of the therapy, a positive dynamics was noted. On the 5th day after surgery in a relatively satisfactory condition, the patient was transferred to the emergency department, and on the 24th day she was discharged home.

The number of patients with endogenous intoxication syndrome who have been given now with traditional IV treatment with NaCIO:

With limited peritonitis 17;

With common peritonitis 13;

With pancreatic necrosis 14

Total: 44 people.

Infusion of a 0.06% solution at a dose of 400 ml was carried out in 16 patients

9 patients; 7 patients; 12 patients.

cops, the normalization of the indicators KShchS. Thus, with a mild endogenous intoxication syndrome, it is advisable to use NaCIO at a concentration of 300 mg / l for immunostimulating purpose. In case of severe endogenous intoxication syndrome above degree I, it is advisable to use NaCIO at a concentration of 600 mg / l as an oxidizing agent with a detoxifying purpose.

In all variants of application of NaCIO, precautionary measures must be observed: NaCIO infusion at a concentration of not higher than 600 mg / l should be carried out in the catheterized central veins under the control of the level of volemia (as a rule, after hemodilution to NT-40%), glycemia level (glucose blood not lower than 5 mmol / l), hemostasis (pr. St. Red. not more than 15 minutes).

(56) A.O. Sukhover. The use of indirect electrochemical oxidation for detoxification in pancreatic necrosis. Abstract of Cand. Diss., N 1990, p. 20-21.

N.M. Fedorovsky and others in the book. Surgical sepsis. Abstracts of the 2nd All-Union Conference. Tula. 1989.S. 46

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Claims (1)

The claims are three in a volume equal to 1/10 of the volume of the circulating method for treating endogenous intoxication, while including infusion-transfusion necessities of immunostimulation are administered detoxification and antibacterial-0.03% solution, and if necessary therapy, characterized in that to increase detoxification - 0.06% is additionally administered intravenously with the drug. 0.03 - 0.06% hypochlorite solution per