RU2149026C1 - Method of treatment of trophic ulcer of venous genesis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: invention relates to conservative methods of treatment of trophic ulcers of venous genesis. Method involves applying on ulcer dialdehydecellulose-base napkins containing immobilized trypsin and 100 mg of mexidol. Additionally, mexidol is administrated by intramuscular route at the dose 100 ml per injection for 5 days. EFFECT: accelerated and simplified treatment of trophic ulcers. 1 tbl, 1 ex

Description

 The invention relates to medicine, specifically to conservative methods for the treatment of trophic ulcers of venous origin.

 A known method of traditional treatment of trophic ulcers of venous origin, which consists in the fact that the ulcer is applied a zinc-gel bandage. A bandage is applied for 30-40 days, sometimes up to 3 months. At the same time, ulcers are toiletted with irrigation with proteolytic enzymes and the parallel appointment of physiotherapy (Big Medical Encyclopedia. M., Sovetskaya Encyclopedia Publishing House, 1985, v.25, p. 347-348). Treatment with traditional dressings is long, protracted and does not always lead to ulcer closure.

 The closest to the claimed method of treating trophic ulcers is known, which consists in applying a napkin with an immobilized proteolytic enzyme, Dalcex-trypsin, through which a semiconductor low-energy laser is irradiated daily (A.S. USSR N 1598269, MKI A 61 N 5 / 06, 1988).

 Epithelization during treatment in a known manner was observed on the 9-12th day.

 The invention solves the problem of accelerating and simplifying the method of treatment of trophic ulcers of venous origin.

 The problem is solved due to the fact that in the method of treating trophic ulcers using a dialdehyde cellulose-based napkin containing immobilized trypsin, a napkin containing an additional 100 mg of mexidol is used and 100 mg per injection of mexidol is administered intramuscularly for 5 days.

 Mexidol belongs to the derivatives of 3-hydroxypyridine and is 2-ethyl-6-methylpyridine succinate, a synthetic antioxidant (P.I. Tolstykh, V. T. Krivikhin et al. Laser radiation and antioxidants in the treatment of purulent-necrotic processes of the lower extremities in patients with sugar diabetes. M., Publishing house "Orbit-M", 1998, S. 43).

Mexidol is a structural analogue of the group of vitamins B ₆ .

 The method is as follows.

 Immediately after the patient is admitted to the hospital, the ulcer surface toilet is carried out with a 3% hydrogen peroxide solution and the ulcers are covered with DAC-trypsin wipes containing 100 mg of Mexidol, and Mexidol 100 mg per injection for 5 days is administered intramuscularly to the patient for 5 days.

In the treatment of the proposed method, trophic ulcers of small sizes from 1 to 3 cm ² close within 7-8 days, and medium (from 4 to 10 cm ² ) by 14 days.

 The invention illustrates an example.

 Example. Patient Ch., 46 years old, was admitted 10.10.98 with complaints of trophic ulcers in the lower third of the leg on the anterior-medial surface. From the history of the disease it is known that in 1993 an operation - phlebectomy was performed on the left lower limb, and in 1995 - on the right. Trophic ulcers on the lower extremities appeared in the month of April 1998 and, despite treatment with various ointment dressings, did not epithelize.

 On examination, the left lower limb in the middle and lower third of the tibia is dark gray, there is no edema. On palpation, moderate soreness along the postoperative scars is noted. On the anteromedial surface there is an ulcer 2.5-4.0 cm in size, with a slight wound discharge. On the right is an ulcer of 2.5-2.5 cm in size with separate sections of dry necrosis. When examining the veins of the lower extremities in a duplex scan mode, the color flow mapping method revealed: deep veins are passable, phase blood flow, valves in the veins are sufficient. Superficial veins are not scanned. When viewed from the organs: systemic pathological changes were not detected. Pulse 80 in 1 min, blood pressure 130/90 mm RT. Art.

 Diagnosis: chronic venous insufficiency of the lower extremities, chronic ulcers. Inductive cellulitis of the left lower leg. Condition after combined phlebectomy on the left - in 1993, on the right - in 1995.

 Immediately after admission to the hospital, the toilet of the ulcer surface was made with 3% hydrogen peroxide solution, and then the ulcers were covered with DAC-trypsin wipes with Mexidol (100 mg Mexidol on a 10x10 cm napkin). Within 5 days, the patient was intramuscularly injected with Mexidol 100 mg per 1 injection.

 The ulcers cleared of purulent and necrotic masses on the second day, on the fourth - healthy juicy granulations appeared, on the 14th day the ulcers were epithelized.

 To illustrate the high efficiency of the proposed method of treatment, a comparison was made of the results of the treatment of trophic ulcers of the lower extremities by traditional, known methods.

Patients were treated whose ulcer surface area ranged from 10 to 20 cm ² and from 20 to 40 cm ² .

 In the first group of patients (treatment using traditional dressings) after cleansing the ulcer surface from purulent and necrotic masses and at the beginning of epithelialization, a zinc-gel dressing was applied, which included an equal amount of zinc oxide and gelatin - 50 g, 300 g of glycerol and 100 ml distilled water.

 In the second group of patients, after the ulcer toilet, napkins containing immobilized trypsin were applied and a semiconductor low-energy laser was irradiated.

 The third group of patients was treated with wipes containing immobilized trypsin and Mexidol and intramuscular injection of Mexidol.

 The treatment results are shown in table 1.

 An essential step in the treatment of patients with ulcers of the lower extremities is a halving of the ulcer area, which in the first group of patients treated with traditional dressings occurred on 20.4 ± 1.0 days. In the second group of patients treated with Dalcex-trypsin wipes, a 50% reduction in ulcer area occurred on day 18.5 ± 1.5, and in the third group of patients treated with Dalcex-trypsin + mexidol wipes, the reduction in area ulcers occurred on the 15 ± 1.5th day.

 As can be seen from the above data, the use of Dalcex-trypsin + Mexidol wipes shortens the treatment time for trophic ulcers and in most cases leads to ulcer closure.

Claims (1)

 A method of treating trophic ulcers, including the use of dialdehyde cellulose-based napkins containing immobilized trypsin, characterized in that napkins containing an additional 100 mg of Mexidol are used, and 100 ml of Mexidol is administered intramuscularly for 5 days per injection.

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