RU2193890C2 - Method for prophylaxis of purulent- inflammatory complications of occasional traumatic and operational wounds - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: staphylo-protean-pyocyanic vaccine (SPPV) is intraoperationally injected into the wound at the quantity of 0.3-1.0 ml. The method enables to obtain specific immune response in more shortened period of time. It prevents the development of purulent-inflammatory wound complications. EFFECT: higher efficiency of prophylaxis. 2 ex, 1 tbl

Description

 The invention relates to medicine, namely to surgery, and can be used to prevent purulent-inflammatory complications of accidental traumatic and surgical wounds.

 Known methods for the prevention of wound suppurative inflammatory complications by topical application of antibiotics. At the same time, antibiotics are used in the form of powders, solutions, and immobilized on suture material [1, 10].

 However, local methods of combating wound infections with antibacterial drugs suffer from a limited time. The antimicrobial effect is determined by the physical ability of the antimicrobial agent to enter the wound during dressing. The prevalence of multi-resistant strains among potential pathogens of infectious wound complications for most antibiotics used significantly reduces the prophylactic significance of antibacterial agents. Inactivating in the wound due to binding to proteins plays an important role in the decrease in the activity of antibiotics with topical application [10].

 Therefore, in recent years, immunological aspects of the prevention of wound infections have been actively developed. It has been established that in the natural course of the infectious process in the wound at its early stages, the most important role in providing resistance to the pathogen is played by nonspecific immunity factors: natural antibodies, complement and polymorphonuclear leukocytes. Subsequently, specific immune reactions begin, which culminate in the production of specific antibodies, which appear in the blood 3-7 days after contact with the antigen [5].

 However, pathogenic microorganisms that have invaded the wound have certain mechanisms of suppression of the macroorganism's immune system. For example, in Pseudomonas aeruginosa, the immunosuppressive mechanism is due to the destructive effect of the elastase enzyme on IgG immunoglobulin [13].

 The use of vaccine preparations containing instead of living cultures only antigenic complexes eliminates the development of immunosuppressive mechanisms, thereby obtaining an adequate immune response in the shortest possible time. In order to prevent infections by active immunization, intramuscular, inhaled, and oral methods of administering vaccines have been proposed [2, 4, 6, 11, 12]. There are reports of local application in the form of applications of monovaccine preparations for the treatment of foci of purulent infection [8, 9].

 The prototype is a method for the prevention of infectious wound complications by intramuscular immunization using a staphyloprotein-Pseudomonas aeruginosa associated (SPSA) vaccine [2]. SPSA vaccine contains staphylococcus anatoxins and Pseudomonas aeruginosa as protective antigens, staphylococcus cytoplasmic antigen and soluble antigens of 6 protea strains [7]. However, with systemic immunization, the immune response is formed only 10-14 days after vaccination [2], which does not provide complete prevention of purulent-inflammatory complications from traumatic and surgical wounds.

 The objective of the present invention is the prevention of purulent-inflammatory wound complications due to trans-immunization of patients with SPSA vaccine.

 The task is achieved in that the PCA vaccine is injected directly into the wound in an amount of 0.3-1.0 ml. At the same time, the natural mechanism of antibody genesis is preserved - the acquaintance of the macroorganism's immune cells with infection antigens occurs in the wound itself, with the only difference being that an antigenic complex from the most likely causative agents of wound infection is used instead of a bacterial agent. Local administration of the SPSA vaccine can prevent purulent-inflammatory wound complications due to the development of a specific immune response in a shorter time.

 The technical result is a reduction in treatment time.

 The method is as follows. Under local infiltration anesthesia, surgical treatment of the wound is performed. Non-viable tissue is removed, wound sanitation is carried out according to the generally accepted method using solutions of hydrogen peroxide and antiseptics. Stitches are placed on the wound. Before tightening the sutures, an SPSA vaccine in the amount of 0.3-1.0 ml is applied to the wound surface with a syringe. After this, the sutures are tightened, achieving a tight contact of the edges of the wound. Excess vaccine flowing through the suture line is removed with a swab. Apply an aseptic dressing.

 We used this method during surgical treatment in 17 outpatients with random wounds and in 3 patients operated on for acute destructive appendicitis while suturing an abdominal wall wound.

 Out of the number of outpatients with random wounds, 6 (35.3%) turned on the first day after receiving the injury with manifestations of infection, on the second day 6 (35.3%), on the third 5 (29.4%).

 The result of postoperative observation of patients.

 At the first ligation, a slight swelling of the suture line was observed after 24 hours. On the third day, the suture line in all patients was calm. In all cases, healing began by primary intention, the formation of a narrow linear skin scar. Sutures were removed on the 5-7th day.

 An increase in body temperature was not observed in any of the observations. On the part of the general blood test (white blood cell count, ESR), deviations from the baseline were not observed.

 7 patients underwent immunological studies. In the research results, an increase in the relative number of B-lymphocytes from 22.34 ± 0.72 to 24.67 ± 1.01, the ratio of T-helpers to T-suppressors from 0.86 ± 0.04 to 1.09 ± 0, was found. 04 (p <0.001). An increase in the content of M and G immunoglobulins in the blood was observed from 1.11 ± 0.1 to 1.71 ± 0.11 (g / l) and from 12.12 ± 0.77 to 16.1 ± 0.89 (g / l) respectively (p <0.001). Phagocytosis activation was noted, the phagocytic index increased from 47.34 ± 2.46% to 56.41 ± 3.11%.

 Example 1. Patient M., 52 years old. He turned to the surgical room of the clinic 22 hours after receiving a personal injury - a cut of a fragment of window glass on the left side surface of the chest. Objectively: on the left half of the chest there is a musculocutaneous wound measuring 10 • 12 cm, depth up to 4.5 cm. The wound surface is covered with a blood clot.

 Under local anesthesia with a 0.5% solution of novocaine 80 ml, primary surgical treatment of the wound, toilet and sanitation were performed. Stitched to the wound. Before tightening the sutures, 1.0 SPSA vaccine was applied to the wound. The seams are tight. Aseptic dressing.

 On dressing every other day - slight swelling along the suture line. There is no detachable. Dressing change. After two days at the dressing, the swelling of the suture line subsided. Sutures were removed on the seventh day. Primary healing.

 Example 2. Patient A., 32 years old. Diagnosis: Bruised chin wound. Injured in the gym. He sought medical help 44 hours after receiving an injury. There is a wound on the chin, measuring 4 x 2 cm with uneven, bruised edges. Tissues around the wound are swollen, infiltrated.

 Under local anesthesia with a 0.5% novocaine solution, primary surgical treatment of the wound was performed. Stitched. Before tightening the sutures, a 0.5 ml SPSA vaccine was applied to the wound surface. Aseptic dressing. Healing by first intention. Sutures were removed on the 5th day.

 The general results of the treatment of ambulatory patients with random wounds with local application of vaccine treatment and the control group of patients are presented in the table.

 As can be seen from the data presented, the treatment of wounds using CIICA vaccines avoided suppuration of wounds. At the same time, the frequency of purulent complications during the healing of open soft tissue injuries is about 22% [3].

 In the group of patients operated on in the hospital for acute destructive appendicitis with treatment of the surgical wound with the SPSA vaccine, no wound complications were observed. All three patients had healing of the postoperative wound by primary intention.

Sources of information
1. Wolf L. V. Suture materials based on biologically active synthetic and artificial fibers. // In the book: First All-Union Conference "Modern Approaches to the Development of Effective Dressings and Suture Materials, - Moscow, 1989. - P. 189-190.

 2. Gataullin N. G., Mikhailova N. A., Sibagatullin N. G. et al. Immunocorrection in patients with acquired heart defects with a multicomponent staphyloprotein-pseudomonas vaccine // The role of immunobiological preparations in modern medicine (materials of the international symposium). - Ufa, 1995. - Part 2, S. 38-40.

 3. Diagnosis and treatment of wounds. Ed. SOUTH. Shaposhnikov. M .: Medicine, 1984, p. 150.

 4. Kreinin L. S., Levina L. A., Kaverina K. G., and others. A method of passive-active therapy of Protein infection // USSR Author Certificate 1091392, class. A 61 K 39/00, 1982.

 5. Lebedev K.A., Ponyakin I.D. Immunogram in clinical practice. Moscow. 1990, 222 p.

 6. Lyashenko V. A., Alexander S. K., Kovaleva L. G. et al. Immunomodulating effect of vaccine preparations for their parenteral and local use // Act. questions development, production, use of immunobiological and pharmaceutical preparations. Ufa, 2000 .-- Part 1, S. 228-231.

 7. Mikhailova N. A., Kunyagina OV, Grabar Yu.M. and others. A method of obtaining an associated vaccine for the prevention of infections caused by opportunistic bacteria // Patent 2035189, class. A 61 K 39/116, publ. 01/02/96, BI 14.

 8. Moroz A.F., Kharitonova A.M., Chanturia Ts.K. Morphological study of organs and tissues of mice infected after a burn with a strain of Pseudomonas aeruginosa and treated with Pseudomonas multivalent corpuscular vaccine and tobramycin // Antibiotics. - 1983. - 5. - S. 341-5.

 9. Prevention of Nosocomial Infection: A Guide for Physicians Ed. Kovaleva L.G.// M., 1993, p. 212.

 10. Wounds and wound infection. Edited by M.I. Cousin and B.M. Kostyuchenok, M .: Medicine. - 1990, 199-200 s.

 11. Struchkov V.I., Nedvetskaya L.M., Immunological prophylaxis of suppuration of a postoperative wound // Surgery.-1978. - 9. - S. 8-12.

 12. Soloviev P.M., Petrova I.V., Kovalev S.V. Immune correction, prevention and treatment of purulent-septic complications in cardiac surgery // M .: Medicine, 1987, 159 p.

 13. Holder J.A., Wheeter R. Experimental studies of the pathogenesis of infectione owing to Pseudomonas acruginosa elastase, an IgG protease // Can J. Microbiol. - 1984. - 30. - 9. - 1118-1128.

Claims (1)

 A method for the prevention of purulent-inflammatory complications of accidental traumatic and surgical wounds using a staphyloprotein-pseudomonas aeruginosa (SPSA) vaccine based on protective antigens from the pathogens of purulent infections, characterized in that the SPSA vaccine is administered intraoperatively into the wound in an amount of 0.3-1 , 0 ml.

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