RU2243778C2 - Method for treating aftereffects of traumatic and intraoperational damage of limbs' soft tissues in patients with polytrauma - Google Patents

Abstract

FIELD: medicine, anesthesiology, resuscitation, traumatology, orthopedics.

SUBSTANCE: additionally to infusion, transfusion, antibacterial therapies and measures on stabilization of osseous fragments one should introduce hordox simultaneously at the quantity of 500000 U during the 1^st d after trauma, then - every 8 h per 200000 U for 2 d and before operation simultaneously at the quantity of 500000 U, then every 8 h per 200000 U for 2 d or ingitryl simultaneously at the quantity of 150 U during the 1^st d after trauma to continue therapy for 2-3 d at the quantity of 150 U daily, and before operation it should be introduced simultaneously at the quantity of 150 U to continue therapy for 2-3 d at the quantity of 150 U daily. The present innovation enables to suppress excessive production of cytokines that in its turn favors prevention of pain syndrome, edema and soft tissue necrosis development in the affected limb.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, more specifically traumatology and orthopedics, and can be used to treat patients with polytrauma.

In victims of extensive soft tissue damage to limbs, biologically active substances enter the bloodstream - mediators of immune reactions (cytokines-interleukins, tumor necrosis factor (TNF &), interferons, fibronectin, growth factors, chemotactic factors, eicosanoids, etc.) that protect the body from aggression.

In a normal, self-regulating immune response (inflammation or destruction of foreign and damaged “native” tissues), an increase in energy production occurs, a protective febrile reaction occurs, and regeneration of damaged tissues is stimulated.

However, when mediators are formed in excess, which is characteristic of a post-traumatic inflammatory response, tissue destruction occurs instead of regeneration and interstitial edema instead of localizing the damaging factor. (Zilber A.P. “Medicine of critical conditions”, 1995, p. 147-188.)

A known method of treating patients with polytrauma by conducting infusion, transfusion and antibacterial therapy and measures to stabilize bone fragments (Zilber A.P. “Medicine of critical conditions”, 1995, S. 147-188). However, all of the above methods are not able to prevent the massive entry into the bloodstream and tissues of biologically active substances of the kinin, complementary, coagulating fibrinolytic and cytokine series.

This can lead to the development of severe edema of the damaged limb, the development of severe pain, temperature reaction and, as a result, to soft tissue necrosis.

The objective of the invention is to suppress the excess production of the kallikrein-kinin system, and therefore, the excessive production of cytokines, which helps to prevent the development of edema of the injured limb, the development of severe pain, temperature reaction and soft tissue necrosis.

The problem is solved in that in the method of treating the consequences of traumatic and intraoperative damage to the soft tissues of the limbs in patients with polytrauma by conducting infusion, transfusion, antibacterial therapy and stabilization of bone fragments, the patient is additionally administered Aprotinin, which is used as Gordox or Ingitrile, and Gordox is administered simultaneously on the first day after the injury in the amount of 500,000 units, then 200,000 units every 8 hours for 2 days and immediately before surgery 500,000 units, then 200,000 PIECES every 8 hours for 2 days, and Ingitrile is administered simultaneously in the first day after the injury in the amount of 150 PIECES, then 150 PIECES daily for 2-3 days and before the operation in the amount of 150 PIECES, then 150 PIECES daily 2-3 days.

It is known that the protease inhibitor Aprotinin (Gordoks, Kontrikal, Ingitril) inactivates proteinases (plasmin, kininogenases, trypsin, chymotrypsin, etc.) in the blood plasma and body tissues.

The method is as follows. A patient with polytrauma against the background of infusion, transfusion and antibacterial therapy and measures to stabilize bone fragments in the first day after the injury is immediately injected with Gordox in the amount of 500,000 units. Next, Gordox is administered at 200,000 units every 8 hours for 2 days. Also, Gordox is administered in an amount of 500,000 units at a time before surgery, then Gordox is administered at 200,000 units every 8 hours for 2 days. Inhitrile is administered on the first day after an injury simultaneously in the amount of 150 PIECES and continue treatment for 2-3 days at 150 PIECES per day. Inhitrile is administered immediately before the operation in an amount of 150 PIECES and continue treatment for 2-3 days at 150 PIECES per day.

Clinical examples.

1. Patient M.I.A., 42 years old, medical history No. 14803, was in the NIISP named after N.V. Sklifosovsky from 08.22.02 to 02.09.02.

Diagnosis: concomitant injury. Open comminuted fracture of the right femur in / 3 and c / 3 with displacement of fragments. Bruised wound of 1 finger of the right hand. Dull abdominal trauma, subcapsular spleen hematoma. Brain concussion. Abrasions of the face, neck.

Upon admission to the intensive care unit, infusion and transfusion, antibacterial therapy was carried out. The primary surgical treatment of the wound of the right thigh was performed, the fracture was fixed by skeletal traction. Gordox was administered to the patient on an isotonic NaCl solution in an amount of 500,000 units at a time on the first day after the injury, then 200,000 units every 8 hours for 2 days.

On August 28, 02 an operation was performed - closed blocking osteosynthesis of the right femur UFN. Before surgery, the patient was immediately administered Gordox 500,000 units and then 200,000 units every 8 hours for 2 days. Also, the patient was given infusion therapy (Reopoliglukin, Trisol), transfusion therapy (FFP, Albumin), antibiotic therapy (Fortsef 2 g / day, Amikacin 1 g / day No. 10, Metranidazole 100.0 X 2 r / day No. 6), antithrombotic (Fraxiparin 0.6 / day No. 10) and immunocorrective therapy (anti-staphylococcal human immunoglobulin 3.0 No. 5).

In the postoperative period, thanks to the introduction of Gordox, only 2 injections of Omnopon were made 2% 1.0 s / c during the first day (usually after such operations 3 injections of narcotic painkillers are administered within 3 days), limb edema was moderate and resolved within 5 days (usually edema resolves within 8-10 days), there were no soft tissue necrosis. The patient is activated with additional support on crutches for 5 days after surgery. Against the background of the therapy, the wounds healed by primary intention.

2. Patient Sh.V.V., 31 years old, medical history No. 17833, was in the NIISP named after N.V. Sklifosovsky from 01.10.01 to 12.20.01.

Diagnosis: concomitant injury. Fracture of the arch and base of the skull, upper jaw type Fore 1, left zygomatic bone. Bruise of the brain. Rupture of the pubic symphysis and both sacroiliac joints. Closed comminuted fracture in / 3 and c / 3 of the left thigh with displacement of fragments. Fracture of the right radius in s / 3 with displacement. Fracture of the outer ankle of the right lower leg, both ankles and the posterior edge of the left tibia with subluxation of the foot outward and posterior. Postcatheterization cystitis.

According to the patient, an injury on the eve of admission as a result of a fall from a great height. NIIISP conducted infusion, transfusion and antibacterial therapy, closed reposition of the ankles of the right lower leg, elimination of subluxation of the foot, fixation with plaster splint bandages, double-jaw splinting was performed on duty of the jaw on the jaw on the jaw of the hospital, HCB No. 36. Against the background of the therapy, Ingitril was administered simultaneously in the first day after the injury in the amount of 150 PIECES and continued treatment for 3 days at 150 PIECES per day.

10.10.01 the following operations were performed: 1) closed blocking osteosynthesis of the left femur with a long PFN, 2) osteosynthesis of the pubic joint with the AO plate, 3) osteosynthesis of the right sacroiliac joint with the AO screw, 4) osteosynthesis of the left sacroiliac joint with the AO screw. The patient was administered intra-operatively Ingitril in the amount of 150 units. Further, the administration of Ingitril was continued in the amount of 150 PIECES daily for 3 days. Against the background of ongoing anti-mediator, antibacterial, infusion, antithrombotic therapy, primary wound healing is primary. On October 23, 01, an operation of osteosynthesis of the right radial bone with an AO plate was performed. Primary healing. On ultrasound of the deep veins of the lower extremities and pelvis in the dynamics of thrombosis was not detected.

The use of the anti-mediator drug Ingitril made it possible to simultaneously produce a large volume of surgical interventions without a pronounced inflammatory reaction of soft tissues: 1) closed blocking osteosynthesis of the left femur with long PFN, 2) osteosynthesis of the pubic joint with the AO plate, 3) osteosynthesis of the right sacroiliac joint with the AO screw, 4) osteosynthesis of the left sacroiliac joint with the AO screw. There was also a significant decrease in pain (the number of injections of narcotic painkillers from 3 injections per day for 3 days was reduced to 3 injections during the first days after surgery), swelling of the operated limbs was moderate and resolved within 5 days (usually edema resolves by 8- 10 days), there was no soft tissue necrosis. The body temperature was subfebrile for 5 days, while the temperature usually rises to febrile numbers within 5-7 days, then within 10 days to subfebrile numbers.

The method proposed by the authors was applied in 65 patients with polytrauma in the early postresuscitative period, intraoperatively and in the early postoperative period.

The use of Aprotinin (Gordox, Ingitril) intravenously in order to suppress the excessive activity of the kallikrein-kinin system, and therefore, the excessive production of cytokines, led to the following clinical results.

1. Decrease in temperature reaction.

2. The absence of postoperative edema of the limb in 21 victims. In 44 cases, edema of the operated limb was minimal.

3. A significant reduction in postoperative pain in all patients, which allowed to reduce the number of injections of narcotic analgesics by 2-3 times.

4. Wound healing by primary intention in 62 patients. Limiting the spread of skin necrosis in 3 patients with subsequent secondary wound healing.

Claims (1)

A method of treating the consequences of traumatic and intraoperative damage to the soft tissues of the limbs in patients with polytrauma by conducting infusion, transfusion and antibacterial therapy and measures to stabilize bone fragments, characterized in that gordox is additionally administered simultaneously in an amount of 500,000 units on the first day after the injury, then every 8 200,000 units per hour for 2 days and before the operation simultaneously in an amount of 500,000 units, then every 8 hours for 200,000 units for 2 days or instantly in an amount of 150 ingitrile D in the first days after injury and treatment continued for 2-3 days in an amount of 150 units per day, and before an operation, it is administered simultaneously at 150 IU and continue treatment for 2-3 days in an amount of 150 units per day.