RU2265455C1 - Method for treating chemical esophageal burns - Google Patents

Abstract

FIELD: medicine, toxicology, resuscitation.

SUBSTANCE: one should introduce preparations due to transmembranous wound dialysis: from the 1^st to the 3d d after chemical burn one should introduce dialyzate of the following composition: solution of rheopolyglukin 100 ml, 2%-lidocaine 4 ml, 1%-dioxidine 10 ml, dexamethasone 8 mg, and from the 4^th to the 7^th d of the disease mentioned it is useful to introduce dialyzate including: solution of rheopolyglukin 100 ml, 1%-dioxidine 10 ml, 5%-ascorbic acid 5 ml; moreover, transmembranous wound dialysis should be carried out once daily. The present innovation enables to conduct local treatment of chemical esophageal burns due to taking into consideration the phases of wound process of burn trauma that, in its turn, favors for alleviating and accelerating clinical flow of the disease in question and preventing the development of complications.

EFFECT: higher efficiency of therapy.

1 cl, 2 ex

Description

The invention relates to medicine and can be used for therapeutic purposes with chemical burns of the esophagus.

A known method of using inhibitors of proteolysis and fibrinolysis in the treatment of chemical burns of the esophagus by electrophoresis on the burned mucous membrane of the esophagus / 1 /.

The advantage of this method is the direct effect of drugs on the mucous membrane of the esophagus.

The disadvantage of this method is the inability to use the method in the early post-burn period, in connection with severe pain, swelling and hemorrhagic syndrome.

The objective of the proposed method is to conduct antimicrobial, anti-inflammatory, analgesic, hemostatic and regenerative effects at different stages of the wound process directly on the burnt mucous membrane of the esophagus.

The task is carried out due to the fact that the use of drugs is carried out by transmembrane wound dialysis: from 1 to 3 days after a chemical burn, the composition of the dialysate includes a solution of reopoliglukin 100 ml, lidocaine 2% 4 ml, dioxidine 1% 10 ml, dexamethasone 8 mg; from 4 to 7 days - a solution of reopoliglyukin 100 ml, dioxidine 1% 10 ml, ascorbic acid 5% 5 ml; moreover, transmembrane wound dialysis is carried out 1 time per day.

Local wound dialysis is performed using the device (RF patent for utility model No. 36769, A 61 M 1/16, 03/27/2004). Upon receipt of drugs (dialysate) on the mucous membrane of the esophagus according to the laws of thermodynamics, the concentration gradient of substances inside the tube and out of it aligns.

In 1-3 days after a chemical burn of the esophagus, the dialysate contains

reopoliglyukin 100 ml,

lidocaine 2% 4 ml,

dioxidine 1% 10 ml,

dexamethasone 8 mg

For 4-7 days after a chemical burn, the dialysate contains

reopoliglyukin 100 ml,

dioxidine 1% 10 ml,

ascorbic acid 5% 5 ml.

The method is carried out using a fibroesophagoscope; a device from a semipermeable membrane is inserted through the nasal cavity or oral cavity into the esophagus and stomach so that the part of the gastric probe that is covered with a semipermeable membrane is in the lumen of the esophagus, the end of the probe is in the stomach, and the initial part of the probe together with a polyvinyl chloride tube, it protruded 10-20 cm from the nasal cavity. Through a polyvinyl chloride tube, a dialysate solution enters the cavity of the tubular membrane using a Janet syringe in a mixed state, consisting box 1 to 3 days after a chemical burn from a solution of reopoliglukin 100 ml, lidocaine 2% 4 ml, dioxidine 1% 10 ml, dexamethasone 8 mg; from 4 to 7 days - a solution of reopoliglyukin 100 ml, dioxidine 1% 10 ml, ascorbic acid 5% 5 ml. Dialysate removal and replacement with a new one is carried out once a day.

With the help of a gastric tube installed in the stomach, a regular hourly nutrition of the patient is carried out with nutritious, energetic, high-calorie mixtures.

The device must be replaced with fibroesophagoscopic control for 5 days, if necessary, extension to 7 days (in total).

On the 5th or 7th day in the presence of clinical and fibroscopic improvement, local transmembrane wound dialysis is stopped.

We treated 10 patients with chemical burns of the esophagus 2-3 degrees. Against the background of general anti-inflammatory, antibacterial, regenerative therapy, the patients underwent local wound dialysis, installing a tube from a semipermeable membrane into the lumen of the esophagus 1-2 days after a burn. The duration of standing of the tube was on average 5-7 days.

During endoscopic examination, positive dynamics was observed in all patients, which is expressed in maintaining the patency of the esophagus for the endoscope, a decrease in fibrin overlay on the organ wall, faster onset of epithelization in the burn zone and complete cleansing of the mucosa by the 10th day with a second degree burn and by 15- m days with a burn of the III degree.

The development of a persistent cicatricial process, which required further therapeutic bougienage, according to x-ray of the esophagus with contrast, was observed only in 1 patient who was admitted to the clinic 4 days after the injury with gross violations of the algorithm of care at the initial stages.

Example 1

Patient P., 52 years old, was admitted to the ENT department of the regional clinical hospital with complaints of pain when swallowing, difficulty in passing a food lump, hoarseness, difficulty breathing, vomiting, nausea, weakness. From the anamnesis it was found that 1.5 hours ago the patient accidentally drank a small amount of acetic acid, after which the above complaints appeared, which over the last boom were growing.

On admission: the skin is pale, moist, the mucous membrane of the oropharynx is slightly hyperemic, vesicular breathing during auscultation, no wheezing, NPV 20 min, cardiac tones clear, rhythmic blood pressure 100/65 mm Hg, pulse 88 min. The abdomen is soft, painless. Physiological administration is normal. With indirect laryngoscopy, there is swelling of the epiglottis, hyperemia of the mucous membrane of the larynx, and the glottis is wide.

The patient underwent a sampling of the entire spectrum of laboratory tests, fibroesophagoscopy.

Diagnosed with Acetic acid poisoning. Chemical burn of the esophagus II tbsp. Acute laryngitis. Stenosis of the larynx I tbsp.

Against the background of traditional therapy, the patient underwent local transmembrane wound dialysis with the installation of the previously designated device in the esophagus and stomach. The duration of wound dialysis is 6 days. The composition of dialysis in the first three days consisted of a solution of reopoliglukin 100 ml, lidocaine 2% 4 ml, dioxidine 1% 10 ml, dexamethasone 8 mg. From 4 to 6 days of illness, a solution of reopoliglucin 100 ml, dioxidine 1% 10 ml, ascorbic acid 5% 5 ml were used in the dialysate.

After removal of the device, the patient showed a positive fibroscopic picture; on day 10, when conducting an x-ray of the esophagus with a contrast of stenotic constrictions, it was not detected. The duration of the patient in the hospital was 10 days.

On examination after 2 months, the patient did not show complaints, while radiography of the esophagus with a contrast of stenotic narrowing was not detected.

Example 2

Patient N., 17 years old, was admitted to the toxicology department of the emergency hospital with complaints of pain when swallowing, difficulty in passing the food lump, vomiting, nausea, weakness. From the anamnesis it was found out that 2 hours ago a patient with a suicidal purpose (after a quarrel with her mother) drank about 100 ml of acetic acid, after which the above complaints appeared, which have been growing lately.

On admission: the skin is pale, moist, the mucous membrane of the oropharynx is slightly hyperemic, vesicular breathing during auscultation, no wheezing, NPV 22 min, heart sounds clear, rhythmic, blood pressure 110/70 mm Hg, pulse 82 min. The abdomen is soft, painless. Physiological administration is normal.

The patient was sampled the entire spectrum of laboratory tests, fibroesophagoscopy.

Diagnosed. Acetic acid poisoning. Chemical burn of the esophagus II-III Art.

Against the background of traditional therapy, the patient underwent local transmembrane food dialysis with the device installed in the esophagus and stomach (RF patent No. 36769). The duration of wound dialysis is 7 days. The composition of dialysis in the first three days consisted of a solution of reopoliglukin 100 ml, lidocaine 2% 4 ml, dioxidine 1% 10 ml, dexamethasone 8 mg. From 4 to 7 days of the disease, a solution of reopoliglukin 100 ml, dioxidine 1% 10 ml, ascorbic acid 5% 5 ml was used in the dialysate.

After removal of the device, the patient showed a positive fibroscopic picture; on day 15, when radiography of the esophagus with a contrast of stenotic narrowing was not detected. The duration of the patient in the hospital was 15 days.

On examination after 3 months, the patient did not show complaints, while radiography of the esophagus with a contrast of stenotic narrowing was not detected.

The proposed method allows local treatment of chemical burns of the esophagus, taking into account the phases of the wound process of burn injury, and thereby facilitates and accelerates the clinical course of the disease and prevents the development of complications.

Literature

1.K.S. Ormantayev, K.K. Kozhakanov, V.L. Jackson, N.V. Povarnitsina. The use of proteolysis inhibitors in the complex treatment of chemical burns of the esophagus in children. // Pediatrics. 1991. - No. 6. - S. 62-65.

2. A.A. Lak. Prevention and treatment of endotoxemia in traumatic and burn disease using transmembrane wound dialysis. // Abstract of dissertation for the degree of Doctor of Medical Sciences in surgery. - Krasnoyarsk. - 2002.

Claims (2)

1. A method of treating chemical burns of the esophagus, including the local use of chemotherapeutic drugs, characterized in that the use of drugs is carried out by transmembrane wound dialysis: from the 1st to the 3rd days after a chemical burn, the dialysate contains a solution of reopoliglukin 100 ml, lidocaine 2% - 4 ml, dioxidine 1% - 10 ml, dexamethasone 8 mg, from the 4th to the 7th days of the disease - a solution of reopoliglyukin 100 ml, dioxidine 1% -10 ml, ascorbic acid 5% - 5 ml. 2. The method according to claim 1, characterized in that the transmembrane wound dialysis is carried out 1 time per day.