RU2397779C2 - Method of local treatment of frostbites in pre-reactive and early reactive periods of trauma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to surgery and intensive therapy, and can be used in treatment of patients with frostbites in pre-reactive and early reactive periods of trauma. For this purpose medications which as active component contain superoxiddismutase are used locally. After that heat-insulating bandage is applied for term not shorter than 24 hours.

EFFECT: method allows to ensure increased efficiency of local treatment of frostbites due to pathogenetic impact aimed at stopping effects of oxidative stress and tissue hypoxia resulting from combined effect of medication, in which superoxiddismutase is used as active substance, and heat-insulating bandage.

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Description

The invention relates to medicine, in particular to surgery, and can be used in the treatment of frostbite in general surgical departments and in thermal injury clinics.

Known methods of conservative treatment of frostbite of the extremities with ointment dressings with various kinds of ingredients (Vishnevsky ointment, syntomycin emulsion, etc.). These treatment methods provide thermal insulation of the frostbitten tissue site, and the therapeutic effect is determined by the local effect of ointments on the affected tissue [1; 2; 3].

The disadvantage of this method is the insufficient therapeutic effect associated with the lack of antioxidant activity and pathogenetic orientation of the action of drugs, as well as the inability to ensure the penetration of drugs deep into the damaged tissues.

A known method of local treatment of frostbite by introducing drugs into the cellular space of the hands and feet [4]. With this method of treatment, a mixture of drugs (novocaine solution, heparin, hydrocortisone, monomycin) is injected into the affected limbs, resulting in a high concentration of drugs in the frostbite zone.

The disadvantage of this method is its significant morbidity associated with the need to introduce into the tissue a significant amount of drugs. In addition, the additional introduction of fluid contributes to the growth of existing edema of the affected limb.

The closest in combination of essential features is a method of treating frostbite of the extremities, based on the use of a heat-insulating dressing with medicinal solutions (nicotinic acid solution, halidor, heparin solution) in combination with the drug transport and antiseptic mechanisms of action (dimexide) [6] .

The disadvantage of the method selected as a prototype is its relatively low efficiency, which is due to the following circumstances. Dimexide has weak antioxidant properties and is not able to completely stop the effects of oxidative stress. Dimexide alone can cause tissue damage. Dimexide is very quickly and easily absorbed by tissues, this is accompanied by a sharp temporary increase in membrane permeability, which can lead to rapid saturation of cells with toxic tissue breakdown products at a certain stage of the wound process, which in turn increases the depth of the lesion. Another drawback of DMSO is the accumulation in it of toxic decomposition products of thioether and sulfone, which have an unpleasant odor, during storage. The rate of accumulation of toxic products increases sharply in complex formulations, so formulations containing DMSO actually have a significantly shorter shelf life than the manufacturer claims.

Also disadvantages of DMSO include side effects in the form of an allergic reaction: itchy dermatitis, skin rashes, mild burning, itching, and in rare cases bronchospasm. Their frequency depends on the concentration of DMSO and the patient's predisposition. With excessive administration, it causes the phenomenon of vitrification of the skin. In addition, with the use of dimexide, itchy dermatitis can develop. The drug may increase the toxicity of certain drugs, caution should be exercised when prescribed simultaneously with other drugs. The drug is contraindicated in cases of impaired antitoxic function of the kidneys, with angina pectoris, severe atherosclerosis, glaucoma, cataracts and a number of other diseases.

The objective of the present invention is to increase the effectiveness of local treatment of frostbite due to pathogenetic effects aimed at stopping the phenomena of oxidative stress and tissue hypoxia.

According to the invention, the problem is solved in that in the method of local treatment of frostbite in the pre-reactive and early reactive periods of injury, which consists in the use of heat-insulating dressings in combination with local use of drugs, superoxide dismutase is used as the active ingredient.

The use of superoxide dismutase (SOD) allows for the pathogenetic correction of tissue hypoxia, which ensures the regeneration of damaged cells, accelerates the epithelization of wounds, and prevents the appearance of coarse scar tissue. This effect is due to the antioxidant effect of SOD.

According to the patent and scientific and technical literature, in medicine the use of SOD for the treatment of frostbite is unknown.

The method is as follows. For all patients who came directly from the street or after no more than 24 hours from the moment of injury, SOD in the form of a cream (Soderm-Extra, or Soderm-Forte) is applied to the affected segments of the limbs, followed by a thermally insulating cotton-gauze dressing for a period of at least 24 hours Along with this, all patients undergo intravenous infusion complex with antispasmodics and anticoagulants 1-2 times a day, in accordance with generally accepted rules. The next day, the application of the cream is combined with the use of conventional bandage dressings with preservation of infusion therapy.

Table
Cream formulations with antioxidant action Name of components Soderm - Forte Soderm - Extra Raw materials cosmetic "superoxide dismutase" TU 9154-001-96790366- 0.07 0.07 2007 Glycerin GOST 6824-76 - 5.0 Vaseline (GOST 3582-84) 10.4 - Medical liquid paraffin (GOST 3164-78) 7.0 Silver nitrate (GOST 1277-75, chda) 0.00085 - PEG-8 stearate (A mixture of polyethylene glycol esters of stearic acid Myrj 45) GOST 12.1.007-76 11.4 Stearox 920 (Mixture of stearic acid polyethylene glycol esters) TU 6-14-778-83 14.0 Polyethylene oxide base (alloy of polyethylene oxide 400 MP Biomedical, cat. Number 151912, lot 7781E and polyethylene oxide 1500 MP Biomedical, cat. Number 151915, lot 2749C, in a weight ratio of 1: 1) Up to 100% Methylparaben, propylparaben, imidozolidinyl urea GF, issue X, p. 474 1.0 Drinking or purified water GOST 2874-82 FS 42-2619-97 Up to 100% 5.0

As an experiment, a similar technique was carried out on rats. We give examples of experimental results and clinical use in the conditions of the Research Institute of Emergency Medicine. Yu.Yu. Dzhanelidze.

Example 1. In white rats of males weighing 200-220 g frostbite was achieved by

exposure of liquid nitrogen to shaved skin from 30 s. The measurements were carried out by an EHF-dielectrometer before modeling a cold lesion, immediately after frostbite and after 30-60 minutes of exposure to a cream with SOD. In areas without the use of cream, the appearance of intracellular edema is noted, which indicates a more pronounced cellular alteration. In control histological studies conducted after 6 months, in areas using SOD, more structured connective tissue with areas of almost unchanged tissues was noted.

Example 2. Patient S. 32 years old, was admitted to the Research Institute of the joint venture named after Yu.Yu. Dzhanelidze 03/05/2007 with a diagnosis of Combined injury: Frostbite feet 2-4 tbsp. Early reactive period. HRMT: Concussion. Abrasions and hematomas of the face. She was injured as a result of a robbery on the street. She was unconscious without shoes for about 4 hours at a temperature of -8 ° C. I sought medical help after 5 hours. On admission: the feet are cyanotic, hypothermia and moderate edema, extending to the lower third of the legs. The vascular reaction and sensitivity are reduced up to the complete absence in the distal toes of the toes. After the inspection, a heat-insulating dressing was made using SOD. Combination therapy included detoxification, drugs that improve microcirculation, and prevention of thrombosis. The next day, there is an increase in soft tissue edema to the level of the middle third of the legs, the appearance of blisters with hemorrhagic contents, normalization of the vascular reaction, sensitivity and local temperature in the distal parts and toes. Ligation with SOD was performed.

In the following days, the tactics of general and local therapy did not differ from the generally accepted. On the 7th day, relief of edema. The wounds in the areas of the opened bubbles are covered with a brown scab.

In the next 2 weeks, active wound cleansing followed by regional and islet epithelization took place. The patient was discharged on day 21 with completely healed wounds.

Example 3. Patient M., 38 years old, was admitted to the Research Institute of Sp. Yu.Yu. Janelidze February 24, 2007 with a diagnosis of Frostbite feet 2-4 tbsp. Prereactive period. Received frostbite as a result of a long stay in the forest without shoes (exposure for 6 hours, temperature up to -10 ° C). Immediately went to the hospital.

At admission: hypothermia, severe cyanosis of the feet. The vascular reaction and sensitivity are reduced up to the complete absence in the distal parts of the feet.

Heat-insulating dressings with cream were applied to the patient. The next day, marked swelling of the soft tissues to the level of the middle third of the legs and the appearance of hemorrhagic blisters on the plantar and dorsum of the feet are noted. The appearance of a vascular reaction and sensitivity in the distal parts and toes, the normalization of local temperature. Ligation with SOD was performed.

In the following days, the tactics of general and local therapy did not differ from the generally accepted. On the 6th day, relief of edema. The wounds in the areas of the opened bubbles are covered with a brown scab.

In the next 2 weeks, active wound cleansing followed by regional and islet epithelization took place. The patient was discharged on the 27th day with completely healed wounds.

Thus, the proposed method for the local treatment of frostbite in the pre-reactive and early reactive periods of injury with the use of SOD provides the regeneration of damaged cells, accelerates the epithelization of wounds. This method is simple and convenient to use, does not require additional equipment and special training of personnel and can be implemented in the work of any surgical department. Topical SOD creams are well tolerated by patients, without causing any discomfort. Not only a decrease in the frequency of necro-formation was noted, but also in the long-term period, the formation of less coarse connective tissue in the scarring sites.

During laboratory and clinical trials, no side effects of allergic reactions were detected.

Information sources

1. Aryev T.Ya. On the slow and fast warming of frostbitten limbs // Tomsk State University Journal. Surgery. - 1939. - t. 57, No. 5. - p. 527-535.

2. King L.N., Sokolovsky A.S., Sidenko V.N., Klimova L.P. The use of heat-insulating dressings in the complex treatment of frostbite. The second scientific conf. on the problem of "Cold injury", Leningrad, April 6-7, 1989 - S.43-44.

3. King L.N. New approaches to the conservative treatment of acute frostbite in the pre-reactive and early reactive periods. Abstract. Diss. Ph.D. - Tomsk: 1992, 23 p.

4. Kotelnikov V.P. Frostbite. - M .: Medicine, 1988 .-- 254 p.

5. Mashkovsky MD. Medicines. - M., Medicine. - 1987. - t.1., P.202-203.

6. A method of conservative treatment of frostbite of the extremities. RF patent №2191004, author Satylbaldiev V.M.

Claims (1)

A method for the treatment of frostbite in pre-reactive and early reactive periods of injury, including the local use of drugs, characterized in that they use drugs that contain superoxide dismutase as an active ingredient, followed by applying a heat-insulating dressing for a period of at least 24 hours