RU2408395C1 - Method of treating complicated spinal trauma and diseases accompanied by hypoxia and tissue ischemia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurosurgery, neurology, and can be used in treating complicated spinal trauma accompanied by hypoxia and body tissue ischemia. That is ensured by perineural radicular paravertebral block. The block contains the introduction of a mixture containing 15 ml of 1% novocaine, 15 ml of Mexidol, containing 750 mg of Mexidol and 10 ml of 0.5 % novocaine.

EFFECT: method allows to activate energy synthesising mitochondrial functions and to improve energy metabolism in a cell due to optimal concentration of an antioxidant drug mixed with an anaesthetic.

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Description

The invention relates to medicine, namely to neurosurgery, neurology, traumatology, orthopedics, abdominal, thoracic and maxillofacial surgery, and is used to treat diseases and injuries of the contents of the spinal column, complicated by neurological deficiency, organs of the chest and abdominal cavity, pelvis, region lower extremities and head, both in the postoperative period of management of patients, and in the conservative treatment of these diseases.

A known method of treating a pathological condition by reducing afferent impulse from the focus or efferent impulse to the focus through the use of regional therapeutic blockades using local anesthetics, which are delivered either directly to the pathological focus, or to a large neurovascular bundle or vegetative plexus, which allows you to change the conditions of the nervous trophism, humoral regulation of metabolic processes, microcirculation, local and regional hemodynamics in the pathological focus ( one). The method of Novocainic blockade of A.M. Vishnevsky, as a therapeutic method, has a long history, but it has become less popular due to the recent appearance of a large number of selectively acting medications. In addition, the literature contains data on the optimal effect of irrigation of the organs of the body (spinal cord) with solutions containing a combination of pharmacological agents (2).

It is known that in a pathologically altered organ, microcirculation decreases, and this reduces the possibility of achieving an optimal concentration of the administered drug in the tissues of this organ. On the contrary, an increase in the density of the network of functioning microvessels in organs after regional blockades and a decrease in the linear velocity of blood flow were established - under these conditions, mass transfer from vessels to tissues increases. Blockades of large reflexogenic zones can be used for targeted transport of various drugs (1).

The closest to the proposed method, in its technical solution, are methods of implementing novocaine blockades with hydrocortisone (3) and dimephosphone (4), but the breadth of their therapeutic use is limited by functional disorders and the prevention of complications. In addition, it was noted that local and prolonged use of glucocorticosteroids leads to a slowdown in the healing process of the surgical wound and the need, in the future, for a gradual dose reduction. The demands of today compel us to seek new, more effective regional blockades using modern drugs. Antioxidants, in particular, the domestic pharmacological preparation Mexidol, comply with these requirements. Mexidol stabilizes the membrane structures of blood cells (red blood cells and platelets) during hemolysis, has a lipid-lowering effect, reduces total cholesterol, and reduces enzymatic toxemia and endogenous intoxication in acute pancreatitis. The mechanism of action of Mexidol is due to its antioxidant and membrane-protective action. It inhibits lipid peroxidation processes, increases the activity of superoxide oxidase, restores impaired membrane structure and function, modulates the activity of membrane-bound enzymes (calcium-independent phosphodiesterase, adenylate cyclase, acetylcholinesterase), receptor complexes (benzodiazenine, GABA, acetylcholine binding), which with ligands, helps to preserve the structural and functional organization of biomembranes, transport of neurotransmitters, and improve synaptic chi. Mexidol increases the content of dopamine in the brain. It has the ability to enhance the compensatory activation of aerobic glycolysis, reduce the degree of inhibition of oxidative processes in the Krebs cycle and hypoxia with an increase in the content of ATP and creatine phosphate, activate the energy-synthesizing functions of mitochondria, and stabilize cell membranes.

The invention is expressed by a combination of essential features sufficient to achieve the desired technical result, which consists in activating the energy synthesizing functions of mitochondria and improving energy metabolism in the cell due to the optimal concentration of the antioxidant drug used in a mixture with an anesthetic introduced into the tissue of a pathologically altered organ, when applied regional blockade.

This essence lies in the fact that a method of treating a complicated spinal injury, accompanied by hypoxia and ischemia of body tissues, involves conducting a regional blockade with an anesthetic. The blockade is carried out by perineural-radicular paravertebral administration of a mixture consisting of 15 ml of a 1% solution of novocaine, 15 ml of a solution of mexidol containing 750 mg of mexidol, and 10 ml of a 0.5% solution of novocaine.

The use of a drug with antihypoxic and membrane stabilizing effects increases the body's resistance to stress. It increases the body's resistance to the effects of various damaging factors, to oxygen-dependent pathological conditions (shock, hypoxia and ischemia, cerebrovascular accident, intoxication with alcohol and antipsychotics), activating the energy-synthesizing functions of mitochondria and improving energy metabolism in the cell.

A method for the treatment of complicated spinal trauma and diseases accompanied by hypoxia and ischemia of body tissues is as follows.

The amount of the mixture necessary for blockade is prepared by adding an antioxidant solution to the anesthetic solution in selected concentrations. A long needle with a stop at a selected level of the spine, at a distance of about three centimeters from the spinous process, is carried out perpendicularly to the stop in the transverse process or in the rib. After abutment in the bone, the limiter is installed at a distance of about two centimeters from the skin. The needle is pulled back by a centimeter and deviates by 30-35 ° in relation to the sagittal plane and moves deeper, until the limiter comes into contact with the skin. Then the specified mixture is introduced. The procedure is repeated on the other side of the spinous process. Thus, two active substances are simultaneously supplied to the sympathetic trunk and spinal nerves.

Clinical example.

Patient L. RL, born in 1987, source of illness: No. 2227, was treated at the neurosurgery department of the NTCT “WTO” from 04.13.09 with a diagnosis of s / compression fractures of L1 and L2 vertebral bodies per 1 / 4, unstable compression-comminuted fracture of the body and the arch part of the L4 vertebra with narrowing of the spinal canal, complicated by n / paraparesis with impaired function of the pelvic organs. 04/15/09 operation: Posterior transpedicular spinal fusion with metal rod system «Sofamor Danek» at the level of L3-L5 vertebrae, decompressive laminectomy of the L4 vertebra body. Further treatment of the patient was carried out using domestic preparations: 1% and 0.5% solutions of novocaine and antioxidant - Mexidol 50 mg / ml in ampoules (registration number: P N002161 / 01 of 03/14/2008). On the first day of treatment, the patient received perineural-radicular paravertebral blockade with a mixture of 15.0 ml of 1% novocaine, 15 ml (750 mg) of mexidol and 10.0 ml of 0.5% novocaine, at the level of L3-L4. After performing a syringe test, 10.0 ml of the mixture was injected, the needle was pulled to the level of the transverse process, and the remaining 30.0 ml of the mixture was injected here. The procedure was repeated on the other side of the spinous process. In the future, the blockade lasted up to 12 days. Within seven days, lower paraparesis regressed, the next week positive dynamics was clearly monitored, and on day 12 the patient's pelvic function returned. When extracting complaints, the patient did not show, neurological status - with positive dynamics.

The proposed mixture has significant advantages over the means used in the prototype methods, due to the ability of the antioxidant preparation to improve and stabilize brain metabolism and blood supply to the brain, improve microcirculation and rheological properties of blood while reducing platelet aggregation (5).

Information sources

1. Ibatullin I.A. et al. Regional blockade in surgery. // A guide for doctors. - Kazan, 2003 .-- S. 10, 280-282. - 335 p.

2. Reyes O., Sosa I., Kuffler D.P. Neuroprotection of spinal neurons against blunt trauma and ischemia. // P R Health Sci. J. - 2003 .-- Vol.22 (3). - P.277-286.

3. Skaromets A.A., Skaromets A.P., Skaromets T.A. Nervous diseases. // M. - 2005. - P.373. - 543 p.

4. Tumakaev R.F., Bochkarev D.V. RF patent No. 2322974. // Bull. discoveries and inventions. - 2008, No. 6. - S.393.

5. "Radar +" enceclopedia of drugs 2007. - LLC "Radar-Patent", M., 2007. - S.538-539.

Claims (1)

A method for the treatment of complicated spinal injury accompanied by hypoxia and ischemia of body tissues, including regional blockade with an anesthetic, characterized in that such blockade is carried out by perineural-radicular paravertebral injection of a mixture consisting of 15 ml of 1% novocaine solution, 15 ml of mexidol solution containing 750 mg of Mexidol, and 10 ml of a 0.5% solution of novocaine.