SU1623660A1 - Method for treatment of bacterial complication of severe closed cranioserebral injury - Google Patents

Abstract

The object of the invention is the immunocorrection of a bacterial complication of severe closed head trauma. The invention relates to the field of medicine, in particular to neurotraumatology, and can be applied in the complex treatment of bacterial complications of traumatic brain injury. The purpose of the invention is to reduce mortality. The goal is achieved by studying the immune status and administering for 7-10 days after injury, during the period of the maximum degree of secondary immunodeficiency, T-activation is 0.01-1.0 intramuscularly in combination with methyluracil 1.5-2 g orally daily for 10 days. The treatment with immunocorrective drugs is carried out against the background of the main complex anti-inflammatory, detoxification and desensitization therapy. The use of this method in 14 patients with severe closed brain injury, which was complicated by the secondary purulent-inflammatory process in the lungs, reduced mortality in this group of patients by 26 , 4% Ј

Description

The invention relates to medicine, namely to neurotraumatology, and can be used for the integrated treatment of bacterial complications resulting from severe closed head trauma (TGTI).

The purpose of the invention is to reduce mortality.

The method is carried out as follows.

In a patient with IHTB, the immune status is determined over a period of 1-3, 7-10 days. To do this, from the ulnar vein take 5-7 ml of blood in a tube with heparin (0.2 ml at a dilution of 1: 7), gently mix. Lymphocytes were isolated by centrifugation in a ficolda-urografin density gradient of 1.007 g / l using the Bayum method.

The number of T- and B-lymphocytes was determined by the method of spontaneous rosetting by Mendes, the level of immunoregulatory cells (theophylline-sensitive).

T-suppressants, theophylline-resistant (T-helper) by their sensitivity to theophylline according to Limatibul. The amount of immunoglobulins was determined by the method of radial immunodiffusion in the gel according to Maucini, the phagocytic activity of leukocytes was determined. activin in the amount of 0.01-1.0% daily in combination with methyluracil 1.0-2 g orally for 10 days against the background of complex anti-inflammatory therapy.

The method is confirmed by the following example.

Example I Patient I, 29 years old, was taken to the neurosurgical department of a clinic 6 hours after a severe closed head injury received in a car accident. State of severe Consciousness is lost (coma III) Noisy breathing, frequency 30 per 1 min, blood pressure 140/90 mmHg Pulse 160 beats / min. In the lungs breathing veO5 GS

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zicular, single wheezing Pupils narrow, do not react to light Consumption of squint, tendon reflexes are reduced from the hands, higher on the right No legs are caused Abdominal and pathological reflexes are absent Rear muscle stiffness 3 transverse fingers Kernig's symptom positive Two scalp wounds on the scalp 7 and 4 cm long. During lumbar puncture - massive subarachnoid hemorrhage. There is no bone pathology on the craniogram. On the radiograph of the lungs - partial right pneumothorax, congestion in the lungs. ECHO EG - slipping nor no. The fundus of the eye without features. Complete blood count - HB 147 g / l, erythrocytes 4,6ХЮ12 / l, leukocytes 14,4ХЮ9 / l, П 13, С 70, Э 1, М 6, Л 10, ESR 22 mm / h Hematocrit 47, temperature up to 38 ° C Blood for immunity Td 46% -903 cells, 157 cells, Т „22% - 431 cells, Those 24% - 471.1 cells Phagocytic activity of leukocytes 30%, content JgJ92 U / ml

Diagnosis of severe obstruction of the cranial head injury of the trunk шиб shib urine Massive subarachnoid hemorrhage, coma III Head injuries

The patient was in the intensive care unit. Treatment of penicillin 6 million units per day in / m, kanomitsin 1 g / day, hemodez in / in, tental in / m, reopolyglucin in / in, cavinton in / in, glucose with insulin in / in , native plasma i / v, vitamins B, C, humidified oxygen, cans After two days the condition remains heavy Neurological dynamics are not present In the lungs there were more wheezing more on the right When ang, blood leaked narcosis leukocytosis - 15.7X XYu9 / l, relative lymphocytosis - 23, increased ESR - 25 mm / h. When x-ray of the lungs infiltrated in all areas Radiation small foci Blood on immunology T 42% - 378 cells, B 7% - 63 cells, Tx 29% - 261 cells, Te 13% - 117 cells Phagocytic neutrophil activity 29%, Jg level 86 IU / ml In connection with the delay sputum produced lower tracheostomy. After 7 days, the neurological condition stabilized. Began to respond to pain stimuli. In the lungs a mass of rales Hi tracheostomy aspirate the mucosa. Temperature 38-39 ° C On the x-ray of the lungs - 2 side of pneumonia Blood test leukocytosis 18.1 XY9 / 9. , П 8 С 65, Э 2, Б 1, М 2. Л 22, ОЭ 2 mm / h Immunological indicators Т 39% - 277.9 кл, В l 13% - 91 cells, 24% 168 cells, Te 15% - 109.9 cells Phagocytic activity of leukocytes 22% Level JgJ 76 IU / ml Bakposev - erythromycin sensitivity to neposporins Replaced antibiotics for kefzol 2 g per day in / additionally encephabol, piracetam in the probe and nmnokorrigiruyuschie drugs - T AK

Tivin 0.01 - 1.0% v / m daily in combination with methiouracil 0.7 - 100.0% per probe 3 times

Example 2 Patient B, 22 years old, was taken to the neurosurgical department of a hospital clinic 1 h after a traumatic brain injury caused by a flight accident motor flight.

Upon admission, consciousness is absent. Breathing is increased up to 24 in 1 in. Art p j och bark 140/80 mm Hg. Pulse 98 beats / 1 min. In the lungs, gasping of the vesicular, single scattered rales. Pupils moderately narrowed equal. Tendon reflexes lowered to the right. Left causes Babinsky symptom. Rigid muscles of the occiput on 3 transverse fingers. Kernig symptom is positive. Avial shoulder. Wounds. Hemorrhage in the cell of the right eye. No fractures on the craniogram. Radiography of the: congestion ECHO-EG - no displacement, signs of hypertension. At the fundus - contours of the optic nerve discs. Stevans. Vienna is enlarged, curved. Lumbar puncture of the subarachnoid. hemorrhage Complete blood count Hb 165 g / l, leukocytes 2.8 xU / l, P 5, C 70. M 2, L 23, ESR - 8 mm / h Temperature up to 38 ° С

Immunological blood counts T lymphocytes 43% -0.774 cells X U9 / l, B-lymphocytes 15% - 0.270 cellsHY9 / -n, T helpers 28% -O.O.01 l HUT / lT suppressors 15% 0.270 cellsHY9 /.), FAL 35%, the content of immunoglobulin J 82 IU / ml

Diagnosis of a brain contusion with a severe stack, left skull fracture. Left-sided wounds. Bopnoy's right shoulder was treated in the intensive care unit during the night of therapy, receiving complex treatment with penicillin, kanomycin, hemodez, glucose with VH ulnnom, native plasma, vitamin C, oxygen inhalation , banks on the chest, cavinton, nootropil

After 7 days, the patient's condition improved, but remained hard — reacts to painful stimuli, opens his eyes. There are no neurological dynamics. In the lungs there were single moist rales more to the left. In general, the blood test increased leukocytosis to 21.8XY9 // ,, ESR 18 mm / h During radiography of the lungs, more lung tissue infiltration areas were seen to the left. T-lymphocytes 310 - 0,686 cells HYU9 / l, B-lymphocytes9% 0, 148 to XY9 / l T-helper cells were detected in the study of immunological blood parameters

15% 0, 308 K. XY9 / l, T-supregorsor 16% - 0.378 Cl XY9 / l, FAL 25%, level of immunoglobulin J 78 IU / ml With bactepha sputum on microflora, sensitivity to the antibiotics of the csfalosporin group was changed 2 g per day additionally assigned to them

munocorrective therapy; T-activin 0.01 -1.0% i / m daily, methyluracil 0.5 twice daily orally.

For 10 days, combined anti-inflammatory and immunocorrective treatment was carried out. The patient's condition improved. The degree of impairment of consciousness has decreased to stunned. Neurologically, light right-sided hemiparesis was preserved. Hearing in the left ear was sharply reduced. On examination, the ENT doctor revealed a post-traumatic neuritis of the auditory nerve on the left. Temperature 37.2 ° C. In general, the blood test: HB 123 g / l, leukocytes 7,1ХЮ9 / l; P 7; C 53; L 29; M 10; ESR 3 mm / h. In the lungs, single wheezes are heard ausculta tively. Radiographically determined enhancement of the vascular pattern with small infiltration foci is more to the left. Immunological blood parameters: T-lymphocytes 39% - 0.0710 cells HY9 / l; B-lymphocytes 14% - 0,255 C. HU9 / l; T-helper cells 1 |% - 0,200 Cl. X U9 / l, T-suppressors 28% - 0.509 cells. X XY9 / l, FAL 42%, the level of immunoglobulin J 122 IU / ml

The patient's condition improved further. In satisfactory condition, the patient was discharged on the 37th day under the supervision of a neuropathologist and therapist at the place of residence.

A statistical comparison of lethality in similar groups of patients with and without immunotherapy was given a significant reduction in mortality by 26.4%.

Claims (1)

Invention Formula A method for treating a bacterial complication of severe closed craniocerebral trauma, which consists in performing antibiotic therapy of sulfanilotherapy and antiinflammatory detoxification therapy, characterized in that, in order to reduce lethality, T-activin 0 is administered an additional 7-10 days after injury. , 01% -1.0 ml intramuscularly in combination with methyluracil in a dose of 1-2 g daily for 10 days.