SU1033141A1 - Method of treating destructive pancreatitis - Google Patents

Abstract

METHOD OF TREATMENT. DESTRUCTIVE PANCREATITIS by means of a recurrent infusion of drugs into the celiac artery along the catheter, is established transfemorally, receiving a fever, which, in order to: reduce enzymatic toxemia, at the same time infusion of the solution, including reopolyglucin 400-800 ml, Gordox 400-500 thousand units, B-group vitamins 5-6 ml, heparin 5-10 thousand units, into the portal vein through a catheter installed intermittently. (Ls

Description

WITH

W The invention relates to medicine, namely surgery, and can be used in surgical clinics for treating patients with destructive forms of acute pancreatitis. There is a method for treating destructive pancreatitis by administering peripheral and central venous system of anti-enzyme preparations. There is also a method for treating destructive pancreatitis by way of reorganization. infusions of medicinal preparations into the celiac artery along the leg set transfemorally 2. However, the known methods accompany enzyme toxemia. The purpose of the invention is to reduce enzymatic toxemia. This goal is achieved by the fact that according to the method of treating destructive pancreatitis by regular infusion of drugs into the celiac artery along the catheter established transfemorally, infusion of a solution comprising 400-800 ml of reopolygluquine, 400-500 thousand units is simultaneously infused. vitamins of group B 5-6 ml, heparin 5-10 thousand units into the portal vein through the transhepatic catheter. Example. Sick T. was admitted to the clinic in a difficult condition with a clinical picture of hemorrhagic pancreatic necrosis. Diagnosis of verifications on operations. The patient underwent abdominal pancreatic cancer, cholecystostomy, and packing of the omental bursa. However, after the operation, the patient's condition remained extremely difficult, the current of one family progressed, having been intoxicated with delirium, and there was an increase in blood pressure. Due to this, the patient decided to carry out the developed method of treating pancreatitis. Under local anesthesia with a solution of novocaine 0.15 30.0, the femur is punctured with the Kifot needle. The metal conductor is not inserted into the urethra, along which the red Edman's simulated catheter is led to the aor. The tip of the catheter is mounted on the front wall of the aorta along its left contour, and when the catheter is retracting, the second junction is installed in the celiac trunk. Through the installed catheter, celiac acupuncture was performed with a dose of 40 ml of 76% dilution of verografin at a rate of 10 ml / s. A series of images was taken in the arterial, parenchymal and venous phases. After that, the catheter is fixed to the skin by silk for a continuous electoral continuous infusion of the glucosonocaine mixture, heparin, pride. After that, the portal vein was catalyzed. Under local anesthesia, a solution of novocaine 0.25% 90.0 (novocaine was injected in layers into the skin, subcutaneous fat, intercostal muscles, to the parietal peritoneum of the liver capsule in the 8th and 9th intercostal space in the mid-axillary line) at the puncture site, the skin was calcined with a scalpel. Then, a special needle, 28 cm long, consisting of a metal stylet and a radiopaque catheter worn on it (inner diameter 1.14 mm, outer one - 1.58 mm), pierced the intercostal space and liver. At the time of liver puncture and needle placement, the patient stops breathing. The needle, under the control of an electron-optical amplifier (EIU), was directed horizontally to the interpositional disc between 11 and 12 thoracic vertebrae. The data of the previously performed celiography allowed to orient in the projection of the portal vein. The needle advance was stopped at a distance of 1-2 cm from the right contour of the spine. The stiletto of the needle was immediately removed, and a syringe was attached to the catheter, which, during slow removal of the catheter, was continuously aspirated until the appearance of dark venous blood. The correct position of the top of the catheter in the lumen of the portal vein or its branches was checked by injecting 1-2 ml of KOHTpasTHoro substance under the control of an electron-optical amplifier. Then a J-shaped guide was inserted into the portal vein and a catheter was inserted into the portal vein with its help. The catheter was fixed to the skin with silk also for continuous infusion of reopolyglukine, heparin, gordox, as well as for fractional injections of solutions of vitamins. After termination of the celiac trunk kiteterization and portal vein, they were injected with a syringe of 100,000 KIE of gordox to create a therapeutic level of antifermental drugs in the hepato-pancreato-duodenal zone. For 4 days, this patient was continuously infused into the celiac trunk and into the portal vein. Preparations were administered to the celiac artery with the following regimens and parameters: the rate of administration was 20 drops per minute (50 ml / h); the total volume of the treatment solution and the day amounted to 1200 ml. The quantitative composition of gordox in the cranberry-novocaine mixture introduced by this patient: Glucose 5% -250.0 Novocain 0.25% 250.0 Gordox, KIELOOO, Heparin, units 2500

The drugs were injected into the portal vein with the following regimens and parameters: injection rate of 10-12 drops per minute (25-30 ml / h); The total amount of treatment solution per day is 800 .1000 ml.

The quantitative composition of a continuously infused mixture with reopolyglucin;

Reopoliglyukin 400,0 Gordoks KIE 300000. Heparin, units 2500

continuous infusion of vitamins - not produced. Witgmins were introduced

fractional into the portal vein in the following dosages:

  3.0

B3.0

с5,0

A special feature is the day. continuous infusion of medicinal products in this patient was co-infused into the celiac dtvol and portal vein at one time.

AT . The table shows patient data T. 6 measurements of portal pressure and other indicators for which the effectiveness of the therapy was evaluated.

Dynamics of changes

Claims (1)

METHOD OF TREATMENT. DESTRUCUTIVNO! Pancreatitis by regional infusion of drugs into the celiac artery through a catheter established transfemorally, characterized in that, in order to reduce enzymatic toxemia, an infusion of a solution including reopoliglyukin 400-800 ml, goroxox 400-500 thousand units, is simultaneously carried out. B vitamins of 5-6 ml, heparin 5-10 thousand units, into the portal vein through a catheter installed transhepally. su ap 1.033141 ........