Method of treating patients with gallbladder dyskinesia. RU patent 2486909.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiotherapy, gastroenterology. The method involves dietary therapy No. 5, general pine baths, magnetic laser therapy, intake of mineral water with underlying sparing training regimen followed by transverse galvanisation of the epigastrial area. The transverse galvanisation immediately follows the intake of mineral water between 10 to 11 o'clock. Additionally, the right hypochondrium and sternum are exposed to EHF radiation generated by a broadband noise transducer with a frequency of 40-63 GHz, for 10 minutes per each area, every day; the therapeutic course is 10-12 procedures.

EFFECT: method enables higher clinical effectiveness ensured by using a chronobiological approach to treating the patients for the purpose of relieving the functional disorders of the bile system with underlying increased adaptive capacities of the body.

2 ex, 2 tbl

The invention relates to medicine, namely to a restorative medicine, physical therapy and gastroenterology and can be used to treat patients with a dyskinesia of the gallbladder.

Closest to the proposed a method of treatment of diseases -separating system [1], including the appointment of magnetic-laser therapy, General baths, indoor reception of mineral water and intragastric electrophoresis. However, the known method is not effective, since not take into account the peculiarities of the biorhythm of functional activity of the biliary system.

The new technical task is to reduce the time the relief of clinical symptoms of the disease, normalization of the functional state of the biliary system on the background of increase of adaptational possibilities of the organism, at the expense of approach to the treatment.

To resolve the task in the way of treatment of patients with a dyskinesia of the gall bladder, which includes the background sparing-training regime dietary meals according to the diet №5, General pine baths, therapy, internal reception of mineral water with the subsequent carrying out of transverse galvanization region the epigastrium, transverse galvanisation is conducted immediately after the reception of mineral water in the period from 10.00 till 11.00 hours with the further conduct of EHF-effects on the 3-th and 4-th projection zones in the right hypochondrium and on the sternum area broadband noise emitter with a frequency of 40-63 GHz 10 minutes each zone, daily, on a course of 10-12 procedures.

The method is as follows: on the background of sparing-training mode and therapeutic limited supply of products that have chemical, thermal and mechanical irritation of mucous recommended by the Institute of nutrition of RAMS (appropriate diet №5, after Pevzner), shall: ingestion of low mineral content of sulphate-hydro carbonate (9 group type) of total mineralization of up to 5 g/DM 3 (Slavic, Smirnovskaya), temperature +38-+40 C, 3 times a day 30-40 min before meals, 100-150 ml per reception for the course of treatment; galvanizing epigastrium given immediately after internal reception patient 150 ml of mineral water (which it takes in during the course of treatment), warmed up to 38-40 degrees, if the electrodes are imposed as follows: anode (+) area of 200 cm 2 in the front region the epigastrium and cathode (-) area of 200 cm 2 in the rear of the region segments of the D-6 D-9, current up to 15 mA, duration of the procedure is 20 minutes, daily, on a course of 10-12 procedures, the procedure is valid from 10.00 to 11.00, common pine baths, the preparation of baths: 50.0 ml of coniferous concentrate dissolve in 200,0 l tap water), water temperature of 36-37°With 15 minutes, every day, in the 2nd half of the day, on a course of 10-12 procedures; therapy apparatus of the «MILTA» consistently on 3 zones (zone , left and right hypochondrium on lines), in contact with a frequency of 5 Hz, 3 min each zone, the course of 10-12 [1]; EHF-therapy apparatus of the «SEM-every comfort to the charity Fund» is carried out by means of two projection zones - the 3rd and the 4th (in the right hypochondrium and on the sternum area) broadband noise emitter with a frequency of 40-63 GHz (emitter is marked: №4), in 10 minutes each zone; daily, on a course of 10-12 procedures; Placement procedures in complex treatment was carried out with the observance of the principles of physiotherapy: break between ongoing procedures should be at least 40 minutes.

Components of the method of treatment ensure restoration of the functional state of the gall bladder on the background of increase of adaptational possibilities of the organism. One of the vehicles that contribute to the improvement of physico-chemical properties of bile and improve bile secretion, is the internal reception mineral waters, the most widely used sulfate-hydrocarbonate (9 group type) of total mineralization of up to 5 g/DM 3

Galvanization has a normalizing effect on the motor and secretory function of the biliary system, improves the circulation of the blood in the liver, promotes the favorable changes in the system of non-specific immunity. To increase bile actions and strengthening the drainage of the bile-excreting ducts transverse galvanizing epigastrium recommended immediately after the reception of mineral water inside, in the ascending phase of the rhythm of the functional activity of the biliary system (10.00-11.00).

General pine baths contribute to the reduction of asthenic syndrome, have a normalizing and a light sedative effect, have a non-specific effect, causing General reaction of the organism, aimed at the maintenance and preservation of homeostasis.

therapies have a positive effect on the functional state of the liver and biliary system and the adaptive capacity of the body in General.

EHF-therapy favorably affects the functional state of the hepatobiliary system, contributes to the increase of protective and adaptive abilities of the body and has a normalizing effect on the structure of the biological rhythms of organism functional systems [3, 10].

A distinctive feature of the proposed method is to use approach in the appointment of a comprehensive treatment, in General, aimed at reduction of the functional disorders of the excretory system on the background of enhancing the adaptive capacity of the organism.

The proposed method is based on clinical observations of a group of patients in clinics of Tomsk research Institute of balneology and physiotherapy. Conducted the examination and treatment of 57 patients. Verification of diagnosis dyskinesia of the gall bladder was implemented on the basis of who recommendations.

The main group (1 gr.) accounted for 27 patients treated with the proposed method of complex treatment. As a comparison group, were patients (n 30), who received similar to the main group, treatment, but without the use of approach (2 gr.).

Tolerability and efficacy of therapeutic the complex was estimated on the basis of the severity of the main clinical symptoms in the form of reduction of a degree of pain, heartburn, nausea, pain in the mouth, disappearances symptom Kera (cystic symptom), as well as on the basis of improvement of parameters of functional activity of the liver and biliary system in the form of normalization of indicator contractile function of the gallbladder (), according to the dynamic ultrasound, enhancing the adaptive capacity of the body (Garkavi .. et al.), improve the health index, calculated with account of all clinical, laboratory and instrumental data, arranged in points. Immediate effectiveness of treatment was calculated on the increase in the index of health, as well as in the number of patients with positive results of the treatment («improvement» and «significant improvement»). The data of the effectiveness of treatment are reflected in tables 1 and 2.

From table 1 shows that in the group of patients treated by the way, a higher efficiency in comparison with the control. After the complex treatment was noted improvement in functional status of the biliary system on the background of significantly improving the overall health of patients.

So, immediately after the treatment of 81.4% of the patients of the basic group were completely absent clinical complaints, and other (18.6 per cent) intensity is the main complaints (in points) significantly decreased (p=of 0.0011): intensity of pain decreased from 3.0±0.07 to 1,1 ħ 0.02; heartburn - from 2.3±0.11 to 1,1±0,12, bitterness - from 2.9±0.13 to 1,0±0,10, nausea from 2.3±0.09 to 1,1±0,08. In the control group dynamics of clinical complaints was the same, but the importance of reducing the intensity of clinical symptoms was lower (p=0,0068).

All patients of the main group considerably improved parameters of the functional condition of the biliary system. So, the majority of patients of the main group (74,1%) indicators of gallbladder motor function normalized, and in the control group only 53.4 percent.

When analyzing the dynamics of quantitative values in the main group of patients with type dyskinesia of the gall bladder immediately after treatment revealed that he rose from 23.7±6,1% to 46.2±9,7% (p=0,0017), in the group of comparison - from 24.3 ħ 6.3% to 41.9±11,2% (p=of 0.0038). in patients of the main group, with type dyskinesia of the gall bladder, decreased 71,3±9,6% to 56.7±8,4% (p=of 0.0011), and in the group of comparison - with 70,7±8.9% to 65,3±10,2% (p=0.013). As seen from these data, the functional state of the gall bladder improved in both groups, regardless of the type diskineticakih violations (p<0,031 and p<0,043).

Analysis of dynamics of the levels of reactivity - UR (..) revealed the following: the total number of patients with high UR in the main group increased by 63.0% to 88.9% (increase +25,9%), and in the group of comparison - with 66.7% up to 80,0% (increase by +13.3 percent). The data obtained suggest a positive impact of treatment on the indicators of adaptive opportunities of an organism.

When analyzing the dynamics of the health index (table 1) show that this index has been rising in the main group from 52.6±9,6% to 73.3 ħ 4.9% (p=0.0001), and in the group of comparison - from 52.9±9,1% to 67.5±7,1% (p=0.0001). Moreover, the average OF the after treatment in the main group was higher than in the comparison group (p=0,016).

When calculating the effectiveness of the immediate treatment considered an outcome such as a «significant improvement» and «improvement». Immediate effectiveness (table 2) in the main group amounted to 92.6 per cent, which is higher than in the group of comparison - 80,0%. The revealed difference in the structure of effectiveness (table 2). So, in the main group, the number of patients with «significant improvement» (when the increase OF exceed 15.0%) is accounted for 77.8%, and in the comparison group by 46.7%. The number of patients with «improvement» (when the increase OF=10,1-15%) accounted for 14.8% and 33.3%, respectively.

Clinical tolerability of treatment noted as a good, negative load on the functional state of individual systems and the whole organism have been identified. The overall effectiveness of the proposed method is higher than in controls. In General, the proposed method of complex treatment with the use of approach avoids the drawbacks of the existing methods and to improve the quality and efficiency of complex treatment of patients with a dyskinesia of the gallbladder.

Example 1

Sick P., 39 years old, was admitted to the medical Department clinics with a diagnosis of gallbladder type, chronic cholecystitis, remission stage. Considers herself a patient more than 4 years. Sick, worried about the pain and heaviness in the right hypochondrium, arising after the disturbance of the diet and the emotional feelings, bitterness in the mouth, nausea, recorded headaches.

From the first day of staying in hospital the patient was scheduled examination, and with the 3-day treatment in accordance with the claimed manner, namely, sparing-training mode and clinical nutrition with the restriction of products that have chemical, thermal to mechanical irritation of mucous recommended by the nutrition Institute of Russian Academy of medical Sciences (corresponding to the diet №5, after Pevzner), ingestion of low mineral content of sulphate-sodium (9 group type) of total mineralization of up to 5 g/DM 3 , temperature - 38-+40 C, 3 times a day 30-40 before eating, to 100-150 ml per reception during the course of treatment; galvanization epigastrium immediately after taking internally patient 150 ml of mineral water (which she takes during the course of treatment), warmed up to 38-40 degrees, if the electrodes are imposed as follows: anode (+) area of 200 cm 2 front on the epigastric region and the cathode (-) area of 200 cm 2 in the rear of the region segments of the D-6 D-9, current up to 15 mA, duration of the procedure is 20 minutes, daily, on a course of 10-12 procedures, the procedure from 10.00 to 11.00, common pine baths, the preparation of baths: 50.0 ml of coniferous concentrate dissolve in 200,0 litre of water), water temperature of 36-37°With 15 minutes, every day, in the 2nd half of the day, in the course of 12 procedures; therapy apparatus of the «MILTA» consistently on 3 zones (zone of the epigastrium, left and right hypochondrium on lines), in contact with a frequency of 5 Hz for 3 minutes on each zone, in the course of 12 [11]; EHF-therapy apparatus of the «SEM-every comfort-FU» is carried out by means of 2 projection zones 3-4th (in the right hypochondrium and on the sternum area) broadband noise emitter with a frequency of 40-63 GHz (emitter is marked: №4), 10 minutes each zone, daily, in the course of 12 procedures; Placement procedures in complex treatment was carried out with observance of principles of physiotherapy: break between ongoing procedures should be at least 40 minutes.

Treatment the patient was well tolerated on the 3-th day from the start of treatment observed decrease in the severity of pain and dyspeptic syndrome, 7-day - stoped pain in the right hypochondrium, bitter taste, nausea. The physical examination absent symptom Kera (cystic symptom). According to the data of dynamic ultrasound normalized increase of 21.9% to 46.1%, raising the level of lymphocytes in the General analysis of blood from 21% to 32% showed increase of adaptational possibilities of the organism, index health increased from 54.6 to 87.8, indicating that the direct effect of the treatment and meant «significant improvement».

Example 2

Sick C., 43 years old, was admitted to the medical Department clinics with a diagnosis of gall-bladder Dyskinesia passages as to hypermotor type in combination with chronic cholecystitis, remission stage. Considers herself a patient over 5 years. Sick disturbed paroxysmal pain in the right hypochondrium, arising after stressful situations and emotional surge, violations in the diet, and also - the bitterness in the mouth, nausea.

Patient treatment was well tolerated, after 3 days of treatment was a decrease in the intensity of pain and dyspeptic syndromes, 5th procedures were stopped completely pain and right hypochondrium, bitter taste, nausea, improve the General state of health, was absent symptom Kera (gastrointestinal symptoms, the physical examination. According to the data of dynamic ultrasound, normalized , decreasing from 70.6% to 56.2%, raising the level of lymphocytes in the General analysis of blood from 20% to 31% indicated increases of adaptational possibilities of the organism, the health index increased from 52.6 to 84,7 evidence of the effectiveness of the treatment to mean «significant improvement».

Thus, the proposed method of treatment, using approach, to enhance the effectiveness of complex therapy due to stopping of clinical symptoms of the disease, the improvement and normalization of indices of functional state of the biliary system, increase of adaptational possibilities of the organism in the absence of complications and side effects.

Table 1. Dynamics of clinical and functional indices in complex treatment (Pitch s).

Note: SFP ha - an indicator of contractile function of the gallbladder: p - reliability of differences in the groups compared with the initial data; R 1-2 - reliability of differences of results after the treatment, between groups.

Table 2. Immediate effectiveness of the complex treatment (%)

Note: n - the absolute number of patients from all surveyed; % relative number of patients from all surveyed;

Application

Table 1

Target indicator

group

Soil j

before treatment

after treatment

R

before treatment

after treatment

R

R 1-2

PSF ha when dyskinesia of the gall bladder (<50,0%)

23,7±6,1

46,2±9,7

0,0017

24,3±6,3

41,9±11,2

of 0.0038

0,031

PSF ha when dyskinesia of the gall bladder (>60,0%)

71,3±9,6

56,7±8,4

of 0.0011

70,7±8,9

65,3±10,2

0,013

0,043

Health index (%)

52,6±9,6

73,3 ħ 4.9

0,0001

52,9±9,1

67,5±7,1

0,0001

0,016

Table 2

Indicator

Main group (n=27)

The control group (n=30)

Significant improvement

77,8% (n=21)

63,3% (n=19)

Improvement

14,8% (n=4)

16,1% (n-S)

A slight improvement

7,4% (n=2)

of 16.7% (n=5)

Without changes

(n=0)

3,3% (n=1)

Deterioration

(n=0)

(n=0)

Immediate effectiveness of

92,6% (n=25)

80,0% (n=24)

Sources of information

1. The method of treatment of patients with the diseases of gastroduodenal and excretory systems. Patent of Russian Federation №2257215 from 27.07.2005. Bul. no.21.

2. E.B. Physical factors in gastroenterology. / .Б.. - M: Medicine, 1987. - 304 C.

3. V. A. Galkin Dyskinesia of the gall bladder. Principles of diagnostics and treatment. / .. // Therapeutic archives. - 2005. - №8. - P.55-57.

4. Garkavi .. reaction, and activation therapy. Part I, II. / .., .Б., .. and others - Ekaterinburg: Philanthropist, 2002-2003. - 336 C.

5. State standard (GOST 13273-88 «mineral drinking Water treatment m medicinal-table).

6. Levitsky .., Poddubnaya O.A. Biological rhythms in increase of efficiency of treatment of patients with chronic opisthorchiasis. // Problems of balneology, physiotherapy and Leche. physical education, 2007, №5, p.38-42.

7. Orange I.E. Basics - and hronofizioterapii. / .., .., ..Б etc. / Scient. amended ... Sverdlovsk: Izd-vo Ural. University, 1989. - 139 C.

8. Orange I.E. EHF-therapy: problems and prospects. / .., .. // problems of balneology, physiotherapy and spot. physical culture. - 2003. - №1. - P.46-48.

9. Smirnov I.N. Multicriteria evaluation system of medical rehabilitation of patients with hypertension. / .., .., .Б., .. // Sat. mater. jubilee scientific and practical. Conf. "Actual questions of balneology, rehabilitation medicine and ". - Pyatigorsk, 2010. - C.189-190.

10. Methods and techniques of physiotherapeutic procedures (Handbook). / Under the editorship of ..Б. - Tver: Provincial medicine, 2003. - 403 C.

11. Khetagurov L.G. Application - and bioupravlyaemoy in surgery. / .., .., ... // Proc. Dokl. the 3rd scientific conference. «Phytotherapy, , biologically active substances of natural origin in the 21st century». - M, 2000. - c.321.

12. Zimmerman .. Extremely high frequency therapy and its possible application in gastroenterology. / .., .., ... // . honey. Journe. - 1995. - №1-2. - P.88-93.

13. Yakovenko .. Chronic diseases of extrahepatic bile ducts. Diagnosis and treatment. / .., .. // Method. manual for physicians. - M: . - 2001. - 31 C.

Method of treating patients with a dyskinesia of the gall bladder, including against the background of sparing-training regime dietary meals according to the diet №5, General pine baths, therapy the internal intake of mineral water with the subsequent carrying out of transverse galvanization epigastrium, wherein the transverse galvanisation is conducted immediately after the reception of mineral water in the period from 10 to 11 hours, at the further conduct of EHF-impact on the right hypochondrium and the sternum area broadband noise emitter with a frequency of 40-63 GHz, 10 minutes at each zone, daily, on a course of 10-12 procedures.