Pain relief in chronic pancreatitis


(57) Abstract:

The invention relates to gastroenterology. The purpose of increasing the effectiveness of pain management therapy in chronic pancreatitis. The goal is addressed through the use of the drug "Prostenon", analgesic effect which is implemented pathogenetically elimination of hypertonic pancreatic ducts, choledochus, the gallbladder and the nature of the impact on vneshnepoliticheskoy secretion /inhibition of the enzymatic product, but not the water part of/. Due to these properties of the drug facilitated the passage of the pancreatic juice, is eliminated pain syndrome. 1 Il. 5 table.

The invention relates to medicine, namely to gastroenterology and can be used for the treatment of chronic pancreatitis in acute phase.

There are many different drugs used for pain management therapy of patients with chronic pancreatitis (CP). In particular, intramuscular injections of 2-4 ml of 50% solution of dipyrone, 1-2 ml of a 1.5% solution of gangleronum, 5 ml baralgina, 1-2 ml of 2% solution of morphine, intravenous drip infusion of 0.25% solution of novocaine, etc.

However, the problem of relieving pain, as ia the matter of funds, used in CP, or not fully docked pain syndrome, or cropped almost completely (promedol, baralgin), but briefly, creating the need for multiple daily injections maximum doses of various analgesics. However, the use of the most effective non-narcotic analgesics baralgina, novocaine often complicated by a variety of allergic reactions and the use of narcotic analgesics (morphine, and others) is sharply limited by the high risk of becoming addicted to them.

The purpose of the invention increase the effectiveness of pain management therapy in chronic pancreatitis.

This goal is achieved by the use of the drug "Prostenon" (PROSTENONUM), which corresponds to the criterion "novelty" and "significant differences".

The drug is injected intravenously, drip. Before application of 0.1% (or 0.5% ) solution prostenona diluted with 300 ml of sterile isotonic solution of sodium chloride. Starting from 7-10 drops in 1 minute, gradually the rate of infusion adjusted to 40 drops in 1 min With the drug at a rate of over 40 drops in 1 min in patients was sometimes a headache. The quantity of the drug ranges from 0.0 labial or not achieved at all. With the introduction of prostenona dose of more than 0.01 mg/kg often lead to headaches. Single dose prostenona during the course of therapy can be reduced, since the fixing painkiller effect from the initial introduction of the drug is provided in the following dose, part 2/3 or even 1/2 of the original. The dose of the drug and its rate of introduction vary within these limits and should be adjusted depending on individual sensitivity to it. The frequency and number of infusions prostenona determined by the efficiency and durability of relieving pain.

High analgesic efficacy prostenona by the comparative studies baralgin (one of the most effective non-narcotic analgesics), injected intramuscularly 2 times a day. The results of the study are given in table.1, from which it follows that the relief of pain in CP patients in the acute phase of the disease when applied prostenona occurs much earlier than the traditional use of baralgina.

It is especially important to notice that high analgesic efficacy prostenona in CP patients is related to the fact that the drug pathogenetical prostenona. According to the views of leading domestic gastroenterologists, one of the main causes of pain in CP patients increased intraductal pressure. Meanwhile, the impact of prostenona exocrine activity of the pancreas and acid-forming function of the stomach along with a pronounced antispasmodic effect on the pancreatic ducts, choledoch and gall bladder (probably on the sphincter of Oddi) helps reduce pressure in the pancreatic duct, thus eliminating pain.

Investigated the influence of prostenona spontaneous vneshnepoliticheskoy secretion and stimulated antiproton f (a stimulating effect on the last vneshnepoliticheskoy function of healthy individuals and patients with CP are presented in table. 2). With this purpose, conducted simultaneous gastroduodenal sensing using dual-probe. Through the gastric channel probe constantly aspiration to exclude pancreatic stimulation. Within 20 min was collected basal portion of the pancreatic juice. Then 15 patients of CP for 50 min was carried out by intravenous drip prostenona with the speed of 0.08 g/min In 20 patients with CP Prov the donkey introduction one of the drugs (or combinations thereof) duodenal contents aspirated with a 20 minute intervals. Determined the amount of each portion of the secret activity of amylase, trypsin and lipase, as well as the rate of bicarbonate. The amylase activity was determined by the method of Caraway, lipase by Bondi in the modification M. S. Rozhkova, trypsin by Anson Worldly in its own modifications, bicarbonate by the method of back titration. In table.3 shows that the introduction of prostenona both healthy and patients with CP caused a rapid (20 min), but short increase of bicarbonate and total volume of duodenal contents. The activity of pancreatic enzymes when this did not undergo any changes. This limited impact prostenona spontaneous vneshnepoliticheskoy secretion. When determining the impact prostenona stimulated pancreatic secretion determined that increased activity of trypsin, amylase and lipase as a result of stimulation by ectoprocta f significantly inhibited by prostenona. No notable influence prostenona indicators stimulated antiproton F. secretion of bicarbonate and water (PL.4 and the drawing illustrating this invention).

So, prostenon inhibits stimulated the enzymatic activity of the pancreas, thereby reducing the total to the bicarbonate and water, that improves the rheological properties of the secretions and facilitates its passage into the duodenum. Thus, the established character of the influence of prostenona exocrine gland function contributes to the reduction of pressure in the pancreatic ducts.

The decrease in enzyme production of the pancreas under the influence prostenona is also associated with the known property of prostaglandins group E to inhibit the secretion of hydrochloric acid in the stomach, thus excluding the stimulating effect of the latter is not exocrine function of the pancreas, (In the examined patients with CP debit hour of hydrochloric acid in the course (10 times) introduction prostenona decreased from 3,90,28 mEq/h to 2,10,26 mEq/h, (p < 0,05).

Pronounced skin effect prostenona pancreatic ducts (for example Wirsung duct occured in the region of the pancreatic head), choledoch and the gallbladder was documented sonography ultrasound machine company "Toshiba (Japan). The results are shown in table.5.

From table.5 it follows that prostenon (0.08 g/kg/min 50 min) has a pronounced antispasmodic effect on these elements. Troubleshooting Hyper the political juice, that also helps to eliminate pain.

It should be noted that in none of the cases in the treatment prostenona not observed any complications.

No complications when using prostenona, more effective and long-lasting analgesic effect of the latter, pathogenetically implemented, small doses and the possibility of use in patients with concomitant diseases of the liver, kidneys, distinguishes it from other analgesics for relief of pain in patients with chronic pancreatitis.

Application prostenona as an analgesic in chronic pancreatitis.


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