A method for the treatment of dumping syndrome

 

(57) Abstract:

The invention relates to physical therapy and is intended for treatment of dumping syndrome in patients undergoing surgery for ulcer. Patients assigned to the complex of therapeutic and preventive measures, including health resort health-protective mode, clinical nutrition, physical therapy, internal reception of mineral water, carbonic mineral baths, as well as electrophoresis of dalargin sinusoidal modulated current with a modulation frequency of 150 Hz, the depth of 25%, amperage 6 - 10 mA, the first 5 min I come from, the next 5 min - IV is a native of work, duration of parcels 3 c in 1.5-2 hours after eating, in the course of 10 treatments in alternation with baths. The proposed method of treatment contributes to the inhibition of motility of the gastrointestinal tract, reduces the reflex excitability of the sympathetic nervous system, reduces the severity of autonomic and hormonal reactions of the heart, blood vessels, brain. table 1.

The invention relates to medicine and can find application in the treatment of patients operated on for stomach ulcer duodenal ulcer (abdc), have developed dumping syndrome (DS).

In the treatment of DS isaku physical factors (mineral water, peloids, methods of physiotherapy - and pulsed galvanic currents, electrophoresis of novocaine, hexane and others). However, existing methods of treatment DS is not effective enough.

There is a method of treatment of DS patients YAB after gastrectomy, the application of therapeutic mineral waters, mineral baths and electrophoresis of philodina sinusoidal modulated currents (SMC). The impact of ITC in continuous mode, bipolar, amperage of 20 mA, a frequency of 100 Hz, for 5 minutes I come to work and for the next 5 minutes IV come when the modulation depth of 50% (L. I. Novozhilova, N. With.Molchanov, I. C. buhtoyarov of authorship N 1169668, registered in the State. register of inventions of the USSR 01.04.1985 year ). The method allowed to reduce the main clinical manifestations of dumping syndrome and positive dynamics of indicators of vascular reactions, ECG, blood glucose, but this effect was developed only to the end of treatment and was not expressed.

The rationale for the development of the proposed method was evidence of the ability of the synthetic analogue of enkephalins - dalargin and sinusoidal modulated currents (SMC) used in the mode is the least irritating destist in the ganglion system, to reduce the reflex excitability of the sympathetic nervous system and smooth muscles of the stomach and intestines.

The essence of the proposed method lies in the complex influence of physical factors in combination with chemotherapy on the main pathogenetic mechanisms of dumping syndrome: increased speed of evacuation of food masses of the operated stomach into the small intestine, increased reflex excitability in the asthma of cholinergie, hyperactively "anterointernal axis with severe autonomic and hormonal response of the heart, blood vessels, brain.

The method is as follows. Patients assigned to the complex of therapeutic and preventive measures, including SANATORNO-resort treatment, therapeutic nutrition (diet with restriction of carbohydrates, the fractional power), physical therapy, internal reception moderately mineralized carbon dioxide chloride-hydrocarbonate sodium mineral water from the calculation of 3.0-3.5 ml per 1 kg of patient's body weight 3 times a day for 45-60 minutes before meals, carbonated mineral bath temperature 36-37oC through the day, 8-10 procedures for the course, and electrophoresis of dalargin sinusoidal modulated the particular patient), the first 5 minutes I come from, the next 5 minutes IV kind of work, duration of parcels 3 sec. At the anode raspolagaet in pyloro-duodenal region, the gasket put 4 ml of working solution of dalargin (1mg drug dissolved in 4 ml of distilled water). The procedure is carried out in 1.5-2 hours after a meal, in the course of 10 treatments, in alternation with baths. We have chosen for the injection of dalargin mode CMT gives easy undulating surface modulation, low irritant effect while maintaining the analgesic actions.

Observations were carried out on 20 patients suffering from dumping syndrome after gastrectomy for ulcer. Among the observed male patients was 15, 5 women, aged mostly between 30 and 50 years. Severe dumping syndrome occurred in 5, moderate in 12, light 3. Hypoglycemic syndrome was diagnosed in 7, gastritis gastric stump 6, afferent loop syndrome in 4, enterocolitis, adhesive disease, cholecystitis, hepatitis, pancreatitis, iron deficiency anemia, respectively, 6, 5, 3, 4, 4, 5 patients.

Patients in addition to detailed clinical examination were determined: blood count, blood glucose, amylase, bilirubin, hall is and the height of the dumping of the reaction was determined by heart rate, blood pressure (BP), ECG, blood glucose. These studies were conducted at the beginning and end of treatment. After treatment, most patients have disappeared or decreased clinical symptoms of dumping syndrome and other-post gastro-resection disorders, there is a favourable dynamics of the vascular manifestations (table). Significant improvement noted in 7, the improvement in 13 patients. It should be noted that the positive dynamics of clinical symptoms appear in patients after receiving II-III procedures.

Comparative analysis of treatment results for the proposed method and the known method prototype (electrophoresis of philodina sinusoidal modulated currents, drinking mineral water and mineral baths) allowed us to identify distinct advantage of the proposed method before known as clinical indicators (clinical symptoms of dumping syndrome and other-post gastro-resection disorders), and indicators of vascular manifestations, data of blood glucose and ECG.

The effectiveness of the treatment of dumping syndrome proposed method: significant improvement of 33%, an improvement of 67%; in a known manner: a significant improvement of 10%, ulovane CMT-phoresis of dalargin 4-5 days the method of the prototype 20-24 days.

When using CMT-phoresis of dalargin for patients while maintaining an objective signs of dumping syndrome (increased heart rate, increased blood pressure, glycemia) disappeared subjective symptoms - weakness, sweating, palpitations, dizziness, nausea. Patients could eat, which is explained by the increased sensitivity of the Central nervous system to visceral influences (in this case with the receptors of the small intestine in response to stimulation with a large amount of food quickly evacuated from the operated stomach into the small intestine).

The proposed method is illustrated by the following example.

Patient S. , 42 years (history N disease N 483) was treated in the conditions of the Essentuki clinic Pyatigorsk, GNIIT in September-October 1999 When entering complained of General weakness, fatigue, particularly pronounced on an empty stomach and with long breaks in meals, pain in the epigastric region after a meal, periodically vomiting bile. After the meal, adopted even in a small amount, says the attacks of acute weakness, drowsiness, palpitations, feeling hot, prodoljayushie the ka method Billroth-II ulcer, complicated by stenosis of the pylorus.

Sick right physique, adequate nutrition (height - 158 cm, weight - 60,5 kg). Skin and visible mucous net, pink, peripheral lymph nodes are not enlarged. In the lungs - vesicular respiration, percutane - pulmonary sound. Pulse 56 in 1 minute, rhythmic, satisfactory properties. Blood pressure 100/60 mm RT. Art. heart sounds clean, regular rhythm. Tongue moist, coated with white bloom. The belly of the correct form, in the act of breathing participates evenly. On the middle line of the belly - postoperative scar from the xiphoid process to the umbilicus. The abdomen is soft, with painful palpation in the epigastric region and in the region of the descending and sigmoid colon. Liver and spleen are not enlarged. Analysis of clinical blood: hemoglobin 135 units , leukocytes 6,2 109/l, eosinophils 2, band 3, segmented 63, lymphocytes 30, monocytes 2. Erythrocyte sedimentation rate of 4 mm/h blood Glucose 3.6 mmol/L. ECG sinus bradycardia.

After ingestion: pulse 88 1 min, BP 135/80 mm RT. Art. blood Glucose of 7.4. ECG acceleration of heart rate, ST depression, and So

Bilirubin in the blood 16 Ám/l (indirect), cholesterol 6.4 mmol/L. ultrasound - moderately expressed diffusely about ulcer and 12 duodenal ulcer): reactive reflux gastritis, hypoglycemic and dumping syndrome moderate, afferent loop syndrome, reactive hepatitis, pancreatitis, enterocolitis.

After treatment, including therapeutic nutrition (diet 2-R with the restriction of carbohydrates, the fractional power), therapeutic physical culture, vnutrenniy receiving moderately mineralized carbon chlorinehydrocarbons sodium source water Essentuki N 4 150 ml 3 times a day for 40 minutes before a meal, platekompaniet baths, electrophoresis of dalargin sinusoidal modulated currents in the epigastric region, 10 sessions of treatment (in alternation with mineral baths), the patient significantly improved health, mood. Disappeared epigastric pain, weakness, fatigue, stopped hypoglycemic seizures and dumping syndrome, vomiting bile, normalized stool. Increased heart rate after eating did not exceed 6 in 1 minute, the AD - 5 mm RT. Art. Disappeared tenderness to palpation of the abdomen. The increase in weight was 1.5 kg, the treatment is regarded as an improvement. It should be noted that the weakening of the manifestations of syndromes-post gastro-resection was observed after administration of the first two procedures CMT-phoresis gave the program, including the use of CMT-phoresis of dalargin for the epigastric region in combination with therapeutic mineral waters, affecting the basic pathogenesis dumping syndrome reduces the reflex excitability of the receptor apparatus of the gastrointestinal tract, slowing the evacuation of food from the stomach and its subsequent passage through the intestines, the elimination or significant reduction of vascular and autonomic manifestations, can improve the effectiveness of Spa therapy-post gastro-resection disorders, to achieve a positive effect in a shorter time - 4-5 day (compared with the method of the prototype at 20-24 days).

A method for the treatment of dumping syndrome in patients undergoing surgery for ulcer, including the effects of sinusoidal modulated current to the epigastric region in combination with the medical nutrition, healing mineral waters and mineral baths, characterized in that use electrophoresis synthetic analogue of enkephalins - dalargin sinusoidal modulated currents used in the mode is the least irritating with modulation frequency of 150 Hz, the depth of 25%, amperage 6 - 10 mA on IMI baths, in the course of 10 treatments.

 

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