Treatment of hemorrhagic stroke

 

(57) Abstract:

The invention relates to medicine, namely, neurology, and is intended for treatment of hemorrhagic stroke. To do this, hold intensive differentiated drug therapy. When this differential treatment is performed with the consideration of arteriovenous difference in oxygen pressure in the blood, intracranial pressure, perfusion pressure of blood in the blood flow of the internal carotid arteries. Additionally, from the first to carry disease thrombotic pneumomassage, reflexology in the form of acupressure brake method and shiatsu therapy of injured extremities. The method allows to increase the effectiveness of treatment and survival rates of patients with hemorrhagic stroke. 3 C.p. f-crystals, 1 table.

The invention relates to clinical neurology and can be used in neurological centers, clinical hospitals, hospitals, clinics, sanatoriums, as well as in the educational process, in clinical and scientific work in the departments of neurology medical schools.

Known methods of treatment of intracranial hemorrhages. The term "Intracranial hemorrhage" (WCG) will meant the influence in the brain or hemorrhagic stroke (GI) is more common SAC. Often hemorrhages occur in the form of blood burst into membranes of the brain and ventricular system. Cause hypertensive VCG is rupture of the arterial vascular wall as a result of its structural changes due to the decrease of activity energy enzymes and increase the number of lysosomes and lysosomal enzymes. Supporting the role of increased fibrinolytic activity of the blood and, in particular, cerebrospinal fluid [1, 2].

One of the adverse consequences of the known methods of treatment VCG becomes ineffectiveness cerebral vasoactive funds. Another adverse consequence of a brain hemorrhage should be considered rapid development of severe intracranial hypertension and brain edema. The latter is associated with loss of autoregulation of the cerebral circulation, and suddenly developing increase in the volume of the intracranial contents, dislocation of the brain, a violation of the outflow of venous blood and cerebrospinal fluid from the skull. Another adverse consequence of hemorrhage in the brain is the development of secondary stem with hyperventilation syndrome, hypocapnia and reduced PaO2in the arterial blood. Comprehensive VL is associated with such a sharp increase in intracranial pressure (ICP), that it becomes equal to or exceeds cerebral perfusion (arterial) pressure, which is normally equal to 75-80 mm RT.article One of the objective criteria of brain death is registered by the Doppler case alternately changing the direction of blood flow in the major arteries in the neck, showing the movement of blood back and forth [3].

It is known that the Central issue of conservative treatment of GI is the use of drugs (PL) procoagulant and antifibrinolytic activities (hemogobin, menadione, calcium salts, askorutin and others). Now for the prevention and combating of cerebral angiospasm use calcium antagonists belonging to the group of dihydropyridines. These drugs reduce the rigidity of red blood cells and platelet aggregation, and improve the fluidity of blood (Wond M., Haley E. C., 1990).

To therapy GUY is everything that is connected with the control of respiration, circulation, water-salt metabolism, nutrition, regulation of pelvic function in the treatment of emergency conditions of the patient, as well as prevention of complications of deep vein thrombosis of the legs and pulmonary embolism, pneumonia, bedsores. When the GUY most often F recent years more and more clearly the change of tactics of treatment of patients with hemorrhagic stroke the rejection of the use of coagulants, the restriction of antifibrinolytic funds and vasodilator PL.

Most closely associated with medical and technical solution chosen as a prototype [3], is a method of treatment of hemorrhagic stroke, which consists in the intensive therapy of the disease prehospital by normalizing heart rhythm, remove shock, conducting respiratory and cardiopulmonary resuscitation, anesthesia for pain relief or elimination of seizures or disorders hemicircular as asystole, collapse and significant increase in blood pressure, for which medication is administered parenterally, usually intravenously or intraarterially, if necessary, conduct an intubation for drainage of the upper respiratory tract, tracheostomy, cardiostimulation and indirect heart massage, when the hospital use of corrective medical complex, including calcium antagonists, as nimodipine, nicardipine, korinfar, and disorders of lipid peroxidation correct use of antioxidants, such as tocopherol, alkanol, oxepin, amoxilin, unital, and from the first day of the beginning of the stroke on the W ill result in water-soluble antioxidants the thromboxane A and prostaglandin F2then interact with calcium antagonists and membrane-stabilizing means in case of instability of membranes, such as glucocorticoids, Essentiale, when the accumulation in the cells of the excitatory neurotransmitter glutamate and aspartate apply their antagonists to suppress perevozbujdenie brain cells, and energy depletion caused by the lack of supply of the brain tissue of oxygen or violation of its utilization during the oxidation process, and the strengthening of anoxia suppress using antihypoxants and nonsteroidal anti-inflammatory drugs type of indomethacin, while the drug complex of complement inhibitors of proteases of animal origin - proteina and antiserotoninergic means, rauwolfia derivatives, antiplatelet agents, such as trental, Corentin, inhibitors of cyclooxygenase - aspirin, indomethacin, beta-blockers, patients with neochimiki, lateral hemorrhage to reduce the frequency of breathing and increase tidal volume applied artificial lung ventilation, and trasilol give intravenous drip for 25000-50000 IU twice per day, within 12 hours, within 8 to 10 days, starting from the first day when this normalizes the acid-base balance, water and electrolyte balance, autonomic disorders, hyperthermia and nutrition [3].

At a known method for the treatment of GI preferably inhibitors of proteases of animal origin - protein (contrical, trasilol), which act not only on the fibrinolytic system, but on the other protease system, in particular kallickrein-kinin, also note the inhibition of the action of thrombin, which eliminates hypercoagulation effect. When KI is often a serious disorder of hemostasis - disseminated intravascular coagulation (DIC). Under these conditions, the blocking antiprotease drugs resulting plasma "proteasome explosion" (Barguzin E. C., 1980) contributes to the prevention of the development of DIC or reduces the clinical and laboratory manifestations.

The disadvantages of this method of treatment GUY the following.

1. Application of PL procoagulant and antifibrinolytic action, such as menadione, calcium salts, askorutin and other, poorly defined and archaic. Moreover, the idea of any real possibilities of using these tools to stop intracranial hemorrhage is not confirmed N. N., 1980).

2. With hemispheric GUY sulemaniyah tools reduce the volume of brain tissue unaffected hemisphere and thereby contribute to the dislocation phenomena affected hemisphere of the brain. Similar can be seen with significant infarctions of the brain. Therefore, in conditions of failure of autoregulation of cerebral circulation sulemaniyah therapy is often ineffective and sometimes even unsafe, moreover, in patients with severe haemorrhage, extensive destruction and breakthrough of blood into the ventricular system of the respiratory resuscitation in the form of artificial lung ventilation (ALV) is ineffective (Popova L. M. et al., 1977).

3. At a known method for the treatment of GI role of hemostatic highly questionable, since the first days of the celebrated long spontaneous amplification of gemokoagulyatsii, and a significant increase in fibrinolytic activity of the cerebrospinal fluid can hardly be realistically reduced by the introduction of antifibrinolytic drugs intravenously or orally. Thus, the introduction of homophobia, as well as ascorbic acid, vikasola and calcium salts in the GI ineffective because patients arrive at the clinic c already held haemorrhage, and all further dynamics of the process determined plateforme, that is the usual type of development of a brain hemorrhage, the appropriateness of the use of antifibrinolytic funds contradictory and at least questionable [3], the reduction of mortality from such treatment is compensated by the increase in the number of patients with cerebral infarcts.

The objective of the invention is improving the survival of patients with hemorrhagic stroke by a complex combination of differentiated drug therapy, acupuncture acupressure, reflexology, shiatsu therapy and pneumomassage damaged limbs of the patient.

The objective of the invention is solved through the application of differential treatment, taking into account the assessment of cerebral blood flow obtained by the arteriovenous difference in oxygen pressure in the blood, systematic readings of systolic, diastolic, mean arterial and cerebral perfusion pressures, estimated intracranial pressure, increasing hypoxia, the linear velocity of blood flow in precerebral and intracerebral vessels to calculate the volumetric flow in the internal carotid arteries and the velocity of the venous outflow in the paralyzed leg. Moreover, drug therapy skin is Costa patient.

The inventive method of treatment of GI as follows.

Every hour measure systolic blood pressure, diastolic blood pressure, mean arterial pressure, equal to the systolic pressure, for example the size of 120 mm RT. Art. , plus two diastolic pressure, for example 2x80 mm RT.article= 160 mm RT.article Received an amount equal in this example 280 mm RT.art., divide by three and get a mean BP value of 93.3 mm RT.art., then compare with the known range of the average AD healthy people, equal to 90-100 mm RT.article In this case, the mean BP of the patient is normal, as it lies in the middle of the range. While systematically determine the partial pressure of oxygen in the blood flowing from the brain, by using a device for measuring the partial voltage PaO2in the blood. The drop in oxygen pressure in the blood obtained from the jugular vein, less than 3.6 kPa (at a rate of 5.3-of 5.92 kPa) indicates severe hypoxia. This basic assessment of brain blood circulation of the patient given by the arteriovenous difference. Simultaneously with this, an electroencephalograph with a built-in Converter Berg-Fourier and microprocessor, perform compression-spectral analysis of biotene, equal in norm 0-15 mm RT.article.

Intracranial pressure equal to 15-30 mm RT.article (2-4 kPa) is considered as high, and more than 50 mm RT.article (of 6.65 kPa) as an absolute pathology. Increased ICP adversely affects the blood supply of the brain, which is appropriately provided only during normal values (75-80 mm RT.article or 9.96-at 10.64 kPa) cerebral perfusion pressure, i.e. the pressure of the circulating arterial blood in the intracranial vessels. Perfusion blood pressure represents the difference between systemic blood pressure and ICP. The decrease of this indicator below 50-60 mm RT.article (6,65-7,98 kPa) involves the risk of cerebral ischemia. With the rapid decrease in cerebral perfusion pressure up to 25 mm RT.article find focal necrosis of brain tissue and drop it below 10 mm RT.article leads to brain death. If ICP reaches the level of systemic blood pressure, intracranial arterial circulation ceases, what are ultrasound Doppler study. Using the latest non-invasive control method of the blood flow velocity in precerebral and intracerebral vessels to calculate the volumetric flow in the internal carotid arteries.

To prevent a similar flowmetry in patients after hemorrhagic stroke, control, register, and find the speed reduction of the venous outflow in the paralyzed leg, on the 3-4th day after the development of acute disorders of cerebral circulation and to normalize thromboelastography and platelet aggregation, which is controlled by analysis of blood coagulation, blood properties before and after treatments are applied from the first day of the disease pneumomassage - thrombotic system. Pneumomassage exercise 2 times a day for the duration of one session of not less than 40 minutes by putting it on a paralyzed leg and implementation of a cyclic therapeutic action to the damaged limb, due to the gradual build up pressure in the cuff of pneumomassage, the value of which changes smoothly from the periphery to the center, with 2 min of compression and 2 min pause in each chamber of the cuff. In addition carry out acupuncture reflexology and Japanese shiatsu therapy feet below technologies.

When bleeding in the brain-hemorrhagic stroke perform acupuncture reflexotherapy in the form of acupressure, brake method 12-15 procedures a day three times a day for the next ONE (2-3 min on each point) is;

ZU SAN LI (36E, 36M, 36St) channel of the stomach, located on the midline of the anterior surface of the leg, 3 CUN below the lower edge of the knee Cup; in combination with the well-known point HAE-GU point ZU-SAN-LI, appointed in functional diseases of the Central nervous system, allergies and hypertension, has a restorative effect;

YES-LIN (7MC, 7KS, NS) Palmar-midline hand channel of the pericardium;

LAO GONG (8MC, 8KS, NS) channel pericardium ("ruler of the heart"), assigned to provide emergency assistance and hysterical attack;

WAI GUAN (5TR, SE, 5TH) rear midline hand channel "three heaters", assigned typically, when motor and sensory disorders of the Central and peripheral character, fatigue and insomnia;

HSIN-SHU(YU) (15V, 15B, 15BI) the first lateral line of the back channel of the bladder, usually assigned in diseases of the heart;

FENG-CHI (20VB, 20G, 20GB) posterior cervical area of the gall bladder channel that is assigned during brain diseases, hemiplegia, diseases of the nose and ear.

Japanese shiatsu therapy of injured extremities of the patient with GI exercise twice a day, within 2 hours after Breakfast and dinner by massage or self-massage. Punction

1. Massage the anterior region of the thigh.

The pips (or points) the impact of the anterior region of the thigh are evenly distributed in a straight line from the front ledge of the pelvic bones easily apparently to the side and lower abdomen, until the middle of the upper edge of the kneecap. To conduct shiatsu massage these points you need to sit down and put on every point both thumbs (right bottom). The rest of the fingers wrapping around the thigh on both sides. Then press on each of the 10 points starting from the middle to the body and ending with the fact that at the knee. Each of them requires exposure within 3 C. This treatment was repeated three times.

2. Massage the inner (facing to the other leg) thigh 10 points this side of the thigh is produced, as in the previous step, and in the same order.

3. Massage the outside of the thigh are also on 10 points. The upper one is located over the greater trochanter of the thigh - bone protrusion, easily identifiable in the upper part of the lateral surface of the thigh. The pressing is carried out in the same manner as in steps 1 and 2.

4. Massage the back of the thigh also 10 points located on the line going down the middle of the back of the thigh. the two fingers, the index and middle connected together, with both hands grasping the thigh on both sides. Each item is processed 3 C. the Procedure is repeated three times.

5. Massage the area kneecap spend 5 points located in the recess around the kneecap. The pressure produced in the United thumbs of both hands - 3 for each point. Repeated three times.

6. Massage the posterior tibiae are carried out by 8 points this area, located on the midline of the posterior surface of the tibia. Each of them is treated for 3 with folded together with the index fingers. The procedure was repeated three times.

7. Massage the side of her Shin produce 6 points situated on a straight line going down the front outer surface of the tibia. Impact thumbs mapped to each other (left to right). The pressure on each item produced within 3 seconds. the Action was repeated three times.

8. Massage the back surface of the foot on the 19 items produced are tied together with thumbs. First hold pressure at 3 points of the anterior surface of the ankle joint, located at the bend in the legs in place Agnosti between the tendons. Each of these points is treated for 3 seconds. Therapy three times. Then the procedure continues by pressing on 16 points back surface of the foot, located in the interosseous spaces, easy apparently even obese people. Massage start with the top points. For each item enough to spend 3 C. Procedure is not repeated.

9. Massage the area of the toes. On each toe are uniformly distributed on its back surface 3 points. For processing it with the thumb and index fingers pinched in the toe in the vertical direction. The first point is located on the nail at its base, the second at the interphalangeal joint, and the third is at the base of the finger. Four points of the plantar region is processed sequentially, starting with the located in the middle of the elevation of the toe on the middle line of the foot. The second point is located within the recessed arch of the foot, the third in the recess of the front of the heel, the fourth in the middle of the heel. The pressure on the produce item within 3 C. the Procedure is repeated three times. Action finish as strong as possible by pressing three times the third point 3 C.

Hand massage.

10. Massage armpit conduct, powerace in the left axillary area. Then click on the first item 5 and repeat this three times. The pressure should be directed towards nadopasana area.

11. Massage the inner surface of the shoulder is performed in 6 centres from the armpit and on the inner surface of the shoulder to the elbow fossa. The thumb, the tip of which is directed towards the armpit, consistently other fingers, clasping a hand, click on each of these points for 3 seconds, repeating this three times.

12. Massage the elbow folds produced by three points located on the line from internal (from the side of the little finger) to the outside (from the side of the thumb) side of the elbow crease. The thumb of the right hand handle each item 3 C. Action was repeated three times.

13. Massage the Palmar surface of the forearm (the part of the arm from the elbow to the wrist) produced 24 points located: 8 horizontal rows by 3 points each. Vertical rows are below 3 points of elbow fold. Thumb press on each of the 3 points for 3 seconds. do This once.

14. Massage deltopectoral furrow that runs from the armpit on the front side of your shoulder to the middle of the key is nye fingers on the outside of the hands, work with every paragraph 3 C. Action was repeated three times.

15. Massage the outside of the shoulder. Turn your hand so that your palm is facing up. Six points of the area are located along the middle of the outer side of the arm, from the shoulder to the elbow. Placing the thumb on the inner part of the hand, click on each of these points the index, middle and ring fingers for 3 seconds. Do this three times.

16. Massage the outside of the forearm produce thumb, starting with the first from the elbow point. The remaining four fingers grasping a forearm with the other hand for support. The points of this region are on the line going from the outer end of the fold of the elbow bend to the middle of the back side of the brush. Click on each item within 3 seconds, Repeat three times.

17. Massage the back of his hand carry items that are located in the interosseous spaces, which is a continuation of the gaps between the fingers. Thumb press on each of these points, starting from the side of the thumb, once within 3 seconds Other fingers support the palm. Must not repeat. All 12 points behind Colnago in his right hand, therapist presses the left thumb points shiatsu, starting from a number lying between thumb and forefinger, and to a number of points around the little finger. Then also treated with another brush.

18. Massage the fingers of the hands. On the fingers of the points of impact are rings of four: two on the front and rear surfaces, two on the side. Such rings three large fingers and four on the rest. The points are located on each phalanx of the finger and at its base. With one hand holding the brush, therapist conducts the pressure by the thumb and forefinger of the other hand on the points in all directions, starting from the points of the thumb, index and other fingers, down to the little finger, each time starting the massage points at the base of the finger. Same thing on the other hand.

19. Massage the palm of the hand. The points on the palm is located on the line going through the center from the base of the middle finger to the middle of the supporting part. Just on the middle line of the palm three points: first, at the base of the support part, the second in the middle, and the third is at the base of the middle finger. therapist takes the hand of the patient, turns it upside palm and connecting together the ends of his thumbs found the Tr palms are superimposed on one another thumbs, the remaining fingers of the masseur grasping hand, and is a strong push for 5 sec. Steps are repeated three times.

Differentiated therapy GI is carried out in conjunction with maintaining adequate HELL due to the use of antihypertensive and hypertensive medicines raise HELL to numbers that exceed the normal for each patient indicators. In cases of low blood pressure (80/60 mm RT.CT.) use Analytics kordiamin and sulfometuron a 10% solution of 2 mg intramuscularly or subcutaneously up to 6 times per day, and kordiamin under the skin, intramuscularly or intravenously in 2 ml 2-3 times a day. Used within 5-7 days giperwolemicescoy hemodilution to improve cerebral microcirculation by reducing hematocrit up to 30-35%, apply gangliosides, in particular carnassial (a mixture of monody and triangulation) on the 1st, 3rd and 5th days of intravenous infusion of 100 mg of drug in 100 ml of saline solution for faster recovery alopecia, neurological disorders, for regression of human consciousness, recovery paresis conduct combined use of aktovegin and instenon - sealed LP 2.5 and 10 ml intravenous drip in isotonic saline or 5% noisy 257 patients with hemorrhagic stroke, that was in the neurology Department of the Main military clinical hospital. Acad. N. N. Burdenko between 1987 and 1995, the table shows the outcomes of treatment of patients with GI.

The first control group of patients with hemorrhagic stroke was treated in 1993, using a known method-prototype [3]. The second control group of patients with hemorrhagic stroke in the hospital in 1994, for the treatment of GI was also used known method-prototype [3]. Patients with a GUY who was in the neurology Department of the hospital in 1995, were treated using the proposed method for the treatment of hemorrhagic stroke.

As can be seen from the table, in 1993, in the first control group survived 15 of the 31 subjects; in 1994, a second control group of 27 patients from 52, i.e., respectively 48,4 and 52%.

In the studied group of patients with GI for 1995 from 43 patients survived 30, or 69.7 per cent, which is 21.3% (or 15 people) compared with the first control group (1993) and 17.7% (or 3 people) more in the study group compared with the second control group (1994). In 1995, in the group treated using the proposed method for the treatment of GI, died 13 patients with hemorrhagica is ilaci 21.3% (3 people), and in comparison with the second control group with HI in 1994, the death rate declined by 17.7% (12 people), i.e. on average by 19.5% mortality below. Thus, the claimed method of treatment of hemorrhagic stroke allows you to reach to 69.7% survival compared to the control, with respectively only 48 and 52%, i.e. significantly improve the recovery of patients with hemorrhagic stroke, to reduce the length of hospitalization for 7-9 days and eventually after 6 months of treatment to prescribe to work up to 70% of patients.

Thus, the claimed method of treatment of hemorrhagic stroke gives the opportunity to improve survival rates of patients with GI by a complex combination of differentiated drug therapy under the simultaneous effect of acupuncture-point reflexology, shiatsu therapy and pneumomassage damaged limbs of patients.

Sources of information

1. Gabashvili C. M., Shakarishvili R. R., M. Janelidze, and other Pathogenetic therapy of hemorrhagic strokes. - Journal. neuropathol. and the psychiatrist. - 1990. - Vol. 7. -S. 19-21.

2. Vilensky B. C. Stroke. - L.: Medicine, 1994.

3. Charles C. A. Treatment of nervous diseases (Guidelines for clinicians). ): Step, 1996. - Translation from English. VP Of Lysenko.- Kiev: high school, 1987. - 72 S.

5. Vohralik Century, Vohralik M. C. Acupuncture//Ant-t above. nerve. activities. and neurophysiology, USSR Academy of Sciences. Bitter, 1978.

6. Sokolov, P. P., Gerasimov, Y. N. Help yourself.- Physical education and sport. - M., 1991. - 238 S.

1. Treatment of hemorrhagic stroke involves intensive medical therapy, differentiated in accordance with objective indicators, wherein the differentiated therapy is performed with the consideration of arteriovenous difference in oxygen pressure in the blood, vnutricerepnogo pressure, perfusion pressure of blood in the blood flow of the internal carotid arteries, in addition to the first day of the disease carry thrombotic pneumomassage, reflexology in the form of acupressure brake method and shiatsu therapy of injured extremities.

2. The method according to p. 1, characterized in that pneumomassage perform from the first day of the disease twice a day, the duration of one session 40 - 50 minutes

3. The method according to p. 1, characterized in that reflexology exercise daily, three times per day rate 12 - 15 procedures for 2 to 3 minutes on each tocuh heart.

4. The method according to p. 1, characterized in that it further enhances the rate of venous outflow, normalize thromboelastography and platelet aggregation and restore the active state of the paralyzed legs through the use of antithrombotic apparatus, made in the form of pneumomassage, worn on the leg, that you are carrying out a cyclic therapeutic effects in the form of changing pressure on the injured limb of the patient by a gradual build up pressure, the value of which changes smoothly from the periphery to the center, with 2 min of compression and 2 min pause.

 

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