Method for the treatment of occlusive arterial disease of the limbs

 

The method relates to medicine, vascular surgery, and can be used for the treatment of occlusive arterial disease of the limbs. Injected alternately in the region or regions of maximum ischemic pain at the beginning of 0.5% solution of novocaine at a dose of 20 ml, and then a 20% solution of sodium oxybutyrate in the dose of 10 ml once in 3 days for a course of 10 treatments. This invention helps to reduce side effects, improve the efficiency of the treatment time increase remission and simplification of the way by rotating the introduction of drugs that avoids, on the one hand, undesirable chemical interactions of these drugs, and on the other hand, allows you to keep their concentration potential in interaction with tissues, and also due to the fact that drugs turn purposefully delivered to the lesion. 1 Il.

The invention relates to medicine, specifically to vascular surgery, and relates to methods of conservative treatment of occlusive arterial disease of the limbs.

There are many methods of conservative treatment of ischemic manifestations in diseases of the arteries of the limbs. Thus, the proposed nutriental, solkoserila and novocaine [7]. Use the introduction nicotinic acid, trental and acetylcholine [2], acetylcholine and morphine [5], intraarterial introduction of 0.15% solution of hydrogen peroxide [4]. The known method intramuscular or intravenous vanaprastha [3], intramuscular injection of pure plasmid [10].

However, most of the proposed methods is very time consuming, has a number of complications and can be used only in a hospital environment. The effectiveness of the proposed methods are not satisfactory in most cases. Re-use of intra-arterial methods introduction associated with damage to the vascular wall and possible thrombosis. The proposed group of drugs for intramuscular or oral administration is ineffective.

There is a method of treating disorders of the peripheral circulation by vnutrikoronarnogo introduction "antihypoxic cocktail" [9]. The injection of the cocktail is limited to the calf muscle. For vnutrikoronarnogo use applied antihypoxic cocktail" in combination with a solution of sodium oxybutyrate [6].

The closest in technical essence (prototype) is a method concerige of 250 ml of 0.25% solution of novocaine, 2 ml of 1% solution of ATP, and 1 ml of 1% solution of vitamin b2and 5% solution of vitamin b6, 3 ml of 0.1% solution of nicotinic acid, 10 ml of 20% solution of sodium oxybutyrate and 1 ml of 10% solution of caffeine-sodium benzoate [8]. Retroperitoneal introduced 200 ml of "cocktail" and vnutritrubnogo - 25 ml in each drumstick. Under this method muscle ischemic limbs enter the cocktail method creeping infiltration in the medial belly of the gastrocnemius muscle.

According to the proposed method uses semicontinuity cocktail that makes it potentially dangerous in terms of allergic conditions. Mixing the components of the cocktail of drugs outside the body leads to the formation of the mixture, a significantly different mechanism of action from its original ingredients, allowing you to experience some concerns of possible side effects. The use of this cocktail in patients with multiple organ pathology makes it unpredictable. Retroperitoneal introduction 200 ml of cocktail is technically difficult event, with possible complications such as collapse, the formation of a hematoma and scar process in the retroperitoneal tissue, making it unsuitable for widespread use in clinical practions treatment, which persists for three months. Six months later, the state of the limb is deteriorating (drawing), it requires hospitalization of patients in specialized surgical hospital.

The problem solved by the invention, is to reduce side effects, increase the effectiveness of treatment, prolonging remission and simplification of the way.

The problem is solved by a method for the treatment of occlusive arterial disease of the limbs by intramuscular alternate introduction to the focus(and) the maximum ischemic pain of 0.5% solution of novocaine at a dose of 20 ml, and then a 20% solution of sodium oxybutyrate in the dose of 10 ml of 1 every three days for a course of 10 treatments.

The method is as follows.

Intramuscularly into the fire(and) most disturbing patient ischemic pain at a depth of 4-6 cm with a syringe in turn impose a 0.5% solution of novocaine at a dose of 20 ml and a 20% solution of sodium oxybutyrate in the dose of 10 ml of 1 times in 3 days. The procedure is repeated 10 times in one or two limbs.

Lesions most disturbing ischemic pain obliterative diseases of arteries of the extremities are in the vast majority of cases the posterior group of muscles of the leg. Rarely in this area may be the rear Central blood flow, to restore the functional activity of the limbs and the ability to work sick.

To illustrate the proposed method given two clinical examples.

Example 1. Patient Y., 76 years. The diagnosis of occlusive atherosclerosis of the lower extremities. Occlusion of left and right femoral arteries. Ischemia 3B degrees to the left and 2A degrees to the right. Trophic ulcer of left foot. Turned 26.04.1999, with complaints of pain, having the maximum intensity in the posterior surface of the left tibia, concerned about the patient alone, the presence of trophic long-term (over six months) unhealed ulcers rear of the left foot. In the right lower leg pain at rest, do not worry. However, the history of pain were detected in the area of the calf muscles through 100 meters of road. Objectively: the left tibia pale color on the rear foot trophic ulcer up to 2.5 cm in diameter. The pulsation of the femoral arteries clear, popliteal artery pulse is not detected. On rheovasogramme shins performed on the apparatus BIOSET 8000 received the following parameters: RI right - 0,3; left - not detected (sine wave). Stroke volume right - of 0.18 cm3left is 0 cm3; the volumetric rate of blood flow to the right - 1.7 cm3/min, left 0 cm3/min. was Performed with 0.5% solution of novocaine at a dose of 20 ml and then 20% solution of sodium oxybutyrate in the dose of 10 ml After 3 days the procedure was repeated. Just performed 10 procedures in both limbs. Upon completion of the course, rest pain was absent, trophic ulcer of left foot epithelials, however, the distance painless way limited by the distance of 20 meters. As a consequence, the right foot of the patient is not disturbed. On rheovasogramme right there was an increase in RI to 0.5, stroke volume 0,31 cm3; volumetric blood flow velocity of 2.6 cm3/minutes Left saved sine wave. Six months later the patient complained of a syndrome of intermittent claudication when driving at a distance of 500 meters. On rheovasogramme RI right to 0.6; stroke volume of 0.35 cm3; volumetric blood flow velocity of 2.8 cm3/min, left RI 0.5; stroke volume 0,31 cm3; volumetric blood flow velocity of 2.6 cm3/min.

Example 2. Patient D.; 72 years. The diagnosis of occlusive atherosclerosis of the lower extremities. Occlusion of right iliac and left femoral arteries. Ischemia 2B degree. Turned 18.05.99 with complaints of pain in the right gluteal region and the left foot that occurs when walking at the distance of 25 meters. On physical examination, is determined by the absence of pulsations in the right femoral and left padcal the indicators: RI 0,4; stroke volume of 0.25 cm3; the volumetric rate of flow of 2.23 cm3/min. the Patient made an introduction in the right gluteal muscle at a depth of 6 cm and the interosseous muscles of the left foot to a depth of 4 cm with a syringe alternately 0.5% solution of novocaine 20 ml of 20% solution of sodium oxybutyrate 10 ml of 1 times in 3 days in both limbs. The procedure was repeated 10 times. After six months at the control examination of complaints the patient is not present, RI on both legs 0.9; stroke volume of 0.55 cm3; the volumetric rate of flow of 3.56 cm3/min. In the result of the treatment, both patients returned to an active lifestyle.

Our proposed method is used in two hundred patients in the outpatient setting. With critical ischemia treatment was performed in 21 patients, five of whom had been suggested amputation of a limb. All patients under the influence of therapy on our proposed method were saved limbs, marked healing of trophic ulcers, elimination of pain at rest, increasing the distance of painless ways to 200 meters with preservation of therapeutic effect for a period of more than one year.

The method allows to increase the amount of collateral blood flow, to restore a functional active is the third we used rheovasography and Doppler.

The positive effect compared with the prototype turns out to be higher, as evidenced by the duration of remission, reaching a maturity of more than one year. This method has virtually no inflammatory complications. The effectiveness of the treatment when using our methodology is constantly increasing, reaching a maximum of one year after the start of treatment, unlike the prototype, the efficiency of which is preserved only in the last 3 months.

Comparative characteristic changes eographical index when applying our proposed method of treatment and the prototype shown in the drawing Initial introduction to the region the most disturbing ischemic pain of 0.5% solution of novocaine allows you to avoid unwanted pain. The subsequent introduction of a solution of sodium oxybutyrate does not cause pain. Alternate introduction solution of novocaine and sodium oxybutyrate avoids, on the one hand, undesirable chemical interactions of these drugs, and on the other hand, allows you to keep their concentration potential in interaction with tissues. The prototype is used semicontinuity cocktail, interaction of drugs which is operamania ischemic pain. Retroperitoneal introduction 200 ml of cocktail, repeated many times, can cause collapse scar process, the formation of hematoma retroperitoneal tissue, which is highly undesirable. In this method, the cocktail is introduced by the method of creeping infiltration in the medial belly of the gastrocnemius muscle regardless of the location of the pain center. According to our suggested way of introduction, i.e. in the region of the most disturbing ischemic pain medications alternately purposefully delivered to the lesion.

Alternate introduction of a 0.5% solution of novocaine and 20% solution of sodium oxybutyrate is performed under aseptic conditions using a single syringe. This avoids inflammatory complications. The proposed prototype retroperitoneal introduction of a cocktail, especially in patients with severe subcutaneous fatty tissue is a difficult manipulation due to insufficient length of the needle disposable syringe, and therefore requires the use of reusable syringes and needles.

Technical implementation of the proposed method is simple, at the same time sufficient to achieve a positive effect. Therefore, it can be applied for testing the m administered drugs 30 ml in the hearth most disturbing ischemic pain at a depth of 4-6 cm does not cause side effects requires only a 30-minute rest. The procedure is performed once in 3 days and repeat 10 times, easily tolerated, does not significantly alter the normal rhythm of life. The positive effect is achieved by alternating intramuscular a 0.5% solution of novocaine and 20% solution of sodium oxybutyrate in a certain place, namely, in the hearth of the most disturbing patient's ischemic pain. This method allowed unlike the prototype twice to increase the effectiveness of the treatment, to avoid possible side effects due to the alternate use of two drugs. A second course of treatment is suggested to one year. Its efficiency is high.

Sources of information 1. Elansky, N. N. Surgical diseases. - M.: Medicine, 1964.

2. Ermolaev C. L. Acute thrombosis of iliac-femoral venous segment (Some questions symptomatology, treatment and rehabilitation). Abstract. dis... Kida. the honey. Sciences. Sverdlovsk 1975.

3. Krotovskaya, S., Zabielska T. F. Mamedov, D. M. Clinical aspects of the use of vanaprastha in patients with atherosclerotic lesions of lower extremities vessels // Ter. arch. - 1991. - 8. - S. 64-69.

4. Lebedev L. C. Surgery of atherosclerosis and its about the forms of occlusive lesions of the vessels of the lower extremities. West. hir. - 1981. - So 126. 1. - S. 78-82.

6. Poyarkov C. D., Poyarkov E. C. Vnutrirodovoe use the new antihypoxic cocktail for the treatment of patients with occlusive vascular disease of the lower extremities. The ID innovations 629 from 02.04.99,

7. Serkin A. C. Early detection, differential diagnosis and complex treatment of patients with obliterating endarteritis in terms of examination: author. dis...Prof. the honey. Sciences. M - 1969. - 23 S.

8. The sokolovich A. G. New aspects of pathogenesis, diagnosis and treatment of critical ischemia of the lower extremities of atherosclerotic Genesis. Dis...Prof. the honey. Sciences. Tomsk. - 2000. - 369 S.

9. The sokolovich, E. Outpatient treatment of patients with chronic ischemic disorders in the extremities. Materials for distribution. excellence honey. keygen. troops. Novosibirsk: publishing house of WMO and SSB BONE, 1979. - S. 122-123.

10. Baumgartner I.; Pieczek, A.; Manor, O.; Blair, R.; Kearney, M.; Walsh, K. ; J. M. Isner Main manifestation intramuscular gene is to stimulate the growth of collateral vessels in patients with critical ischemia. Circulation, 1998, Mar., 31; 97 (12): 1114-23.

Claims

Method for the treatment of occlusive arterial disease of the limbs, which in the interior the region or area of maximum ischemic pain first imposed at 0.5% solution of novocaine at a dose of 20 ml, and then a 20% solution of sodium oxybutyrate in the dose of 10 ml once in 3 days for a course of 10 treatments.

 

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