A method for the treatment of deep venous thrombosis of the lower extremities

 

The invention relates to medicine, to methods afferent therapy and can be used for the treatment of deep venous thrombosis of the lower extremities. Before the blood sampling of the patient's veins are 50-70 U/kg of heparin, produce blood from the patient's vein 2-4 ml per kg of body weight of the patient, carry out ultraviolet irradiation collected blood at an average dose of 1 j/cm²the area of the irradiated surface of the cell is equal to 30 cm², further is carried out 2 times a week discrete plasmapheresis blood, the velocity of blood is 25-40 ml/min and the extraction of plasma per procedure is 8-10 ml/kg, simultaneously administered to the patient angioprotectors. This invention improves the effectiveness of treatment of deep venous thrombosis of the lower extremities, speeding the process of recanalization and prevent the development of trophic disorders prior recanalization. 4 Il.

The invention relates to medicine, in particular to methods and means of treatment of deep venous thrombosis of the lower extremities.

The closest in technical essence and the achieved effect is the method of treatment is the ATA. Such as direct anticoagulants, such as heparin for 5 days followed by transfer to indirect anticoagulants, such as warfarin for 3 months (O. K. Laurence, Clinical Pharmacology, 1987). Fibrinolytic drugs in the proximal thrombosis are of limited use in connection with late (>7 days) treatment of patients.

The disadvantage of this method of treatment is the fact that the use of anticoagulants causes a number of side effects: the use of direct anticoagulants may include bleeding, thrombocytopenia, “rebound” effect when you cancel heparin; with long-term administration of the drug may cause osteoporosis, the transient alopecia.

The effect of indirect anticoagulants can cause bleeding, especially in patients with ischemic cerebrovascular disease, venous thromboembolism and ischemic heart disease. Contraindications to the use of indirect anticoagulants during pregnancy due to penetration through the placental barrier. Despite treatment, the process of organizing thrombus with recanalization of the venous bed is quite slow.

The average stage mechanisatie is accompanied by the appearance by this time, trophic disorders. The technical result, which directed the establishment of this invention is to increase efficiency of treatment of deep-vein thrombosis of the lower extremities, by speeding up the process of recanalization with an average of 4 years to 1.5 years and prevent the development of trophic disorders prior recanalization.

Theoretical background of the proposed method of treatment are the data reported in A. Vogt, Shimisi P. // Kidney Int. - 1982. - Vl.22. - R. 27-35; Konstantinova, I. A. Evaluation of pathogenic and non-pathogenic immune complexes. - M.: Method. Recommendations the Ministry of health, USSR, 1986, Konstantinova N. A., Lavrentiev centuries, Kovalchuk L. C., Petrov R. C. Determination of circulating immune complexes in humans // Laboratory work. - 1982. No. 11. -S. 673-676.

They define the correlation relationship between the excess of circulating immune complexes (CIC), activation of the hemostatic system and inhibition of the complement system. Emphasizing the important role of the reticuloendothelial system (RES) in the natural process of fibrinolysis, the authors point to the presence of functional block RES amid excess of circulating immune complexes (CIC). This leads to slow and perversion (thrombus) lysis of the thrombus. Our research shows criminalities activity the increase of acute phase proteins (seromucoid), immunoglobulins and CEC. And, significantly reduced the level of cell-mediated immunity (CD) is not restored to the stage of complete recanalization of the thrombus. In Fig.1 shows the dynamics of changes in cellular immunity (CD) and complement activity (KA) in patients with postthrombotic disease in the stage of occlusion. These changes are characteristic of the immune process.

In the proposed method of treatment, the effects of exercise on the system reticuloendothelial system (RES). The activation functions of the macrophage system, "unlocking receptors RES" (Lookwood C. M., Peters D. K. Ann Rev. Med., 1980, v.31, R. 167-169; Cjrdonnier D., Vialtel P., Chenais F. et al. - In: Plasma Exchange. Stuttgart, 1980, p.213-219; Gibert E. B., Silver N. B. and other Endogenous photomodification functional state of cells // Efferent therapy, 1995, T. 1, No. 3. - S. 56-58).

Normalization of hemostasis occurs secondarily and indirectly, through normalization of the level of circulating immune complexes (CIC).

The technical result - increase of efficiency of treatment of deep venous thrombosis of the lower extremities, speeding up the process of recanalization and the prevention of the development of trophic disorders before the period of racanelli macrophage system and “unlocking” of the receptors of the reticuloendothelial system.

The technical result is achieved in that in the method of treatment of deep venous thrombosis of the lower extremities based on the use of drugs injected into a vein of the patient 50-70 U/kg of heparin, produce blood from the patient's vein 2-4 ml per kg of body weight, carry out ultraviolet irradiation collected blood at an average dose of 1 j/cm², then hold 2 times a week discrete plasmapheresis blood, simultaneously administered to the patient angioprotectors.

A method for the treatment of deep venous thrombosis of the lower extremities is as follows: before the blood sampling of the patient's veins are 50-70 U/kg of heparin. Produce drawing blood from a vein of the patient in 2-4 ml per kg of body weight of the patient, carry out ultraviolet irradiation collected blood at an average dose of 1 j/cm²the area of the irradiated surface of the cell is equal to 30 cm².

Then hold 2 times a week discrete plasmapheresis blood, the velocity of blood is 25-40 ml/min and the extraction of plasma per procedure is 8-10 ml/kg

The number of treatments plasmapheresis calculated with respect to exchange of plasticstoday 75-the Oia donor preparations by a combination of hemocorrection (poliglyukin, reopoliglyukin, gemodez) and crystalloid solutions (1:3). At the same time the patient is given angioprotectors.

Ultraviolet blood irradiation produced by the apparatus of the MD-73M “Isolde” with mercury germicidal lamp [DRB] 8-1 to 8 watts, reversible motor RD-09.

Plasmapheresis is produced using a refrigerated centrifuge RS-6 in g mode=1800, T=20-25C, t=15 min, plastic containers 500/300 (Baxter, USA, stabilizer, at put od srda street-1), the roller pump AK (“Gambro, Sweden), mechanical Plasmacluster ("Delta SP", Korea).

Example 1

Patient A., 1956 R., and B. No. 1045, received 13.10.97 years with a diagnosis of retrobus deep veins of left hip with complaints of swelling, sharp pain in the left lower extremity, sharply increasing after the walk. Considers himself ill since July 1997, when a diagnosis of acute deep venous thrombosis of the femoral segment of the left lower extremity was hospitalized for 1.5 months. Based on the statement was made following treatment: reopoliglyukin, trental, heparin, nicotinic acid, magnetotherapy. After discharge from hospital notes heaviness in the lower limbs and sharp increase in swelling after walking.

On the recommendation of the vascular Department of the clinic of hospital surgery. Objectively: the left lower limb edema, the difference in diameter of the lower extremities in the direction of the patient is: at the level of the middle third of the thigh 5 cm, at the level of the middle third of the leg 4 see noteworthy sharply underlined venous figure in the field of femur and tibia. Generated by ultrasonic Doppler study: occlusion at the level of the femoral-popliteal segment. (The results of thermographic survey is shown in Fig. 2, which shows thermogram of the thigh and inguinal of lymphosarcoma before treatment (274) and after a course of conservative treatment (281 (A)).

The patient is offered a full course of treatment performed at this stage of the disease. Due to "lack of time" patient refused the proposed scheme. Produced treatment: reopoliglyukin, heparin, Actovegin, diclofen, nicotinic acid, magnetotherapy, Detralex. On day 7, the patient is assigned vanilin. The patient's condition has improved: pain and swelling has decreased considerably, the difference in diameter of the lower extremities in the direction of the patient limb was: at the level of the middle third of the thigh 3 cm, at the level of the middle third of the leg 3, see the Control-Doppler study did not reveal the dynamics is of lymphosarcoma after a course of conventional treatment) celebrated the preservation of maximum temperature 40,87With no significant reduction in the square of the temperature (282-270 pixels), but the total area of hyperthermia increased from 2100 to 2488 pixels (p<0,01). At the insistence of the patient was discharged 9.10.97.

Reentry 15.10.97. Upon receipt produced Doppler study: ileofemoral thrombosis up to the level of bifurcation of the iliac vein with a complete absence of blood flow. Objective: underline venous pattern on the thigh, the left half of hypogastric, the difference in diameter in the direction of the patient limb at the level of the middle third of the thigh is 6 cm, at the level of the middle third of the leg 4 see Tests: er - 4,0510¹²/l, HB - 155 g/l, Les - the 5.4510⁹/l, p - 2%, with 77% e - 1%, b-, LF - 16%, m - 6%, ESR - 19 mm/h, seromucoid - 272 UNITS, circulating immune complexes (CIC) - 120 UNITS, clotting time - 5’40’, time retraction - 12’40’, fibrinolysis - 2,94%. Produced treatment: Ultraviolet blood irradiation (AUTOC) No. 6, discrete plasmapheresis No. 6, agapurin, Actovegin, diclofen, nicotinic acid, ascorbic acid. The patient's condition has improved markedly, swelling at the level of the middle third of the thigh, and lower leg is towards the patient limb 2 see a complete examination on the subject.

Control ultrasonography (USDG) 31.10.97 allowed to reveal on the level of the common femoral (S=0.1 cm², mv=6,9 cm/s, vol=41 ml/min) and popliteal vein (S=0.1 cm², mv=5,9 cm/s, vol=16 ml/min), signs of recanalization. Thermographically is determined by reducing the maximum temperature to 40,62(P>0,05), the decline in the total area of hyperthermia to 1651 pixel (Fig. 4 is a diagram of a direct inguinal of lymphosarcoma after a course of conservative therapy using AUTOC and plasmapheresis, the total area of hyperthermia is 1651 pixel, the area of hyperthermia higher average temperature is 145 pixels, the maximum temperature is 40,62C). The patient was discharged 6.11.97 recommendations. Tests at discharge: er - 4,2810¹²/l, HB - 124 g/l, Le 6,510⁹/l, p - 2%, 65%, e-, b-, LF - 28%, m 5%, ESR - 12 mm/h, seromucoid - ED 197, CEC - 105 UNITS, clotting time 9’20’, the time of retraction 14’, fibrinolysis 22%.

Spent an analysis of the prior art, including searching by the patent and scientific and technical information sources, and identify sources that contain information about the equivalents of the claimed invention, has allowed to establish that sabrinakam of the claimed invention.

The definition from the list of identified unique prototype allowed us to identify a set of essential in relation to perceived technical result of the distinctive features in the claimed method of treatment of deep venous thrombosis of the lower extremities, set forth in the claims.

Therefore, the claimed method of treatment meets the criteria of the invention of “novelty.”

To check compliance with the invention, the criterion of “inventive step” applicants conducted an additional search of the known solutions to identify signs that match the distinctive features of the prototype of the features of the proposed method of treatment.

The search results showed that the claimed invention is not apparent to the expert in the obvious way from the prior art, certain applicants. No impact envisaged the essential features of the claimed invention transformations to achieve a technical result.

Therefore, the claimed invention “industrial applicability” is confirmed by the fact that the proposed method for the treatment of deep venous thrombosis of the lower extremities can be successfully used to treat patients in a wide network of therapeutic whom I adopted in the medical clinics of Russia and CIS.

Claims

A method for the treatment of deep venous thrombosis of the lower extremities based on the use of drugs, characterized in that before the blood sampling of the patient's veins are 50-70 U/kg of heparin, produce blood from the patient's vein 2-4 ml per kg of body weight of the patient, carry out ultraviolet irradiation collected blood at an average dose of 1 j/cm²the area of the irradiated surface of the cell is equal to 30 cm², further is carried out 2 times a week discrete plasmapheresis blood, the velocity of blood is 25-40 ml/min and the extraction of plasma per procedure is 8-10 ml/kg, simultaneously administered to the patient angioprotectors.