Method for postoperation rehabilitation of patients with inspecific inflammatory intestinal diseases

FIELD: medicine, surgery, coloproctology.

SUBSTANCE: one should introduce gelatin-based colloids: gelatinol or gelofusin and crystalloids at 1:1 ratio at total volume of 40-50 ml/kg patient's body weight daily; additionally, since the 2nd to the 7th d after operation it is necessary to conduct enteral nutrition in the form of hypercaloric mixtures by increasing their volume at higher rate of injection starting from 25 ml/h/kg body weight on the 2nd and 3d d up to 100 ml/h on the 6th-7th d. The present innovation enables to improve nutrition of intestinal endothelium, decrease pathogenic and conditionally pathogenic microflora, prevents appearance of postoperational intestinal paresis and restores its function in more shortened terms.

EFFECT: higher efficiency.

1 ex, 3 tbl

 

The invention relates to medicine, surgery, Coloproctology, resuscitation, and can be used for postoperative rehabilitation of patients with non-specific inflammatory bowel disease.

The urgency of the present invention is related to the fact that the number of patients with non-specific inflammatory bowel disease, one is marked ulcerative colitis (UC) and Crohn's disease (CD), grows mainly in people of young working age (20 to 40 years). There has also been an increase in intestinal complications associated with the occurrence of toxic dilatation, perforation, bleeding, combined with extraintestinal complications: liver and biliary tract, kidney, pancreas, nervous system (Adler, Crohn's Disease and ulcerative colitis. Translation from German. Publishing house of M “GEOTAR. Honey.” 2001, pp. 83-115, 122-135, pages 410-415).

The number of patients with these diseases requiring surgical treatment, increases and postoperative period in them occurs with severe complications.

A common lesion of the mucous membrane of the colon in ulcerative colitis and inflammatory lesions of the entire thickness of the intestinal wall in terminal eleite and granulomatoses colitis (Crohn's disease) abruptly changes is a function of the gastrointestinal tract, creating a pronounced intestinal discomfort as the basis for intestinal failure and exhaustion (Kostyuchenko A. L. et al. Enteral nutritional support in intensive medicine. Special literature. S.-Pb. 1996, page 192).

The acuteness of the problem of surgical treatment of patients with UC and BC is associated not only with an extremely severe condition of patients, but the invasiveness and duration of intervention, as well as the need for long-term, comprehensive, intensive therapy in highly skilled Department. When UC and BC affecting all organs and systems, however, morphological changes in the colon primary and are crucial for the manifestation of changes in other organs and systems.

It is known that these diseases of the gastrointestinal tract impaired reabsorption of fluid from the intestine, which is normal to 2.5% of body weight, i.e. during the day in the gastrointestinal tract up to 8 liters of fluid, including proteins, electrolytes that the body loses through inflamed intestine (Crackin VA and co. Intensive therapy-threatening conditions. S.-Pb.: Medical publishing house. 2002, p.10). The replacement of these losses is very difficult.

Development of methods of intensive therapy on the stages of surgical treatment in patients with nonspecific will vocalic is selected bowel disease, with multi-organ disorders is poorly understood problem.

The claimed method was tested, in particular, in patients operated on for UC and BC who underwent surgery: Subtotal resection of the colon with the imposition of an ileostomy and salmostoma, resection of ileo-ceilinga Department of the colon with the imposition of ileo-ceilinga anastomosis, reconstructive surgery by creating small bowel reservoir, ileo-rectal anastomosis and preventive ileostomy.

The known method of postoperative rehabilitation, including infusion therapy during operations on the colon in patients with cancer of the colon (Smirnov V.I. Anesthesia and intensive therapy combined with extensive and combined abdominal surgical interventions. Abstract of Diss. on competition of a scientific degree of Dr. SC M., 1991, page 24). This source reveals the introduction of infusion of colloids and crystalloids in the ratio of 1:4, in which the basis of the colloids are dextrans, and crystalloids - glucose-saline solutions. Such a composition of infusion therapy in a large dilution and ratio of colloids to crystalloids 1:4 with the use of dextrans is not indicated in patients with nonspecific ulcerative colitis and Crohn's disease in connection with the original deficit they prekallikrein. In addition, the izkuyu blood viscosity in patients with UC and BC with the infusion of large amounts of crystalloids exacerbates water-electrolyte disorders in these patients with an initial lack of protein, which shows the effect of hemodilution and contributes to the development of disseminated intravascular coagulation (DIC). This large loss of intestinal contents, up to 8-9 liters per day in patients with inflammatory bowel disease will require with this method of increasing the amount of infusion from 80 to 100 ml per kg of body weight of the patient per day, which will increase the load on the cardiovascular system, liver, kidneys and other organs and can contribute to the development of multiple organ failure.

One of the analogues of the claimed invention is a method of clinical nutrition patients with UC and CD, which were used in two groups of patients (Rumyantsev VG nutritional therapy in inflammatory diseases of the colon. Doc., dis., M., 1992, pp. 266-272).

In the first group of patients use drug therapy (corticosteroids, salicylazosulfapyridine, antibacterial therapy, metrogylum) and enteral nutrition “Kozyata the rate of 500-700 g of dry powder per day, which range from 2500 to 3500 kcal (100 g) was dissolved in a volume of 300-400 ml), this mixture was used 5-7 times per day. In the second group of patients within 2-3 weeks was carried out probe power “Peptisorb” by nasogastric tube with a speed of 40-120 ml/h

However, these ways of doing “medical food” is not very effective for b is selected UC and BC after surgery, because these compounds require a large amount of cultivation that increases water stress on the patient, and large amounts of a single dose increase losses through the intestines and development in the early postoperative period malabsorption. Additionally, the long-term enteral nutrition in the early postoperative period is fraught with the development of pulmonary complications.

The closest analogues, taken as a prototype, is a method of infusion therapy when dealing with complicated course of ulcerative colitis and Crohn's disease, presented by Khachaturova E.A. and Soave. “Infusion-transfusion therapy and anesthesia emergency surgical interventions in patients with a complicated course of ulcerative colitis”, in proceedings of the third national conference of anesthesiology and resuscitation of Georgia. June 29-30, 1990. Tbilisi, pages 377-379. According to this method of infusion-transfusion therapy in different groups depending on metabolic disorders and the severity of the condition was different in scope and reach from 31,25 to 97.5 ml ml kg of body weight per day.

However, the main disadvantage of this method is that large volumes of infusion therapy after the operation, enhance the hemodilution in patients with UC and BC on hormonal therapy, drive the overall increase of fluid overload, the greater reduction in blood viscosity and increase bleeding from surgical wounds.

The aim of the present invention is postoperative rehabilitation of patients with diseases of UC and Crohn's disease in the shortest possible time.

Present for postoperative rehabilitation of patients with this disease are widely used hospital diet (table No. 4, No. 4B), which begin with 4-5 days after surgery, but they were ineffective because they do not contain enough protein, pharmaconutrition, in addition to learning a foreign protein requires more energy that must be expended for his trip. The above diet in terms of hypercatabolism not able to provide the body with sufficient energy. In a concentrated broth obtained when output 1 l of 1 kg of meat on the bone, contains only 2 g of protein (AA Pokrovsky health food. M.: Medicine, 1971, page 62).

It is known that in patients with traumatic operations of protein needs increase to 30 g, and the lack of protein and special nutrients is not conducive to effective restoration of nutritional deficiency, and developed enteric giperbolicheskie mixture or also called hypermetabolism diet, described in the source: Popova FORCE and other Nutrit the main support patients in critical States. M.: Publishing house “News”, 2002, pages 158-161 - 167. Data enteral diets are designed for those in the condition of patients with hypermetabolism and are characterized by high content of nitrogen in the composition of proteins or amino acids 1.5-2 g/kg / day and the ratio of non-protein calories to nitrogen of less than 120:1. In patients with inflammatory bowel disease recovery morphofunctional state of the intestine can be supported

the addition of glutamine and dietary fiber, which is the substrate for formation of short-chain fatty acids. Glutamine enhances the intestinal barrier by stimulating the proliferation and differentiation of enterocytes. In these diets contain medium chain triglycerides, omega-3 and omega-6 fatty acids in order to increase the resistance of patients to develop distress syndrome in adults, the syndrome of multiple organ failure and syndrome of disseminated coagulation (Ivashkin V.T. and other Brief guide gastroenterologie. M: LLC “Publishing house M-News”, 2001, pp. 366-375).

These blends are called fully balanced with high initial energy density at standard dilution (Nutridrink, Strescon), as they generally contain a small amount or not at all contain lactose (Left V.M. and Soave. Clinical nutrition in intensive honey is the Qing. Saint-Petersburg, 2002, page 100).

The technical result of the present invention contributes to the increase in total protein, albumin serum, hydration sectors, normalization of cholesterol and triglycerides, reduction of toxic metabolites, normalization of intestinal metabolites, and this, in turn, improves the nutrition of the intestinal epithelium contributes to the reduction of pathogenic and conditionally pathogenic microflora of the intestine, prevents postoperative paresis, promotes healing of anastomoses and recovery of bowel function.

The claimed technical result is achieved by the use of infusion therapy, including colloids and crystalloids in the ratio of 1:1 with the total volume of 40-50 ml/kg of body weight per day. Within 7 days, apply enteral nutrition from the second day after surgery giperbolicheskimi mixtures: Nutridrink, such as nutrizone-Energy, Stressor, Ensure plus, increasing their volume and speed of injection.

The merits of the method is that the use of infusion therapy, including colloids and crystalloids in the ratio of 1:1 due to severe loss of protein and electrolytes, as well as due to the presence of the effect of hemodilution and syndrome low blood viscosity in these patients. While the solutions imposed at the rate of 40-50 ml per kg body mass in su is key because higher volumes of infusion therapy aggravate the development of intracellular overhydration, protein-free swelling and contribute to the further reduction of blood viscosity, overload the cardiovascular system, the development of renal and hepatic and intestinal failure. Colloids, it is expedient to provide on the basis of gelatin (Relational or Gelofusine), and not on the basis of dextrans and starch, as will be discussed below.

As enteral nutrition from the second day after surgery, apply giperbolicheskie mixture or hypermetabolism diet, such as Nutridrink, such as nutrizone-Energy, Stressor, Ensure-plus, which contribute to the improvement of homeostasis: the increase of total protein, albumin, normalization of cholesterol and triglycerides, reduction of toxic metabolites, normalization of intestinal metabolites, restoration of the functional state of the intestine, i.e. the power of enterocytes, the restoration of the mucous membrane of the intestine, the normalization of short-chain fatty acids (CCGC) and their isomers, and this, in turn, contributes to the normalization of relations obligate intestinal microflora and restore intestinal digestion.

The applicant came to the fact that these compounds must be entered from the second day after the operation, because the mucous membrane of the intestine in terms of postoperative what about the period in need of food, she can get only by enteral, while it is appropriate to introduce these compounds within 7 days of enteral nutrition in this period allows you to restore the suction motor, evacuation, immune function of the gut.

We have developed an approximate scheme of introduction of the above giperkatolichesky mixtures taking into account the period of postoperative intervention:

day 2: 3,0-4,0 ml per kg of body weight per day at a rate of 25 ml per hour;

day 3: 7,0-8,5 ml per kg of body weight per day at a rate of 25 ml per hour;

day 4: 10,0-12,0 ml per kg of body weight per day at 50 ml per hour;

day 5: 14,0-16,0 ml per kg of body weight per day with a speed of 75 ml per hour;

day 6: 21,0-24,0 ml per kg of body weight per day at a rate of 100 ml per hour.

day 7: 21,0-24,0 ml per kg of body weight per day at a rate of 100 ml per hour.

We set the speed of introduction of preparations for enteral nutrition. The recommended rate of infusion of 25 ml/h for 2 and day 3, with subsequent increases absorption of the nutrient mixture to 100 ml/h for 6 - 7th day.

The use of enteral nutrition in compliance with the above recommendations contributes to the gradual adaptation of the small intestine to its functionality, as it takes on the function of the remote colon. This restores its epithelium, reduced intestinal metabolites, normalizes the intestinal microflora, improved near-wall and abdominal intestinal digestion, additionally, reduced absorption of water and electrolytes, is the formation of chyme and getting back to work an ileostomy. As well as the function of the small intestine after the operation is restored after a certain time, in this case, we found that when enteral nutrition and the time is 7 days.

The use of colloids on the basis of gelatin (Gelofuzina and Gelatinosa) in patients with UC and BC normalize blood viscosity, due to the fact that patients with UC and BC syndrome may develop low blood viscosity caused by disorders of kinin-kallikrein system and lack factor XII (factor Fletcher); therefore, application of colloids on the basis of dextrans and starch impractical in these patients.

Table No. 1
Metabolism on day 7 after surgery in patients with UC and BC
IndexBefore surgeryday 7 after surgery
GroupIIIIII
Total protein

Norm 56-80 g/l
51,26±2,5455,2±1,0551,09±1,05 62,5±1,75
Albumin

Norm 38-51 g/l
28,5±1,1628,67±1,1626,5±0,9838,4±1,36
Cholesterol

Rate of 3.8-6.5 g/l
2,28±0,253,45±0,282,45±0,34,9±0,78
Triglycerides

The rate of 0.6-2.28 Mmol/l
1,33±0,10,97±0,111,42±0,171,175±0,17
CZK rate mg/g2,001±0,781,998±0,101,261±0,70,227±0,09
Phenols

Norm 2,2±0.9 Mg/l
3,1±0,216,53±0,523,5±0,34,05±0,61
Nucleotides

The rate of 0.250±0,06% opt. Dps
0,325±0,130,435±0,070,357±0,190,326±0,03
SMP

Norm 0,240 0,03 adept. Dps
0,277±0,0490,401±0,0710,294±0,0570,343±0,75
Urea

The rate of 1.7-8.3 Mmol/l
7,20±1,036,4±0,711,08±0,584,92±0,6
Lymphocytes

Norm 19-37%
8±0,610,2±0,514,5±1,425,3±1,6
Viscosity

Rate of 3.6 poise
2,1±0,082,3±0,043,2±0,053,8±0,08
 I - Control group

II - Group with enteral nutrition
 

Table No. 2
The effect of enteral nutrition on intestinal function and metabolism
IndicatorsThe function of intestineRecovery
 work an ileostomystabilization of biocenosisprotein metabolism
E-such as nutrizone-Energy2-3 daysday 7day 7
Hospital Diet table No. 44-5 day10-12 day10-12 day
Table No. 3
Changes in the water sector in patients with UC and BC after surgery (% failed)
 Before surgery On the 7th day after surgery
Group1212
OO122,5+/-15,7121,4+/-15,3109,0+/sphere-6,4101,0+/-4,3
our75,6+/is 6.274,93+/-5,380,1+/-5,094,6+/-3,1
OCI144,5+/-30,3144, 0mm+/-27,9123,7+/-6,3114,0+/to-7.6
oij70,06+/-8,869,93+/to-9.278,6+/-4,786,1+/is 6.2
BCC84,2+/-3,383,67+/was 3.787,5+/-4,193,2+/-4,5
CGO82,7+/-3,282,55+/-3,3of 87.3+/-3,992,25+/-4,4

OO - total body fluid

OUR - volume of the extracellular fluid,

OKI - cell volume of the liquid,

OIG - volume interstitial fluid,

BCC volume of circulating blood,

CGO - the volume of circulating plasma

1 - control group (table 4),

2 - groupable with enteral nutrition.

The table shows that the introduction of enteral nutrition in the form of hypermetabolism mixtures from 2 to 7 day operations on the colon in the specified mode allows you to restore the disturbed homeostasis of patients affected by operations: Subtotal resection of the colon and ileostomy; ileocecal resection of the Department with the imposition of the anastomosis; reconstructive surgery to create small bowel reservoir, ileo-rectal anastomosis with preventive ileostomy; and to reduce the activity of pathogenic and conditionally pathogenic microflora of the intestine, to prevent the onset of paresis of the intestine and restore its functional activity, to stabilize the protein and fat metabolism and reduce intracellular overload.

Thus, the proposed method postoperative rehabilitation of patients with non-specific inflammatory bowel disease may be recommended surgery, Coloproctology, intensive care, gastroenterology.

Example 1: Patient E. ETC. 55 years old, height 164 see, weight 54 kg, was admitted to the SSC of Coloproctology 28. 07. 03. Diagnosis: ulcerative colitis, total loss, severe form, acute toxic dilatation of the colon. Chronic relapsing course. Carriage of hepatitis C.

Operation was performed 01. 08. 03 Subtotal the Naya resection of the colon with the formation of an ileostomy and salmostoma. On the first day after surgery, the patient total losses amounted 3760 ml, i.e. the volume of infusion therapy in the first day was 3760, or 3760 ml divided by 54 kg (patient weight)=69,6 ml/kg

On the second day after the operation was conducted medication therapy: corticosteroids - prednisone calculation of 2.0 mg/kg of body weight per day; antibacterial therapy: metrogel 6.8 ml per kg of body weight per day, Cefazolin 1 g every 6 hours, prokinetic to stimulate bowel - reglan 2 ml after 4 hours, 6 times per day; infusion therapy, including colloids: gelofusine 500 ml aminoplasmal 500 ml, albumin 10% - 200 ml fresh frozen plasma - 200 ml (a total of 1400 ml); crystalloids - trial 400 ml glucose-potassium mixture of 1000 ml (a total of 1400 ml).

The ratio of colloids and crystalloids amounted to 1400 to 1400, ie 1:1. So the total infusion volume was: 2800 ml divided by 54 kg (patient weight)=51,8 ml/kg of body weight per day.

In addition, from the second day started enteral nutrition giperbaricheskoi a mixture, such as nutrizone - Energy rate of 3.0 ml/kg multiply by 54 kg (patient weight)=162 ml with a speed of 25 ml every hour.

On the third day after surgery, continued the above drug therapy; infusion therapy consisted of colloids: aminoplasmal 1000 ml, albumin 10% 100ml; fresh frozen plasma 250 ml (1350 ml); crystalloids - glucose-potassium mixture is 1350 ml (1350).

The ratio of colloids and crystalloids was 1350 to 1350, ie 1:1. So the total infusion volume was: 2700 divided by 54 kg (patient weight)=50 ml/kg of body weight per day.

Expanded volume of enteral nutrition: 7,14 ml/kg of patient weight, which amounted to 7 times 54 kg (patient weight)=378 ml at a rate of 25 ml per hour.

On the fourth day after the operation continued medical therapy and infusion therapy, including colloids: aminoplasmal 1000 ml, albumin 10% 100 ml (total 1100 ml), crystalloids - glucose-potassium mixture 1100 ml. Ratio of colloids and crystalloids was 1100 and 1100, ie 1:1. So the total infusion volume was: 2200 ml divided by 54 kg (patient weight)=40,74 ml/kg of body weight per day.

Enteral nutrition“, such as nutrizone-Energy” was introduced at the rate of: 10.0 ml/kg of body weight multiplied by 54 (patient weight)=540 ml at 50 ml per hour.

On the fifth day after the operation continued medical therapy; infusion therapy consisted of colloids: aminoplasmal 1000 ml crystalloids - glucose-potassium mixture of 1000 ml. Ratio of colloids and crystalloids corresponded to 1:1.

So the total infusion volume was: 2000 ml divided by 54 kg (patient weight)=37,03 ml/kg of body weight per day.

Enteral nutrition“, such as nutrizone-Energy” was introduced at the rate of: 14 ml/kg multiply by 54 kg (patient weight)=756 ml with a speed of 75 ml per hour.

On the sixth de is ü after the operation continued medical therapy; infusion therapy consisted of colloids: aminoplasmal 500 ml gelofusine 500 ml (1000); crystalloids: glucose-potassium mixture of 1000 ml. Ratio of colloids 1000 ml and 1000 ml of crystalloids was 1:1.

So the total infusion volume was: 2000 ml divided by 54 kg (patient weight)=37,03 ml/kg of body weight per day.

Increased volume of enteral nutrition“, such as nutrizone-Energy based: 21,0 ml/kg multiply by 54 (patient weight)=1134 ml at a rate of 100 ml per hour.

On the 7th day after surgery reduced medical therapy, cancelled reglan, metrogylum, continued introduction of prednisolone from the calculation: 1.5 mg kg of body weight per day. Infusion therapy is reduced to a minimum, only if necessary, was performed correction of water-electrolyte metabolism. Enteral nutrition continued hypermetabolism a mixture, such as nutrizone-Energy based: 21,0 ml/kg multiply by 54 kg (patient weight)=1134 ml at a rate of 100 ml per hour, added table No. 4.

Conduct the drug therapy, including the introduction of prednisolone, prokinetic cerucal, antibacterial therapy; infusion therapy when the ratio of colloids and crystalloids 1:1, including from the second day of enteral nutrition hypermetabolism a mixture, such as nutrizone-Energy” scheme, helped to restore the gastro-intestinal tract, so on the second day separated by ileo the volume was 100 ml, on day 3 800 ml, the fourth day is 450 ml, the fifth day - 400 ml, 6 and 7 days in 400 ml.

According to laboratory tests, after surgery on the second day of the indicators of protein metabolism were: total protein of 56.4 g/l, albumin - 28.4 g/l, urea - 8.6 mmol/l and recovered to 7 days after surgery: total protein increased to 66.7 g/l, albumin to 38.7 g/l, urea decreased to 4.0 mmol/l; fat metabolism was reduced on day 2 after surgery: cholesterol to 2.3 mmol/l, triglycerides up to 0.6 mmol/l, 7 day fat metabolism improved: cholesterol increased and amounted to 5.7 mmol/l, triglycerides increased to 1.2 mmol/L.

There was a stabilization of indicators of blood viscosity at all shear rates, if on the second day after the operation, the viscosity of the blood in peasah was 2,9; 2,9; 3,0; 3,5; 3,6, after infusion therapy when the ratio of colloids and crystalloids 1:1, including colloids, prepared on the basis of gelatin “Gelofusine”, and on the 7th day after surgery, she came to normal: 3,9; 4,0; 4,1; 4,5; 5,1.

Decreased toxic metabolites: on day 2 after surgery, NSR was 0,380 unit opt. density, Nucleotides value (0.475) unit opt. density, Phenols 5,78 mg/l; on the 7th day after surgery, a significant reduction of toxic metabolites: NSR was 0,264 units, Nucleotides - 0, unit 310, Phenols - 3.4 mg/L.

Short-chain fatty acids studied in the AOC is in mg/g, while the norm is:

C2 (acetic acid) - 0,164, C3 (propionic) - 0,013, s (from oil) of 0.002, C4 (oil) - 0,005, iC5 (ISO-valeric) - 0,004, C5 (Valerian) - 0,004;

on the second day after surgery has increased several times:

C2 - (acetic acid) - 0,698, C3 (propionic) - 0,2296, iC4 (from oil) 0,1665, C4 (oil) - 0,276, iC5 (ISO-valeric) to 0.13, C5 (Valerian) - 0,149.

High performance short-chain fatty acids on the second day after surgery indicate violations of the ratios of the intestinal microflora by increasing the content of aerobes (high content of acetic acid), and high activity of anaerobic pathogenic and conditionally pathogenic microflora (high levels of propionic, valerianic and butyric acids), indicating that the increase in microbial proteolytic activity, change saharomicetov type of proteolytic fermentation, which leads to corrosion of glycocalyx and integrity of the intestinal epithelium, in addition, there is a breach of protein and energy metabolism in the liver and the nervous system, which indirectly indicate the high performance ISO-valerianic and ISO-butyric acids, as results confirming the presence of multi-organ disorders.

Short-chain fatty acids on the 7th day after surgery as a result of medication, infusion is therapy and enteral nutrition significantly declined in mg/g:

C2 - (acetic 0,064; C3 - (propionic) - 0,028, s - (somalina - 0,037; C4 (oil) - 0,039, iC5 - (ISO-valeric) - 0,039, C5 - (Valerian) - 0,069, which indicates the improvement ratios of the intestinal microflora, reducing the proteolytic type of fermentation and improved nutrition of the intestinal epithelium, recovery funkcionalnoy activity of the intestine in the postoperative period.

Water balance, measured by the method of rheography in %, on the second day after the operation were: total water body 111%, the total extracellular water is 79%, the total intracellular water is 128%; blood volume is 81%, the volume of circulating plasma is 81%, the volume of interstitial fluid is 77%, i.e. it was noted intracellular overload with fluid deficit by sector, driven not only by the loss of protein and electrolytes, and hormonal therapy, which was given to this patient courses for many years.

On the 7th day after the operation, the water balance amounted to: total water was 95%, extracellular 54%, intracellular 115%, blood volume 65%, the volume of circulating plasma 65%, interstitial fluid 48%, i.e. the use of drug, infusion therapy and enteral nutrition from the second day after surgery hypermetabolism a mixture, such as nutrizone-Energy” improved water balance: decreased botril the exact overload. The postoperative period was uneventful, laparotomic wound healed by first intention, the patient was discharged on the 14th day after the operation.

Thus, the claimed method allows to reduce the volume of infusion therapy in patients with UC and BC due to the inclusion from the second day after surgery, enteral nutrition hypermetabolism mixture, the amount of which increases its absorption by the epithelium, which allows you to restore the functional activity of the intestinal, enhance the metabolism and reduce the stay of patients in hospital.

The way postoperative rehabilitation of patients with non-specific inflammatory bowel disease: ulcerative colitis and Crohn's disease, including infusion therapy, wherein therapy includes colloids on the basis of gelatin - relational or gelofusine and crystalloids in a 1:1 ratio with a total volume of 40-50 ml/kg of patient weight per day, in addition to that from the 2nd to 7th days after the operation, conduct enteral nutrition in the form of giperkatolichesky mixtures, increasing their volume at increasing speed injection with 25 ml/h per kg body weight for 2-d and 3-and day to 100 ml/h for 6-7 days.



 

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EFFECT: expanded tumor treatment possibilities.

FIELD: medicine.

SUBSTANCE: method involves beginning disinvagination with mask narcosis by pumping air into large intestine under X-ray control. The invaginate remaining unstretched, the air is discharged from the intestine by massaging abdomen along the large intestine and pressing abdomen flanks. Next to it, air is pumped into the large intestine and invaginate stretching is carried out with an additional coercion by squeezing invaginated head out towards the neck part. No success being achieved, the procedure is repeated with mask narcosis to eight times. The invaginate remaining unstretched, endotracheal narcosis is given to the patient and myorelaxant drug of transitory action is introduced. Air volume introduced into the intestine is increased. The invaginate-stretching procedure is repeated with endotracheal narcosis to five times.

EFFECT: enhanced effectiveness of treatment.

FIELD: medicine.

SUBSTANCE: method involves administering triple injections of medicament mixture composed of Lidase 32 units, Anicaine 4ml, Dexamethazon 4 mg, Alflutop 1 ml, into Hoff fat pad.

EFFECT: reduced pain and knee joint edema manifestations; increased joint range of motions.

5 tbl

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