Method for rehabilitation in patients with hepatic dysfunction after operative interference upon common bile duct

FIELD: medicine, gastroenterology.

SUBSTANCE: a patient should follow a diet along with the intake of cholagogue species, oats decoction and symptomatic therapy. Moreover, at postoperative period a patient should be prescribed with the intake of drinking mineral water named "Ust' Kachkinskaya 1/99" at 38-40 C at total mineralization being 8.2-8.6 g/cu. m 40-60 min before meals 5-6 times daily at total amount of 200-250 ml for 24 d. Diet is fractional, 6 times daily, calorie amount of 2800-3000 kcal and decrease of highly digestible carbohydrates up to 30 g/d. The method enables to avoid application of hepatoprotectors and antioxidants during therapy to prevent polypragmasy.

EFFECT: higher efficiency of rehabilitation.

3 ex

 

The invention relates to medicine, namely to a gastroenterologist, and can be used for the rehabilitation of patients with liver dysfunction after surgery for common bile duct.

There is a method of rehabilitation of patients with liver dysfunction after surgery for common bile duct using the complex of therapeutic measures, including adherence, diet №5 Pevzner, protecting drugs (Essentiale, LIPOSTABIL etc) and antioxidants (Wagner, E.A., V.V. Khlebnikov, Terekhina N.A. Antioxidants in the treatment of patients with cholelithiasis // Vestnik St.Petersburg University. surgery. - 1997. - T. No. 1. - P.36-39; Rodionov, V.V., Filimonov M.I., Moguce V.M. Calculous cholecystitis: (Complicated by mechanical jaundice). - M.: Medicine, 1991, - 320 C.).

Cons: the duration of the rehabilitation period.

The invention is aimed at solving problems: reduce recovery time, increase the efficiency of the method.

These objectives are achieved by the fact that applies a complex of therapeutic measures. The patient in the postoperative period prescribed ingestion of drinking mineral water (CEM) “Ustkachkintseva 1/99” at a temperature of 38-40°With General mineralization of 8.2-8.6 g/m3the total volume of 200-250 ml for 40-60 minutes before meals 5-6 times a day for 24 days; fractional diet 6 times a day with calories 2800-3000 kcal and ogran the rising of digestible carbohydrates (sugar, jam, jam, honey, candy, etc.) up to 30 g per day; cholagogue collecting, for example No. 5 (“Grass Bashkiria”) at the rate of 100 ml per 30 minutes before Breakfast and lunch for 24 days; the decoction of oats at the rate of 200 ml per day.

Ustkachkintseva water wells 1/99, depth 47,0 m with a total mineralization of 8.2-8.6 g/DM3refers to moderately mineralized sulphate-chloride-calcium-sodium waters (C1 57-60, SO438-43, Na 65-72, CA 21-22 mg·EQ. %). Largest mineralization and the ratio of basic macro-it is close Evgeninskaya type (GOST 13273-88, group XVII).

The method is as follows: a patient with 10-12 days after surgery assign ingestion CEM “Ustkachkintseva 1/99” at a temperature of 38-40°With General mineralization of 8.2-8.6 g/m3for 40-60 minutes before a meal based on 200-250 ml divided by 5-6 receptions per day, for 24 days; fractional diet 6 times a day with calories 2800-3000 kcal and restriction of carbohydrate (sugar, jam, honey, candy, etc.) up to 30 g per day; cholagogue collecting, for example No. 5 (“Grass Bashkiria”) at the rate of 100 ml per 30 minutes before Breakfast and lunch for 24 days; the decoction of oats at the rate of 200 ml per day.

Examples of specific performance.

Example 1. Patient, 56 years. Diagnosis: cholelithiasis. Chronic calculous cholecystitis, acute stage. Stenosis of the large duodenal papilla II degree of Hepatic dysfunction. Was admitted to the gastroenterology Department of the resort-Pitching for 12 hours after endoscopic papillotomy, cholecystectomy. Common blood test on admission: erythrocytes - 3,7×1012leukocyte - 8,0×109(eosinophils - 8, stab - 6, segmented neutrophils - 46, lymphocytes - 36, monocytes - 4), ESR - 44 mm per hour. Biochemical blood test: whole protein - 74 g/l, glucose - 5.8 mmol/l, total bilirubin - 17.3 µmol/l, AST - 42 ME, ALT - 84 ME, ASAT/Alat - 0,5, alkaline phosphatase - 355,5 ME, thymol test - 4,6 units of Rogatory at entry: the index of the volume of liquid liver sinusoidal (IOPS) - 0,49 l/m2. The patient was prescribed intake of CEM “Ustkachkintseva 1/99” at a temperature of 38-40°With General mineralization of 8.2-8.6 g/m3a total volume of 200 ml for 40-60 minutes before meals 5-6 times a day for 24 days; fractional diet 6 times a day with calories 2800-3000 kcal and limit carbohydrates to 30 g per day; choleretic collection No. 5 (“Grass Bashkiria) 100 ml 30 minutes before Breakfast and lunch for 24 days; the decoction of oats 200 ml per day.

Common blood test after sanatorium-resort rehabilitation: erythrocytes - 4,0×1012leukocyte - 8,0×109(eosinophils - 5, band - 2, segmented neutrophils - 49, lymphocytes - 41, monocytes - 3), ESR - 28 mm per hour. Biochemical blood test: whole protein - 84 g/l, glucose - 4,mmol/l, total bilirubin - 12.1 µmol/l, AST - 24 ME, ALAT - 34 ME, ASAT/Alat - 0,71, alkaline phosphatase - 271 ME, thymol test - 4,5% Rogatory at discharge: IOPS - 0.65 l/m2. Thus, the patient returned to normal functional liver function tests, indicating the disappearance of hepatic dysfunction. The patient was discharged to work.

Example 2. Patient T., aged 52. Diagnosis: cholelithiasis. Chronic calculous cholecystitis, acute stage. Choledocholithiasis. Stenosis of the large duodenal papilla III degree. Hepatic dysfunction. Was admitted to the gastroenterology Department of the resort-Rolling on the 13th day after choledocholithotomy, transduodenal papillotomy, cholecystectomy. Common blood test on admission: erythrocytes - 4,1×1012leukocyte - 6,0×109(eosinophils - 4, band - 2, segmented neutrophils - 47, lymphocytes 44, monocytes - 3), ESR - 38 mm per hour. Biochemical blood test: whole protein 75 g/l, glucose - 4.9 mmol/l, total bilirubin and 10.8 µmol/l, AST - 38 ME, ALT - 69 ME, ASAT/Alat - 0,55, alkaline phosphatase - 248 ME, thymol test - 7,8% Rogatory admission: IOPS - 0,53 l/m2. Prescribed for the patient ingestion CEM “Ustkachkintseva 1/99” a total volume of 250 ml for 40-60 minutes before meals 5-6 times a day for 24 days; fractional diet 6 times a day with calories 2800-3000 kcal and limit the easier the digestible carbs to 30 grams per day; choleretic collection No. 5 (“Grass Bashkiria) 100 ml 30 minutes before Breakfast and lunch for 24 days; the decoction of oats 200 ml per day.

Common blood test after sanatorium-resort rehabilitation: erythrocytes - 4,3×1012leukocyte - 5,0×109(eosinophils - 3, band - 2, segmented neutrophils - 38, lymphocytes - 53, monocytes - 4), ESR - 27 mm per hour. Biochemical blood test: whole protein - 85 g/l, glucose - 4.9 mmol/l, total bilirubin - 9.0 µmol/l, AST - 27 ME, ALAT - 26 ME, ASAT/Alat - 1,04, alkaline phosphatase - 136 ME, thymol test - 10,8% Rogatory at discharge: IOPS - 1.22 l/m2. Thus, the patient noted normalization of functional hepatic tests, indicating the disappearance of hepatic dysfunction. The patient is discharged through the day to work.

Example 3. Patient O., 38 years. Diagnosis: cholelithiasis. Chronic calculous cholecystitis, acute stage. Choledocholithiasis. Stenosis of the large duodenal papilla III degree. Obstructive jaundice. Hepatic dysfunction.

Discharged from the emergency Department surgery Bureau on 15 day after choledocholithotomy, transduodenal papillosphincterotomy, cholecystectomy. Common blood test at hospital discharge: erythrocytes - 3,8×1012leukocyte - 17,1×109(eosinophils - 2, band - 4, segmented neutrophils - 54, l is mocity - 33, monocytes - 7), ESR - 27 mm per hour. Biochemical analysis of blood at the time of discharge from hospital: total protein - 65 g/l, glucose - 5.0 mmol/l, total bilirubin - 21 µmol/l, AST - 75 ME, ALT - 84 ME, ASAT/Alat - 0,89, alkaline phosphatase - 125 ME. Rogatory at discharge from hospital: IOPS - 0,78 l/m2. The patient is assigned to outpatient treatment, including: table 1 dragee 3 times a day, Kars 1 dragee 3 times a day, decoction of oats 100 ml 2 times a day (before Breakfast and dinner for 30-40 minutes). Common blood test after outpatient treatment: erythrocytes - 3,9×1012leukocyte - 7,8×109(eosinophils - 2, band - 3, segmented neutrophils - 58, lymphocytes - 34, monocytes - 3), ESR - 15 mm per hour. Biochemical analysis of blood after outpatient treatment: total protein - 67 g/l, glucose - 4.8 mmol/l, total bilirubin of 20 µmol/l, AST - 60 ME, ALAT - 64 ME, ASAT/Alat - 0,93, alkaline phosphatase - 144 ME. Reoperate after outpatient treatment: IOPS - 0.99 l/m2. As a result of rehabilitation in the outpatient setting, the patient remained hypertransaminasemia, and the level of alkaline phosphatase even moderately increased, i.e. signs of hepatic dysfunction remained.

The advantage of the proposed method in rehabilitation of patients with liver dysfunction after surgery for common bile duct without N. the values of hepatic and antioxidants, accelerated rehabilitation treatment and time spent on sick leave for 10-12 days.

The method of rehabilitation of patients with liver dysfunction after surgery for common bile duct, including diet, the purpose of the cholagogue collecting, decoction of oats and symptomatic therapy, wherein the patient in the postoperative period prescribed ingestion CEM “Ustkachkintseva 1/99” at a temperature of 38-40°With General mineralization of 8.2-8.6 g/m3for 40-60 minutes before eating 5-6 times a day with a total volume of 200-250 ml for 24 days, fractional diet 6 times a day with calories 2800-3000 kcal and limit carbohydrates to 30 g per day.



 

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