Method for stimulating motor intestinal activity in patients with vertebral traumas

FIELD: medicine, surgery.

SUBSTANCE: one should introduce solution "Rheamberin 1.5%"intravenously with infusomates at the dosage of 5 ml/kg/d during the next 5 d. Then, 1-2 h later, one should infuse intravenously "Dalargin" at 30 mg/kg/d dissolved in 60 ml 0.9% sodium chloride at the rate of 120 ml/h for 5 d. Additionally, 4-5 h after "Dalargin" injection it is necessary to perform daily intravenous He-Ne laser irradiation of blood beginning since the first day at wave length being 0.63 mcm, power 1 mW, exposure 50-60 min, course lasts for 5 d. The method enables to interrupt intestinal paresis in case of vertebral traumas and wounds in earlier terms.

EFFECT: higher efficiency of therapy.

1 ex

 

The invention relates to medicine, namely to surgery, resuscitation and intensive therapy, and can be used in patients with guns and mine-explosive injuries and spinal cord injuries.

There is a method to drug stimulation of motor activity of the small intestine with the introduction of chlorpromazine and other neuroleptic drugs series (Vchost.exe etc./ Peritonitis, M, Medicine, 1992, s). The mechanism of action is based on blocking the effects of the sympathetic nervous system, resulting in improved intestinal blood flow and as a consequence motor activity.

The disadvantage of this method is the reduction of blood pressure, which is unacceptable for patients in critical condition.

Known method of promoting motor activity of the intestine using cerucal and other prokinetics. The mechanism of action is associated with a Central influence on the trigger zone of the brain stem (Mashkovsky PPM/Drugs. Medicine, 1984, s).

The disadvantage of using these drugs is their lack of effectiveness in the presence of a serious spinal injury.

Known method of promoting motor activity of the intestine proserin (Mashkovsky PPM/Drugs M, Medicine, 1984, s). The mechanism of action of drugs is anticholinesterase the action, that leads to increased intestinal motility.

The disadvantage of using drugs is a violation of electrolyte balance, sudden release of potassium in the blood, which makes its correction. Neostigmine has its positive antipireticescoe action short - only on the first day of the postoperative period (Vchost.exe etc. / Peritonitis, M, Medicine, 1992, s).

The literature describes a method of stimulation of motor activity of the intestine in patients after surgery for bowel preparation "Dalargin (Chestnov A.K. and others, 2003, Patent number 2217139, B. I. No. 33 dated 27.11.2003,, Application No. 2002113978 from 28.05.2002,).

The disadvantage of using this drug as monotherapy is low efficiency of treatment and the short duration of action in patients with severe gunshot mine-explosive injuries and spinal cord injuries.

The claimed invention is directed to solution of the problem consisting in the development of the method of stimulation of motor activity of the intestine in patients with spinal cord injuries, as well as with fire, mines and explosive injuries and spinal cord injuries.

The solution to this problem will allow to significantly increase the efficiency of treatment of patients with this disease, improve treatment outcomes and reduce hospital stay.

To achieve this, technical rez is litate the invention provides the following significant features: use a solution of Reamberine 1,5%, intravenous infusion pump at a dose of 5 ml/kg/day for the first 2-3 hours after injury and daily, once in the morning in the next 5 days, then 1-2 hours infuziruut intravenous "Dalargin at the rate of 30 mg/kg/day, dissolved in 60 ml of 0.9% physiological solution of sodium chloride at a rate of 120 ml /HR for 5 days, additional 4-5 hours after injection of Dalargin" produce daily, starting on the first day, intravenous helium-neon laser irradiation of blood with a wavelength of 0.63, 1 mW, exposure time 50-60 minutes, the course of 5 days.

Between the features and the result has the following causal relationship: use a solution "Reamberine of 1.5%, intravenous infusion pump at a dose of 5 ml/kg/day. During the first 2-3 hours after injury and then daily, once in the morning the next 5 days.

The drug "Reamberin has neuro-, cardio-, hepato - and nephroprotective, antihypoxic, detoxification and antioxidant effect. The main pharmacological effect of the drug is due to the ability to enhance the compensatory activity of aerobic glycolysis, to reduce the degree of inhibition of oxidative processes in the Krebs cycle in hypoxia with an increase in the content of ATP and creatine phosphate. "Reamberin" activates anti siantou system of enzymes and inhibits the processes of lipid peroxidation in esibizioni bodies, providing a stabilizing effect (Vaiaku, Twilog, Allowance, Megamasso "Reamberin in the treatment of critical conditions", St. Petersburg, 2001). The same authors medication "Reamberin of 1.5% is recommended as the metabolic corrector. "Reamberin of 1.5% reduces the level of free-radical processes in the brain and spinal cord, weakens the destruction of membrane elements, neurons and promotes the full restoration of their functions and structure. Allowance, Auero, Megamasso “Biological activity and pharmacological activity of UC.” St. Petersburg, 2000, Then 1-2 hours infuziruut intravenous "Dalargin at the rate of 30 mg/ kg/ day, dissolved in 60 ml of 0.9% physiological solution of sodium chloride at a rate of 120 ml /HR for 5 days.

The drug "Dalargin" has anti-stress effect, inhibiting production of stress hormones (ACTH, cortisol, thyroxine, vasopressin, and others), catecholamines (Yelsk V.H., Slepushkin E, Samsonenko R.A., etc./Pathophysiology, 1985, No. 6, p.15-19; Prom I.A., Slepushkin E, Lishmanov B. I. “Bulletin of experimental biology”, 1984, No. 7, p.18-19). In addition, "Dalargin" has a direct impact on enkephalinase receptors antarinova system (Loginov A.S., Parfenov I.A., Ruchkin I.N. "Dalargin effective tool in the treatment of syndrome time is expressed bowel/ ROS. Gastroenterology journal, 1996, No. 4, p.41-45).

Experimental studies (Khlystov centuries, Pavlenko B.C., Slepushkin E/ Biol. Vsesojuzn. Cardiol. Scient. Center of medical Sciences of the USSR, 1986, No. 2, p.54-55) showed improvement of microcirculation in the stomach and small intestine of rats, who were appointed "Dalargin".

After 4-5 hours after injection of Dalargin" produce daily, starting on the first day, intravenous helium-neon laser irradiation of blood with a wavelength of 0.63 µm, 1 mW, exposure time 50-60 minutes, the course of 5 days.

Biological action of low-intensity laser radiation on the human body is realized in the form of activation of enzymes in erythrocytes, the improvement of rheological properties of blood, normalization of lipid peroxidation, changes in the immune system, normalize the energy balance (loan KU "Lasers in experiment and clinic", M, 1972).

Laser radiation can significantly increase the effectiveness of treatment due to immune disorders, allowing for elimination of immune imbalance that occurs in patients with spinal cord injuries.

When using "Reamberine", "Dalargin and intravenous laser irradiation of blood in the complex can be cut short paresis of the intestine due to trauma and injuries of the spine.

According to the authors of the data set exists, the only signs characterizing the essence of the claimed invention, is not known from the prior art, which allows to make a conclusion about conformity of the invention, the criterion of "novelty".

According to the authors, the essence of the invention is not necessary for the expert in the obvious way from the prior art, since it is not detected by the above-mentioned effect on the resulting technical result - increase of efficiency of treatment of patients with injuries and injuries of the spine, reducing the time of their stay in hospital, which allows to conclude that the criterion of "inventive step".

The set of essential features that characterize the invention are, in principle, can be repeatedly used in surgery, resuscitation and intensive therapy, with results in faster recovery of motor activity of the intestine, which allows to make a conclusion about conformity of the invention, the criterion of "industrial applicability".

The inventive method of stimulation of the intestines in fire, mines and explosive injuries and spinal cord injuries as follows: a study was conducted in two groups of victims with gunshot mines and explosive injuries and spinal cord injuries. All patients were treated in the intensive care branch the resuscitation Vladikavkaz military hospital of the Ministry of Defence, where did directly from the zone of hostilities in Chechnya.

The state of the victims were assessed as severe (8,3±0.7 points on a scale TOLC-P (PR)).

In the first control group included 36 patients, the second main 38 patients. The selected groups were representative in terms of gender and age composition, time since injury, and the severity of the shock, the degree of blood loss, nature of injury, severity of injury and the condition that makes a valid comparative analysis.

During the survey it was found that the paresis I pronounced 36.3%, II degree in 54% of cases, and III degree in 9.7% of cases.

Assessment of the motor activity of the intestine was performed auscultatory and using records electromyography (EAMG-4M).

The criterion for restoration of intestinal peristalsis was the appearance on EAMG waves with an amplitude of 350-550 mV, frequency 14-18 min, which is clinically accompanied by the discharge of gases, listening to a full intestinal peristalsis, decrease signs of intoxication.

Victims of the first group received therapy using standard techniques, including reglan and neostigmine. Restoration of adequate intestinal peristalsis occurred on average 5-6 days.

In patients of group II stimulation of motor activity of the intestine was held on the proposed method using a solution is "Reamberine to 1.5%", intravenous infusion pump at a dose of 5 ml/kg/day for the first 2-3 hours after the injury and once daily in the morning in the next 5 days, then 1-2 hours was infusional intravenous "Dalargin at the rate of 30 mg/kg/day, dissolved in 60 ml of 0.9% physiological solution of sodium chloride at a rate of 120 ml /HR for 5 days, additional 4-5 hours after injection of Dalargin" produced daily, starting on the first day, intravenous helium-neon laser irradiation of blood with a wavelength of 0.63 µm, power 1 mW, exposure time 50-60 minutes, the course of 5 days.

Restoration of intestinal peristalsis occurred on average on day 3 or 4.

Thus, the elimination of symptoms of paresis of the intestine in patients of group II of the proposed method was held on 1-2 days earlier than in the I group. This allows us to conclude that the proposed method of stimulation of motor activity of the intestine in patients with spinal cord injuries is more effective than known in modern practical medicine.

An example of a specific application.

Patient C.,19 years old, was hospitalized 18.02.2001 year in 4 hours and 15 minutes in the intensive care unit of the hospital of Vladikavkaz military hospital. Was diagnosed with “Gunshot gunshot wound in the back. Gunshot fracture of the spinous from otka and temples of the 12th thoracic vertebra. The shock of the second degree.”

Two hours before admission, while being on active duty was injured in the emergency order by air delivered to the stage of providing skilled care.

The state of admission regarded as heavy (8.6 points on a scale TOLC-P(PR)), a/D 90/60 mm Hg, pulse rate is 120 per minute. The wounded man was placed in intensive care, Department of anesthesiology and intensive care. Auscultatory and elektroentsefalograficheskie presence of paresis of the intestine II-nd degree. The Department carried out an intensive therapy aimed at mild shock (introduction analgesics or General anesthesia, conduction of infusion-transfusion events with the use of the solution “Reamberin of 1.5%in a dose of 5 ml/kg/day). Two hours after receipt of the casualty's condition stabilized - a/D went up to 120/80 mm Hg To therapy connected infusion of Dalargin" intravenously at the rate of 30 mg/kg/day, dissolved in 60 ml of 0.9% physiological solution of sodium chloride at a rate of 120 ml /hour. At the same time it was decided to revise the area of injury, including the removal of the destroyed tissues and bone fragments, creating a decompression of the spinal cord and stop bleeding. During the intervention conducted multicomponent ketamine-ventanilla anesthesia without any complications./p>

5 hours after end of infusion "of Dalargin, through the subclavian catheter, a flexible light guide of the apparatus ALOKA-1 held helium-neon laser blood irradiation wavelength of 0.63 µm, 1 mW, exposure time 50 minutes

Further, within five days has been the conventional treatment, which included infusion-transfusion, antibacterial, prophylactic anticoagulant, antimicrobial, cardioprotective therapy. Daily, with the aim of stepping motor activity of the intestine, was applied to the above triad in the specified sequence. Neostigmine, neuroleptic drugs and reglan was not used.

On the second day on EAMG there was an increase of electric potential, and by the end of the third day was determined active intestinal peristalsis and the discharge of gases, which was confirmed by the presence on EAMG waves with a frequency of 0.05-0.2 Hz with an amplitude of 400 to 500 µv. The period of stabilization and normalization of the functions of vital organs was uneventful, which gave the opportunity for an earlier transfer of the victim to the next stage of rehabilitation.

The method of stimulation of motor activity of kishechnika in patients with spinal cord injuries, characterized in that the used solution “Reamberin to 1.5%”, administered intravenously by infusion pump at a dose of 5 ml/kg/day for the first 2-3 spoke injury and once daily in the morning in the next 5 days, then, after 1-2 h infuziruut intravenous “Dalargin at the rate of 30 mg/kg/day, dissolved in 60 ml of 0.9%physiological solution of sodium chloride at a rate of 120 ml/h for 5 days, additional 4-5 h after injection of Dalargin” produce daily, starting on the first day, intravenous helium-neon laser irradiation of blood with a wavelength of 0.63 µm, 1 mW, exposure time 50-60 minutes, the course of 5 days.



 

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3 ex

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1 ex, 2 tbl

FIELD: medicine, pharmacy.

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8 cl, 16 tbl, 39 ex

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1 ex, 5 tbl

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3 ex

FIELD: organic chemistry, medicine, pharmacy.

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or

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13 cl, 88 ex

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or

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13 cl, 88 ex

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6 cl, 5 tbl, 19 ex

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2 ex

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3 cl, 1 ex

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2 ex

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5 cl, 3 dwg

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EFFECT: enhanced effectiveness of treatment.

FIELD: medicine.

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3 cl

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2 cl

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EFFECT: valuable medicinal properties of agent.

3 cl, 4 tbl, 2 ex

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