Method for treating chronic occluding diseases in arteries of inferior limbs

FIELD: medicine, surgery.

SUBSTANCE: medicinal mixture consisting of 10 ml 0.25%-novocaine, 1 ml 1%-emoxypin and 64 c.u. lidase should be injected strictly subcutaneously per 1 ml for each point of injection into the center of plantar surface of nail phalanx of every toe, and for the first inter-toe space - subcutaneously in plantar and rear directions, then, after injections, it is necessary to carry out massage in area if injection with stretching and stroking movements in proximal direction for 10-15 sec, moreover curative seances should be performed every other day , the course being of 5-10 procedures, at repeating this course 3-6 mo later. The present innovation enables to activate transcapillary exchange due to pathogenetically proved impact onto surface and deep lymphatic network of inferior limbs.

EFFECT: higher efficiency of therapy.

1 cl, 2 ex

 

The invention relates to medicine, in particular for surgery and medical treatment of chronic occlusive arterial diseases of the lower extremities (HOSANK).

Closest to the proposed method of treatment, HOSANK is the method lies in the catheterization lymphatic vessels on the rear foot in the first interdigital interval, the fixation in the vessel lumen polyurethane catheter, through which the subsequent by means of injection dosing medication is injected mixture comprising 0.5% solution of novocaine, 1% solution of nicotinic acid, 2% solution of papaverine, heparin [1].

However, this method has some drawbacks:

technical complexity and invasiveness of the method.

- the impossibility of carrying out treatment in outpatient conditions;

- the need for holding infusion of special equipment (dispenser injection);

- high probability of injury catheterized vessel directly catheter when the physical movements of the patient or in excess of the speed of infusion;

- the presence of a catheter attached to the rear foot of the patient, significantly restricts his physical activity;

- high probability of formation of bedsores and infection designated standing of the catheter, especially in patients with impaired peripheral kovoor is to be placed;

- if the specified method of introducing a drug mixture is a therapeutic effect only on deep network of lymphatic system of the lower extremities, while in the pathological process in HOSANK involved as deep and surface network of the lymphatic system of the lower extremities.

A new technical challenge - improving the efficiency of treatment of patients by expanding the area of impact of drugs and reduce the number of complications.

The task to solve a new method for the treatment of chronic occlusive arterial diseases of the lower extremities, which consists in the introduction of medicinal mixtures containing novocaine, to the foot area, and medicinal mixture consisting of 10 ml of 0.25% novocaine, 1 ml of 1% emoxipin and 64 UE lidz, enter strictly intradermally in a volume of 1 ml for each point of introduction into the center of the plantar surface of the ungual phalanx of each toe, and in the first interdigital period subcutaneously into the plantar and dorsal directions, then after the injections, make massage the injection zone in the form of kneading and stroking in the proximal direction of movements in for 10-15 seconds, and healing sessions carried out through the day rate of 5-10 treatments, with a repetition rate of 3-6 months, also when expressed pain syndrome or is technote extremities, introduction medicinal mixture is performed, starting with 0.5 ml of gradually bringing to 1 ml on each point of injection.

The method of introduction is as follows.

1. Foot, dorsal and plantar surfaces, from the end of the phalanx to the middle third of the metatarsal treated according to the method of Grassia-Philonchikova.

2. The plantar surface of the nail phalanx squeeze two fingers for 2-3 seconds until the white spot.

3. The injection needle is injected to the depth of its cut in the skin and produce a drug in a volume of 0.5 to 1 ml, focusing on the sensations of the patient, before the formation of the "lemon peel", while the injectable needle according to the principle of “dry” prick.

4. After removal of the needle perform massage kneading and stroking in the proximal direction of motion at each point of injection for 10-15 seconds.

5. In the first interdigital period of injection is performed in dorsal and plantar directions strictly subcutaneously.

Manipulation is done correctly, if at the injection site appears a white patch on the type of "lemon peel" (this suggests that the introduction made intradermally), and when removing the needle there is no appearance of blood.

Typically, patients feel numbness toes for 5 to 20 minutes, and the ATEM slight feeling of itching, lasting from 20 minutes to 2 hours, turning into a feeling of warmth all over the foot and up depending on the severity of the pathological process. To preserve the sense of heat also depends on the severity of the pathological process and lasts from 2 hours after the first manipulation to 6 months after treatment.

The proposed regime is chosen based on the study of literature data on normal and pathological human normal and pathological histology of the human pharmacokinetics and farmakodinamika drugs in humans [2, 3, 4, 5] and the observation of 37 patients who on the ground of submitted complaints, anamnesis, objective and instrumental examination was diagnosed, “Obliterating atherosclerosis of vessels of lower extremities”, with different severity of insufficiency of blood circulation (classification A.V. Pokrovsky-the Fountain): stage IIA - 6 persons, IIB-IIIa - 23, IIIB - 7 people one patient with critical ischemia. The efficacy was assessed on the basis of clinical data, changes the distance of painless ways and data rheovasography.

Justification mode.

1. The introduction: the introduction of medicinal mixture intradermally justified by the presence of severe network shunt vessels of the skin, providing the hell is a cotton transcapillary exchange between tissues. In particular, the described techniques - cutaneous vessels perform the role of a heat exchanger. Additional blood flow to the skin not only helps to get rid of the feeling of freezing feet and shins, but in later to provide additional blood supply to the skeletal muscles that are most affected by hypoxia. This conclusion can be considered to be pathogenetically justified due to the fact that the skin is able to maintain a significant amount of blood and, if necessary, to put her skeletal muscles.

2. The necessity of introduction of the mixture into the plantar surface of the toes justified the highest concentration in this area of arteriovenous anastomoses and free nerve endings forming thermoreceptors in the skin of the plantar surface of the toes. In addition, the method allows adequate outflow through the lymphatic capillaries, the terminal which blindly end up in the deep layer of the epidermis, which is a trigger in the treatment of HOSANK. And you cannot ignore the fact that lymphovenous insufficiency is one of the components of the pathogenesis of HOSANK and lymph capillary is one of the important components of structural and functional unit of any organ, including the skin and skeletal muscles.

3. The composition of a medicinal mixture is justified by the fact that the mode is in, first of all, is a local anesthetic and a solvent for lidzy when intradermal.

The emoxipin is an antioxidant having antihypoxic, angioprotective and antiaggregatory activity. The drug successfully used for diseases accompanied by increased lipid peroxidation and hypoxia. This is especially important because in the pathogenesis of HOSANK free-radical oxidation plays an important role.

Lydasum - preparation with the most pronounced lymphotropism property, is able to penetrate through the wall of the lymphatic capillary and to accelerate the absorption of medicinal substances, in particular substances with macromolecular structure and not able to penetrate the vascular wall (the so-called buffer property lidz).

4. The need for massage the area of injection drug mixture is justified by the fact that the lymphatic capillary deprived of the muscle layer and the mechanical movement promote a more rapid and deep penetration of the mixture from interstice in lymphatic capillaries.

5. The need for 5-10 procedures related to the fact that the holding is less than 5 procedures does not provide a stable clinical effect and holding more than 10 treatments are not advisable because of the excessive drug load organisms is the patient. Procedures through the day most optimally, because the injected mixture has a cumulative effect and completely removed from the injection zone for at least 36 hours. In addition, most patients suffering from HOSANK, there is swelling of the affected tissues, and excessive voltage tissues with the introduction of drug compound causes pain.

Clinical example 1

Patient K., born in 1930, was admitted for treatment complaining of freezing and numbness of both feet and legs, pain in them when walking 100 metres. According to the patient, the above complaints concerned about 6-7 years. Were outpatients regularly. On examination, the skin of both feet and legs pale, cold to the touch, the coat is missing, ripple saved on the femoral artery on both sides, below - no. On the basis of complaints and physical examination data, laboratory and instrumental examination diagnosis: “Obliterating atherosclerosis of vessels of both lower extremities, occlusion BPS on both sides, KHAN III and stage”. When reovazograficheskie study of the lower extremities: reovazograficheskie index (RI) to the right (legs) - 33, left 56. Venous outflow is obstructed. The value of peripheral vascular resistance (SAR) is increased. Appointed following the traditional course of treatment:

inside the military drip the solution reopoligliukina, pentoxifylline physiological solution;

- blockade of sympathetic ganglia L 3-L 4;

blockages in the calf muscles of both legs with the introduction of antihypoxic cocktail;

- disaggregants.

Further appointed endolymphatic introduction described above medicinal mixture. Given the lack of swelling of the feet and lower sensitivity of the fingers, the patient with the first procedure introduced 1 ml of the mixture in each point of injection. After the procedure the patient has noted the emergence of itching of the feet and lower third of the leg. After 20 minutes the itching was replaced by feelings tide of heat to the toes, persisting for 2 hours. The third procedure is itching minor, for 3-5 minutes, a feeling of warmth in the feet remains on during the day, noted a significant improvement when walking, increasing painless ways to 150 meters. For the obtained effect is made even 3 procedures on the background of traditional treatment. At the time of discharge remained complaints to moderate pain in the calf muscles during intensive walk more than 200 metres, passing quickly when you stop. Your feet and legs warm, the sensitivity of the skin of the feet have recovered. Reovazograficheskie index on the left - 60, the right - 53. Venous return to normal. The value of SAR is reduced.

Clinical example 2

p> Patient S., born in 1945, was admitted for treatment complaining of freezing and severe pain in both feet and legs when walking up to 50 meters. Moves with the help of a cane, and in the far distance accompanied by relatives. According to the patient, the above complaints concerned about 10 years. History: frostbite of the feet about 12 years ago. Were outpatients, irregularly. From the proposed 7 years ago surgical treatment refused. On examination: skin, legs pale, pasty, feet cyanotic, cold to the touch, toes palpation painful, especially pronounced painful reaction to the compression of the fingers. The peripheral pulse is not detected. On the basis of complaints and physical examination data, laboratory and instrumental examination diagnosis: "Obliterating atherosclerosis of vessels of both lower extremities. Occlusion of the iliac-femoral segment on both sides. KHAN IIIB stage". When reovazograficheskie study of the lower extremities: RI at the level of the tibia on the right 10, left - 18. Venous outflow is obstructed. The value of PSS raised.

Assigned to traditional treatment and advanced treatment according to the proposed method. During the first procedure, the patient complained of increased pain in fingers during injection of a medicinal mixture. For this reason, the volume of the mixture was limited to 0.5 ml. The pain disappeared immediately after removing the needle. During the following three procedures administered amount of the mixture was brought to 1 ml Should be noted that for the first time itchy toes appeared after 3 treatments and a slight appearance of heat after 5 treatments, then the patient noted a slight decrease in pain when walking. The pronounced appearance of heat in the feet appeared after 7 treatments, the patient was more than 50 meters. Upon completion of the course of treatment of the foot and lower leg warm, palpation finger painless, takes place independently with a cane over 100 meters. At the time of discharge continued complaints of pain in the legs, the compressive nature of going after the rest. RI on the left and 40 right - 22. Venous return to normal. The value of SAR is reduced.

Thus, the proposed method can improve the effectiveness of treatment of HOSANK in patients of all ages, different degrees of arterial insufficiency due to pathogenetically reasonable impact on the superficial and deep lymphatic network of the lower extremities with subsequent activation of transcapillary exchange.

Advantages of the method:

- the method is not technically difficult and traumatic;

- easily performed in outpatient conditions;

- does not limit the physical activity of the patient;

- allows vazdeistva is to be as deep, and on the superficial lymphatic network of the lower extremities;

- used medicinal mixture pathogenetically substantiated;

for administration of medicinal mixture does not require special equipment.

Sources of information used in the preparation of the description

1. Lokhvitski SV, Gulyaev AU, Kudinov S. Kaliev Lymph vasodilator therapy obliterating diseases of lower limb arteries // problems of sanogenic and pathogenic effects of the environmental impact on the internal environment of the organism. Mat. IV-th international. the Symposium. and V-th scientific-the practical. Conf., ]. The 70th anniversary of academician Y. I. Borodin and the 60th anniversary of Kyrgyztelecom. - Bishkek, 1999. 1. - S-199.

2. Agadzhanyan N.A., tel LINA, tsyrkin VI, Chesnokov S.A. Physiology. M: Mecnica, 2003. - S-267.

3. Bunny INC., Churilov, L.P. Fundamentals of General pathology. - SPb., 1999. - ALBI. - C - 226.

4. Mashkovsky PPM Medicines. P.II. - M.: Medicine, 1994. - P.71, 215.

5. Alimbekov EG, Chelysheva Y.A. Histology. M.: Publishing house GEOTAR-Med, 2001. - S-502.

1. A method for the treatment of chronic occlusive arterial diseases of the lower extremities, which consists in the introduction of medicinal mixtures containing novocaine, to the foot area, wherein the drug mixture consisting of 10 ml of 0.25% novocaine, 1 ml of 1% emoxipin and 64 UE lidz, impose strict is intradermally at 1 ml per point of introduction into the center of the plantar surface of the ungual phalanx of each toe, and in the first interdigital period subcutaneously into the plantar and dorsal directions after injections produce massage the area of injection kneading and stroking in the proximal direction movements within 10-15 s, and healing sessions carried out through the day rate of 5-10 treatments, with a repetition rate of 3-6 months.

2. The method according to claim 1, characterized in that when expressed pain syndrome or swelling of extremities introduction medicinal mixture is performed, starting with 0.5 ml, gradually increasing the volume to 1 ml in each point of introduction.



 

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