Method of autoanalgesia with mixture xenon-oxygen

FIELD: medicine, anesthesiology, rheanimatology.

SUBSTANCE: method involves independent inhalation the mixture xenon-oxygen by a patient in the ratio of xenon to oxygen, vol. % = from 30:70 to 50:50 up to arresting the pain syndrome. Invention shows the expressed analgesic effect at consciousness condition that, in turn, promotes to normalization of hemodynamics, function of neuroendocrine system, normalization of metabolic processes based on improvement in delivery of oxygen in tissues under condition of xenon vasoplegia.

EFFECT: improved method for autoanalgesia.

1 dwg, 5 ex

 

The invention relates to medicine and can be used as a symptomatic therapeutic agent for autoanalgezii.

Known analgesic agent, which is used as autoanalysis and is a pharmaceutical composition comprising inflammatory component and/or at least one non-narcotic analgesic, a purine alkaloid stimulants, sedative component barbiturate and at least one compound selected from the group of nonspecific anti-inflammatory drugs (NSAIDs). The drug relieves pain of almost any etiology (EN 2191605, 2002).

Known method of electroanalgesia limbs, which can also be used to autoanalysis, including the effects of pulsed electric current to the nerve trunks, while the active electrode is inserted through microirrigation puncture method, and the passive electrode is fixed on the skin (RU 2000125946, 2002).

Known method of electroanalgesia, which can be used for the removal and suppression of acute and chronic post-traumatic pain and neurological disorders, in which electroanalgesia use modulated stimulating current pulses and the modulation pulse is converted by a respiration signal of the patient (EN 2019205, 1994).

The General lack visitare olenych methods is their inability to improve and normalize metabolic processes. Analgesic agent in the form of pharmaceutical compositions due to their complexity can cause allergies, aggravation of peptic ulcers, stomach bleeding, gastritis, and sedative component - barbiturate leads to inhibition of consciousness, and drowsiness. How electroanalgesia require special electrical appliance, knowledge engineering application of electrodes, sterility for the introduction of microirrigation puncture method, search the optimal parameters of the current. The period of adaptation to electric shock and is waiting for the anesthetic effect is more than 20 minutes, and the analgesic effect is absent more than 20% of patients.

The known method autoanalgezii nitrous oxide (N2O) when labor pain relief with anaesthetic apparatus Knapp-6, in which the pregnant woman may itself using masks to breathe gazenergeticheskaya a mixture of N2About:O2(50:50) for pain relief during labour and delivery. (Campidanese, in kN.: Analgesia nitrous oxide in obstetric-gynecologic practice. M., 1964, p.27). There are also methods of using nitrous oxide for medical purposes to relieve pain in myocardial infarction (Prichernavskaya and others, in the book: Anaesthesia and intensive care in Oncology. M., 1968, s-210.), in the postoperative period (CH, Snethun, Medical analgeticeskih anesthesia. J. hirurgija, 1962, No. 4, p.7-11).

However, this method is described for stationary conditions, where there is centralized or balloon eyeliner gases: oxygen and nitrous oxide, and the procedure is supervised by medical personnel. Autoanalyzer nitrous oxide is often accompanied by nausea, vomiting, psychomotor agitation, which complicates the procedure. In addition, during long sessions autoanalgezii apparent toxic effect of nitrous oxide on the myocardium, erythropoiesis, develops toxic myelopathy changing the structure of DNA, which is especially dangerous in the first 12 weeks of pregnancy due to teratogenic effects of nitrous oxide.

Known portable nebulizer (analyzer) for liquid anesthetic vapor penthrane (methoxyflurane). Analyzer is a hollow tube made of PTFE, into which is inserted the felt, rolled in a tube. The distal end of the tube is closed by a cover with openings for entry of air. The proximal end is narrowed in the form of a mouthpiece and is inserted into the mouth. Pentron in the amount of 15-20 ml is poured through the distal end of the tube, completely absorbed by the felt and begins to slowly evaporate (boiling point 104°). The proximal end of analgesia is inserted into the mouth, clamped lips, and the patient inhales pair entrana. After 2-4 minutes is a state of analgesia when SOH is anenon the consciousness of the patient. With more prolonged exposure through inhalation may occur narcotic sleep, the hand of the patient is lowered, and analyzer tied ribbon to the forearm of the patient, automatically extracted from the mouth. Waking up after anesthesia pain the patient is again able to carry out the inhalation anesthetic mode autoanalysis. However, autoanalyzer pentanol applies solely to eliminate pain perception is through inhalation of ambient air, not oxygen, which reduces the effectiveness of the procedure. In addition, pentron, like all galogensoderjasimi substances, toxicity (hepato -, nephro-cardio-toxicity) and removed from production.

Known also analyser for trichloroethylene under the name of "Trilon". It is a metal tube. The proximal end of the tube is connected to a face mask, distal end closed by a perforated lid. Inside the hollow cylinder contains folded in the form of a tube of felt, which absorbs trichloroethylene. Mode autoanalysis the patient puts the mask on your face and inhales the vapors of trichloroethylene. However, trichloroethylene discontinued due to toxicity.

There is a method of anesthesia xenon-oxygen (Xe:O2) a mixture of mask type, which consists in the fact that after sedation, for example, atropine and small tranquiliz the torus, spend denitrogenization pure oxygen in a semi-open circuit when the flow O2in the amount of 6-8 l/min, after switching to a closed contour in the breathing bag is left not more than 500 ml of oxygen, xenon is fed into the system anaesthetic apparatus in the amount equal to 1.3 VC patient for 1.5-2 min to achieve a drug concentration of Xe (70%). After the onset of anesthesia face mask is removed, enter the laryngeal mask and at low gasoline conduct subsequent anesthesia, maintaining the oxygen concentration not lower than 30%. Overflow breathing bag gazoenergeticheskuju mixture is removed in a special device for recycling xenon. After the operation, xenon headlights off, and in the anaesthetic machine serves oxygen for 5 min to wash out of xenon from the body. When using the proposed method achieved better denitrogenization (leaching alveolar nitrogen), which leads to lower nitrogen levels up to 0.4%. The absence of nitrogen in a closed loop facilitates correct formation gazenergeticheskaya mixture Heh with O2and carrying out adequate anesthesia. When using the proposed method is achieved by reducing the consumption of expensive Heh 3-4 times in comparison with the known methods, in which gazenergeticheskaya mixture is removed from the respiratory to the contour of the atmosphere (EN 2102088, 1998).

However, these methods of mask type or endotracheal type xenon anesthesia does not apply to the mode autoanalysis and applicable only in the hospital for the surgery and painful manipulations. They are performed by the anesthesiologist, who was trained by the method of low-xenon anesthesia with the use of complex stationary anesthetic technique.

Know the use of xenon-oxygen mixture in adults as gaseous means for anesthesia anesthesia in surgical operations, painful manipulation, removing the pain and pain attacks (Nieborow, etc. in the book. "Xenon in anesthesiology. Clinical and experimental studies", M., Pulse, pp.42-46). However, these variants anesthesia and analgesia are used in stationary conditions with stationary anaesthetic machines and do not refer to the mode autoanalysis.

The technical result achieved by the invention is to improve the efficiency of autoanalysis and receiving therapeutic effect while simplifying effect.

The invention consists in the achievement of the technical result in the way autoanalgezii in which the patient, being conscious, conducts independent inhalation of xenon-oxygen mixture is reaching therapeutic effect and relieving pain at a ratio of xenon to oxygen of from 30:70 to 50:50.

The invention is illustrated in the drawing, which schematically shows a device for the implementation of autoanalysis.

The device comprises a container (1) with Heh:O2a mixture of capacity from 500 to 1000 cm3T-shaped connecting tube (2), a breathing bag (3) with a capacity of up to 3 liters, made of polyethylene or rubber, face mask (4), l-shaped tube (5) with a standard valve (drawing is not marked), the valve (6) for opening and closing the breathing circuit, the nozzle (7) with a rubber cap for the introduction of broncholytics (if necessary), the cap (8) of the injection valve Heh:O2of the mixture. The t-shaped pipe is connected with their ends to the cylinder (1), the breathing bag (3) and a face mask (4), the end of the tube for placement in the respiratory bag has two unrelated cavity.

A device for implementing the method is used as follows. Before using you must attach all of the elements connecting the T-shaped tube (2): on the one hand with the cap of the cartridge (1), and on the other side with a face mask (4), a T-shaped tube to connect with the breathing bag (3). Next, you should block the T-shaped tube valve (6) and press the cap of the injection valve (8) to fill the breathing bag Xe:O2mix until its full unfolding. Next, the patient puts the mask on the face and there is replay its standard rubber straps on the head (straps not shown), sets the valve (5) at the level of + 5 cm water column, opens the valve (6) and makes a few normal breaths into the bag. When losing (i.e. reducing the volume Heh:O2mixture), it is necessary to nurture the new portion of the gas mixture by repeated pressing of the cap of the injection valve (8). On the contrary, when excessive filling of the bag and increase the resistance to exhalation in him triggered the valve and the portion of the exhalation takes place in the atmosphere without having to remove the facial mask.

If using an aerosol of broncholytic (salbutamol, terbutaline, berodual and other) tube spray with aerosol connect with a pipe (7) connecting tube and enter the required dose of broncholytic by 2 times pressing the metering valve. It is not necessary to remove the facial mask in the process of respiration in order to preserve the integrity of the breathing circuit.

5-7 deep breaths pain sharply diminished or completely eliminated, while at the same time relieves asthmatic dyspnea (if it was).

The capacity of the cylinder Heh:O2the mixture can be calculated by 500-1000 ml under a certain pressure, calculated its strength that can provide the volume of gas mixtures for breathing for 30-60 minutes At full flow rate of the gas mixture is Mallon are optimistic about replace the other.

Xenon-oxygen mixture at a concentration of xenon: oxygen from 30:70 to 50:50 has a pronounced analgesic effect in the preservation of human consciousness, allowing him to carry out the mode autoanalysis. Pain contributes to the normalization of hemodynamic parameters, functions of the neuroendocrine system. On the other hand, inhalation of xenon-oxygen mixture contributes to the normalization of metabolic processes by improving oxygen delivery to the tissues in the conditions of xenon vazoplegii, improve microcirculation and favorable molecular interactions of inert gas on the cellular and subcellular levels, has anti-stress effect, eliminates the feeling of fear and tension that contributes to the normalization of neurological processes and vital functions.

To clarify the essence of the invention give the following explanations. Famous:

- autoanalyzer nitrous oxide mask way,

MAC Heh=50-71% (minimum alveolar concentration of anesthetic gas in volume percent oxygen at which 50% of young patients do not respond to painful irritation),

- mask anesthesia (anesthesia) Xe:O2the mixture in the ratio of 70:30 to 80:20, held by the anesthesiologist in a hospital (after sedation) with anaesthetic machines,

- phase xenon mo is anestesia (Heh:O 2the mixture in the ratio of 70:30 to 80:20, held by the anesthesiologist in a hospital (after sedation) with anaesthetic machines):

The first stage is paresthesia and hypoalgesia. Receive from the first 5-6 breaths mixture Heh:O2(70:30) and increased within 1-2 minutes is Characterized by the appearance of the peripheral paresthesias, numbness and weakness in the legs, a feeling of pressure in the epigastrium and spilled by weight in the entire body. Observed noise in the ears, squeezing the head. There is a feeling of intoxication, discoordination, jiggle, as in the boat. Consciousness is clear, breathing is even, the skin is warm and dry, pulse slightly ucase increases hypoalgesia. The pain threshold is increased by 2 times from the original.

The second stage of euphoria and psychomotor activity. Stage comes in 3 min on the background of already reduced pain and visceral sensitivity. Noted a surge of joyful emotions, the feeling of bliss. There logorrhea, the desire to talk about their pleasant experiences. Suggestibility is saved. Gradually increasing stiffness, lethargy, dysarthria. Muscle tone increases. Breathing deepens, becomes uneven. The skin is dry, warm, pink. HELL a few increased, the pulse Ochsen. Pain threshold increased in 3 times.

The third stage - analgesia and partial amnesia. Appears on the 4-th minutes of the Patterns is isoamsa the appearance of pronounced analgesia. Pain threshold is not defined. On painful irritation, the patient does not respond. Consciousness is retained, but come lapses in memory, there are visual images, absurd situations, increasing lethargy, appears (according to subjects) the presentiment of loss of consciousness.

The fourth stage of anesthesia (complete analgesia and amnesia). Coming on the 5th minute Corresponds to 1 level surgery under ether anesthesia (Gigalo). Consciousness is lost, disappear pharyngeal and corneal reflexes. Laryngoscope and the introduction of the laryngeal mask patients do not respond. Eyes narrowed. Breathing rhythmic. Muscle tone is reduced, the jaw drops in. The blood pressure and heart rate normalized. The skin is dry, pink, warm. The patient does not respond to surgical manipulation.

Not known:

- analgesia, inhalation of xenon-oxygen mixture in a ratio of xenon to oxygen of from 30:70 to 50:50 to relieving pain and achieving a therapeutic effect,

- third stage - analgesia and partial amnesia was very wide (according to the parameters of the concentration of He in the mixture), and it can be divided into two phases (two levels):

1 phase - expressed analgesia, conscious saved,

2 phase - expressed analgesia, consciousness inhibited come lapses in memory, there are visual images, absurd situations, appears precost the e ambulance loss of consciousness;

- inhalation of xenon-oxygen mixture in a ratio of xenon to oxygen of from 30:70 to 50:50 can clock to support the 1st phase of the third stage of xenon anesthesia, providing analgesic and therapeutic effects described previously for the xenon monoacetate (Heh:O2the mixture in the ratio of 70:30 to 80:20).

Conclusion:

Self inhalation of xenon-oxygen mixture in a ratio of xenon to oxygen of from 30:70 to 50:50 achieves relief of pain and therapeutic effect.

The method is illustrated by the following examples.

Example 1. Patient S., aged 65. Diagnosis: Ischemic heart disease, angina. After emotional stress and scandal in the family felt a sharp pain in the chest, it became difficult to breathe, there was a fear of death, taking nitrates in normal doses of relief was given. Called the ambulance, waited for her 30 minutes the Pain was filmed, heart failure increased. The patient shows a stronger pain medication and oxygen therapy, and the sooner the better. (Severe angina in case of failure of nitrates and pharmacological means of pain may go into a heart attack). The use of the inhaler with Heh:O2(40:60) gas mixture through 5-7 breaths eased the pain, and after 1 minute (14 breaths) pain disappeared. Arriving by ambulance patient was Dostal the n in the hospital with preservation of the established mode of autoanalysis during transport.

Example 2. Patient T., aged 35, was hit by a car. Diagnosis: a Closed fracture of the Shin bone, bruised chest and fractured ribs with two sides. Broken mechanics of breathing, pain brake cough, increasing respiratory distress. Upon arrival of the ambulance patient is given inhalation Heh:O2(50:50) gas mixture. Pain decreased respiratory excursion of the chest increased, the oxygen was removed hypoxia, improved gas exchange. The victim after 30 minutes was taken to the hospital emergency room. During transport the patient himself supported mode autoanalysis.

Example 3. Patient B., 86 years old. Diagnosis: prostate cancer, severe pulmonary heart disease. In order to relieve pain from needle biopsies of the prostate assigned mode autoanalysis Heh:O2the gas mixture. After 4-5 minutes after inhalation Heh:O2(30:70) mixture needle biopsy performed. Bolezney manipulation moved well, without deterioration of the General condition. Consciousness was maintained during the entire period of manipulation.

Example 4. The young miner in the mine crushed multi-ton metal structure left leg at the level of the upper third of the leg. In mine mode autoanalysis gas mixture Heh:O2(50:50) in combination with a/m administration of fentanyl (2 ml) produced am utazi left leg at the level of the lower third of the thigh. The life of a miner was saved.

Example 5. In a patient after nephrostomy left not functioning drains. Suffers from bronchial asthma. The night was choking and the patient has inhaled aerosol "salbutamol". On the morning of stored residual effects of bronchospasm. It is urgently necessary to perform an audit of the wound, check the patency and proper installation of the drains. Under inhalation Heh:O2(50:50) mixture mode autoanalysis had the stitches removed, the wound divorced, naked kidney and has fallen drainage in the pelvis of the kidney. During inhalation Xe:O2(50:50) to the breathing circuit entered 2 aerosol dose of salbutamol. Disappeared asthmatic component breath, disappeared cyanosis of the lips and nail beds and patient well-being improved significantly. Ended the revision of the wound. Superimposed seams on the skin around drains. Manipulation moved well. Sent to the house in a satisfactory condition.

The method can be applied in the following conditions:

angina, myocardial infarction, pulmonary heart disease, asthmatic status, bronchial asthma, renal and hepatic colic, spastic pain attack, acute pancreatitis, mechanical or burn injury, pain shock, tooth pain, labor pain relief, operative delivery (caesarean section), bolezney manipulation in surgical and ginecologica is some practice (abortion), psycho-emotional stress.

In cases of bronchial asthma attacks or feelings of suffocation from other causes inhaler Heh:O2the mixture can be used for oxygen therapy and relief of bronchospasm. Bronchodilatory effect can be achieved by spraying the appropriate dose aerosol broncholytic to the breathing circuit of the inhaler.

Inhalation Xe:O2the mixture can be carried out in the manner of self - or mutual home prior to the arrival of emergency medical care, prehospital system of emergency medical care, ambulance, sports medicine, and also in terms of the health center or dispensary to relieve emotional stress and normalize neurological status, as well as in a surgical patient with painful dressings, treatment of burn surface, punctures, biopsies, when conducting small gynecological operations.

The way autoanalgezii, namely, that the patient is offered yourself to breathe xenon-oxygen mixture in a ratio of xenon and oxygen in% vol. from 30:70 to 50:50 to relieving pain.



 

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