Method for treating patients after removing gallbladder

FIELD: medicine.

SUBSTANCE: method involves prescribing conservative training motor activity and feeding diet No 5 with low mineralization low carbonic acid concentration sulfate and hydrocarbonate sodium-calcium mineral water being taken. Mineral water baths with low mineralization low carbonic acid concentration sulfate and hydrocarbonate sodium-calcium mineral water are given at 36-37°C during 12-15 min with 8-10 procedures per treatment course. 2.5% succinic acid solution electrophoresis is additionally applied to interscapular zone from cathode with the other washer - anode being placed on liver and right hypochondrium projection zone using current of 15-25 mA during 15-25 min daily with 10-12 procedures per treatment course.

EFFECT: reduced intensity of digestion disorder syndrome manifestation; stabilized peroxide homeostasis; increased organism adaptation capability.

5 tbl

 

The method relates to the field of medicine, namely to the section of gastroenterology, and for the treatment of physical factors in patients with biliary tract disease.

Development of methods of treatment of patients after cholecystectomy is an actual problem of modern medicine. The prevalence of gallstone disease and, accordingly, increase in the number of cholecystectomies, reduce disability and quality of life of patients who underwent surgery necessitates the search for effective treatments for this disease. Polyorgano lesions of the digestive system after the operation, the complexity of their pathogenesis and diversity of clinical manifestations, combine the collective term "post-cholecystectomy syndrome, cause difficulty in achieving a therapeutic effect, and the treatment is mainly symptomatic.

There is a method of treatment of patients after cholecystectomy using atraumatic-training regimen physical activity, diet, intake of mineral water, mineral baths when water temperature is 36-37°C for 12-15 minutes, 8-10 treatments of treatment (Balneology and physiotherapy, 1985, Vol.2). This method of treatment is the prototype for this invention.

However, this method is not effektivnym in respect of correction of the disturbed digestion and energy metabolism as manifestations of disorders of adaptive reactions of the organism of patients in new anatomical and physiological conditions, formed after removal of the gall bladder.

These scientific observations and practical work of physicians and health centers indicate that even when assigning adequate from a clinical point of view of medical facilities at the resort are negative results - indigestion with the development of diarrhea, increased clinical manifestations of opportunistic diseases, developed prior to surgery or after it (pancreatitis, duodenal dyskinesia, peptic ulcer, gastroesophageal reflux disease). This fact can be explained by the fact that the appointment of a patient care is carried out without taking into consideration existing in these patients disorders of adaptation processes and energy metabolism.

The technical result of the proposed method is to increase the effectiveness of rehabilitation treatment after removal of the gallbladder through the correction of disturbed digestion, reduced adaptive reserves of the body of patients and the energy exchange in new anatomical and physiological conditions after surgery. This technical result is achieved by the fact that in complex therapy used electrophoresis of succinic acid as a method of complex influence of galvanic current on his background - input foretical by succinic acid - one of the substrates oxide what s in the Krebs cycle, contribute to the improvement of energy metabolism in the body.

The method is performed as follows: patients within the first 3 days of stay at the resort designate the mode with limited motor activity as one of the elements of adaptation and recovery of energy resources of the organism by reducing energy consumption. In the subsequent motor activity is replaced by the gentle and atraumatic-training. Diet nutrition diet №5. Assigned internal reception mineral water Slavophiles hydrocarbonate-sulphate-sodium-calcium, low-salinity (Slavyanovskaya) at a temperature of 55°starting with small doses on 120,0-150,0 ml per one scoop (2.5 g per 1 kg of patient's body weight), leading to a dose of 3.3 g of water per 1 kg of patient's body weight (200,0-of 250.0 ml per admission) for 3-4 days. Mineral water they take 45 minutes before a meal.

Mineral baths are appointed when the water temperature is 36-37°C for 12-15 minutes, every day, 8-10 treatments on the course of treatment.

With the purpose of correcting existing patients after cholecystectomy violations adaptation processes and energy metabolism appoint electrophoresis of succinic acid, which is carried out as follows: the hydrophilic spacer cathode (-) area of 250-280 cm2impregnated with a 2.5% solution of succinic acid which you have in the interscapular region (D 4-D10segments), strip anode (+) area of 200 cm2impregnated with tap water and placed on the region of the liver and right hypochondrium. Current 15-25 mA (when the light burning sensation under the electrodes), the duration of the treatment 15-25 minutes (gradually increasing in the early days of treatment), exposure is performed daily in the treatment of 10-12 procedures. The methodology is data about important therapeutic role of the influence of galvanic current and succinic acid (substrate oxidation in the Krebs cycle), moreover, that in this category of patients identified disorders of energy metabolism (see data table 2). The location of the electrodes is caused by the need to influence both the overall health and functional status of the liver.

The method can be explained by the following examples.

Patient TLV, 47 years old, medical history, No. 446. Diagnosis at admission: ECB. Cholecystectomy in 1998 Chronic biliarsky pancreatitis in the phase of incomplete remission. Upon receipt complained of expressed General weakness, fatigue, headache, bitter taste in the mouth, nausea, aching pain in the upper abdomen, change of constipation by softening the stool.

Palpation of the abdomen is marked moderately severe pain in the right hypochondrium and epigastrium. Liver invoice is Paeth from under the edge of the costal arch by 1.5-2 cm, sensitive to palpation. Blood count; white blood cell count - 4·109/l, lymphocytes - 22%, neutrophils - 68%, monocytes - 10%, eosinophils - 0. Blood bilirubin - 12.1 µmol/l, cholesterol - 8.4 mmol/l, alkaline phosphatase - 156 u/l, the level of MDA in plasma were 1,268 µmol/l Detected overall energy deficit: the level of ATP in erythrocytes - 508 μmol/l AMP - 68 µmol/l, the energy charge is 0.80, the LDH activity in lymphocytes - 1055 units and GFDG - 530 units of lactate - 1,89 mmol/l pyruvate - 0,966 mmol/L. treatment - regimen physical activity sparing, meals according to the diet №5, internal intake of the mineral water source Slavyanovskaya", mineral baths (8), electrophoresis of 2.5% solution of succinic acid by the method described above, 10 sessions of treatment. At discharge from the hospital had no complaints, pain abdominal palpation was not determined. The size of the liver decreased to the normal range. Survey data after treatment: the number of leukocytes - 4,6·109/l, lymphocytes - 27%, neutrophils - 65%, monocytes - 5%, eosinophils - 2%. Blood bilirubin - 10.1 µmol/l, cholesterol - 4.4 mmol/l, alkaline phosphatase - 136 u/l, the level of MDA in plasma - kgs 1,090 µmol/l, ATP in erythrocytes - 584 μmol/l AMP - 38 µmol/l, the energy charge - 0,89% the Activity of LDH - 1090 units and GFDG - 570 units, lactate - 1,36 mmol/l pyruvate - 0.061 mmol/L. Thus, the p is vedennogo treatment has a positive dynamics as subjective symptoms, and laboratory studies demonstrating the improvement of the functional state of liver energy metabolism and adaptation processes.

Patient SNN., 55 years history No. 944. Diagnosis at admission: ECB. Cholecystectomy in 2005, Chronic biliarsky pancreatitis in the phase of incomplete remission. Complaints at admission: General weakness, fatigue, pain in the epigastric region and around the navel soon after eating, flatulence, constipation. Palpation of the abdomen - mild tenderness in the epigastric region, the projection of the pancreas and in the right hypochondrium. Liver at the edge of the costal arch, painless.

Blood count; white blood cell count is 3.5·109/l, lymphocytes - 20%, neutrophils - 68%, monocytes - 8%, eosinophils - 2. Blood bilirubin - 29 mmol/l, cholesterol - 3.6 mmol/l, alkaline phosphatase - 124 u/l, the MDA level in plasma is 1.16 mmol/l ATP in erythrocytes - 600 µmol/l AMP - 60 µmol/l, the energy charge - 0,82 ed, the LDH activity in lymphocytes - 1025 units and GFDG - 525 units, lactate - 2.9 mmol/l pyruvate - 0,080 mmol/l, which is typical for a deficit of energy metabolism. A course of treatment: mode of motor activity sparing, meals according to the diet №5, internal reception mineral water source Slavyanovskaya", mineral baths (10) electrophoresis of 2.5% solution of succinic acid in the description of the Noah above methodology, 10 sessions of treatment. At discharge from the hospital had no complaints. Palpation tenderness of the abdomen was not determined. The liver is not enlarged. Blood count: leukocytes - 6,2·109/l, lymphocytes - 33%, neutrophils - 59%, monocytes - 4%, eosinophils - 2%. Blood bilirubin is 17.2 µmol/l, cholesterol - 3.6 mmol/l, alkaline phosphatase - 101 u/l, the level of MDA in plasma - 0.84 µmol/l, ATP in erythrocytes - 680 µmol/l AMP - 43 µmol/l, the energy charge - 0,89%, LDH activity in lymphocytes - 1070 units and GFDG - 560 units, lactate - 2.0 mmol/l pyruvate - 0,070 mmol/L. Thus, improving clinical assessment is marked on the background of the improvement of the functional status of the liver and energy metabolism and the state of adaptation. He was discharged with improvement.

Patient SGA 52-year history No. 1543. Diagnosis: ECB. Cholecystectomy in 2003, Chronic gastroduodenitis with stored secretory activity in the phase of incomplete remission. Complaints at admission: General weakness, decreased performance, irritability. Pain whining character in the upper abdomen after 1 hour after eating, heaviness in the right hypochondrium, heartburn, bitter taste in the mouth, belching air, flatulence, constipation change breaks a chair. Blood count: leukocytes - 3,7·109/l, lymphocytes - 18%, neutrophils - 70%, monocytes 8%and eosin is the world of cultural - 2. Blood bilirubin at 18.1 µmol/l, cholesterol - 4.8 mmol/l, alkaline phosphatase - 211 u/l, the level of MDA in plasma - 1,29 mmol/l Detected overall energy deficit: the level of ATP in erythrocytes - 524 μmol/l AMP - 72 µmol/l, the energy charge to 0.08, units of LDH activity in lymphocytes - 1095 units and GFDG - 580 units, lactate is 2.44 mmol/l pyruvate - 0.09 mmol/l treatment - regimen physical activity sparing, meals according to the diet No. 5, the internal intake of the mineral water source Slavyanovskaya", mineral baths (10), electrophoresis of 2.5% solution of succinic acid by the method described above, 12 procedures for the course of treatment. At discharge from the hospital had no complaints, pain abdominal palpation was not determined. The liver was reduced to normal size. As a result of the treatment the patient's condition has improved, disappeared abdominal pain, dyspepsia, became more regular stools, decreased bloating, improved appetite, sleep, became more cheerful, decreased General weakness.

Survey data after treatment: the number of leukocytes - 7,8·109/l, lymphocytes - 23%, neutrophils - 65%, monocytes 7%, and eosinophils - 3%. Bilirubin blood of 13.1 µmol/l, cholesterol - 4.1 mmol/l, alkaline phosphatase - 136 u/l, the MDA level in plasma is 0.86 µmol/l, ATP in erythrocytes - 582 µmol/l AMP - 48 µmol/l, the energy charge - 0,83% the Activity of LDH - unit 1040, a-GPD is - 550 units, lactate - to 1.42 mmol/l pyruvate - 0,049 mmol/l In the treatment of positive dynamics of clinical symptoms and laboratory data (Hematology indicators, test, liver function test, indices of adaptation and energy metabolism).

The method was tested in conditions of Zheleznovodsk clinic - branch of Federal state institution "Pyatigorsk, GNIIT University on two groups of patients - main (20 people) and in the comparison group - control (25 people), treated according to the method of the invention and prototype respectively. Clinical characteristics of patients are shown in table 1.

Table 1

Clinical characteristics of the main and control groups of patients
IndexThe main group n=20 number %Control group n=25 number %
Floormale3-155-20
female17-8520-80
Age20-30 years--
31-40 years1-5-
41-50 years9-4513-52
over 50 years10-50 12-48
Time after surgeryup to 3 years6-3012-48
3-5 years6-303-12
more than 5 years8-4010-40
ComorbiditiesAbdc2-102-8
XP. pancreatitis18-9015-60
CHD1-51-4
Arterial hypertension2-103-12

As the data in table 1, the distribution of patients according to the main clinical characteristics in the main and control groups was identical.

We identified a significant impairment of energy metabolism in patients after cholecystectomy. The data of these indicators in comparison with healthy individuals are given in table. 2.

Table 2

Indicators of energy metabolism in the blood of patients after cholecystectomy and healthy persons
IndexIIIP
healthy individuals (n=15)sick individuals (n=45)I-II
ATP µmol/l689,87±25,64472,9 6,16<0,05
AMF, umol/l28,39±2,474,07±0,79<0,05
Energy units0,84±0,0060,624±0,0133<0,05
ATP/AMP24,3±0,017,17±0,12<0,05
SDG, % active.1071,13±4,511246±6,40<0,05
a-GPDH, units555,0±5,96597,4±9,49>0,05
MDA plasma, mmol/l1,03±0,020,98±0,03>0,05
Lactate, mmol/l1,26±0,033,78±0,149<0,05
Pyruvate, mmol/l0,07±0,0010,072±0,002>0,05

Insufficient energy supply significant portion of patients after cholecystectomy leads to the need to consider this fact as in the appointment of the motor mode and the degree of load treatments, and the inclusion of additional medical factors.

Dynamics of clinical manifestations of the disease in the main and control Gruppo reflected in the table. 3.

Tab the Itza 3

Dynamics of clinical symptoms and objective data that results from the application of the method of the invention (I) and prototype (II)
IndexI main group (n=20)II control group (n=25)
the source frequency indicatorpositive dynamicsthe source frequency indicatorpositive dynamicsP
Pain12-60%8-66,7%15-60%5-33,3%<0,05
Dyspeptic syndrome16-80%11-68,8%19-76%9-47,4%<0,05
Astheno-neurotic syndrome14-70%12-85,7%17-68%14-82,4%>0,05
Hepatomegaly11-55%7-63,6%15-60%7-46,7%>0,05
Tenderness to palpation of the abdomen6-30%5-83,3%7-28%3-43%<0,05

Are given in table. 3 data show that the positive dynamics of the main manifestations of the disease was more pronounced in the study group compared to control who inoj - this refers to pain and dyspeptic syndrome and normalization of liver size.

According to laboratory studies noted the following changes in the main indicators of the functional state of the liver, lipid peroxidation and energy metabolism in the main and control groups (table 4, 5).

Table 4

Blood biochemical parameters before and after treatment in the main and control groups of patients
IndexI main group (n=20) M±mII control group (n=25) M±mp
before the treatmentafter the treatmentbefore the treatmentafter the treatmentI-II
Bilirubin, µmol/l22,3±0,0918,3±0,0523,4±0,0821,8±0,01<0,05
Cholesterol, mmol/l6,0±0,125,9±0,126,3±0,026,1±0,02>0,05
Alkaline phosphatase, u/l123,3±5,0by 115.7±4,2of 123.2± and 4.9121, 1million±4,8>0,05
MDA in plasma, mmol/l1,03±0,04 0,85±0,030,94±0,030,91±0,03<0,05

Table 5

Indicators of energy metabolism before and after treatment in the main and control groups of patients
IndexI main group (n=20)II control group (n=25)p
before the treatmentafter the treatmentbefore the treatmentafter the treatmentI-II
ATP µmol/l473,2±a total of 8.74524,9±10.30 a.m.472,6±8,78484,3±6,86<0,05
AMF, umol/l76,1±0,9259,4±1,3872,4±1,1265,5±1,42<0,05
Energy units0,61±0,020,89±0,020,63±0,020,72±0,01<0,05
ATP/AMP7,14±0,163br11.01±0,2957,19±0,179,42±0,33<0,05
SDG, %1246±8,3141068±26,9601245±9,561128±25,64>0,05
a-GPDH, units623,7±9,99532,5±10,92576,4±13,88548,5±9,15>0,05
Lactate, mmol/l3,49±of € 0.195a 3.87±0,5584,01±0,213,9±0,43>0,05
Pyruvate, mmol/l0,073±0,0030,061±0,0020,072±0,0030,070±0,002<0,05

The survey results show an improvement of the functional state of the liver, indicators of lipid peroxidation and energy metabolism. When comparing the results of treatment in both groups was observed a marked advantage medical complex using electrophoresis of succinic acid. In contrast to the control group of patients in the study group was significantly decreased levels of bilirubin in the blood and MDA in plasma significantly increased ATP levels and energy charge, decreased levels of AMP and pyruvate.

Thus, patients who underwent cholecystectomy, there is considerable disturbance of the General condition in the form of pain, dyspeptic and astheno-neurotic syndrome, as well as violations of the functional state of the liver and processes of adaptation according to the hematological parameters, lipid peroxidation and energy in the ical exchange.

To increase the effectiveness of rehabilitation treatment after removal of the gall bladder at the stage of sanatorium-resort treatment, along with the ingestion Slavophiles mineralized sulphate-hydrocarbonate calcium-sodium mineral water and mineral baths, recommended the appointment of electrophoresis of 2.5% solution of succinic acid by the developed technique, this helps to reduce the severity of the syndrome of disturbed digestion after surgery, stabilization of peroxide homeostasis and increase the adaptive capacities of the organism, including energy metabolism.

The method of treatment of patients after gallbladder removal, which includes gentle or gently-training regimen physical activity, meals according to the diet №5, ingestion mineralized Slavophiles sulphate-hydrocarbonate sodium-calcium mineral water and holding mineral baths using Slavophiles sulphate-hydrocarbonate sodium-calcium mineral water at a temperature of 36-37°C for 12-15 min, 8-10 treatments on the course of treatment, characterized in that it further carry out electrophoresis of 2.5%aqueous solution of succinic acid in the interscapular area with the cathode at the location of the other strip - anode - area projection of the liver and right poreber is at an amperage of 15 to 25 mA for 15-25 minutes each day, treatment of 10-12 procedures.



 

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