Method of conservative treatment of acute pancreatitis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery and endocrinology, and can be used in the patients requiring a conservative treatment of acute pancreatitis. That is ensured by a standard medical therapy by the introduction of infusion preparations, anaesthetics, spasmolytics, vasoconstrictors, antibiotics, novocaine, cytostatics, omeprazole, sandostatin. For the period of treatment, hunger with voluminous drinking is prescribed. Pit of the stomach is cooled. In addition, procaine blocks in the round ligament of liver are applied that implements the introduction of at least 200 mg of Immunomax and 10 ml of 5-fluorouracil. During 2 days, at least 1.0 g of metronidazole, 0.1 g of furaginum, at least 15.0 g of Enterosgel are intaken. During the whole therapeutic course, at least 1 ml of Sporobacterine suspension together with cooled water is taken once a day. Starting from the sixth day and during the whole therapeutic course of hospital treatment, 1 tablet of Mezym forte 2 times a day is prescribed. For at least two weeks after discharge from the hospital, treatment in a locally available health resort is continued.

EFFECT: method allows reducing considerably the probability of acute pancreatitis transition into a destructive form due to the effect of specified therapy by various pathogenesis links of specified disease.

2 ex

 

Method of conservative treatment of acute pancreatitis refers to medicine, namely to pancreatology, and can be used in the treatment of acute pancreatitis, both independently and as an additional treatment used in gastroenterology, surgery, intensive care, trauma, combustology.

The known method of conservative treatment of acute pancreatitis, including detoxification therapy, protease inhibitors, cytostatics(1, 2, 3, 5).

The disadvantage of this method is insufficient correction of tissue and humoral immunity, the use of anti-inflammatory drugs that stop the spread of bacteria from the intestine to other organs and tissues, without the use of chelators, do not use the Spa treatment immediately after discharge from the hospital.

There is a method of treatment of acute pancreatitis, including the application of cold on the stomach, avoiding the consumption of food, the use of drinking water in large quantities, antibiotic therapy(1, 2, 5).

The disadvantage of this method is insufficient correction of tissue and humoral immunity, the use of anti-inflammatory drugs that stop the spread of bacteria from the intestine to other organs and tissues, without the use of chelators, do not use the Spa treatment immediately after the Peeps from the hospital.

The known method of conservative treatment of acute pancreatitis, including application kilotonnage drugs omeprazole, drugs that reduce the secretion of pancreatic enzymes and 5-fluorouracil, sandostatin, octreotide acetate, protease inhibitors - contrical, gordox(1, 2, 3, 4).

The disadvantage of this method is insufficient correction of tissue and humoral immunity, the use of anti-inflammatory drugs that stop the spread of bacteria from the intestine to other organs and tissues, without the use of chelators, do not use the Spa treatment immediately after discharge from the hospital.

There is a method of treatment of acute pancreatitis, including the use of procaine blockade of perirenal fat and the round ligament of the liver(1, 2, 3).

The disadvantage of this method is insufficient correction of tissue and humoral immunity, the use of anti-inflammatory drugs that stop the spread of bacteria from the intestine to other organs and tissues, without the use of chelators, do not use the Spa treatment immediately after discharge from the hospital.

The purpose of the method of the invention is to improve results of conservative treatment of acute pancreatitis, prevention of tissue hypoxia, tissue and humoral immunity, profilakticheskaya of disorders of the hepatobiliary system reduce the number of cases of transition of acute pancreatitis in the destructive form of the disease, rehabilitation of patients after discharge from hospital.

This method is achieved by the fact that during the novocaine blockade in the round ligament of the liver to enter at least 200 mg of Immunomax and 10 ml of 5-fluorouracil, within 2 days inside are not less than 1.0 g of metronidazole, 0.1 g furagin, not less than 15.0 g of enterosgel, during the whole course of treatment once a day shall not be less than 1 ml of suspension of sporobacterin together with cooling water, and on the sixth day and during the whole course of inpatient treatment take 1 tablet Mezim Forte 2 times a day, and then after discharge from the hospital in a period of not less than two weeks, continue treatment in the local sanatorium.

Comparison of proposed method with other known methods of conservative treatment of acute pancreatitis showed its compliance with the criteria of the invention.

The method is used as follows.

A patient with acute pancreatitis perform all of the required amount of diagnosing diseases - laboratory and instrumental and spend the conventional anti-inflammatory and conservative treatment of acute pancreatitis. Thus during procaine blockade in the round ligament of the liver to enter at least 200 mg of Immunomax and 10 ml of 5-fluorine is acyl, within 2 days inside are not less than 1.0 g of metronidazole, 0.1 g furagin, not less than 15.0 g of enterosgel (1,1,3,3-tetrahydroxy-1,3 - dimethylsiloxane of polyhydrate) and/or not less than 2.0 g other enterosorbiruyuschee funds during the entire course of treatment once a day shall not be less than 1 ml of suspension of sporobacterin together with cooling water, the amount of which is not less than 1 l per day, and on the sixth day and during the whole course of inpatient treatment take 1 tablet Mezim Forte 2 times a day or 1 tablet Mezim Forte 10 000 once a day, and then after discharge from hospital for at least two weeks, continue treatment in the local sanatorium.

Clinical example 1. Patient B., 39 years old, became ill acutely after a breach, diet and alcohol. Was treated independently, however, abdominal pain intensified. An ambulance was called, and urgently hospitalized 19.10.08, Department of surgery MMU "GKB them. N.I. Pirogov No. 1" go Samara with a diagnosis of acute pancreatitis andb 30424/2400. At admission the patient complained of severe abdominal pain, nausea, vomiting, were determined severe pain in the epigastric region of the abdomen. In the blood was determined 14,8 thousand leukocytes, hemoglobin was 160 g/l, stab neutrophils was 7, amylase serum amounted to 750 IU/ml, destacamos was 2048 units Urine protein was determined 0,033 g/l, leukocytes 18-24, erythrocytes - 5 in the field of view. Body temperature was 37.5 degrees. By ultrasound (ultrasound) from 19.10.08, the head size was 3.0 cm, body 2.2 cm, tail 3.3 cm, the echogenicity of the pancreas was increased due to the swelling of the pancreas. The patient within 2 days of taking inside not less than 1.0 g of metronidazole, 0.1 g furagin, 15.0 g of enterosgel, during the whole course of treatment once a day took 1 ml suspension of sporobacterin together with cooling water, and on the sixth day and during the whole course of inpatient treatment took 1 tablet Mezim Forte 2 times a day, 22.10. 08,, 28.10. 08,, 29.10 08, someone made procaine blockade in the round ligament of the liver, which included the introduction of 200 mg of a solution of Immunomax and 10 ml of 5-florouracil. The patient's condition has improved. According to the General analysis of blood from 28.10.08, blood leukocytes were $ 7.6 thousand, diastasis of urine from 1.11.08 was 64 units, amylase blood 125% abdominal Pain subsided. 5.11.08, made ultrasound of the pancreas, the head size was 3.3 cm, body 2 cm, tail 3,3 see the Echogenicity of the pancreas was reduced edema was not determined, positive dynamics. 6.11.2008, was discharged for outpatient treatment. After discharge from the hospital within 2 weeks continued to take sanatorium Leche is the local dispensaries with diet and intake of dining still water, work capacity was fully restored. The patient was examined 2 months after treatment. The condition is satisfactory, began to labor, disease recurrence was not.

Clinical example 2. Patient K., aged 40, became ill acutely after a breach, diet and alcohol. Called an ambulance and in the emergency order 5.01.08, was admitted to the surgical ward No. 7 MMU "city clinical hospital №1 named after. N.I. Pirogov go Samara with a diagnosis of acute pancreatitis andb 322/31. At admission the patient complained of severe abdominal pain, nausea, vomiting, were determined severe pain in the epigastric region of the abdomen. In the blood was determined to 14.3 thousand leukocytes, 35 band neutrophils, amylase serum was 500 IU/ml, diastasis urine was 2048 units In the urine was determined protein 1,31 g/l, leucocytes 3, erythrocytes 5 in the field of view. Body temperature was 37.3 degrees. According to the U.S. from 7.01.08, the size of the head of the pancreas was 4.1 cm, body 3.0 cm, tail 4.0 cm, the echogenicity of the pancreas was increased due to the swelling and infiltration. 5.01.08, and 6.01.08, the patient ingested 1.0 g of metronidazole, 0.1 g furagin, 15.0 g of enterosgel, with 5.01.08, and during the entire course of treatment the patient was ingested once a day, 1 ml suspension of sporobacterin together with 100 ml of chilled table water, with 11.01.08, Yves throughout the course of inpatient treatment, the patient took 1 tablet Mezim Forte 2 times a day. 8.01. 08,, 9.01. 08,, 10.01 08,, 14.01.08,, 17.01.08, and 20.01.08, the patient in the round ligament of the liver was done procaine blockade, which included 200 mg of a solution of Immunomax, 10 ml of 5-florouracil and 80 ml of 0.5% solution of novocaine. The patient's condition has improved, abdominal pain subsided. According to the General analysis of blood from 28.01.08, blood leukocytes were $ 7.6 thousand, diastasis urine was 64 units, amylase blood 125% 28.01. 08, ultrasound pancreatic head size was 3.3 cm, body 2.2 cm, tail 3.8 cm, defined decrease in echogenicity of the pancreas, swelling of the pancreas was not determined. 29. 01. 08 was discharged to outpatient treatment. After discharge from the hospital within 2 weeks of continued treatment in sanatorium-preventorium, work capacity was fully restored. The patient was examined 3 months after the treatment. The condition is satisfactory, no complaints, pain on palpation of the abdomen was not determined, began to labor, disease recurrence was not.

The method allows to improve the results of treatment of acute pancreatitis and to prevent the development of destructive forms of the disease requiring surgical treatment. Method of conservative treatment of acute pancreatitis applied in 26 patients who achieved clinical recovery without surgical intervention.

Historicalinformation

1. Milonov O., Taskin CD, Zebrowski CENTURIES Postoperative complications and dangers in abdominal surgery. - M.: Medicine, 1990. - s-255.

2. B.V. Petrovsky Selected lectures on clinical surgery. -M.: Medicine, 1968. - s-362.

3. Bienkov LI, Zubarev P.N., Trofimov V.M. and other Emergency surgery of the chest and abdomen: a Guide for physicians. - SPb.: Hippocrates, 2002. - s-372.

4. Savel'ev V.S. Guide emergency surgery of the abdominal cavity. - M.: Publishing house "Triada-X, 2005, - s-396.

5. Berkow R., Fletcher E. Manual medicine. Diagnosis and therapy. 2 so T.I.: Transl. from English. - M.: Mir, 1997. - p.543-545.

Method of conservative treatment of acute pancreatitis, including the introduction of intravenous fluids, analgesics, antispasmodics, vazopressorov, antibiotics, procaine, drugs, omeprazole, sandostatin procaine blockade of the round ligament of the liver, the use of hunger during treatment, excessive drinking, cooling the epigastric region of the abdomen, characterized in that during the novocaine blockade in the round ligament of the liver to enter at least 200 mg of Immunomax and 10 ml of 5-fluorouracil, within 2 days inside are not less than 1.0 g of metronidazole, 0.1 g furagin, not less than 15.0 g of enterosgel, during the whole course treatment once a day shall not be less than 1 ml of suspension of sporobacterin together with the OHL is by water, and on the sixth day and during the whole course of inpatient treatment take 1 tablet Mezim Forte 2 times a day, and then after discharge from hospital for at least two weeks, continue treatment in the local sanatorium.



 

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