Method for correction of disturbed structural-functional properties of red cells and immune status in patients suffering acute pancreatitis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely surgery, and concerns correction of disturbed structural-functional properties of red cells and immune status in patients with acute pancreatitis. For this purpose a complex pharmacotherapy is added by the single intramuscular introduction of the preparation Longidase 3000 IU on the 3, 6, 9, 12 and 15 days; the intravenous drop infusion of the preparation hypoxene 2.0 g once a day for 7 days, by dissolving the content of ampoule ex tempore in 5% glucose 400 ml, and the intravenous slow introduction of Essentiale H 5.0 ml once a day for 10 days.

EFFECT: method provides clinical effectiveness ensured by intensified repair processes and anti-infectious body resistance.

1 ex, 1 dwg

 

The invention relates to medicine, in particular to surgery.

Acute pancreatitis remains the most severe purulent-septic diseases, which is the main reason for the development of sepsis syndrome and multiple organ failure. The successes of modern medicine gave surgeons a number of effective methods to save the lives of patients with acute pancreatitis. However, the number of postoperative complications the most severe forms of acute pancreatitis in the last decade remains at the level of 20-35% and has no tendency to further decrease. Existing at the present stage of differences in surgical tactics, antibiotic therapy does not have a significant impact on further reducing the number of extra - abdominal complications, and therefore improve treatment outcomes can only be achieved with a deep understanding of the pathogenetic mechanisms of the inflammatory process. Early diagnosis immunometabolic violations timely and targeted impact on the pathophysiological mechanisms of acute pancreatitis will prevent the development of serious complications requiring repeated surgical interventions. Because the immune and oxidative mechanisms and structural-functional properties of erythrocyte membranes is a mandatory element in the pathogenesis of FS is cnyh forms of acute pancreatitis, in modern conditions of successful treatment is impossible without taking into account the mechanisms of action of drugs on the immune and oxidative system of the patient. Moreover, the organization of the cytoplasmic membrane of cells, tissues and organs determines, to a large extent, the course of the disease. In this regard, for adequate pharmacokineti and increase the effectiveness of treatment requires the use of immunomodulatory, antioxidant and membraneactive funds.

Currently closest to the invention is a Method of treatment of acute pancreatitis with the use of the drug "Galavit (Immunotherapy with destructive pancreatitis. Methodological manual for doctors. / Usenik, Dwikardana, Overvue etc. - Krasnoyarsk, 2006. - 14 C.; Garipov, P.M. Acute destructive pancreatitis: immunological aspects in diagnosis and treatment. / Ramgarhia, Sargysan. // Medical journal of Bashkortostan. - 2010. - V.5, №4. - P.55-60).

However, the prototype has several disadvantages: despite the description of the importance of immune disorders in the pathogenesis of acute pancreatitis, the authors recommend the use of immunokorrigiruyuschuyu therapy using the drug "Galavit", the drug "Galavit has mainly immunokorrigiruyuschy (immunomodulatory) effects, whereas unattended AB the Directors, there remains the problem of adhesive obstruction, one of the most frequent and severe complications in the treatment of destructive forms of acute pancreatitis pathogenesis which plays a key role in the immune homeostasis and in the first place - macrophage level of anti-infective protection; status of lipid peroxidation and the organization of the cytoplasmic membrane of the cells of organs and tissues, which play an important role in the pathogenesis of immunological disorders.

The technical result of the invention is to correct the structural and functional properties of erythrocytes and immune and oxidative disorders, reduced treatment time, reduced incidence of complications and improve the quality of life of patients with acute pancreatitis.

The technical result is achieved by the fact that in addition to the integrated pharmacotherapy for the treatment of patients with acute pancreatitis, regardless of the severity of the condition is used pharmacological method of influence: the drug, "Longdata", which in addition to the N-oxide-poly-1,4-ethyleneimine possessing immunomodulatory (immunokorrigiruyuschy) properties, is conjugate hyaluronidase (lydasum)with proteolytic enzyme (hyaluronidase) activity prolonged action and anti-inflammatory properties, which introduced ME 3000 intramuscularly once at 3, 6, 9, 12 and 15 days; "lipoxen", with antioxidant (antihypoxant) activity, injected 2.0-1 g once a day for 7 days intravenously by drip infusion, the contents of the ampoule ex tempore dissolved in 400 ml of 5% glucose solution; "Essentiale N"with membraneactive activity, introduce 5.0 ml intravenously slowly 1 time a day for 10 days.

The invention is illustrated in the following drawing: the dynamics of representative proteins of the membrane of red blood cells: α - and β-spectrin, ankyrin, biotransport protein (ATB), the protein band 4.1, pallidin, protein bands 4.5, dematin, actin, glyceraldehyde-3-phosphate dehydrogenase (G-3-PD), tropomyosin, glutathione-S-transferase (G-S-T), the dynamics of the sorption properties of the membrane of red blood cells: the sorption ability of erythrocytes (SSE) and the sorption capacity of their glycocalyx (NEGP); cytokine status: α - primary mediator inflammation, which plays a significant role in coordinating the inflammatory response and cytokine cascade, IL-1β, which is the main mediator of the development of local inflammatory reactions, Ostrovskogo response at the level of the organism, capable of launching products about 100 cytokines, IL-6 is an important proinflammatory cytokine, IL-8 - the main chemotactic factor for neutrophils peripheral blood, IL-10 and IL-4, anti-inflammatory cytokines; Akti the activity of the complement system: the level of C 3and C4components of the complement system; indicators of functional activity of neutrophils of peripheral blood phagocytic index (PI), phagocytic number (FC), NBT-test spontaneous and stimulated simhasanam (nst-br, Nst-Art.); products of lipid peroxidation: malondialdehyde (MDA) and acylhydrazines (AGP) and catalase activity in patients who received the treatment developed by the scheme (in the drawing indicated by the dashed line) and treated traditionally (in the drawing, a solid line) based on indicators of healthy donors (which in the drawing is the radius of the circle), indicating significant differences (p<0,05) group treated with the scheme developed in relation to the group treated traditionally (in the drawing indicated by white circles).

Developed a method of treatment of patients with acute pancreatitis by using the application in complex treatment of pharmacological methods of influence: "Longdata", "Lipoxin and Essentiale N" - combination immunomodulator, antioxidant and membranoprotector, which significantly reduce the rate of level α spectrin, pallidin, IL-6, C3C4components of the complement system, indicators of functional-metabolic activity of neutrophils, malondialdehyde and catalase activity, is all this leads to increased anti-infective resistance of the organism, has membraneactive properties, anti-inflammatory and regenerative properties, enhances the reparative regeneration processes.

The method is as follows.

After establishing the clinical diagnosis of the patient as part of an integrated pharmacotherapy impose additional 3000 ME "Longdata" intramuscularly once at 3, 6, 9, 12 and 15 days; 2.0 g "Lipoxen" 1 times a day for 7 days intravenously by drip infusion, the contents of the ampoule ex tempore dissolved in 400 ml of 5% glucose solution and 5.0 ml "Essentiale N" slow intravenous 1 time a day for 10 days.

For comparison of treatment results for the proposed methods were applied therapy group patients with acute pancreatitis according to the traditional conventional methods.

Conducted traditional treatment in patients with acute pancreatitis allow 10-14 days to stop pain, bloating, 14 to 15 days, on physical examination, the presence of parapancreatic infiltrate, and ultrasound signs of acute pancreatitis, in addition, to prevent the development of septic complications in 60% of cases, which indicates a lack of clinical efficacy of traditional treatment regimens.

The proposed treatment regimen was more effective, because its use has reduced the duration of subjective symptoms is about 7 days, the presence of pancreatic infiltrate an objective examination and ultrasound signs of acute pancreatitis - up to 10 days, to reduce the number of purulent complications up to 25%, thus, prevent their development in 75% of patients.

Identified subjective and clinical data were confirmed by immunological indicators and oxidative profile and condition of the structural and functional properties of red blood cells in patients with acute pancreatitis under the influence of treatment. It is established that in the process of traditional treatment normalized only NEGP, level G-S-T, protein bands 4.5, G-3-PD, the remaining indicators are significantly different from the indicators of healthy donors.

When treatment is given by the developed technique with the inclusion of drugs "Longdata", "Lipoxin and Essentiale N" normalizes all the indicators of the functional activity of neutrophils peripheral blood, also noted a pronounced anti-inflammatory effect of pharmacological scheme, because its use reduces the levels α, IL-1β, IL-8, normalizes the concentration of IL-6 and increases the level of IL-10 and expressed membraneactive effect, because it reduces the representativeness of dematin, actin, pallidin and α-actin (drawing).

Clinical example. Patient S., 41, was admitted to the surgical Department of the MUSES "city clinical hospital №4" , Kursk 15.06.09 with a diagnosis of strainenergy pancreatitis. From history: acutely ill, about 7 hours ago. Hospitalized in MUSES "city clinical hospital №4" gburski.

A comprehensive survey:

OAK: er. 4,8×1012/l b 161 g/l, the CPU 1,0, LC 8,8×109/l, P-3, p-72, e-2, LF-21, Mon-2, the sedimentation rate of 5 mm/h

OAM: quantity - 50 ml, color - yellow, transparent, reaction - neutral density - 1010 g/l, protein - 0,165 g/l, epithelium - flat 3-4 in p/C, leukocyte - 1-3 p/C, R - 2-3 p/C. Diastasis 1024 g/h × L.

Ultrasonography. Liver steatosis, biliary hypertension no, ha exoneration. Mud 25×27×26 mm, heterogeneous, uneven contour. The main pancreatic duct is not lazerette.

Conclusion: swelling of the pancreas.

The patient was conducted intensive conservative therapy: infusion with antispasmodics, analgesics, antifermentny drugs, antibiotic therapy, immunostimulirutuyu therapy drug "Longdata", antioxidant therapy "Lipoxen" and membraneactive therapy drug "Essentiale N".

Dynamic ultrasound monitoring in a month have signs of chronic pancreatitis exacerbation.

Thus, the combined use of drugs "Longdata", "Lipoxin and Essentiale N" in the adjuvant pharmacotherapy in patients with acute pancreatitis at the same time corrects disorders of the immune status of lipid peroxidation and structural-is unctionally properties of red blood cells and significantly reduces clinical manifestations, shown in the treatment of patients with acute pancreatitis. Consequently, in the treatment of patients with acute pancreatitis has high therapeutic effect, reduced the rate of complications, which improves their quality of life.

Method of correction of violations of the structural and functional properties of erythrocytes and immune status in patients with acute pancreatitis, characterized in that the patient in complex pharmacotherapy impose additional 3000 ME "Longdata" intramuscularly once at 3, 6, 9, 12 and 15 days; 2,0, "Lipoxin" 1 times a day for 7 days intravenously by drip infusion, the contents of the ampoule ex tempore dissolved in 400 ml of 5% glucose solution and 5.0 ml "Essentiale N" slow intravenous 1 time a day for 10 days.



 

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41 cl, 2 dwg, 6 tbl, 76 ex

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3 tbl, 1 ex, 1 dwg

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2 ex

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1 ex, 7 dwg

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2 tbl

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1 tbl, 1 ex

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2 cl, 4 tbl

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11 cl, 3 ex

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7 cl, 1 tbl, 4 ex

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