Method for increasing effectiveness of endosurgical management of patients suffering acute biliary pancreatitis

FIELD: medicine.

SUBSTANCE: thoracic epidural analgesia is conducted by puncturing and catheterisation of an epidural space at ThVIII - ThIX before the expiry of 24 hours from the onset of a disease after a moderate intravenous infusion therapy in the amount of 15-20 mg/kg of crystalloid solutions. 20 minutes before an expected endoscopic papillosphincterotomy, a catheter is moved 4-5 cm in a cranial direction. At ThV-ThX, 0.4% naropin 10-12 ml or 0.2% Marcaine 10-12 ml and clonidine 100 mcg are administered through a catheter. That is followed by a pre-medication by administering 0.1% atropine 0.5-1 ml and 0.5% relanium 1-2 ml. Thereafter, the patient is taken to an X-ray operation room to conduct the endoscopic papillosphincterotomy without an endoscopic retrograde cholangiopancreatography with general pancreatic duct stenting. After the operation has been completed, the patient is taken to an intensive care unit wherein an extended epidural analgesia is conducted by administering 0.2% naropin 10-12 ml or 0.15% marcaine 10-12 ml into the epidural space every 4 hours until the patient is taken to a department of surgery.

EFFECT: early intestinal motility recovery, increased pancreatic secretion, prevented spasm of the gastrointestinal sphincter ensured by a pathological complete blockade of sympathetic impulsing.

1 ex

 

The invention relates to medicine, in particular for endosurgery and anesthesiology, and applies tactics of treatment of patients with the syndrome of biliary hypertension, acute biliary pancreatitis.

The proportion of acute biliary pancreatitis in the structure of acute inflammation of the pancreas, according to various authors, 30-40% of cases[1, 2, 3, 4, 5]. Overall mortality in acute pancreatitis, both in our country and in the European countries is 7%-10%, and in severe acute biliary pancreatitis reaches 20%-39% [4].

There is a conservative treatment for acute biliary pancreatitis, which includes the use of various drugs: drugs that reduce exocrine activity of the pancreas (somatostatin), which improves motor function of the intestine (prokinetic, cholinomimetic agents), non-hormonal anti-inflammatory drugs, heparin, and others.

The disadvantages of this method are the low efficiency and a high risk of developing septic complications, high cost of these drugs, high risk of relapse.

Known endosurgical treatment of acute biliary pancreatitis, which in the early stages perform endoscopic papillosphincterotomy, using as obezbolivaet what I narcotic analgesics, intravenous anesthesia or endotracheal anesthesia (prototype). Some researchers recommend the use of epidural anesthesia with local anesthetics only paresis of the intestine and in the presence of satisfactory evidence of pancreatic necrosis.

The disadvantages of this method are its lack of effectiveness, since, in some cases, swelling of the papillae after endoscopic papillosphincterotomy leads to violation of the outflow of pancreatic juice, which negatively affects the course of the disease. And the use of the above methods of anesthesia does not provide a complete blockade of pathological sympathetic activity and in the immediate postoperative period leads to the inhibition of intestinal peristalsis, increase comproducts pancreas, as well as spasm of the sphincters of the gastrointestinal tract. A delayed application of epidural anesthesia only local anesthetics is not effective.

The technical result of the claimed method is to increase the efficiency of treatment of patients with acute biliary pancreatitis.

The technical result is achieved by the fact that the way to improve efficiency endosurgical treatment of patients with acute biliary pancreatitis, including early, up to 24 hours, for endoscopic papillosphincterotomy without e is roscopically retrograde pancreatography with stenting common pancreatic duct, performing against the backdrop of thoracic epidural analgesia with the purpose for which, after reasonable intravenous infusion therapy in the volume of 15-20 ml/kg crystalloid solutions, the dotted line and kateteriziruyut epidural space at the level of ThVIII - ThIX, the catheter promote 4-5 cm in the cranial direction, 20 minutes before the expected endoscopic papillosphincterotomy to achieve sensory and sympathetic blocks of a ThV-ThX, through the epidural catheter impose naropina solution of 0.4% - 10-12 ml or solution marcaine 0,2% - 10-12 ml and the solution clonidine 100 mcg, after sedation with the use of a solution of atropine 0,1% - 0,5-1 ml of a solution Relanium a 0.5% 1-2 ml of the patient served in the x-ray operation room for endoscopic transpapillary intervention, and after endoscopic transpapillary intervention the patient is transferred to the intensive care unit, where they extended epidural analgesia is injected into the epidural space every 4 hours solution naropin 0,2% - 10-12 ml or solution marcaine 0,15% - 10-12 ml to transfer the patient in the surgical ward.

The essence of the proposed method.

Improving the efficiency of treatment of patients with acute biliary pancreatitis is achieved early endoscopic papillosphincterotomy, without endoscopic [retr] the grapes of pancreatography, with stenting common pancreatic duct, with the use of thoracic epidural analgesia with local anesthetics and α2-agonist Central action.

In conducting retrospective study in state budgetary educational institution of higher professional education "Volgograd state medical University Clinic No. 1 in 2008 - 2012, it is proved that the use of this tactic has significantly reduced the number of deaths (5.8 times), the cost of treatment in these patients and the time of their hospitalization (2.1 times).

When using the inventive method offers the possibility of effective treatment of patients with acute pain and comorbidity.

Methodology the proposed method.

The method is as follows. After ultrasound or MRI to confirm a patient with acute pancreatitis signs of choledocholithiasis or stenosis of the major duodenal papilla, the patient arrives in the ICU, where, after a moderate intravenous infusion therapy in the volume of 15-20 ml of crystalloid solutions, the dotted line and kateteriziruyut epidural space at the level of ThVIII - ThIX, the catheter promote 4-5 cm in the cranial direction, 20 minutes before the expected endoscopic papillosphincterotomy to achieve sensory and sympathetic blocks of a ThV - ThX,through the epidural catheter impose naropina solution of 0.4% - 10-12 ml or solution marcaine 0,2% - 10-12 ml and the solution clonidine 100 mcg, after sedation with the use of a solution of atropine 0.1% to 0.5-1 ml of a solution Relanium a 0.5% 1-2 ml of the patient served in the x-ray operation room to conduct endoscopic papillosphincterotomy without endoscopic retrograde pancreatography, with stenting common pancreatic duct, and after endoscopic transpapillary intervention the patient is transferred to the intensive care unit, where they extended epidural analgesia is injected into the epidural space every 4 hours solution naropin 0,2% - 10-12 ml or solution marcaine 0,15% - 10-12 ml to transfer in surgical branch.

An example of a specific implementation.

Example.

Patient N., 41 year history No. 504, was admitted to the surgical Department of the hospital №1 Wagga 09.02.12 at 09.40 hours with a diagnosis of post-cholecystectomy syndrome. Choledocholithiasis. Acute biliary pancreatitis.

Patient transferred to the intensive care unit for preparation for endoscopic papillosphincterotomy.

09.02.12 was made urgent endoscopic papillosphincterotomy, lithoextraction, stenting of the main pancreatic duct.

As the anesthesia was used thoracic epidural analgesia.

The Protocol breast disease the General analgesia.

Infusion therapy: aq NaCl 0,9% - 400ml, aq Glucose 5% - 400ml. Under aseptic conditions, under local anesthesia Sol. Lidocaini 2% - 2ml, level ThVIII - ThIX produced puncture and catheterization of the epidural space, the catheter is pulled to 5 cm in the cranial direction, the suction test is negative, put a test dose of Sol. Lidocaini 2% - 4 ml, 15 min signs of intrathecal injection of anesthetic no. Aseptic dressing, catheter fixed with adhesive tape.

After carrying out the suction of the sample entered the main dose: Sol. Marcaini 0,2% - 12ml, Sol. Klofelini 0.01% by lml. After 15 min: sensory block level ThV - ThXI, sympathetic block ThIV - ThXII.

Breathing independent, adequate, stable hemodynamics, HELL 125/65 mm Hg, PS 67 1 min, rhythmic.

With sedation/entered: Sol. Atropini of 0.1% to 0.6 ml, Sol. Relanii 0,5% - 1 ml. The patient is transported in the x-ray operation room.

Protocol operations No. 28.

In the stomach - the picture is mixed gastritis. The mucosa of the duodenal bulb edematous, hyperemic. Large duodenal papilla significantly pronounced swollen, the mouth up to 4 mm with scalloped edges, covered with fibrin. From the mouth of the choledochus bile is not received. Canulate to 60 mm Retrograde cholangiography was not performed. Endoscopic papillosphincterotomy to 18 mm In instrumental revision and reorganization of the choledochus received calculus di the meter. 11 mm cholesterol "putty". From the mouth of the choledochus actively enters the bile. Through the mouth of the common pancreatic duct held plastic stent diameter 5Fr.

Diagnosis: post-cholecystectomy syndrome. Choledocholithiasis. Acute biliary pancreatitis.

In the postoperative period was held conservative therapy, prolonged epidural analgesia. After 20 hours removed the catheter from the epidural space, the patient was transferred from intensive care to the surgical Department. Within 2 days of normal laboratory values, disappeared clinical signs of acute pancreatitis. When the control ultrasound data for the presence of free fluid in the abdominal cavity is not revealed. After 4 days recorded samochodzie stent of the common pancreatic duct. Discharged on the 6th day in a satisfactory condition.

Advantages, the positive effect of the claimed method:

- The effectiveness of the inventive method more efficient than all known methods of treatment of acute biliary pancreatitis;

- The use of this method reduces the risk of fatal complications (pancreatic shock, multiple organ failure);

- Safe in patients with severe concomitant (particularly cardiovascular) pathology;

- The claimed method can significantly cut the ü the incidence of septic complications;

Compared with other methods do not require significant expenses.

It should be noted that the application of the inventive method leads to a reduction of the average duration of hospitalization with 16.8 days to 7.9 days. This relative reduction in mortality of 82.9%. The reduction in the absolute risk of fatal complications is 6.3%.

References

1. Kim V.L., Khakimov MS, Karimov FS Retrograde endobiliary intervention in acute biliary pancreatitis // Annals of surgery, 2005; 4: 39-42.

2. Kovachev KG, Abdullayev EG, Chacabuco MS, Abdullayev SUPERVISION Opportunities endoscopic techniques in the treatment of patients with acute biliary pancreatitis // Bulletin of the Ivanovo medical Academy, 2010; 4(15): 24-28.

3. Nazarenko, M., Nazarenko, D.P., Kanishchev J.V., Tarasov O., Loktionov A.L., Alyokhin S.A. Surgical tactics in acute biliary pancreatitis // Annals of surgical Hepatology, 2011; 4(16): 71-76.

4. Pascari ST. Pathogenetic approaches in the treatment of biliary pancreatitis // Herald of the Russian military medical Academy, 2010; 3: 78-83.

5. Shapovalianz YEAR, Myl'nikov, A.G., eagles, HE, Pankov A.G., Budzinskaya S.A., Ardzinov T.B. Diagnosis and treatment of acute biliary pancreatitis // Annals of surgical Hepatology, 2009; 1(14): 29-33.

The way to improve efficiency endoh the surgical treatment of patients with acute biliary pancreatitis, characterized in that for this purpose perform early, up to 24 hours, endoscopic papillosphincterotomy without endoscopic retrograde pancreatography with stenting common pancreatic duct, which perform against the backdrop of thoracic epidural analgesia with the purpose for which, after reasonable intravenous infusion therapy in the volume of 15-20 ml/kg crystalloid solutions, the dotted line and kateteriziruyut epidural space at the level of ThVIII-ThIX, the catheter promote 4-5 cm in the cranial direction, 20 minutes before the expected endoscopic papillosphincterotomy to achieve sensory and sympathetic blocks of a ThV-ThX, through an epidural catheter is injected solution naropin 0,4% - 10-12 ml or solution marcaine 0,2% - 10-12 ml and the solution clonidine 100 mcg, after sedation with the use of a solution of atropine 0.1% to 0.5-1 ml of a solution Relanium a 0.5% 1-2 ml of the patient served in the x-ray operation room for endoscopic transpapillary intervention, and after endoscopic transpapillary intervention the patient is transferred to the intensive care unit, where they extended epidural analgesia is injected into the epidural space every 4 hours solution naropin 0,2% - 10-12 ml or solution marcaine 0,15% - 10-12 ml to transfer the patient to the surgical the e branch.



 

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22 cl

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2 tbl, 2 ex

FIELD: medicine.

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4 cl, 3 ex

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1 tbl, 5 ex

FIELD: medicine.

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8 cl, 3 ex

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2 ex

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10 cl, 1 tbl, 2 ex

FIELD: medicine.

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2 tbl, 5 ex

FIELD: medicine, pharmaceutics.

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14 cl, 15 ex, 8 tbl, 3 dwg

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16 cl, 12 ex, 6 tbl, 4 dwg

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2 tbl, 4 ex

FIELD: medicine.

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3 tbl

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60 cl, 3 tbl, 65 ex

FIELD: medicine.

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7 cl, 1 tbl, 2 ex

FIELD: medicine.

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2 ex, 3 tbl

FIELD: medicine, pharmaceutics.

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2 tbl

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to pharmaceutical industry, namely to a microcapsules for preventing or treating hepatic disorders. The microcapsules for preventing or treating hepatic disorders containing a capsule coating, an encapsulating suspension of a therapeutically effective hepatocyte count in a physical contact with a hepatocyte-stimulating amount of erythropoietin. A method for preparing microcapsules involving preparing the suspension of the therapeutically effective hepatocyte count and the hepatocyte-stimulating amount of erythropoietin to bring them in physical contact with each other, and encapsulating the suspension of hepatocytes and erythropoietin in a biologically compatible capsule shell so that to form a microcapsule. A method for preventing or treating a hepatic disorder in an individual in need thereof involving administering the microcapsules in the individual in need thereof. The method for introducing the hepatocytes in the individual involving administering the microcapsules in the individual. A method for hepatocyte culture in a culture medium involving hepatocyte culture in the microcapsules in the appropriate culture medium.

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20 cl, 1 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to treating fatty liver degeneration. The method of treating a patient suffering fatty liver degeneration involves administering a therapeutically effective amount of cysteamine or cystamine, or a pharmaceutically acceptable salt thereof as a part of a composition. The method of treating the patient suffering non-alcoholic fatty liver degeneration (NAFLD) or non-alcoholic steatohepatitis (HASH) involves administering the therapeutically effective amount of the composition containing cysteamine or cystamine, or the pharmaceutically acceptable salt thereof. In both methods, the composition may be presented by a delayed or controlled release dosage form containing an enteric coating and providing the improved delivery of cysteamine or cystamine, or the pharmaceutically acceptable salt thereof.

EFFECT: improving the method of treating.

24 cl, 3 ex, 7 dwg

Immunomodulator // 2497514

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to chemical-pharmaceutical industry, and represents an immunomodulator for treating chronic hepatitis, hepatic cancer, lymphatic sarcoma, chronic leukemia, and for improving the functions of liver and blood-forming organs, for enhancing the immunobiological body characteristics, prepared by mixing 1000 ml of an aqueous infusion of sandy everlasting blossom, pepper mint herb and chicory herb with 50 ml of bovine serum containing leukaemia oncovirus antibodies, 20 ml of wild rosemary infusion, 40 g of ascorbic acid, 2 g of sorbic acid, 0.2 g of folic acid until the ingredients are dissolved completely, with adding 60 g of liver powder, 30 g of lymphatic node powder, 30 g of young bovine spleen powder; the prepared solution is settled at room temperature for 24 hours, then kept at a boiling water bath for 30 minutes and cooled for 6-8 hours at room temperature; the settled solution is filtered, wherein the aqueous herbal solution is prepared by mixing equal proportions of the separately prepared aqueous infusions of 40 g of pepper mint herb in 1000 ml of water, 30 g of sandy everlasting blossom in 1000 ml of water and 30 g of chicory herb in 1000 ml of water, while the wild rosemary infusion is prepared by infusing 60 g of ground wild rosemary blossom in 1000 ml of 70% purified ethanol.

EFFECT: invention provides creating the high-efficacy agent and reducing the length of treatment.

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely to gastroenterology and may be used for treating hepatitis C. For this purpose, an effective amount of glutaryl histamine or a pharmaceutically acceptable salt thereof is introduced into the patient. The above agent may be administered in a combination with pegylated interferon and ribavirin. The group of inventions also refers to a pharmaceutical composition for treating viral hepatitis C. This group of inventions enables disclosing a new drug preparation having a manifested antiviral effect and being effective in treating viral hepatitis C.

EFFECT: what is developed is the effective combination of the drug preparations for treating viral hepatitis C, which allows reducing the rate of side effects of the antiviral therapy substantially.

39 cl, 3 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, namely otorhinolaryngology and may be used for various ear diseases. That is ensured by presenting the systems for electrophoresis drug delivery to a human or animal ear drum. The system contains an ear tampon having distal and proximal portions with a tube passing in between and having a smaller rigidity as compared to the proximal and distal portions of the ear tampon. One flexible sealing element extending from an external surface of the tube and closer to a distal end than to a proximal one. An electrode consisting of an extended shaft, a tip having a greater diameter as compared to the trunk. The electrode is placed inside of the tube of the ear tampon from the retracted position wherein a fluid can flow in the tube round the electrode into the extended position, wherein the electrode tip is in contact with the internal surface of the tube thereby preventing the fluid flow in the tube. The system can also comprise two flexible sealing members integrated with the extended tube. There are also presented methods for anaesthetising the ear drum by using the given system. There are presented kit for anaesthetising comprising the drug delivery system and controller coupled with the electrode.

EFFECT: inventions provide the drug delivery, including anaesthetics into the patients being in the vertical position, due to a possibility to retain the solution hermetically in the external ear canal with no additional conditions provided.

23 cl, 12 dwg

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