Method of treating patients with obliterating diseases of lower extremity arteries

FIELD: medicine.

SUBSTANCE: method involves introducing the preparation Cytoflavin. A mixture of therapeutic substances consisting of Cytoflavin 5.0 ml and 0.5% Novocaine 5.0 ml is introduced by lymphotropic interstitial injection in the anteriolateral or posteriolateral surface of the upper or middle segments of the shin after preliminary local anaesthesia of the injection area with 0.5% Novocaine 5.0 ml.

EFFECT: method provides more effective treatment of obliterating diseases of lower extremity arteries, manages or relieves rest pains, increases a pain threshold, enlarges a painless walking distance, presents an alternative to the intravenous route of administration of Cytoflavin, causes no post-infusion headaches.

2 ex

 

The invention relates to medicine, in particular for lymphology, and can be used for the treatment of occlusive atherosclerotic lesions in arteries of the lower extremities.

The existing conservative therapy (Vigilence, Mbereko, Immolith. Angioprotective in the complex treatment of patients with obliterating diseases of lower limb arteries. Methodological manual for doctors. - M., 2011. - 24 S.), includes drug therapy, aimed at the correction of endothelial dysfunction, hemorheological and hemocoagulation disorders, as well as on the prevention of progression of the atherosclerotic process. It is recommended to use preparations of different groups with the aim of correction of endothelial dysfunction (statins, beta-blockers, ACE inhibitors, low molecular weight heparins). To correct rheological and coagulation properties of blood is recommended the use of antiplatelet drugs (aspirin, dipyridamole, plavix, ticlid, Cilostazol), intravenous infusion of nicotinic acid (having the properties of the antiplatelet agent and the indirect fibrinolytic), drug-natural analogue of prostaglandin E1 (vazaprostan, alprostadil), drug heparinoid vessl due f (sulodexide), anticoagulant therapy with low molecular weight heparins (Fraxiparine, Fragmin, therapy).

When obliterating diseases of lower limb arteries IIIa stage, you receive a "rest pain", and in stage IIIB pain to peace is added swelling of the leg and foot (classification Fontenay-Pokrovsky, modified Saveliev B.C., V. M. Koshkin). When conducting comprehensive medication therapy all of the above the most effective drugs to combat pain syndrome is a therapy vazaprostan (alprostadil).

However, therapy vazaprostan requires:

1. Conditions specialized hospital (Department of vascular surgery).

2. The necessity of puncturing veins.

3. Implementation intravenous infusion within 3 hours.

In addition, it should be noted:

1. Therapy vazaprostan has many side effects.

2. There are many contraindications for its use.

3. Vazaprostan is an expensive drug.

Know the drug CYTOFLAVIN (Instructions for medical use of the drug CYTOFLAVIN. The order of the Federal service on surveillance in healthcare and social development dated 23.12.05 №74). According to this statement, cytoflavin is used only intravenously in breeding by 100.0-200.0 ml of 5%-10,0% glucose solution or of 0.9% solution of sodium chloride. However, some patients with peripheral occlusive arterial diseases dims the x extremities at intravenous introduction of cytoflavin along with the positive effect, namely, warming the limbs and decrease pain in extremity, manifested side effects in the form of severe headaches, which have to discontinue therapy cytoflavin. It is known that in the treatment of many diseases is more efficient lymphotropic drug administration (Borodin SCI Institute of lymphology and problems lymphology // Bulletin of the Siberian branch of the Russian Academy of medical Sciences. - 2001. No. 4. - P.5-11). Also known "Method of treatment of cerebrovascular diseases and asthenic syndrome, patent RF №2463045 from 10.10.2012, authors gariaev N.A., Zavgorodny IG, which is the closest analogue in the treatment of vascular disease atherosclerotic origin lymphotropic by way of introduction of cytoflavin.

However, in this way:

1. Used suboccipital lymphadenopathy access to the drug for regional treatment of cerebrovascular diseases, but are not regional for treatment of obliterating diseases of lower limb arteries.

2. Used dose of cytoflavin with the introduction of 2.0 ml, which is not enough to ensure a pronounced and long-lasting clinical effect in obliterating diseases of lower limb arteries in IIIa-IIIB stage.

3. The introduction of cytoflavin lymphotropic more than 2.0 ml, even in a mixture with novocaine sometimes painful.

We have developed, aprobar the van and used in the adjuvant drug therapy, recommended Scientific center of cardiovascular surgery named. Ahibalava Russian Academy of medical Sciences and Department of cardiovascular surgery, Ramapo (authors: Vigilence, Mbereko, Immolith. Angioprotective in the complex treatment of patients with obliterating diseases of lower limb arteries. Methodological manual for doctors. - M., 2011. 24 C.), the method of treatment of obliterating diseases of lower limb arteries, which is as follows: a mixture of drugs, consisting of cytoflavin 5.0 ml and 0,5%novocaine -5,0 ml, injected lymphotropic by interstitial injection in the anterior-lateral or posterior-lateral surface of the upper or middle segments of the tibia, after preliminary local anesthesia injection site novocaine 0,5%-5,0 ml once a day.

Dose rate and number of courses are determined by the clinical picture of the disease.

The invention is aimed at solving the following tasks:

1. To increase the efficiency of treatment of obliterating diseases of lower limb arteries with a new way of introducing a mixture of cytoflavin with novocaine.

2. Reduce dose of cytoflavin due to regional lymphotropic introduction compared with intravenous administration.

3. Avoid intravenous route of administration of the drug to minimize the occurrence of adverse reactii 4 - bit in order to work the way painless injection of a mixture of cytoflavin with novocaine, suitable for daily long-term administration, calculated on a months-long courses of therapy.

Examples of specific performance.

Example 1. Patient O., 87 years of age. Do not smoke during the last 22 years. 20 (was at the front) 65 years occasionally smoked. Appealed with complaints of increased pain in the right foot, especially in the first finger, and tibia. The patient appeared constant pain peace not only in the daytime, but at night, which deprived him of sleep. Considers himself ill for about five years, when he first showed symptoms of intermittent claudication, gradually decreasing the distance painless walk. In March - April 2012 increased pain in the lower leg and foot, appeared trophic ulcer on the first finger of the right foot. In may 2012 were on inspection and treatment at the Department of cardiovascular surgery of the city clinical hospital №4. Conducted abdominal aortoarteritis. Identified numerous levels of stenosis from 55 to 84% performance arteries such as the femoral, popliteal. The Diagnosis Of Atherosclerosis. Stenosis of the iliac arteries on both sides. Occlusion of right femoral arteries, leg arteries on both sides. Chronic arterial insufficiency stage IV on the right. Treated with vazaprostan 60 µg intravenous drip slowly №10. After the treatment the patient's condition has improved, the pain of sin is rum decreased, normalized sleep, the plague of the first finger of the right foot under a dry scab. The state of relative comfort in the right ankle and foot alone against the backdrop of continuing Plavix 75 mg 1 time/day, Liprimar 80 mg 1 time/day remained about one month and then appeared again pain rest. Was started therapy by intravenous infusion of a solution of cytoflavin 10 ml, diluted in physiological NaCl solution. However, along with decrease in pain in the Shin every time infusion of cytoflavin appeared severe headaches, and intravenous injection of cytoflavin had to be abandoned. In this regard, we carried out lymphotropic therapy with a mixture of cytoflavin 5.0 ml and 0,5%novocaine -5,0 ml after prior local anesthetic novocaine 0,5%-5,0 ml of the injection area of the anterior-lateral surface of the upper segment of the leg. Injection was accompanied by the cessation of pain, a feeling of warmth in the leg and foot for 16-24 hours after administration of a medicinal mixture, no headaches, increased tolerance to stress (in the form of walks on the street, which was previously impossible). Injections were made in the first three months of daily, and the next three months through the day for six months in the outpatient setting until the next course vanaprasta in the hospital.

When is EP 2. Patient S., aged 65. Smokes. Complaints on a daily constant pain left leg and foot when walking and at rest, swelling of the leg and foot. Considers himself ill the last five years, when there were symptoms of intermittent claudication. In February 2012 were examined and treated in the surgical Department of the city clinical hospital No. 2 in the city of Perm. Conducted abdominal aortoarteritis. Identified numerous levels of stenosis from 57 to 89% of the iliac, femoral, popliteal arteries. The Diagnosis Of Atherosclerosis. Stenosis of the iliac arteries on both sides. Occlusion of left femoral arteries, popliteal arteries, leg arteries on both sides. Chronic arterial insufficiency IIIB stage left. The Department conducted treatment with sulodexide (Oars Duo f) 1 vial (600 LE) 2 times a day intramuscularly for 10 days, then discharged for further outpatient continue treatment with sulodexide 1 capsule (500 LE) 2 times a day for 60 days. The patient noted improvement in reduction of edema of the legs and feet, reducing pain. We have conducted several courses lymphotropic injection in the middle third of the posterior-lateral surface of the left tibia mixture of cytoflavin 5.0 ml and 0,5%novocaine -5,0 ml after prior local anesthetic novocaine 0,5%-5,0 Jr. During the course of the pain syndrome in the lower leg and the foot was reduced and again vozvrashalas is between courses.

The use of the claimed method provides the following benefits/

1. Improving the quality of treatment of obliterating diseases of lower limb arteries.

2. Minimizing the appearance of undesirable side reactions, available intravenously.

3. Reducing the dose of the drug compared with intravenous administration.

4. The applicability of this method of treatment in the outpatient setting.

5. Reducing the cost of the drug Cytoflavin in 2 times.

A method for the treatment of patients with obliterating diseases of lower limb arteries, including the introduction of the drug Cytoflavin, characterized in that the mixture of drugs, consisting of cytoflavin 5.0 ml and procaine 0.5% to 5.0 ml, injected lymphotropic by interstitial injection in the anterior-lateral or posterior-lateral surface of the upper or middle segments of the tibia after preliminary local anesthesia injection site novocaine of 0.5% to 5.0 ml



 

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