RU2460515C1 - Method for detoxification infusion therapy of patients in desomorphine consumption - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and represents a method for detoxification infusion therapy of drug-impaired patients involving the introduction of an infusion preparation and preparations enhancing the somatic state, differing by the fact that the therapy is prescribed once admitted to hospital and starts with measuring the extent of the infusion therapy by determining a degree of narcotisation manifestation, namely the presence of changed response syndrome, psychological dependence syndrome (obsession), physical dependence syndrome (compulsion) and withdrawal syndrome, body weight and daily physiological requirements that is followed by calculating the extent of the infusion therapy by formula: U=Kn×(Ks×MT)+PR; the infusion preparations are presented by electrolyte/glucose/colloid solutions in the ratio 3:3:1; it is added with psychopharmacotherapy; the therapeutic course makes 5-7 days in case of observing changed response, 10-14 days in case of psychological dependence, 15-21 days in case of physical dependence, 22-30 days in withdrawal syndrome with the extent of the infusion therapy calculated by formula is divided on 3 portions and administered in the patient at regular intervals within one day; if the patient is unassisted to compensate physiological requirements, the amount of parenteral solutions is reduced respectively.

EFFECT: invention provides adequate detoxification infusion therapy of patients in desomorphine consumption, higher effectiveness and reduced length of the therapy.

Description

The present invention relates to medicine, namely to psychiatry, narcology, transfusiology.

Desomorphine addiction is one of the new wave addictions, which is based on the artisanal production of desomorphine, which in the criminal environment has received the name “crocodile”. This medical-social phenomenon became widespread after 2000, therefore, the average age of modern desomorphine addicts is 24-25 years old, and tends to involve young people. Desomorphine addiction began to spread rapidly after 2005, taking on the character of a hidden pandemic. In terms of consumption in Russia, the share of artisanal desomorphine in the total volume quickly rose to 25-28%, taking second place after heroin addiction, which is 55-58%. Addicts turn to desomorphine when it is impossible to acquire heroin. The treatment of such victims requires considerable effort and material costs.

According to the narcological dispensary of the Republic of Bashkortostan, hepatitis B, C, and AIDS are found in 33% of desomorphine addicts.

When analyzing cases of patients with signs of drug use entering the burn ward of the Municipal Clinical Hospital No. 18 of Ufa over the past two years, it was found that up to 15% of adult patients received a conclusion about their multidrug abuse. Such victims received thermal burns during the preparation of narcotic surrogates, in particular desomorphine. Narcological patients, due to their somatic burden, as well as to developing complications when using psychoactive substances and / or desomorphine, are being treated in the departments of general and purulent surgery. According to the Ufa Medical Emergency Hospital, 6% of drug-dependent patients are admitted for inpatient treatment to the department of surgery with purulent diseases. As a result of intoxication and an overdose of narcotic surrogates, drug addicts are hospitalized in the toxicological and resuscitation departments in a serious and extremely serious condition.

Drug addiction often develops according to a well-known pattern, when a patient for a long time consumes psychoactive substances in sequence as their psychotropic effect intensifies. As a rule, addiction begins with smoking mixtures, in the future there is a heroin intake with the transition to narcotic surrogates, in particular recently to desomorphine. Addiction is characterized by the presence of a number of symptoms of the disease, which can occur with an increase in the duration and frequency of use, as well as the quality of the used psychoactive substances and / or narcotic substitutes. The main criteria for evaluating the course of drug addiction are: syndrome of altered reactivity to a narcotic substance; mental dependence syndrome; physical dependence syndrome.

The concept of "mutual burden" syndrome is used in the diagnosis and treatment of somatic pathology. This principle is used in patients with drug addiction, when a combination of several nosological forms or diagnoses is noted. Diagnosis and treatment of such conditions that subsequently arise from the use of psychoactive substances is an urgent problem for practical public health. In such patients, massive damage to the internal organs is observed - from the toxic effects of desomorphine, the cardiovascular system, central and peripheral nervous system, liver, kidneys, spleen are affected, and the immune system is destroyed. Phlebitis, thrombophlebitis, phlegmon, extensive soft tissue necrosis, sepsis are formed.

A known method of treating withdrawal symptoms in heroin addiction, including therapy with a set of drugs, including including infusion agents (hemodez, reopoliglyukin), drugs that regulate metabolic processes (cocarboxylase, riboxin, ascorbic acid, B vitamins), angioprotectors (piracetam, trental ), as well as tranquilizers (phenazepam, relanium) and analgesics (analgin, baralgin, pentalgin, ketamine, diclofenac sodium), after which, to overcome the compulsive attraction to heroin, thereafter The first stage of treatment, which usually occurs on the 3-4th day of therapy, includes the use of dimephosphone intravenously 2 times a day at a rate of 60 mg / kg per day in courses, and an individual (course) treatment regimen for dimephosphone is developed based on the severity of heroin withdrawal syndrome, which is evaluated at the height of algid symptoms (the period of "breaking" on the Kolba-Hemmilsbach scale) [patent RU 2191019, 2002].

There is a known method for the treatment of drug addiction, which consists in the elimination of intoxication and withdrawal symptoms, then, in the presence of an obsessive-compulsive syndrome in the structure of mental dependence, they perform billateral cingulotomy, while stereotactic intervention is carried out against the background of emotional stress mediated psychotherapy in the postoperative period during For 10-20 days, rational and suggestive psychotherapy is carried out twice a day [patent RU 2197183, 2003].

A known method for the treatment of drug addiction, characterized in that upon admission of the patient to the hospital find out, among other things, the time of the last injection of the drug. If the patient does not have a pronounced withdrawal syndrome, i.e. 4-8 hours after the last injection of the drug, the patient is given an intravenous drip of ozonized physiological solution with an ozone concentration of 300-500 mcg / l. On the second day, an ozone-oxygen mixture with an ozone concentration in the gas phase of 1200-1500 μg / l of 1-2 ml is injected subcutaneously into the biologically active points of the cervical-collar zone, along the U11 meridian 11UP, 42UP paired on both sides and 14XL. For pain in the lumbar region, knee joints, calf muscles, an ozone-oxygen mixture is injected into the points of the lumbar region of 25.26 U and on legs 40 U, 57 U paired on both sides. When a patient with severe withdrawal syndrome arrives 12-16 hours after the last injection of the drug, an ozone-oxygen mixture with an ozone concentration in the gas phase of 1200-1500 μg / l of 1-2 ml is first introduced into biologically active points of the cervical-collar zone, according to U11 Meridian 11UP, 42UP paired on both sides and 14ХШ. Then, 25, 26UP and on legs 40UP, 57UP are paired on both sides of the lumbar region. After that, an intravenous drip of ozonized physiological solution with an ozone concentration of 300-500 μg / L is carried out. Ozone therapy is carried out for 4-5 days. In parallel with ozone therapy, the patient is prescribed: painkillers (4-5 days), antidepressants 10 days), alpha-blockers (5-7 days) and sedatives (10 days). As a rule, withdrawal symptoms are relieved already on the 4th day. On the 5-6th day, opiate receptor blockers are prescribed - anthoxone 1 tablet 1 time per day for 10 days and metabolic preparations, for example, cytoflavin 10 ml per 200 ml of 5% glucose drip from 5 to 10 procedures [patent RU 2302227, 2007 g.].

The prototype of the invention is a method of treating alcoholism and drug addiction using a medicine containing aqueous solutions of sodium chloride, ascorbic acid, vitamin B6, aminophylline, corglycon, diphenhydramine, relanium, furosemide, magnesium sulfate nootropil. At the first stage, a psychosuggestive effect is carried out with a motivation for complete recovery and refusal to take alcoholic and / or narcological substances. At the second stage, detoxification therapy is carried out for 13-15 days, which includes deep bowel cleansing with aqueous solutions based on extracts of medicinal plants; intravenous administration of the drug “haemodesis” based on polyvinylpyrrolidone in an amount of 400-800 ml daily and a 10% solution of ascorbic acid in physiological saline and / or water at the rate of 100-120 g of dry matter per day; oral administration of a medicine of 100 ml 4 times a day and ascorbic acid in an amount of 15-20 g per day. In the third stage, for 2.5-3.5 months, supportive herbal medicine is administered by oral intake of infusions from medicinal plants [patent RU 2181593, 2002]. The disadvantages of this method are the following circumstances: its use does not take into account the severity of anesthesia and somatic burden, use the drug Hemodez, which is currently not used in the treatment of patients, and ascorbic acid in large doses, other types of drugs are used as a medicine, the method is laborious and not efficient enough.

The objective of the invention is to develop a method of detoxification and infusion treatment of patients with the use of desomorphine, which increases efficiency and reduces the duration of therapy.

The technical result is an adequate detoxification and infusion treatment of patients with the use of desomorphine.

The proposed method detoxification and infusion treatment of patients with the use of desomorphine is as follows. First, determine the volume of infusion therapy, for which they establish the severity of the patient's anesthesia - the presence of a syndrome of altered reactivity to a narcotic substance, a syndrome of mental dependence (obsessive attraction), a syndrome of physical dependence (compulsive attraction) and withdrawal syndrome, the patient's body weight, physiological needs of the body in ml, during the day, after which the volume of infusion therapy in ml is calculated by the formula

V = Kn × (Ks × MT) + FP, where

V is the volume of infusion therapy, in ml;

Kn - coefficient of severity of anesthesia: 1.0 - with altered reactivity to a narcotic substance; 1.5 - in the presence of mental dependence (obsessive attraction); 2.0 - in the presence of physical dependence (compulsive attraction); 2.5 - with withdrawal symptoms;

Ks - coefficient of somatic burden with the use of psychoactive substances and / or desomorphine, equal to 0.2;

MT - patient body weight in grams;

AF - physiological needs of the body during the day, in ml.

The main criteria for assessing the course of drug addiction are used: the presence of a syndrome of altered reactivity to a narcotic substance, a syndrome of mental dependence, a syndrome of physical dependence and withdrawal syndrome. Calculation of physiological needs is made: from 1 to 10 kg - 100 ml of fluid per day; 11-20 kg - 50 ml; over 20 kg - 10 ml (body weight 70 kg, physiological need will be: 10 × 100 + 10 × 50 + 50 × 10 = 2000 ml (http://www.medmoon.ru :; http: //ochilds.narod. com / 0192.html).

The main environments for infusion therapy are balanced electrolyte solutions, glucose solutions of various concentrations, colloids. For patients intoxicated with the use of desomorphine, infusion media are administered at a ratio of electrolyte / glucose / colloid solutions of 3: 3: 1. In addition, two groups of drugs are administered to the patient: improving the somatic state of the body (vitamins, drugs that improve the state of microcirculation, metabolic processes, protectors and adaptogens, antibiotics according to indications, etc.) and psychopharmacological drugs (antipsychotics, tranquilizers, antidepressants, nootropics, etc. )

The duration of treatment is: 5-7 days - with an altered reactivity to a narcotic substance; 10-14 days - in the presence of mental dependence (obsessive attraction); 15-21 days - in the presence of physical dependence (compulsive attraction); 22-30 days - with withdrawal symptoms. The volume of infusion therapy calculated by the formula is divided into 3 parts and administered to the patient at equal time intervals. When physiological needs are compensated by the natural intake of liquid for drug-addicted patients, the volume of parenteral solutions administered is reduced accordingly, that is, by the volume of physiological needs.

In the available sources of scientific, medical and patent information, the authors did not find an identical method of detoxification and infusion treatment of patients using desomorphine, including determining the volume of infusion therapy taking into account the degree of anesthesia of the patient, his weight and physiological needs, carrying out infusion therapy at a ratio of electrolyte / glucose solutions / colloids 3: 3: 1, psychopharmacotherapy, course of treatment 5-7 days - with altered reactivity to the narcotic substance; 10-14 days - in the presence of mental dependence; 15-21 days - in the presence of physical dependence; 22-30 days - with withdrawal symptoms, moreover, the volume of infusion therapy calculated by the formula is divided into 3 parts and administered to the patient at regular intervals throughout the day, and if the physiological needs are compensated to the patients themselves, the volume of parenteral solutions is reduced accordingly. Thus, the claimed invention meets the criterion of "Novelty."

The authors' studies proved that the proposed method of detoxification and infusion treatment of patients with desomorphine, including determining the volume of infusion therapy taking into account the degree of anesthesia of the patient, his weight and physiological needs, conducting infusion therapy with a ratio of electrolyte / glucose / colloid solutions of 3: 3: 1, psychopharmacotherapy, a course of treatment of 5-7 days - with altered reactivity to a narcotic substance; 10-14 days - in the presence of mental dependence; 15-21 days - in the presence of physical dependence; 22-30 days - with withdrawal symptoms, and the volume of infusion therapy calculated by the formula is divided into 3 parts and administered to the patient at regular intervals throughout the day, and when compensating for the physiological needs of the patients themselves, the amount of parenterally administered solutions is reduced accordingly, allowing for detoxification -infusion treatment of patients with the use of desomorphine. Thus, the claimed invention meets the criterion of "Inventive step".

In this way, 8 patients were treated in a state of drug intoxication and intoxication with varying severity of anesthesia in the intensive care unit and intensive care unit, as well as in the somatic department of the Municipal Clinical Hospital No. 18 of Ufa. In all cases, the specified technical result was achieved.

We give an example of clinical use of the proposed method.

Patient G. 30 years old No. 211162 in 2011 was delivered by the ambulance team from the liquidated drug stadium. Upon admission, the patient's body weight was 70 kg. Upon receipt, contact is difficult, conditionally oriented in the place, time, and self. The degree of anesthesia of the patient - with changes in reactivity to the narcotic substance, mental, physical dependence and severe withdrawal syndrome. The phenomena of psycho-production. He was hospitalized in the intensive care unit and intensive care unit of the Municipal Clinical Hospital No. 18 of Ufa with a diagnosis of Intoxication with narcotic surrogates (desomorphine). Phlebitis, thrombophlebitis of the upper, lower extremities. The treatment was carried out in the intensive care unit and intensive care unit of the proposed method, where the volume of infusion therapy was first determined by the formula V = Kn × (Ks × MT) + AF, which was: V = 2.5 × (0.2 × 7000) +2000 V = 5500 ml. The daily volume is divided into 3 parts, one dose was V = 1830 ml. The ratio of electrolyte / glucose / colloid solutions is 3: 3: 1. Thus, the daily volume of electrolytes was 2360 ml, glucose 5% and 10% 2360 ml, colloids 780 ml. In addition, vitamins were used in the hypervitaminization regimen - 5% solution of vitamin B ₁ 10 ml 3 times a day, 5% solution of vitamin B ₆ 10 ml 3 times a day, 5% solution of vitamin C 20 ml 3 times a day. In order to improve the state of microcirculation and metabolic processes: pentoxifylline 2% 5 ml 3 times a day, riboxin 2% solution of 20 ml 3 times a day, aminophylline 2.4% 3 times a day. In order to correct psycho-productive symptoms and withdrawal symptoms: atarax 100 mg 3 times a day, amitriptyline 75 mg 3 times a day. In order to treat the phenomena of phlebitis, thrombophlebitis of the upper and lower extremities, ceftriaxone 1.0 2 times a day, dressings with heparin and levomekoli ointments were used.

Within 5 days the patient was in the intensive care unit and intensive care unit, subsequently transferred to the somatic department, where treatment was continued using the proposed method. The duration of treatment was 30 days, of which 5 days in the intensive care unit and intensive care and 25 days in the somatic department. In the department, the physiological need was replenished independently, respectively, the volume of detoxification and infusion treatment decreased by 2000 ml and amounted to 3500 ml.

During treatment, the condition is stabilized, encephalopathy and psychosis did not develop, and withdrawal symptoms were stopped. The phenomena of phlebitis, thrombophlebitis in the course of treatment with positive dynamics were stopped. The patient gained weight, laboratory indicators within the age norm. There was criticism of his condition and the abuse of narcotic surrogates.

The proposed method is easily reproducible in a hospital environment, and when it is used, the indicated technical result is achieved. Thus, the claimed invention meets the criterion of "Industrial applicability".

Claims (1)

A method of detoxification and infusion therapy of patients intoxicated, including the introduction of an infusion drug and drugs that improve somatic condition, characterized in that the therapy is started upon admission of the patient, the volume of infusion therapy is first determined, for which the degree of anesthesia is established, namely the presence a syndrome of altered reactivity to a narcotic substance, a syndrome of mental dependence (obsessive drive), a syndrome of physical dependence (comp ulcerative attraction) and withdrawal symptoms, body weight and physiological needs of the body during the day, after which the volume of infusion therapy is calculated by the formula:
V = Kn · (Ks · MT) + FP,
where V is the volume of infusion therapy, ml;
Kn - coefficient of severity of anesthesia: 1.0 - with altered reactivity to a narcotic substance; 1.5 - in the presence of mental dependence (obsessive attraction); 2.0 - in the presence of physical dependence (compulsive attraction); 2.5 - with withdrawal symptoms;
Ks - coefficient of somatic burden with the use of psychoactive substances and / or desomorphine, equal to 0.2;
MT - patient body weight, g;
AF - physiological needs of the body during the day, ml,
as infusion preparations, solutions of electrolytes / glucose / colloids are introduced at a ratio of 3: 3: 1, psychopharmacotherapy is additionally carried out, the course of treatment is 5-7 days - with an altered reactivity to the narcotic substance; 10-14 days - in the presence of mental dependence; 15-21 days - in the presence of physical dependence; 22-30 days - with withdrawal symptoms, moreover, the volume of infusion therapy calculated by the formula is divided into 3 parts and administered to the patient at regular intervals throughout the day, and to compensate for the physiological need for patients, the volume of parenteral solutions administered is reduced accordingly.