RU2720662C1 - Method of treating patients with gallbladder hypomotor dysfunction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely physiotherapy, and can be used for treating patients with gallbladder hypomotor dysfunction. That is ensured by vibration exposure with frequency 62 Hz and amplitude 5–6 mm followed by a vibrator with a semi-spherical massage attachment. For the patient's vibromassage session, the patient is laid on the table surface on the left side; the right side is inclined to the table surface in a position suitable for access to the right hypochondrium. Strain the pressure vibrator massager for 3–4 minutes on the front abdominal wall under the eleventh rib, under the point of the gall bladder bottom location. Vibratory wave is directed from under the ribs to the gallbladder bottom. Additionally, the gallbladder walls are exposed to a vibration wave by placing the massage attachment perpendicularly on area between 10 and 11 ribs for 1–2 minutes. Length of session is 12–15 minutes, the therapeutic course is 15–20 procedures.

EFFECT: application of the method intensifies the motor and contractile function of the gallbladder, up to complete removal of sediment and sludge, including sludge, which is at the initial stage of formation of stones.

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Description

The invention relates to medicine, namely physiotherapy, and can be used to treat patients with hypomotor dysfunction of the gallbladder.

The disease is accompanied by pain like biliary colic and impaired gallbladder emptying function. Insufficient contractility of the walls of the gallbladder leads to the accumulation of sediment in the form of mucus and sludge.

Hypomotor biliary dyskinesia is treated according to the principle of stimulation. To do this, use various choleretic drugs that accelerate motility and stimulate the contraction of the gallbladder. With this form of the disease, the organization of a rational diet is especially important. From the means of traditional medicine, decoctions of choleretic plants are used: corn stigmas, rose hips, tansy.

One of the means that contribute to the improvement of the physicochemical properties of bile and the improvement of bile secretion is the internal intake of mineral waters, among which the most widely used are low-mineralized sulfate-bicarbonate (9 groups, Zheleznovodsk type) general mineralization up to 5 g / dm ³ .

Of the modern methods of normalizing effects on the motor and secretory function of the biliary system, galvanization is provided, which improves blood circulation in the liver. Magnetic laser therapy and electromagnetic therapy also favorably affect the functional state of the liver and gallbladder, which helps to increase the body's protective and adaptive capabilities and has a normalizing effect on the structure of biological rhythms of the body’s functional systems.

Known methods for complex stimulation of gallbladder motility, for example, the method according to RF patent No. 2504411, A61N 1/32, A61N 2/04 A61K 36/28 A61P 1/16, increasing the effectiveness of treatment of patients with hypomotor dysfunction of the gallbladder by improving motor function by improving bile secretion and blood circulation in the liver. Against the background of taking the choleretic drug Hofitol and diet therapy, the use of a complexly modulated pulsed electric current with a neural-like pulse shape, which increases the excitability and conductivity of nerve fibers, stimulates the nerve and vascular formations of the gallbladder wall and improves the motor-evacuation function of the gallbladder. The disadvantages of the method include the complexity and duration of the course using an electric stimulator and a low-frequency magnetotherapy apparatus.

A known method for the treatment of patients with dyskinesia of the gallbladder according to the patent of the Russian Federation No. 2486909, A61N 1/20 A61N 2/04 A61N 5/02 A61K 35/08 A61P 1/16. The method includes, against the background of a gentle-training regime, therapeutic nutrition according to diet No. 5, general coniferous baths, magnetic laser therapy, internal intake of mineral water, followed by transverse galvanization of the epigastric region. In this case, transverse galvanization is carried out immediately after the intake of mineral water in the period from 10 to 11 hours. In addition, an EHF effect is performed on the right hypochondrium and sternum region with a broadband noise emitter with a frequency of 40-63 GHz, 10 minutes for each zone, daily, for a course of 10-12 procedures.

A common disadvantage of the known methods of treatment is the complexity of the equipment used, the need for special knowledge from medical personnel, and the duration of the procedures that are unpleasant for the patient's sensations.

Closest to the claimed of known analogues is the Method of rehabilitation of children with biliary dyskinesia according to the patent of the Russian Federation No. 2120271, A61M 39/06. This method differentiates biliary dyskinesia into hypomotor and hypertonic types, using various methods of vibration massage for treatment. At the same time, with the hypertonic type, they affect acupuncture points, which cannot be used in general medical practice, since the physio physiotherapist must have additional training and acupuncture practice, which practically does not happen, and the physician's prescribers, nurses, are also not trained to finding acupuncture points.

With the hypomotor type of dyskinesia, the actions and conditions of which were used to compare with the proposed method, first on an empty stomach they conduct a tube with alkaline mineral water, then a thermal vibro massager with a hemispherical nozzle is connected acting on the gallbladder and liver region (common signs with the prototype).

The problem solved by the invention is the ability to conduct medical procedures in violation of the ejection and movement of bile in an outpatient setting without medication on the physico-chemical properties of bile and without the use of complex electrical equipment, which is especially important for district and rural medical centers.

The technical result of the proposed solution is manifested in increased motility, contractile function of the gallbladder up to the complete removal of sediment and sludge, including sludge, which is at the initial stage of stone formation.

The technical result is achieved by the fact that in the proposed method, the treatment procedure is started by having a control picture of an ultrasound of the gallbladder: its location, size, including wall thickness, adhesion size in the case of soldering of the gallbladder wall to the liver wall with a significant thickening of the gallbladder walls. Then they carry out a tubage, give the patient a choleretic (tea with honey), lay on a couch on the stomach and put a warm heating pad (about 60 degrees) under his right side, on which he lies for 15-20 minutes, until the heating pad cools down. Then the patient’s body is turned on the left side, while the right side is inclined (more or less depending on the complexion) to the surface of the couch. In this position, the gallbladder sags and provides convenient access to the right hypochondrium. Under the point of location of the bottom of the gallbladder, a manual vibrator with a hemispherical nozzle is applied and the vibration massage procedure begins. Massage is carried out according to a stable technique (A.N. Mumin, A.V. Volotovskaya. Vibrotherapy. Teaching aid. Minsk. 2007). The main position of the impact of vibration is located on the anterior abdominal wall under the location of the bottom of the gallbladder, under the eleventh rib. Additionally, to influence the walls of the gallbladder, the vibrational wave is directed in a straight line by setting the vibrator nozzle perpendicularly between the tenth and eleventh ribs. At the same time, vibration massage is carried out at one and the other points of application of the massage nozzle stably, 3-4 minutes per point of the main application and 1-2 minutes at the intercostal position of the nozzle, as causing painful sensations. The pressure force of the massage nozzle is also different, up to 9 kgf in the main position and 2-4 kgf in the intercostal space. Recommended session time is 12-15 minutes. The course of treatment is usually 15-20 procedures. At the end of the course of treatment, ultrasound images are taken for comparison with ultrasound images before starting treatment.

For the procedure, D-25 brand manual vibratory massagers with a frequency of 50 to 69 Hz were used. Since the wall of the gallbladder is at least 3-5 cm from the skin surface, the amplitude should be at least 5-6 mm for effective exposure to the vibrational wave.

With vibrational exposure to the walls of the gallbladder, the sludge is expelled into the duodenum, while normal liquid bile enters the place of the sludge. During vibration massage, the liquid part of bile is mixed with sludge, violating the structure and crystallization of sludge, which prevents the formation of stones. As an additional effect during vibration, there is a vibration massage of the liver, blood flow and bile outflow in the liver improve.

The use of a vibrator combines a pushing and massaging effect, while not only the sludge is pushed out, but also the gallbladder walls are softened, softened. Moreover, the walls are flexed, which completely lost their elasticity, become dense and sclerotic. After a course of treatment, the walls of the gallbladder regain the ability to stretch and contract.

A stable massage technique was chosen because in case of removal of thick stagnant bile, sludge, a more energetic physical effect on the surface of the gallbladder is required. With the chosen parameters of the vibration frequency and amplitude, the vibrational wave reaches the spine with a person weighing up to 70 kg. The higher the weight, the shorter the vibration wavelength.

At the same time, in the patient’s body position, in which the gallbladder is in a sagging state, it receives oscillation in all directions when the vibrational wave is directed to the bottom of the gallbladder. With a perpendicular intercostal direction, it penetrates deep into the gallbladder, kneading its walls, and in the case of a commissure between the gallbladder and the liver with repeated courses of vibration massage, a decrease and separation of the adhesion is possible.

Examination of patients and monitoring the results of the method using ultrasound diagnostics was carried out for three years on the basis of the medical center LLC "SANTA-MED-7", operating since 2007 (Khabarovsk). All patients were examined before meals (on an empty stomach) and after meals, and then these same patients were observed after treatment by gastroenterologists who are treated in full with tubes, and all stimulants. The control was the volume (amount) of sediment - sludge after treatment and only after eating. It was found out how much this volume differed from the original, after eating, i.e. when the survey was first conducted. Almost the sediment in the gallbladder after standard treatment remains the same. The sediment is reduced (often up to 100% emission) only after extrusion by the proposed method. Often in this case (at 100% ejection) the “living” walls of the gallbladder begin to be determined, such walls again acquire elasticity (elasticity-extensibility) and the gallbladder again begins to easily stretch and contract.

Example 1 of a specific implementation of the method. Patient M.K., 17 years old. Weight 90 kg. Diagnosis: Hypomotor dysfunction of the gallbladder. Complaints of heaviness in the right hypochondrium, bitterness in the mouth, bad breath, belching, selective appetite, increased fatigue. On palpation, soreness in the Shoffar zone, positive bladder symptoms are determined. Liver +1.5 cm from under the costal arch, the edge is elastic. Ultrasound of the abdominal cavity - the gall bladder is enlarged in size, pear-shaped. The wall is thickened, in the lumen - thick parietal bile.

Echocholecystography - the degree of maximum contraction of the gallbladder - 26%. Hypokinesia of the gallbladder.

Rheohepatography (RGT) - a decrease in total hepatic blood flow due to both its fractions (arterial and portal), a decrease in the tone of the arterial liver vessels, a decrease in the rate of portal blood flow, and stagnation of blood in the portal system of the liver.

Biochemical analysis of blood: total bilirubin - 28.64 μmol / l, alkaline phosphatase - 342.20 U / l.

After a course of treatment (20 procedures) according to the claimed method, the patient had complaints of pain and a feeling of heaviness in the right hypochondrium, the appetite improved, the taste of bitterness in the mouth disappeared. On palpation, the liver is painless along the edge of the costal arch. Bubble symptoms are negative. Echocholecystography - the degree of maximum reduction is 46%. Norm.

In the RGG, a significant improvement in hepatic blood flow was observed due to normalization of the resistance of the arterial vessels of the liver. In the biochemical analysis of blood - total bilirubin - 20.12 μmol / l, alkaline phosphatase - 230.10 U / l.

After discharge for 4 months. exacerbations of pain were not observed.

Ultrasound results are shown in the images of FIG. 1-2.

FIG. 1 Ultrasound scan before treatment, left before eating, right after eating. The release of bile after eating (right) is not more than 20%.

FIG. 2 Snapshot of ultrasound after treatment of the proposed method. After eating, bile flow increased to 95%

Example 2. Patient P. 63 years old, weight 70 kg. The diagnosis of chronic cholecystitis. The exacerbation of the disease occurred after barbecue with alcohol. A blood test showed an increase in the number of leukocytes to 13 thousand, ESR increased to 21 mm / hour. ALT 26 units / l (No. up to 18.0), ACT 29 units / L (No. up to 22.0). The intestines are inflated with gases, pressure on the diaphragm caused shortness of breath, complaints of pain in the right hypochondrium. Ultrasound revealed an over-inflated gallbladder measuring 12.7 × 6.5 cm, filled with sediment and sludge. After the patient took painkillers and two No-Shpa tablets, after 20 minutes a bile squeezing session was carried out according to the claimed method with a three-time repetition during the day. During the week, 20 sessions of extrusion of bile were performed. After the ninth session, the gall bladder decreased after eating to a size of 5.5 × 2.7 cm, gas from the intestines disappeared, the stomach fell, pain disappeared, and appetite appeared. Blood tests improved: leukocytes decreased to 7.9 thousand, ESR - up to 11 mm / hour, ALT - up to 15 units / l, ACT - up to 18 units / l. On the control ultrasound, a month later, the gallbladder on an empty stomach (before eating) was 6.3 × 2.9 cm and after eating after an hour, 3.5 × 1.9 cm.

Ultrasound results are shown in the pictures. FIG. 3 - Snapshot of the ultrasound of the gallbladder before extruding bile by the present method. FIG. 4 - Snapshot of the ultrasound of the gallbladder after treatment by extrusion of bile by the present method.

Claims (1)

A method of treating patients with hypomotor dysfunction of the gallbladder, which consists in the fact that after the tubing, vibration exposure is applied with a frequency of 62 Hz and an amplitude of 5-6 mm using a vibrator with a hemispherical massage nozzle, characterized in that for the session of vibration massage the patient is laid on the table surface on the left side, while the right side is inclined to the surface of the table in a position convenient for access to the right hypochondrium, then, for 3-4 minutes, pressure is applied to the front abdomen with a massage nozzle of a vibrator the wall under the eleventh rib, under the location of the bottom of the gallbladder, directing a vibrational wave from under the rib to the bottom of the gallbladder, additionally act on the walls of the gallbladder with a vibrational wave, setting the massage nozzle perpendicular to the area between 10 and 11 ribs for 1-2 min, while the duration of the session is 12-15 minutes, the course of treatment is 15-20 procedures.

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