RU2071761C1 - Method for treatment of obliterating atherosclerosis of vessels of power extremities - Google Patents

Abstract

FIELD: medicine, surgery and therapy. SUBSTANCE: first predominant type of affection is determined, i.e. whether it is right-, left-side or mixed type. Depending on detected type of affection, pain-inflicting action is taken from outside by successively and alternately exerting pressure by fingers with force causing pain and return tension of muscles, but not above maximum tolerance level of painful sensation. Said procedure lasts 1-3 s and is undertaken 1-5 times, choice of areas to be thus-treated being dependent on type of affection. EFFECT: higher efficiency.

Description

 The invention relates to medicine, namely to the treatment of vascular diseases, and can be used as an independent method for the treatment of arteriosclerosis obliterans of the lower extremities (OASNK).

 Obliterating atherosclerosis of the vessels of the lower extremities is a polyetiological disease associated with impaired adaptive reactions of the vascular system, a change in metabolism, the coagulation system and manifesting ischemic syndrome due to obliteration of the lumen of blood vessels (I. Makshanov. Thromboblastic diseases of the arteries of the lower extremities. Minsk: Belarus, 1975, p. .38, 40). The disease is characterized by a progressive type of course. Severe ischemia and trophic changes develop after 5-15 years from the onset of the first clinical symptoms (Shalimov A.A. Dryuk N.F. Surgery of the aorta and major arteries. Kiev: Health, 1979, p.208). Atherosclerosis progresses faster in patients older than 50 years, as well as those suffering from diabetes. Proceeding from this, the percentage of patients with disabilities is high. The second stage of the disease is an indication for determining 3 groups, and in some cases 2 groups of disability (Makshanov I.Ya. p. 144).

 Conservative and surgical methods are used to treat atherosclerosis obliterans of the lower extremities. Of the conservative methods, drug treatment, physiotherapeutic methods, physiotherapy exercises, balneotherapy, hydrotherapy, barotherapy are widespread.

 Of the medical methods, the most widely used are vasodilator drugs, vitamin therapy, treatment with anticoagulants and hormones. Perirenal novocaine blockades, intravenous infusions of polyglucin, intra-arterial administration of drugs are used.

 However, the results of drug treatment are mixed. Vasodilators often worsen the general condition, trophism in patients with diabetes mellitus, can weaken the activity of the heart, deepen ischemic, trophoparaletic complications (Bondarchuk A.V. Disease of peripheral vessels. L. Medicine, 1969, p. 220-222). Long-term use leads to adrenal hypoplasia (Akulova R.F. Chronic arterial and venous insufficiency. M. Medicine, 1975, p. 153). Novocainic blockade can lead to multiple thrombembolic blockages (Bondarchuk A.V. p.220-222). Polyglukin can produce severe anaphylactic reactions. An increase in tissue temperature during balneotherapy leads to a narrowing of blood vessels and aggravates roundabout blood flow (I. Makshanov, p. 118, 114).

 Thus, the existing drugs that affect the metabolic processes in tissues with obliterating diseases are not very specific and are not effective in all patients (Shalimov A.A. Dryuk N.F. p. 288).

 Surgical interventions used according to strict indications are elements of complex therapy, since without the subsequent conservative treatment they give only a temporary effect (I. Makshanov, p. 99). Of the surgical treatments, the most common lumbar sympathectomy. It is known that with complete denervation of the limb, blood flow in the vessels increases by 2 times, while working muscle requires an increase in blood flow by 10-15 times. Therefore, sympathectomy is not enough for the normal functioning of the limb (I. Makshanov p. 99). After a certain time, a complete or almost complete restoration of innervation occurs (I. Makshanov, p. 100). With the development of severe ischemia, its use is undesirable, since it does not prevent the development of gangrene and does not lead to a decrease in the level of amputation (Klimov V.N. Herald of surgery, 1984, N 9, p. 54).

 An equally common method of surgical treatment are various reconstructive operations on the vessels. But reconstructive operations do not stop the main process, and during the first two years approximately 25% of patients have repeated occlusion, and after 5-8 years, transplants function only in 10% of patients (I. Ya. Makshanov p. 103, 104).

 An epinephroectomy operation is used, which gives a certain positive effect. But partial removal of the adrenal glands has only a temporary effect, since compensatory hypertrophy of the remaining part of the adrenal gland occurs. The total removal of both adrenal glands leads to dire consequences (I. Makshanov, p. 101).

 Thus, the treatment of vascular diseases is a complex problem of clinical medicine. The lack of effectiveness of therapeutic measures even with their complex use does not allow to stop the development of the pathological process, which leads to the need to perform amputations, the frequency of which can reach from 15.5 and up to 68% in patients with obliterating diseases (Vishnevsky A.A. Krakovsky N.I. Zolotarevsky V. Ya. Obliterating diseases of limb arteries. M. 1972, p. 147).

 Various physiotherapeutic methods are used to stimulate blood flow (I. Makshanov, p. 118). These methods are not strictly specific in the nature of their action. They are used in alternation or courses of diathermy of the lumbosacral region, longitudinal diathermy, UHF on the feet and lower legs, electrophoresis, ultrasound, phonophoresis, amplipulse, hydrotherapy. The listed methods are used as additional and are contraindicated in many concomitant diseases.

 Experience in the treatment of OASN with acupuncture is small. The use of various techniques does not give a satisfactory result (Zhu-lian. A Guide to Modern Zhen-Chiu Therapy: Acupuncture and Cauterization, St. Petersburg: Comet: Irlen, 1992, p.271).

 Therefore, the search for new effective and inexpensive treatment methods is very important.

 The main clinical symptoms of atherosclerosis obliterans of the vessels of the lower extremities: intermittent claudication, weakening or lack of pulsation of the arterial vessels of the foot, popliteal region, trophic disorders of limb tissues. In the later stages of the disease, ulceration, more often in the area of the toes, and gangrene join.

 The closest known in essence to the achieved result can be considered a method for the treatment of atherosclerosis obliterans of the lower extremities (OASNK), including exposure to paravertebral and reflexogenic zones, selected depending on the location of the lesion (see, for example, Bondarchuk A.V. p.224, 225).

 The problem to which the present invention is directed, is to create an independent method of drug-free treatment of obliterating atherosclerosis of the vessels of the lower extremities, using internal hidden reserves of the body. The proposed method allows you to choose the optimal method of treatment, which is independent and does not combine with any other treatment methods.

 This problem is solved by the fact that according to the method of treatment of atherosclerosis obliterans of the lower extremities, they affect biologically active points and zones that are associated with the peripheral and central nervous system and normalize metabolic processes in the body, external pain (VBI): successively alternating pressure with fingers with effort not less than the force causing the appearance of pain and response muscle tension, and not more than the level of maximum pain tolerance of the patient, for which the latter they are laid on the stomach and, as biologically active points, paravertebral (right, left or both sides) and interspinous zones of the cervical, thoracic and lumbosacral spine, as well as zones and points on the legs along the interested channels (liver, kidneys, spleen) are used , bladder, gall bladder, stomach), and each effect is carried out for 1-3 seconds from 1 to 5 times, with the response of the local muscle tension of the patient at the time of external pain and breath holding. Procedures are carried out every other day to 10-12 per course.

 The invention is based on the theoretical developments of V.A. Kopylov, presented by him in the work Functional abilities of the nervous system and its role in physiological processes, State Committee on Science and Technology, VINITI, N 1953-85, Dep. Moscow, 1985.

 The method is as follows.

 Before starting treatment, a thorough collection of complaints, anamnesis, an objective examination are carried out, if necessary, laboratory tests and additional examination methods are prescribed (blood, urine, ECG, ultrasound of the limb vessels, etc.), i.e. An accurate topical diagnosis of the nature and level of vascular damage is performed.

 An individual treatment program is determined depending on the type of pathological process. Distinguish between right-sided, left-sided and mixed types of pathological process, which determine the individual program of exposure by the method of VBV.

 The right type is accompanied by pain in the right lower limb. In case of pain in the two lower limbs, the right began to hurt earlier. There is necessarily one or another pathology of the abdominal organs.

 The left type is manifested by pain in the left lower limb. There is a serious cardiological pathology (IHD, heart attacks).

 The mixed type combines the characteristics of the right and left types.

 The therapeutic effect on the selected zones is carried out successively by alternating pressure with an effort of not less than the force causing the appearance of the pain syndrome and muscle response, but not more than the level of maximum pain tolerance of the patient, and each effort is carried out for 1-3 seconds from 1 to 5 times with the fingers . The procedures are carried out every other day for 10-12 sessions, monitoring the patient's condition both before the procedure and after it.

 With the right-sided type of lesion, external pain is performed paravertebrally on the right, then on both lower extremities or only on the right along the meridians of the gallbladder, stomach, and bladder.

 With the left-sided type of lesion, the effect is exerted on the paravertebral zones on the left along the entire spine, interspinous zones along the entire spine, on biologically active points on the left lower limb along the meridians of the liver, kidneys, and spleen.

 With a mixed type of lesion, an exposure program is carried out, which includes elements of both types of lesions.

 Using the method described above, on the basis of the Territorial Medical Association No. 5 of Mogilev, together with the Department of Vascular Surgery of the Medical Unit of the Chemical Fiber Plant of Mogilev in 1993, a study was conducted to determine the effectiveness of the method. The study consisted of a group of people suffering from atherosclerosis obliterans of the lower extremities, a course of treatment with the method of VBV with a simultaneous examination before and after the course. The examination took into account the distance that the patient is able to go before the appearance of a pain attack in the calf muscles, the patients' complaints were evaluated: the strength of the pain attack, the sensation of numbness in the feet, and increased sensitivity to cold. An ultrasound examination of the vessels of the lower extremities was performed in all patients to confirm the diagnosis, as well as in a number of patients before and after treatment to determine the dynamics. On a bicycle ergometer, the maximum load on the lower extremities was measured until the first pain of characteristic localization appeared. The group of patients suffering from atherosclerosis obliterans of the vessels of the lower extremities consisted of 21 people, all men, aged 44 to 83 years. Most had a variety of concomitant pathologies.

 The main criterion for the effectiveness of treatment of atherosclerosis obliterans of the vessels of the lower extremities is a decrease in the strength of a pain attack in the calf muscles during movement, an increase in the distance traveled before the onset of this attack, as well as restoration of sensitivity in the toes, the disappearance of the symptom of pathological sensitivity to cold.

 In this group of symptoms, improvement was detected in 91% of treated patients. The distance to the appearance of pain in the calf muscle increased by 1.5-4 times. In some patients, when moving at a moderate speed, a pain attack does not occur at all. Ultrasound of the vessels of the lower extremities showed a slight improvement in blood circulation in 50% of cases. When bicycle ergometry revealed an increase in ultimate load by 1.3-2.3 times.

 Examples of specific performance of the method.

 Example 1. Patient F. A.I. Born 1927 disabled person 2 groups for general disease. He complained of pain in both lower extremities from the heel to the knee joint on the back surface of a compressive nature, associated with movement, as a result of which in a straight line can not go more than 250 meters. After a short rest, the pain goes away. Left pain combined with numbness of the toes. He became ill 2 years ago, at first only the right lower limb was ill. An ultrasound study confirmed the diagnosis: obliterating atherosclerosis of the vessels of the lower extremities. Blood circulation disturbance in the stage of subcompensation was revealed. Also worried about abdominal pain, bloating, heartburn, belching, constipation. He was registered with a gastroenterologist with a diagnosis of chronic gastritis, chronic colitis.

 After evaluating the complaints and data from objective studies, the right-sided type was determined, in accordance with which the impact program was implemented.

 The therapeutic effect was carried out successively by alternating pressure of the fingers with an effort of not less than the force that causes the onset of pain and response muscle tension, and not more than the level of maximum pain tolerance, and each effort was carried out for 1-3 seconds from 1 to 5 times. The patient was placed on his stomach and began to act paravertebrally to the right of the 2 cervical vertebra to the end of the spine, then the exposure was performed along the interspinous spaces of the entire spine. Then, an impact was performed on both lower extremities along the meridians of the gallbladder, stomach, and bladder. The procedures were repeated every other day, the total number of procedures 12. At the same time, complaints and objective status were evaluated each time.

 After treatment with the method of VVB, pain during movement in a moderate rhythm did not occur. When moving with a quick step in a straight line after 1000 meters, there was a tightening in the calves. With repeated ultrasound, circulatory disorders in the stage of compensation. For eleven months, the general condition of the patient did not worsen. I did not take any medications. According to the patient, "spent the whole summer and autumn in the forest, picking mushrooms and berries."

 In May 1994, pain during movement appeared again, although less intense and starting from 500 meters when moving in a straight line. After the second course of VBV, there is no pain during movement. She feels well. When walking fast, starting from 1000 meters, there is a pulling in the calves. Ultrasound of the vessels of the lower extremities circulatory disorders in the stage of compensation.

 Example 2. Patient K P.Ya. Born in 1920 sick for about two years. He complained of pain in the left lower limb when moving in the calf muscle, the sensitivity of the feet to cold was increased, for the appearance of pain in the left lower limb, it was enough to walk 100 meters. Of the concomitant pathology, he suffers from coronary heart disease, angina pectoris. Myocardial infarction suffered in 1988.

 After evaluating complaints and data from objective studies, the left-side type is determined.

 The therapeutic effect was carried out successively by alternating pressure of the fingers with an effort of not less than the force causing the appearance of pain and response muscle tension, and not more than the level of maximum pain tolerance, each effort was carried out for 1-3 seconds from 1 to 5 times. The patient was laid on his stomach and the first paravertebral effect was started to the left of the 2 cervical vertebra to the end of the spine, and then the inter-spinal gaps of the entire spine were exposed. Then, the effect on the left leg was performed along the meridians of the liver, kidneys, and spleen. Procedures were carried out every other day, only 10 procedures. During each visit, complaints and general condition were evaluated.

 As a result of treatment, the intensity of pain in the left lower limb decreased, the appearance of pain in the calf muscles occurs after passing more than 200 meters in a straight line. Hypersensitivity to cold has disappeared. The general condition has improved.

 Example 3. Patient G V.D. Born 1926 sick for about six years. When handling, pain in the calf muscles of both limbs was disturbed, numbness of the toes, more left, increased sensitivity to cold. In a straight line, until the appearance of pain in the calves, it is enough to walk 500 meters. He was registered at a cardiologist and gastroenterologist for coronary heart disease, angina pectoris, chronic gastritis, chronic cholecystitis, chronic colitis, hemorrhoids.

 After evaluating the complaints, medical history and objective data, a mixed type of lesion is established.

 The therapeutic effect was carried out successively by alternating pressure of the fingers with an effort of not less than the force that causes the onset of pain and response muscle tension, and not more than the level of maximum pain tolerance, and each effort was carried out for 1-3 seconds from 1 to 5 times. The patient was laid on his stomach and began to act paravertebrally to the right and left of the 2 cervical vertebra and along the entire spine, then the exposure was performed along the interspinous spaces of the entire spine. Then on the lower extremities along the meridians of the gallbladder, bladder, liver, kidney, spleen and stomach. Procedures were repeated every other day, only 10 procedures. Each visit was evaluated complaints, general condition.

 After the treatment: the general condition improved, the distance to the appearance of a pain attack in the calf muscles increased by 3 times, the intensity of the pain attack decreased, cold intolerance of the feet and numbness of the toes disappeared.

 Analyzing the results, we can draw the following conclusions. The method of VBV is effective in the treatment of patients with atherosclerosis obliterans of the lower extremities. The method can be used as the main method of treatment, while there is no need for expensive vascular drugs. The method is available, it can be used in clinics. When using the method of VBV there are no complications: there was not a single case of exacerbation of concomitant pathology. There is a simple and cheap method for monitoring the dynamics of treatment and evaluating the results of near and far - the method of bicycle ergometry.

Claims (1)

 A method for the treatment of atherosclerosis obliterans of the lower extremities, including exposure to paravertebral and reflexogenic zones, selected depending on the location of the lesion, characterized in that the primary type of lesion is preliminarily identified right-sided, left-sided, mixed and depending on the type of lesion detected, the external pain is sequentially alternating pressure with fingers, with an effort causing pain and response muscle tension, but not more than maximum pain tolerance, for 1 3 s, from 1 to 5 times, and with the left-sided type of lesion, the effect is exerted on the paravertebral zones on the left along the entire spine, interspinous zones of the entire spine and on biologically active points on the left lower limb along the meridians of the liver, kidneys , spleen, with a right-sided type of lesion, external pain is applied paravertebrally to the right, then on both lower extremities along the meridians of the gallbladder, stomach, bladder, with a mixed type of lesion They carry out an impact program, which includes elements of rehabilitation programs for right-sided and left-sided types of damage, the procedures are repeated every other day until 10 12 per course.