RU2154474C2 - Method for treating the cases of alimentary dystrophy - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying dietetic therapy in three stages in combination with physiotherapy and medicamentous therapy. Duration of the first stage is 12-15 days, of the second stage is 15-20 days, of the third one is 20-60 days. Food allowance is calculated for 1 kg of target body mass. Energy value and calorific value of food is increased in proceeding from one stage to another one. First stage physiotherapy consists of ultraviolet radiation, monitored cleaning and intestine oxygenation. The second stage includes hyperbaric oxygenation and oxygen baths. The third stage includes ultraviolet radiation of autoblood. Polyenzyme preparations, electrolyte solutions and 10-20% albumin solution are administered as medicamentous therapy. Retabolyl is additionally administered at the third stage in the amount of one injection a week. The whole course is 3 injections. EFFECT: enhanced effectiveness of treatment; normalized metabolism processes in organism; lower number of lethal outcomes. 1 tbl

Description

 The invention relates to medicine, in particular to the treatment of a disease such as alimentary dystrophy.

 In modern conditions, there are more and more cases of extreme exhaustion of people due to an imbalance in nutrition due to a decrease in the standard of living of the average citizen and numerous stressful situations associated with national conflicts, the revival of many prejudices, such as long, inept posts not only by adults, but also children and adolescents. The desire to get rid of excess weight, as well as to “clear” the body of toxins, plays a role, which has led to the spread of such “fashionable” areas as “separate nutrition”, vegetarianism unbalanced in chemical composition, independent starvation without medical control. All this often leads to loss of body weight, up to the development of alimentary dystrophy.

 Alimentary dystrophy is a disease that develops as a result of prolonged complete or incomplete starvation, which can occur with inadequate physiological needs of nutrients entering the body. It is characterized by general exhaustion, progressive disorders of all types of organs and tissues, and a violation of their functions. In severe cases, these phenomena can become irreversible.

 For many years after the Great Patriotic War, given the sufficient welfare of the population, almost until recently, issues of alimentary dystrophy of adults were not given due attention. Only in the work of L.A. Stroganova and N.A. Aleksandrova "Chronic eating disorders in young children" - Lecture for medical students (Publishing House of the Leningrad Institute for Advanced Medical Studies, Department of Pediatrics N2, L., 1987, p. 37). This issue was addressed. However, this work concerned only children of an early (up to 1 year of life) age, which fundamentally limits the application of the recommendations of this work.

 Closest to the patented method, both for the intended purpose and for the totality of the signs used, is the treatment method described in the book: "Experience of Soviet medicine in the Great Patriotic War of 1941-45." T. VIII "Violation of General Nutrition" / Ed. Gelstein M. Medgiz 1951, p. 127-133. This method is accepted by us as a prototype.

 The essence of the known method of treatment consists in measures including diet therapy, represented by traditional foods enriched in hematogen, erythroferrin, baker's yeast and casein, and drug therapy, represented by vitamins A, B, C and PP.

- Significant disadvantages of this method are:
- slow recovery of body weight, physical and mental performance;
- frequent complications in the form of dysentery, pneumonia, tuberculosis.

 These shortcomings reduced the effectiveness of treatment and often led to death even after a sufficiently long treatment.

 The purpose of the invention is to eliminate in a shorter time the clinical manifestations of nutritional dystrophy by quickly restoring body weight, metabolic processes, physical and mental performance, minimizing mortality from this disease, preventing the development of complications.

 This goal is achieved by the fact that in the method of treating nutritional dystrophy, which includes diet therapy based on foods of high nutritional value and drug therapy with vitamin preparations, the treatment process is carried out in three stages with a duration of: 1st stage 12-15 days; The 2nd stage of 15-20 days and the 3rd stage of 20-60 days, diet therapy at each stage is based on the balance of nutrients and energy value per kg of proper body weight; increasing their number from stage to stage according to the scheme: proteins and fats of 1.6-2.0 g / kg; 2.0-2.5 g / kg; 2.5-3.0 g / kg and carbohydrates - 4.5-6.5 g / kg; 6.5-8.0 g / kg; 8.0-8.5 g / kg, and the energy value of each stage should be 38.8-52.0 kcal / kg; 52.0-64.5 kcal / kg and 64.5-73.0 kcal / kg, respectively, drug therapy at all three stages of treatment is provided in addition to vitamins, the appointment of polyenzyme preparations, electrolyte solutions and 10-20% albumin solution, and at the 3rd stage of retabolil injection, one per week but no more than three, and, in addition, physiotherapeutic procedures are carried out, including oxygenation and monitor bowel cleansing and total ultraviolet radiation at the 1st stage, hyperbaric oxygenation and oxygen at the 2nd stage baths and at the 3rd stage ultraviolet autocr vi.

As can be seen from the above-described essence of the patented method of treating nutritional dystrophy, diet therapy, as an integral part of this method, is represented by a balanced dietary chemical composition and energy value including easily digestible products of increased biological value of animal and plant origin (entits, soy protein isolates enriched with mineral vitamin complex). Calculation of the diet should be carried out per kilogram of proper body weight, calculated according to Brock's well-known formula:
Body weight in kg = Height in cm - 100
The required balance is achieved by introducing a phased-in amount of nutrients with the corresponding energy value (see table)
Drug therapy, along with the use of vitamin preparations: an oil solution of vitamin A, taking AEVITA capsules and intravenous drip of water-soluble vitamins in a 5% glucose solution, provides for the appointment of 1-2 tablets in each meal, electrolyte solutions and all-enzyme preparations 10-20% albumin solution, depending on the severity of dysproteinemia with hypoalbuminemia. At the 3rd stage, after saturation of the body with complete proteins, balanced in amino acid composition, and an increase in body weight of at least 3.5-4.5 kg, anabolic steroids are prescribed (retabolil 1.0 - intramuscularly) - once every 7 days, but not more than three injections.

 Of course, at the discretion of the attending physician, it is possible to use intravenous drip of a complex of drugs: cocarboxylase, ascorbic acid and panangin in saline or glucose and other types of conventional symptomatic treatment.

 At the same time, physiotherapy is used, which at the 1st stage includes total ultraviolet, oxygenation and monitor bowel cleansing. The latter procedure is intestinal monitor dialysis, achieved by intestinal lavage with the help of a monitor for intestinal cleansing (AIOK-1), first proposed for the treatment of other categories of patients in 1995 in the methodological manual “Pathological detoxification and metabolic correction”, St. Petersburg Medical Academy of Medical Sciences, 1995 g., 20 s. - Authors Mikhailovich V.A., Belyakov N.A., Miroshnichenko A.G. and etc.

 The procedure is carried out by introducing a 4-channel probe into the anus to the rheotosigmoid canal of the colon, followed by the removal of bacterial toxins and hydrodynamic massage of the intestinal walls, affecting the bloodstream and stimulating intestinal motility. A decoction of chamomile or lignosorb at the rate of 5 g / kg of the patient’s body weight is introduced onto the sheath thus prepared through the irrigation channel of the probe. The duration of the procedure is 30-35 minutes and is prescribed daily in the morning. At the 2nd stage, hyperbaric oxygenation is carried out and oxygen baths are prescribed, and at the 3rd stage - autoblood ultraviolet.

 The combination of diet therapy, medical treatment and physiotherapy described above gives the proposed method a new and very positive property - the rapid restoration of physical and mental performance against the background of normalization of body weight. This super-total effect contributes to the virtually elimination of fatalities and the quick recovery of disability.

 The patented method of treating nutritional dystrophy allows the attending physician, on the basis of continuous monitoring of the patient’s condition and correction of step-by-step comprehensive measures, including calculation of the chemical composition of proteins, fats, carbohydrates and energy value of the diet, vitamin therapy and symptomatic drug therapy and physiotherapeutic procedures, to achieve the main goals: to interrupt the development of dystrophic phenomena, to restore body weight and normal course of metabolic pro essov in the body, recover the latter - physical and mental.

 Clinical examples.

 Example 1. Patient E., 54 years old, was admitted to the clinic with a body mass deficit of more than 50% (with growth of 158 cm, body weight - 24 kg). The diagnosis at admission is alimentary dystrophy of 3 degrees of severity. The patient complained of a sharp weakness that practically did not allow movement, lack of appetite and independent stool, discomfort in the stomach area that occurs during eating and persists after eating for about an hour, bleeding gums when brushing your teeth. For the first time I began to follow a diet two years ago, when body weight was 56 kg. I followed the diet due to periodically occurring dyspeptic disorders, first excluding meat from the diet, then milk and dairy products, bakery products, gradually decreasing the frequency of meals and the amount of food consumed. So for 2 years, weight loss was 30 kg. Last month, the patient's daily diet consisted of 3 dried apricots and 4 dried prunes, infused in a glass of boiling water, after which the patient lost another 4 kg.

 An objective examination attracted attention to the pronounced manifestations of multivitamin deficiency - seizures in the corners of the mouth, peeling of the skin with the manifestations of hyperkeratosis on the elbows with subcutaneous hemorrhages throughout the body, "raspberry", "polished" tongue. During auscultation, heart sounds are sharply muffled. Pulse 35 beats per minute. Blood pressure 60/25 mm RT. Art. On the electrocardiogram signs of myocardial dystrophy. Despite repeated conversations with the patient, she categorically refused to include products of increased biological value in the diet, and traditional products, despite observing the principles of mechanical and chemical sparing during their preparation, continued to cause discomfort in the stomach of the patient, which did not contribute to the expansion of the diet. The patient also categorically refused physiotherapy. The patient underwent only symptomatic drug therapy. After 5 days from the moment of admission to the hospital, a fatal outcome occurred. In the section, death came from cardiovascular failure, which developed against a background of severe nutritional dystrophy.

 The method has been tested.

 Example 2. Patient B., 17 years old, was admitted to the clinic with a body mass deficit of more than 50% (with a height of 168 cm, body weight 30 kg). The diagnosis is alimentary dystrophy.

 Upon admission, the patient complained of severe weakness, amenorrhea during the last year, the practical absence of an independent stool, heaviness in the abdomen and discomfort after each meal, swelling of the lower extremities. She associates her disease with the exclusion from the diet of animal products (meat, fish, eggs, butter) and the transition to a vegetarian lifestyle, the cause of which the patient did not explain. An objective examination reveals the multiple manifestations of polyvitamin deficiency: brittle hair and nails, hair loss, dryness and peeling of the skin, “sticking” in the corners of the mouth, bleeding gums, bright red lips and shiny raspberry tongue, manifestation of pellagroid changes on the limbs in the form of “red” gloves and socks ", swelling of the lower extremities. In clinical and biochemical analyzes upon admission: a decrease in hemoglobin and red blood cells, as well as a decrease in the total protein level due to albumin fractions and an increase in globulin fractions. X-ray of the stomach with inspection after 1.5; 2; eight; 12 and 24 hours revealed a sharp decrease in the motor-evacuation function of the gastrointestinal tract.

 Starting from the 1st day of treatment, the patient began to receive a balanced diet of the 1st stage with the inclusion of products of increased biological value, while the amount of protein in the diet was 1.8 g, fat 1.8 g and carbohydrates 4.7 g per kilogram recommended body weight. From physiotherapeutic procedures, in addition to general ultraviolet irradiation, the patient received monitor bowel cleansing and intestinal oxygenation. Vitamin therapy included taking an oil solution of vitamin A 2 drops 3 times a day, water-soluble vitamins were administered intravenously in a 5% glucose solution. Drug therapy included the administration of panzinorm 1 tablet 6 times a day with meals and intravenous drip 3 times a week 10% albumin in an amount of 100 ml. The duration of the 1st stage was 12 days. The patient was in the rehabilitation department for another 30 days. Thus, the treatment of the 3rd stage was 31 days. The patient was discharged in satisfactory condition with an increase in body weight of 25 kg from the start of treatment. After 4 months from the start of treatment, the patient's body weight was 58 kg. After 8 months, the patient recovered menstruation on the background of restored body weight. At the 2nd stage, the patient's diet included: protein 2.2 g, fat 2.2 g, carbohydrates 6.7 g. Physiotherapeutic treatment included hyperbaric oxygenation and oxygen baths. From fat-soluble vitamins, the patient received AEVIT 1 capsule 3 times a day, water-soluble vitamins were administered in a 5% glucose solution parenterally. Of the medicines, the patient continued taking panzinorm. The duration of the 2nd stage was 18 days. At the 3rd stage, the patient received: 2.7 g of protein, 2.7 g of fat and 8.2 g of carbohydrates per kilogram of body weight. Physiotherapeutic treatment was represented by ultraviolet irradiation of autologous blood. The patient continued to take polyenzyme preparations and on the 31st day from the start of treatment the patient was transferred to the rehabilitation department.

 Example 3. The patient is 44 years old, was admitted to the hospital unconscious with a body mass deficit of more than 50% (with a height of 170 cm, body weight 29 kg). The diagnosis of admission alimentary dystrophy III degree of severity. After carrying out the necessary resuscitation measures, the patient regained consciousness. The patient complained of severe weakness, chilliness, drowsiness, absence of menstruation for 2.5 years, lack of appetite and independent stool, swelling of the lower extremities. From the anamnesis of the disease, it was possible to find out that the last 3 years the patient was independently engaged in "therapeutic" starvation in order to treat headaches, and over 2 years the weight loss was 25 kg. The last 40-day fasting, about which the patient read in one of the popular magazines, was observed in order to "cleanse" the body of "toxins", led to the loss of another 11 kg of body weight, after which the patient's condition worsened and she was delivered unconscious in hospital.

 An objective examination attracts attention to the signs of polyhypovitaminosis: pellagroid manifestations in the form of red “gloves and socks”, peeling of the skin, brittle nails, hair loss, tooth prints on the lateral surfaces of the tongue.

 When conducting laboratory and instrumental methods of research in a patient from the side of clinical analyzes, no changes were detected. In biochemical analyzes, a decrease in serum potassium and glucose levels was noted. During fibrogastroduodenoscopy and sigmoidoscopy, the patient revealed diffuse atrophic changes in the mucosa of the esophagus, stomach and duodenum, as well as the mucosa of the rectum and initial part of the sigmoid colon.

 Stage 1 diet therapy, in addition to traditional food products, included protein entit and soy milk (products of high biological value), while the amount of protein in the diet was 1.9 g, fat - 1.9 g, carbohydrates 4.8 g , which was 43 kcal per kilogram of body weight. Physiotherapy was represented by monitor bowel cleansing and intestinal oxygenation, conducted against a background of general ultraviolet radiation. The patient received fat-soluble vitamins and water-soluble, administered intravenously. The duration of the 1st stage was 13 days. At the 2nd stage, the amount of protein, fat, carbohydrates in the diet was 2 g, 2 g, 6.5 g (52 kcal) per kilogram of body weight, respectively. Physiotherapeutic treatment was represented by hyperbaric oxygenation and oxygen baths. The patient received the festival 1 tablet 5-6 times a day with meals, as well as electrolyte solutions administered in a 5% glucose solution and water-soluble vitamins. The duration of the 2nd stage was 16 days. At the 3rd stage, diet therapy was represented by a combination of traditional foods and products of high biological value with the amount of protein, fat and carbohydrates, respectively 2.5 g, 2.5 g and 8 g, which amounted to 64 kcal per kilogram of body weight. Physiotherapeutic treatment was represented by ultraviolet irradiation of autologous blood. On the 30th day from the start of treatment, the patient was discharged and treatment continued on an outpatient basis. The duration of the 3rd stage was 45 days. During this period of time, the patient fully recovered mental and physical performance, body weight reached its original value, the patient began to work. After 8 months, menstruation recovered.

 Example 4. Patient S., 50 years old, was admitted to the gastroenterological department in a moderate condition with a diagnosis of Illness of the operated stomach (a year ago he underwent resection of the stomach according to Billroth II for gastrointestinal bleeding), afferent loop syndrome. Complications: alimentary dystrophy of the II degree of severity. Complaints upon admission: severe weakness, loss of body weight by 19 kg over the last 6 months, heaviness and discomfort in the epigastric region, more on the right associated with eating, bitterness in the mouth with periodic regurgitation of bile, vomiting of bile 1-2 times a month, bloating, more after eating, lack of independent stool (stool only with enemas). The patient associates the deficit of body weight and the gastrointestinal manifestations described above with the restriction of self in food due to fear of the appearance of the above clinical picture.

 An objective examination attracts attention to the absence of subcutaneous fat, some atrophy of skeletal muscles and the manifestation of signs of polyhypovitaminosis: dry skin, a “geographical” tongue with tooth imprints on the side surface.

 In clinical and biochemical parameters, the patient showed a decrease in total protein to 60 g / l due to albumin fractions, which amounted to 41% and a slight decrease in hemoglobin and red blood cells. The rest is without features. Given the lack of body weight, the basis of the treatment was a physiologically complete nutrition in fractional portions up to 6-8 times a day, with the inclusion of products of increased biological value with a gradual increase in chemical composition and bringing it per 1 kg of body weight per protein to 2.0 g, fat 2 , 0 g, carbohydrates 5.0 g with a total energy value of 46 kcal.

 From the 1st day of the physiotherapeutic procedures, the patient received total ultraviolet radiation and monitor bowel cleansing, intestinal oxygenation. To enhance metabolic processes, the patient at the 1st stage received parenterally water-soluble vitamins in a 5% glucose solution. To normalize protein synthesis, 10% albumin solution 2 times a week, 100 ml each. To improve digestion, the patient was prescribed multienzyme preparations. The duration of the 1st stage was 12 days. Diet therapy of the 2nd stage was represented by 2.4 g of protein, 2.4 g of fat, 7.9 g of carbohydrates per kilogram of proper body weight with a total energy value of 61 kcal per kilogram of body weight. Physiotherapy during this period was represented by hyperbaric oxygenation and oxygen baths. In order to improve intestinal biocenosis, the patient received enterosorbents and a soy-based lactic acid drink. The duration of the 2nd stage was 15 days. Stage 3 diet therapy included various food products including products of increased biological value with protein, fat, carbohydrate content of 2.1 g, 2.1 g, 6.9 g per kilogram of body weight with a total energy value of 53 kcal per kilogram of weight body. To improve microcirculation and restore immune status, the patient received ultraviolet irradiation of autologous blood (5 sessions). On day 32 from the start of treatment, the patient was discharged for outpatient treatment. The duration of the 3rd stage was 25 days. After 6 months from the start of treatment, the patient fully recovered physical and mental performance. Body weight has reached the original. After 8 months, the patient returned to his workplace.

Claims (1)

 A method of treating nutritional dystrophy, including diet therapy and vitamin therapy, characterized in that diet therapy is carried out in 3 stages in combination with physiotherapy and drug therapy, the duration of 1 stage is 12-15 days, 2 stages 15-20 days, 3 stages 20-60 days; calculation of the diet is carried out per kg of proper body weight, where at stage 1 1.6 - 2.0 g / kg of proteins and fats, 4.5 - 6.5 g / kg of carbohydrates are introduced, the energy value is 38.8 - 52, 0 kcal; at the 2nd stage, 2.0 - 2.5 g / kg of proteins and fats, 6.5 - 8.0 g / kg of carbohydrates, energy value 52.0 - 64.5 kcal; at the 3rd stage, 2.5 - 3.0 g / kg of proteins and fats, 8.0 - 8.5 g / kg of carbohydrates, energy value of 64.5 - 73.0 kcal; from physiotherapy, patients are carried out at the 1st stage - general ultraviolet radiation, monitor cleaning and oxygenation of the intestine, at the 2nd stage - hyperbaric oxygenation and oxygen baths, at the 3rd stage - autologous blood; during all three stages, drug therapy is prescribed in the form of multi-enzyme preparations, electrolyte solutions and 10 - 20% albumin solution, and at stage 3, retabolil is additionally administered at the rate of 1 injection per week, in total no more than 3 injections.

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