RU2157249C2 - Method for enhancing effectiveness in treating complex cases of gastric and duodenal peptic ulcer - Google Patents

Abstract

FIELD: medical engineering. SUBSTANCE: method involves administering Quamatel for modifying formed blood elements in extracorporal mode in combination with curative plasmapheresis sessions. To do it, 800 ml of blood is taken from a vein into Hemacon sack. Then, 150-200 ml of sodium chloride solution is injected to the patient. Hemacon sacks are centrifuged, plasma is removed and formed blood elements are diluted with 0.9% sodium chloride solution and intravenously injected to the patient later on during 30-40 min. 20 mg of Quamatel and 100 ml of 0.9% sodium chloride solution is added to the second Hemacon sack and the sack is set into thermostat. Incubation being over, the sack contents is intravenously dripped to the patient. EFFECT: enhanced effectiveness in treating very large, ulcers not cicatrizing during long time; accelerated treatment course; lower drug consumption.

Description

 The invention is used in medicine, namely in gastroenterology, to increase the effectiveness of pharmacotherapy of complex cases of gastric ulcer and duodenal ulcer (duodenal ulcer), which include large and giant ulcers, as well as long-term non-healing (torpid) stomach ulcers and duodenum.

 Among the known methods of treating patients with large, gigantic, as well as long-term non-healing stomach ulcers and duodenal ulcers, surgical treatment methods occupy a significant place (18.3% of the total number of patients operated on for gastric ulcer and duodenal ulcer), however, this leads to prolonged hospitalization of the patient in the postoperative period , requires significant economic costs for surgical intervention and subsequent comprehensive pharmacotherapy. In addition, surgical treatment of gastric ulcer and duodenal ulcer can lead to disruption of the morphofunctional structure of the gastrointestinal tract, which can result in disability of the patient (V. P. Petrov., V. V. Osipov. Choosing the method of surgical treatment of gastric ulcer - Bulletin of Surgery , 1997 - N 5. - S. 16-19).

 Among the existing methods of treating gastric ulcer and duodenum, pharmacotherapy with H2-histamine-blockers is widely used. At the same time, there was a high efficiency of generation III H2 histamine blocking agent famotidine (kvamatel, Gideon Richter, Hungary), produced in both tablet and injection forms, but with the traditional method of drug administration there are a number of disadvantages: low bioavailability - for tablet forms kvamatela (38-51%), the need for twice intravenous administration of kvamatela for 5-10 days, which implies the consumption of an injectable form of the drug per treatment course up to 200-400 mg (M.V. Leonova, Yu.B. Belousov. H2-blockers in gastre enterologicheskoy practice -. M., 1996 -. 58).

 A known method is closer to the invention when in the treatment of peptic ulcer of the stomach and duodenum using methods of efferent medicine, including therapeutic plasmapheresis. However, the described technique, in particular therapeutic plasmapheresis, was used in combination with traditional methods of drug administration, which excluded the potentiation of the pharmacological effect of the H2-histamine blocker, in particular the quamatelum (ID Besedin. Clinical efficacy of treating patients with gastroduodenal ulcers using extracorporeal blood processing methods and endoscopic drug exposure: Author's abstract of a dissertation for Candidate of Medical Sciences (Voronezh, 1997).

 In gastroenterology for the treatment of gastric ulcer and duodenum, extracorporeal modification of blood cells with drugs that affect reparative processes in the mucosa of the gastrointestinal tract has not been previously performed.

 Purpose: to create a way to improve the treatment of complex cases of gastric ulcer and duodenal ulcer to reduce the number of surgical interventions, reduce hospitalization, achieve the longest possible remission of the disease.

 This goal is achieved by the use of extracorporeal modification of blood cells using an injectable form of an H2-histamine-blocker, for example, a quamamel, in combination with therapeutic plasmapheresis procedures.

 The method is as follows.

 First, the patient is laid on a functional bed. Under aseptic conditions, 800 ml of blood is taken from a cubital vein using a 500/300 ml Gemacon bag, then a 0.9% sodium chloride solution of 150 - 200 ml is injected into the patient with a substitute purpose, then drip at a rate of 20 drops per a minute.

 Gemacon bags are centrifuged in a PC - 6 centrifuge at 2500 rpm for 15 minutes, then plasma is removed from the bags using an extractor. A 300 ml bag with blood cells is diluted with 0.9% sodium chloride solution, followed by intravenous administration to the patient for 30-40 minutes.

 In a second 500 ml Gemacon bag, 100 ml of a 0.9% sodium chloride solution and 20 mg of quamatel, previously diluted in 5 ml of the solvent supplied with the drug, are added, after which the bag is placed in a thermostat for 30 minutes at a temperature of 37 degrees . After incubation, the contents of the bag are administered intravenously drip to the patient, then a sterile dressing is applied to the puncture site for 1.5-2 hours.

 The proposed method for the treatment of complex cases of gastric ulcer and duodenal ulcer involves 5 to 7 sessions of therapeutic plasmapheresis with extracorporeal modification of blood cells, for example, quamatel, with an interval between sessions of 1 to 2 days under the control of the level of total serum protein and a general blood test. In those days when plasmapheresis sessions were not carried out, the patient received quamatel in tablet form at 40 mg per day. The consumption of the injectable form of the drug per treatment course is 100-140 mg.

 The total duration of course therapy using the proposed method of treatment is 17-30 days in the treatment of large, gigantic and long-term non-healing stomach ulcers, and 14-18 days for duodenal ulcer.

 Example. 1. Patient Popko Valentina Petrovna, 51 years old, medical history N 1108, was admitted to the gastroenterological department of the Road Clinical Hospital at Voronezh I 02.16.98 with a diagnosis of peptic ulcer in the acute phase, often recurring duodenal ulcer.

 At the first endoscopic examination (from February 19, 1998), a chronic duodenal ulcer of a duodenal bulb of up to 0.8 cm was detected. The patient was prescribed traditional pharmacotherapy, including diet, ranitidine, solcoseryl, metronidazole, de-nol, almagel, autohemotherapy No. 10, laser therapy N 10, UFOK N 5. The patient received this therapy for 21 days, but without a positive clinical effect.

 During the control endoscopic examination (from 03/11/98), it was found that the ulcer of the duodenal bulb increased in size to 1.5 cm.

 In order to increase the effectiveness of treatment in a patient, the method of plasmapheresis with extracorporeal modification of blood cells by the quamatel was used with intervals between sessions of 1-2 days N 5.

 Against the background of the treatment, the patient had a positive dynamics of the clinical condition.

 During the control endoscopic examination (dated March 25, 1998), complete scarring of the duodenal ulcer of the duodenal bulb was noted.

 Subsequent outpatient monitoring (within 6 months after discharge from the hospital) showed that this patient did not have a recurrence of peptic ulcer.

 2. Patient Kozodaev Anatoly Nikolaevich, 36 years old, medical history N 2356, was admitted to the surgical department of the Road Clinical Hospital at Voronezh I station on 06.04.98 with a diagnosis of peptic ulcer, exacerbation. Often a relapsing stomach ulcer.

 At the first endoscopic examination (from 06/06/98), a chronic ulcer of the upper third of the body of the stomach up to 2.5 cm in size was found with a pronounced exacerbation of chronic gastritis.

 The patient was prescribed traditional pharmacotherapy, which included diet, almagel, solcoseryl, anti-Helicobacter pills (de-nol, clarithromycin, trichopolum), and the plasmapheresis method was used with extracorporeal modification of blood cells by a quamatel at intervals between days 7 - 2.

 Against the background of the treatment, a positive dynamics of the clinical condition of the patient was noted. During the control endoscopic examination (from April 30, 1998), it was established that the ulcer of the body of the stomach completely healed.

 Subsequent outpatient monitoring (within 4 months after discharge from the hospital) recurrence of peptic ulcer in this patient was not observed.

 In the above examples, side effects from the therapy were not observed.

 Thus, the positive effect of the proposed method is to increase the effectiveness of the treatment of complex cases of gastric ulcer and duodenal ulcer, which is associated with a combination of the therapeutic effect of therapeutic plasmapheresis sessions and extracorporeal modification of blood cells with the use of H2 histamine-blocker, for example, squamate, which made it possible to potentiate the pharmacological effect of the drug.

 The proposed method for improving the treatment of gastric ulcer and duodenal ulcer allows for conservative treatment of large, giant and long-term non-healing ulcers in a shorter time period (gastric ulcer - 17-30 days, duodenal ulcer - 14-18 days), reduce the consumption of the drug per course therapy, as well as reduce the number of surgical interventions in the treatment of complex cases of peptic ulcer disease.

Claims (1)

A method for increasing the effectiveness of the treatment of complex cases of gastric and duodenal ulcer, including plasmapheresis with removal of plasma, isolation of blood cells, their subsequent dilution in 0.9% sodium chloride solution and return to the patient, characterized in that in the bag "Gemacon "containing blood cells, in addition to 100 ml of 0.9% sodium chloride solution, 500 mg of quamatel, previously diluted in 5 ml of solvent, is added to 500 ml, after which the bag is placed in a thermostat for 30 minutes at a temperature ature 37 ^o and after the end of the incubation, its contents are administered intravenously dropwise to the patient, the course of treatment is 5-7 sessions, conducted after 1-2 days, in the intervals between which the patient takes quamatel orally at 40 mg per day.