RU2161972C2 - Method for applying complex pathogenetic therapy of patients suffering from opisthorchiasis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying first diagnostic intubation. Electrically activated aqueous solution of EWS-K is administered as a drink. It is prepared by adding 20 ml of 10% CaCl₂ solution, 25 ml of MgSO₄ solution, 15 ml of 4% KCl solution to the smaller anode reservoir of Espero apparatus and 50 ml of 0.01% KMnO₄ solution to the greater cathode reservoir. Rectal micro- enemas are administered with heated neutral EWS-A (anolyte) solution used with 1/3 of tea spoon of cooking salt added into anode zone. Antihelminthic preparations are administered at the fifth day according to standard scheme with the total course and single dose being reduced by 1/3. Duodenal lavage with phytosolutions is carried out at the next day. EFFECT: enhanced effectiveness of treatment. 1 tbl

Description

 The invention relates to medicine, in particular to gastroenterology, and can be used for the complex treatment of parasitic diseases, for example opisthorchiasis, in various clinical forms.

 Currently, a successful solution to the problem of systemic diseases, in particular opisthorchiasis, is determined not so much by their early detection as by the improvement of treatment methods. The widespread prevalence of helminthiases in fairly large areas makes their study an urgent problem. The clinic of opisthorchiasis is characterized by signs of damage to the parasitic organs of the opisthorchis (liver, bile ducts, gall bladder, pancreas) and changes in the gastrointestinal tract. This explains the need to develop a comprehensive phased-rehabilitation treatment of patients with the inclusion of anti-inflammatory, stimulating therapeutic measures, preparatory therapy in order to create conditions for a more effective treatment of the disease using known chemicals, as well as potentiating their action and subsequent correction of functional disorders of the digestive system persisting after deworming.

 As a rule, treatment of parasitic diseases is carried out only if there are any disorders of the digestive system in people infected with opisthorchia. So, with chronic opisthorchiasis, the liver and hepatic ducts, pancreas, duodenum, small and large intestines are constantly involved in the pathological process.

 In the chronic phase of the disease, opisthorchis in an amount from several copies to tens of thousands mechanically damages sections of the mucous biliary system. These changes lead to dyskinetic disorders of the gallbladder and biliary tract, which in turn leads to the development of the inflammatory process. Differential diagnosis and subsequent treatment of various forms of cholecystitis, biliary dyskinesia, cholangitis is carried out mainly according to cholecystography, echolocation, duodenal sounding. Modern methods of treatment of parasitic diseases include, first of all, etiotropic drugs aimed at suppressing invasion, etching parasites with the help of specific chemotherapeutic agents. It is known that the deworming of patients with chronic opisthorchiasis, contributing to the cessation of the progression of the process, in some cases does not lead to a complete recovery.

 For the treatment of chronic opisthorchiasis, two main drugs are currently used - biltricid and chloxyl and their analogues, including foreign ones. However, with satisfactory tolerance by patients of many of these drugs, adverse reactions are inevitable: headache, increased stool, dizziness, dyspeptic symptoms, pain in the right hypochondrium, nausea, heartburn, skin itching, urticaria. Moreover, many of these drugs are contraindicated in patients with cardiovascular insufficiency, kidney and other chronic diseases (Finger A.I. Clinic, diagnosis, treatment of lesions of the pancreatic-duodenal zone with opisthorchiasis. - Author. Cand. Dissertation. - 1983. - S. 147-153).

 Most chemicals have many contraindications due to their side effects. Moreover, some authors note the absence of positive clinical dynamics after specific chemotherapy and the development of organ pathology after the use of drugs such as, for example, chloroxyl. In order to ensure the possibility of reducing the side effects of chemicals, it is proposed that pathogenetic preventive therapy be carried out with special emphasis on stopping the manifestations of the main pathogenetic syndromes. But the known means of preventive therapy do not solve the problem of reducing the toxic effect of chemicals.

 Known methods for the treatment of parasitic diseases, including the conduct of pathogenetic preventive therapy using antibiotics, sedatives, anabolic steroids, prednisolone, vitamins. (A.I. Paltsev. - Digestive diseases in chronic opisthorchiasis (clinic, diagnosis, treatment). - Novosibirsk. - 1996. - P. 145-146). The implementation of complex pathogenetic preventive therapy accompanying specific treatment with chemotherapy allows, according to the author, to compensate for the clinical, biochemical, immunological parameters of various sections of the digestive system, primarily the liver, and to stop the manifestations of the main pathogenetic syndromes before (or after) specific chemotherapy. However, the use of hormonal drugs and antibiotics as preventive measures also does not go unnoticed for patients in whom the digestive system is already burdened with intoxication, significant changes in the immune system, etc., especially since the dosages of chemical preparations remain unchanged and have no tendency to decrease.

 Deworming, based on combination chemotherapy, includes tubing according to Demyanov, intestinal irrigation, the appointment of anti-inflammatory drugs, choleretic herbs. After the course of deworming is completed, drug and physiotherapeutic stimulation of biliary tract function continues.

 In recent years, methods have been developed for the complex treatment of opisthorchiasis, including the use of a new physiotherapeutic agent - diadynamophoresis of a 5% solution of “dry” brine as a stage of rehabilitation treatment after chemotherapy (E.I. Beloborodova et al. Chronic opisthorchiasis and digestive system. - Tomsk 1996 . - S. 22). The stage of rehabilitation treatment is included in the course of rehabilitation measures in order to improve the functional state of the stomach, the changes of which inevitably persist after deworming. However, such rehabilitation measures are carried out only at the stage of rehabilitation (spa) treatment, and do not precede chemotherapy.

 The prototype adopted a method of treating opisthorchiasis, including, along with chemotherapy, the conduct of preventive pathogenetic therapy using tubas with mineral water and intestinal irrigation. (A.I. Paltsev. - Clinic, diagnosis, treatment of lesions of the pancreatic-duodenal zone in chronic opisthorchiasis. - Author. Cand. Diss. - 1983. - P. 14).

 However, tyubazh are prescribed, as a rule, after many days of taking a chemotherapy drug, such as chloxyl, in addition, the effectiveness of this procedure is low, and intestinal irrigation, most often with plant solutions, is also carried out after chemotherapy.

 The aim of the present invention is to stop the manifestations of the main pathogenetic syndromes of opisthorchiasis by specific therapeutic flushing, prior chemotherapy, and creating conditions for potentiation of the action of drugs.

This goal is achieved by the fact that preventive pathogenetic therapy of opisthorchiasis includes therapeutic washing with antiseptic and parasitotropic purposes, for which, against the background of the intake of Narine-F dietary supplement, electroactivated aqueous solutions (EVR) per os are prescribed and in the form of rectal microclysters for three days stay in the hospital after diagnostic duodenal sounding and immediately before taking (administering) chemotherapy and subsequent intestinal irrigation, and a solution of EVR-K is prepared for drinking (to atolite) with the addition of 20 ml of a 10% solution of CaCl ₂ , 15 ml of a 4% solution of KCl, 25 ml of a 5% solution of MgSO ₄ to 1000 ml of distilled water, into the anode zone, 50 ml of 0.01% KMnO ₄ solution - to the cathode area of the Espero apparatus; for rectal washes, a heated neutral solution of EVR-A (anolyte) is used with 1/3 teaspoon of sodium chloride (NaCl) added to the anode zone. After chemotherapy, a therapeutic duodenal lavage is prescribed.

 Drinking solutions are prescribed within 3 days following the first sounding of hospital stay in a dosage of 100-200 ml 3 times a day 20-40 minutes before meals; in the evening, they carry out cleaning therapeutic enemas with a heated neutral solution of EVR-A (anolyte), activate 12 minutes and use the solution from a larger container. Enemas with EVR-A have an anti-inflammatory, antiseptic effect, and in combination with per os administration of EVR-K, an effect of activation of opisthorchis eggs (parasitotropic effect) is achieved. The wide range of nutritional supplements "Narine-F" is prescribed from 1 day on the entire course of treatment in a dosage of 1 tbsp. l 3 times a day before meals in order to reduce intoxication when taking chemotherapy drugs.

 On day 5, specific treatment is carried out with the appointment of anthelmintic drugs (biltricid, praziquantel, chloxil and analogues) according to the scheme according to the instructions for use, but with a reduced single and general course dosage of the chemotherapy. The next day, duodenal washing with vegetable solutions (for example, with chamomile) is carried out.

 Intraduodenal electrophoresis with electrolytic silver and delagil is prescribed to patients with massive invasion, concomitant diseases, and especially with an allergic history, whose deworming is accompanied by toxic-allergic reactions. (EE Bazhenov et al. Treatment of chronic opisthorchiasis with intraduodenal electrophoresis of electrolytic silver and delagil. Actual problems of gastroenterology. - Sat scientific pt. Tr. - Tomsk. - 1994. - P. 14).

 An analysis of various treatment methods for common parasitic diseases, such as opisthorchiasis, conducted by a number of researchers and practitioners, confirms the need for complex therapy aimed at more quickly identifying and stopping the main clinical symptoms. Physiotherapeutic methods of treatment used to date, such as tubages, do not allow to achieve the effect of activation ("awakening") of opisthorchis eggs, which multiply in the intestines of the host in large quantities. The change in the functional state of the integumentary epithelium caused by parasites leads to impaired absorption of food substances, primarily fats and fat-soluble vitamins. The use of electroactivated aqueous solutions saturated with micronutrient salts allows the possibility of activation of helminth eggs and their partial washing out of the bile ducts and gall bladder - the sites of their maximum accumulation and reproduction - during the preliminary therapeutic washing (preventive therapy) - already at the stage preceding chemotherapy treatment. Subsequent chemical exposure is more effective, because a greater number of parasites falls into the area of action of chemotherapy. A bacteriological examination of feces for opisthorchiasis reveals the presence of dysbiosis of varying severity in a large number of patients, which in turn leads to a decrease in the body's immune system.

 The therapeutic effect is enhanced by the inclusion of the Narine-F dietary supplement and the implantation of intestinal omnoflora, which have high bacteriostatic activity and stimulate the growth of human microflora, in the preventive therapy phase.

 The preventive treatment stage proposed according to the invention allows the administration of drugs in subtherapeutic doses due to the fact that when exposed to electroconductive solutions in combination with manipulations to stimulate human microflora, the effect of activating parasites, their partial leaching, as well as enhancing the effect of chemotherapy is achieved.

 Thus, the inclusion in the treatment course of the complex "Narine-F, implantation of intestinal omnoflora and the appointment of electroactivated aqueous solutions according to a certain scheme and in certain proportions of trace elements, allows us to conclude that the invention meets the criterion of" significant differences ".

 The method of complex pathogenetic therapy of patients with opisthorchiasis is as follows.

On the first day, therapeutic sounding with herbal solutions is prescribed, which is carried out in order to relieve inflammation of the bile ducts and the active outflow of bile, which allows access to places of parasite accumulation. From 2 days throughout the course of treatment, a per os electroactivated aqueous solution is prescribed (100 ml 3 times a day 20-40 minutes before meals in small sips), prepared according to the following recipe: 1000 are poured into a small and large capacity of the Espero apparatus ml heated to 30-40 ^o C distilled water. In a small container (anode) add 20 ml of a 10% solution of CaCl ₂ , 25 ml of a 5% solution of MgSO ₄ , 15 ml of 4% KCl; 50 ml of a 0.01% KMnO ₄ solution are added to the cathode zone. After exposure (7 min), the solution is ready to drink. A solution from a large container (catholyte) should be drunk only on the day of its preparation, the next day the solution is prepared again.

On the same first days (every other day) in the evening before bedtime, patients are prescribed cleaning enemas with catholyte (1-1.5 L) of the following composition: 1/3 teaspoon is added to the anode zone with distilled water heated to 45-55 ^o C sodium chloride (NaCl); the solution is activated for 12 minutes and injected into the intestine in a warm form (t = 38-40 ^o C). Moreover, for washing from a large capacity of the apparatus, such a volume of liquid is taken that causes the urge to defecate, but is retained in the rectum for at least 20-40 minutes. The purpose of this manipulation is to achieve an anti-inflammatory effect, restore the integrity of the mucosa and prepare the intestines for the subsequent implantation of omnoflora. "Narine-F" is prescribed from 1 day to 1 tbsp. l 2-3 times a day 30-40 minutes before meals for the entire course to achieve an immunostimulating, bacteriostatic effect, improve metabolic processes, and also to stimulate the growth of its own intestinal microflora. Diet - sour milk, crackers, vegetables. On day 4-8 - no-spa in 2 tablets. 3 times a day.

 On day 9, a one-day treatment with biltricide is performed, but the daily dose is divided into three doses at night: 22 hours, 2 and 6 hours. In this case, the single dose is reduced: instead of the generally accepted single dose of 20 mg, we prescribed 15 mg per 1 kg of body weight (total dose - 45 mg per 1 kg of body weight). On the next (10) day, therapeutic duodenal sounding with vegetable solutions, such as chamomile, is prescribed to relieve intoxication by actively washing the corpses of helminths and the remnants of chemotherapeutic agents.

 On the 11th day in the evening, a cleansing enema with anolyte (1-1.5 L) is performed, on the 15th day - with catholyte in order to obtain an antiseptic, bactericidal and bacteriostatic effect in relation to live helminths and their washing out of the intestine. On the next (12) day, in order to increase their own immune system and create a physiological balance, rectal implantation of bacterial preparations (bacteriophage, bificol, etc.) is performed through a probe according to our methodology (Pat. RF N 2092167).

 The proposed method of treatment with the use of electroactivated aqueous solutions against the background of the Narine-F dietary supplement with a wide spectrum of activity has obvious advantages over the known methods of treating parasitic diseases, including the method adopted as a prototype. Our studies have shown that the appointment of electroactivated aqueous solutions with a certain amount and ratio of active elements during the first days of hospital stay not only activates parasites, but also has an anti-inflammatory, immunostimulating and detoxifying effect and can significantly reduce the dose of a chemotherapy drug.

 The effectiveness of the proposed method was studied on the example of two groups of patients. Patients of the first group (38 people) received anthelmintic treatment with praziquantel (biltricide), which was prescribed in a daily dose of 60 mg per kg of body weight (one-day course). Pathogenetic therapy included tubing with mineral water (according to Demyanov) - after completion of chemotherapy. In 18 (47.3%) patients, side effects of praziquantel in various manifestations were noted - from headaches, fever to joint pain, ECG changes, etc .; the frequency of their manifestation led to the need to cancel anthelmintics in 4 (10.5%) patients, 5 (13.1%) patients underwent additional symptomatic treatment. Probing after treatment with praziquantel revealed the presence of parasites in 7 patients who were prescribed a second course after 6 months.

 Patients of the second group (96 people) underwent a course of combined pathogenetic treatment according to the proposed method using the Narine-F dietary supplement during the entire course and electroactivated aqueous solutions before the appointment of praziquantel.

 The daily dose of praziquantel for most patients (91 people) was reduced relative to the standard dose by 1/3 and amounted to 45 mg per 1 kg of body weight (15 mg per dose - only 3 doses per day). In 14 (14.5%) patients after chemotherapy, side effects were noted (in 6 - skin itching, facial flushing, in 8 - dizziness, weakness). The remaining group of patients - 82 people. (85.4%) did not complain during the entire treatment course. Duodenal sounding performed after 6 months revealed the absence of parasites in 96 (100%) patients.

 Dynamic monitoring of patients of both groups after 3-6-12 months showed that in most patients of the first group (29 people - 76.3%) there was no positive dynamics, in 8 people. (8.3%) there was a clinical improvement, 1 person. for re-examination did not appear. On the contrary, in a larger number of patients of the 2nd group (85 people - 88.5%) clinical improvement was noted (see table at the end of the description).

 Example 1. Patient P., 36 years old. He was admitted to the clinic of the Interregional Center for Correction of Human Microbiocenosis (MCCMCH) with a diagnosis of opisthorchiasis, hr. parasitic cholecystitis. In the anamnesis - hr. gastroduodenitis, hr. tonsillitis. Complaints of pain in the right hypochondrium, flatulence, bitterness in the mouth.

 On examination, the abdomen is of the usual configuration, painful in the projection of the gallbladder. Diagnosis: opisthorchiasis (first detected), hr. parasitic cholecystitis cf. Art. severity, mixed dyskinesia of GWP.

 Appointment: Starting from the second day (the first day - diagnostic sounding) - drink with EVR-K for 3 days, 100 ml 3 times a day 40 minutes before meals, supplement "Narine-F" - 1 tbsp. l 3 times a day. On the 5th day after the cleansing enema - rectal lavage of the intestine with a warm solution of EVR-A (anolyte) with NaCl, no-shpa - 1 table. 3 times a day, continue drinking with EVR-K 50 ml 3 times a day before meals.

 On day 6, the drug biltricid is a one-day course in three doses (after 6 hours), 15 mg per kg of body weight after a meal. The next day - the second duodenal sounding - washing according to Vitebsk, at the end of washing - enter the bacteriophage through the probe (10.0).

 Already on the 5th day in the hospital, pain in the right hypochondrium decreased. Remained dyspeptic symptoms, anorexia, general weakness. The abdomen is soft, moderately painful with deep palpation. Chair once a day, decorated.

 On the 7th day (after taking biltricide and duodenal washing), parasites were not detected, bitterness in the mouth disappeared, health was normal. Discharged with positive dynamics.

 It is recommended to continue taking choleretic herbs for 1 month, tubage 1 time per week, "Narine-F" - for 1 month. When probing after 6 months. no parasites have been identified.

 Example 2. Patient Z., 41 years old. He was admitted to the hospital with a diagnosis of opisthorchiasis, exacerbation. Complains of constant dull pain in the right hypochondrium, skin itching, rashes on the skin of the arms and legs, nausea. In the anamnesis - hr. cholecystitis with exacerbations 2-3 times a year. Sensing results: in serving “B” (60 ml.) - opisthorchis eggs. Feces on the ovum - eggs of the opisthorchis. On examination - the tongue is overlaid, tension in the projection of the gallbladder. The abdomen is painful on palpation. Diagnosis: opisthorchiasis in the acute stage, hypomotor dyskinesia of gastrointestinal tract.

 Appointments: within the first 3 days after sensing - drinking a warm solution of EVR-K in 100 ml 3 times a day for 40 minutes before eating, the drug "Narine-F" for 1 tbsp. l 3 times a day, suprastin - 1 tablet. for the night.

 On the 5th day - after a cleansing enema - rectal washing with a warm solution of EVR-A with NaCl. On day 6, antiparasitic therapy was prescribed - biltricide - not more than 45 mg per 1 kg of body weight in three divided doses one hour after eating. Herbal medicine - a decoction of oats - 50 ml 3 times a day before meals. Diet - table N 5.

 On day 6 - duodenal washing in Vitebsk (with a solution of chamomile). At the end of washing, the introduction of bificol through a probe (40.0). The patient does not complain of nausea, the pain in the right hypochondrium decreased. Headaches stopped on the 5th day of hospital stay.

 As a result of the study of duodenal contents and microscopic analysis, parasites were not identified. On day 9, the severity in the right hypochondrium significantly decreased, the general condition is satisfactory. Nausea does not bother, there was an appetite, a quiet sleep. On palpation - the liver is not enlarged. Chair once a day, decorated.

 Discharged in satisfactory condition under the supervision of an infectious disease specialist. Recommended: tyubazh - 1 time in 10 days, for 10 days, continue taking choleretic herbs.

 At the next probe (after 6 months) no parasites were detected.

Claims (1)

The method of complex pathogenetic therapy of opisthorchiasis patients, including the appointment of anthelmintic drugs, characterized in that after a diagnostic probe while taking Narine-F for the first three days, the patient is prescribed to drink an electroactivated aqueous solution of EVR-K prepared by adding the device to a small anode capacity " Espero "20 ml of a 10% solution of CaCl ₂ , 25 ml of a 5% solution of MgSO ₄ , 15 ml of a 4% solution of KCl, and in a large cathode capacity - 50 ml of a 0.01% solution of KMnO ₄ and rectal microclysters using m heated neutral solution of EVR-A (anolyte) with the addition of 1/3 teaspoon of sodium chloride (NaCl) to the anode zone, and anthelmintic preparations are prescribed for 5 days according to the standard scheme, but with a reduced by 1/3 single and general course dose, the next day, duodenal washing with vegetable solutions is carried out.

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