RU2198645C2 - Method for treating asthenoneurotic syndrome in combination with autonomic-vascular dystonia in patients working under risk conditions of intoxication by heavy metals and metal-containing pesticides - Google Patents

Abstract

FIELD: medicine, neurology, reflexotherapy. SUBSTANCE: after two-dlong adaptation one should daily conduct ultrasound inhalations with chloride-hydrocarbonate-sodium mineral water. Since the fourth day of therapy it is necessary to take general hydrogen sulfide baths in a day, eight procedures/course. Since the fifth day of therapy one should carry out daily acupuncture therapy by inserting needles into corporal acupuncture points by the second braking variant. The method prolongs remission duration. EFFECT: higher efficiency of therapy. 1 ex, 7 tbl

Description

 The invention relates to medicine, namely to neurology, balneology, physiotherapy and reflexology.

 Known methods of treating neurosis, neurasthenia with various syndromes, as well as impaired cerebral hemodynamics, immune status, etc. [1, 2, 3], however, the known methods do not give the desired result, the treatment is long, the timing of remission is small.

 The objective of the invention is to reduce the duration of treatment, lengthening remission.

This object is achieved in that after a two-day adaptation, ultrasonic inhalations of sodium chloride-hydrocarbonate-sodium with a fluorine content of 6.2 mg / dm ^{3 of} mineral water are carried out daily, in the amount of 10 procedures per course, common hydrogen sulfide baths are carried out every other day, starting from the fourth day of treatment , in the amount of eight procedures per course, and acupuncture by introducing needles into the corporal acupuncture points for 30-40 minutes according to the second inhibitory option is carried out daily, starting from the fifth day of treatment, for a course of 8 procedures. If the procedures coincide in one day, a temporary break of 1-2 hours is established between them.

 Scheme vacation procedures are presented in table 1.

 The method is as follows.

 After a two-day adaptation of the patient in the resort, from the 3rd day he is prescribed ultrasonic inhalation with Sochi fluoride-containing mineral water. The technique of transpulmonary exposure to the body with high fluorine-containing mineral water (Sochi type GOST 1327-88) is performed using highly dispersed aerosols of this water, obtained and injected into the respiratory tract using the TUR USI-50 ultrasonic inhaler (with registration number 21 / 6- 86 of the State Register of Medical Products 1996), the design advantages of the TUR USI-50 inhaler (drop spectrum 0.5-8 μm, fogging efficiency 2.5 mg / min, air flow adjustable from 0 to 20 l / min) give opportunity right yl dosed amount administered to the respiratory tract therapeutic substance.

 Initially, 10 ml of Sochi mineral water is poured into the inhaler, then about 5 ml is added before each procedure.

The mode of inhalation administration of Sochi mineral water:
1. The flow rate of the mixture is 5 mg / min.

 2. The duration of the inhalation of the mixture 3 minutes

3. A therapeutic agent is a drinking therapeutic fluorine-containing mineral water, which is chloride-hydrocarbonatonium, of average salinity with a fluorine content of 6.2 mg / dm ³ .

 4. Inhalation course: 10 procedures dispensed daily.

 On the fourth day of treatment, common hydrogen sulfide baths are connected, every other day, 8 at a concentration of hydrogen sulfide from 50-100-150 mg / l (table 1).

 Acupuncture is prescribed on the fifth day of a course of treatment. Acupuncture is carried out in a classical way, by introducing needles into corporal points for 30-40 minutes according to the second, so-called inhibitory option, which allows influencing stress-limiting systems of the body. For the acupuncture procedure, reusable stainless steel needles with a metal handle are used (registration number 93 / 199-102 of the 1996 State Register of Medical Products).

 Acupuncture treatment begins with classic acupuncture points that have a restorative and sedative effect: G1-10 (2); G1-11 (2); E-36 (2). Then on the second day, points are connected to the treatment to normalize the functional state of the nervous system and improve sleep: G1-4 (2) TR-5 (2) RP-9 (2). On the third day, points are used to relieve vasospasm, reduce vascular tone and normalize blood microcirculation in the vessels of the brain: T-14; T-15; V-10 (2); 1G-15 (2). During the fourth day - points for relieving pain with cervicalgia, cervical-occipital region and dizziness: T-13; T-12; V-11 (2); V-13 (2). On the fifth day, points are used to restore venous circulation and eliminate pain in the collar area: V-12 (2); T-12; T-14; VB-21 (2). During the sixth day, points are used to normalize the functional state of the nervous system and restore sleep: G1-10 (2); G1-11 (2); E-36 (2). On the seventh day, acupuncture points are used for sedative and restorative action: C 1-4 (2); TR-5 (2); RP-9 (2). On the eighth day - points for relieving pain from headaches and dizziness T-14; T-15; V-10 (2); 1G-15 (2). During the ninth day, points are connected to restore cerebral nervous hemodynamics, reduce vascular tone and normalize venous circulation T-13; T-12; V-11 (2); V-13 (2). On the final tenth day, acupuncture points are used to finally consolidate the achieved result and eliminate the remaining pain syndromes in the occipital-collar region.

 In the process of treatment, immunostimulating points are used repeatedly: Gl-4; Gl-11; TR-5; E-36; V-11; T-14 for the normalization of cellular and humoral immunity. Points located in the collar region and occipital part of the skull V-10; T-15; T-14; VB-21; 1G-15; T-13; T-12; V-11; V-13; V-12 are designed to affect the centers of the sympathetic and parasympathetic departments of the autonomic nervous system in order to restore cerebral hemodynamics and relieve pain in this area.

 Paired points are used symmetrically on both sides, at the same time, no more than 6-7 points per procedure. The combination of all the above points was the main therapeutic acupuncture prescription.

 If the vacation procedures coincide on the same day, a temporary break of 1-2 hours is established between them.

 General treatment by the proposed method is completed on the 18th day of the patient's stay in the clinic.

 Example. Patient S., 30 years old, has been in a neurological clinic since March 10, 2000 (she has been working as an agronomist in a greenhouse for 6 years, has contact with metal-containing pesticides during the preparation of toxic chemicals for spraying and irrigation) of the center with a diagnosis of Asthenic-neurotic syndrome in combined with vegetovascular dystonia.

 At the time of admission to the clinic, the patient complained of headaches after nervous and emotional stress and fluctuations in blood pressure, dizziness after fluctuations in blood pressure, weakness after work in the evening, fatigue after physical and nervous stress, irritability, short temper, conflict, sleep disturbance, pain in the region of the heart after neuro-emotional stress, palpitations, pain in the lumbar spine.

 History of the present disease: considers herself sick since 1995, when after emergency, intoxication work at the end of the day, she began to notice increased weakness, irritability, malaise, but did not go to the doctors, as these phenomena disappeared after a two-three-day rest. Then the symptoms gradually worsened and headaches, dizziness, and a feeling of heaviness in the heart area began to appear at the top of the neuro-emotional overstrain. It was examined on an outpatient basis, where the diagnosis was made: Asthenic-neurotic syndrome in combination with vegetovascular dystonia. It was treated: sedatives, tonic and vasodilators. It is not registered, it is treated extremely rarely, only on an outpatient basis up to 1 time per year.

 In 2000, she entered the clinic of the Scientific Research Center of Balneology and Rehabilitation.

 Data from an objective study: the patient's condition is satisfactory. The skin and visible mucous membranes are clean, pink in color. Subcutaneous fat is well developed. Lymph nodes accessible for palpation, not enlarged. The boundaries of relative cardiac dullness are not changed. Apical impulse in the fifth intercostal space. Heart sounds are muffled, rhythmic. HELL 110/70 mm Hg pulse 76 beats min satisfactory filling and tension. Respiratory organs: percussion pulmonary sound, ascultative-vesicular breathing, no wheezing. The abdomen on palpation is soft, painless. The liver along the edge of the costal arch, painless on palpation. The spleen is not enlarged. The chair is not changed. Palpation of the kidney area is painless. Pasternatsky’s symptom is negative on both sides. Urination is free and painless. Support and movement organs: upon palpation of the spine along the spinous processes and paravertebral points on both sides, slight pain in the lumbar spine is noted. Movement in the spine is relatively free and painless. Lasegus's symptom is negative on both sides.

 Nervous system: patient contact, emotionally labile, talkative, FMN - deviation from the norm is not noted. Sensory impairment could not be detected. Tendon-periosteal reflexes are enlivened on both sides, the same, with extended zones of innervation. In the Romberg position, it is unstable, swaying slightly. Finger-nasal test - according to the functional type. Shallow thermor of fingers and eyelids. Skin dermographism is persistent, red, spilled.

Data from paraclinical examination methods (before treatment): general blood test HB 116.1 g / l; er 4.2 • 10 ¹² / l; color. pok. 0.83; lake. - 7.75 • 10 ⁹ / l; ESR 6 mm / h; segmented 50; stab 2; eosonophils 1; monocytes 7; lymphocytes 40.

 General urine analysis: straw yellow; specific weight 1.015; transparent sour; no protein; no sugar; lake. 2-4-6 p / sp.

 ECG - sinus rhythm. Normal position of the electrical axis of the heart. Moderate changes in the myocardium.

 REG - blood vessels in the brain within normal limits. Arterial tone is increased, venous stasis is revealed. The elastic properties of blood vessels are slightly reduced. FmS-Pu 40; A / T 18%; D / A 85%; And / A 85%; Fmd-Pu 3.0; A / T 18%; D / A 75%; And / A 75%.

 Biochemical blood test: medium-molecular peptides 0.357 conv. units the binding ability of serum albumin is 14.6 g / l.

 Immunological status: T-71% -2104.4; Vl-24% -711.4; Tx-37% -778.6; Ts-34% -715.5; IgM-1.24 g / l; IgGe-14.0 g / l; IgA-2.5 g / L.

 Psychological tests: Taylor-29, state self-assessment questionnaire: activity-10; mood-9; anxiety-7.

 During the examination, the diagnosis was established: Asthenic-neurotic syndrome in combination with vegetovascular dystonia.

Assigned treatment according to the proposed method:
- climatic procedures for regime P;
- the mode of physical activity is gentle-training;
- adaptation 2 days - morning gymnastics in P mode, diet 15;
- ultrasonic inhalations of Sochinskaya mineral water (table 1) daily for a course of treatment of 10 procedures;
- total hydrogen sulfide baths according to the developed shortened procedure (table 1) strictly every other day, for the course of treatment of 8 baths.

 - acupuncture, daily, for the course of treatment 10 procedures (table 1).

 During the 24-day stay of the patient in the clinic, she was examined by a doctor 7 times.

 At the second appointment with the doctor: the patient was well adapted, her health was satisfactory. Complaints remain the same. The heart tones at the apex are clear and rhythmic. HELL 110/70; pulse 76 beats min satisfactory filling and tension. The treatment is well tolerated. The patient is fully examined according to scientific requirements.

 At the third reception - the patient’s well-being is gradually improving, she has a good rest and is being treated, she has become calmer, more balanced, more cheerful, more active and cheerful. The treatment is well tolerated, notes positive changes.

 At the fourth reception - the patient's well-being improves, sleep gradually recovered, headaches are absent, dizziness does not bother. Blood pressure stabilized at normal numbers, the treatment tolerates well, notes improvement.

 At the fifth reception - the patient's well-being improves, his sleep has completely recovered, there are no pains in the heart area, he does not notice a heartbeat. The treatment is well tolerated, notes improvement.

 At the final appointment - the patient became calmer, more balanced, more alert, more active, more cheerful, sleep was restored, headaches were absent, dizziness did not bother, blood pressure stabilized at normal numbers, there were no pains in the heart area, she didn’t notice a heartbeat.

 The patient was discharged with significant improvement.

Examination data after treatment:
ECG - sinus rhythm. Normal position of the electrical axis of the heart. Improving trophism in the myocardium of the posterior wall of the left ventricle.

 REG - blood vessels in the brain are normal. The tone of the arteries returned to normal. Venous circulation has recovered. The elastic property of the vessels is normal: FmS-Pu 4.0; A / T 14%; D / A 52%; And / A 52%; Fmd-Pu 3.5; A / T 14%; D / A 59%; And / A 59%.

 A general blood test and a general urine test are normal.

 Biochemical blood test: medium molecular peptides 0.221 conv. units the binding ability of serum albumin is 27.6 g / l.

 Immunological status T 1624.0; Vl 464.0; Tx-57% -925.7; Ts-23% -373.5; IgM 1.04 g / l; IgGe 17.6 g / l; IgA 2.5 g / l.

 Psychological status: taylor 16; self-assessment questionnaire: activity 16; mood 13; anxiety 12.

 After the treatment, normalization of all the main indicators, restoration of the ECG, REG, biochemical and immunological parameters took place.

 To assess the effectiveness of the proposed method, a comparative characteristic of two groups of patients.

 Group I - 40 patients (prototype) with astheno-neurotic disorders in combination with vegetative-vascular dystonia in people working at risk under the influence of heavy metals and metal-containing pesticides in production received a classical treatment course consisting of 10 common hydrogen sulfide baths, designed for 24 days course treatment.

 Group II - 40 patients with astheno-neurotic syndrome in combination with vegetative-vascular dystonia, which developed under the influence of heavy metals and metal-containing pesticides at work - received treatment according to the proposed method according to table 1.

 Both groups are identical in disease, age, and contact with harmful substances in the workplace - thiol poisons.

 From table 2 it is seen that after treatment in the I group remains 45.5% of the initial complaints, and in the II group - 25.9%, which is 19.5% more effective.

 From the data of table 3, it is seen that the effectiveness of the proposed method of treatment is significantly higher - by 34.1% - according to the results of the comparative characteristics of objective neurological data.

 From the analysis of table 4, we can conclude that under the influence of common hydrogen sulfide baths according to the shortened method in combination with ultrasonic inhalations of Sochi mineral water and acupuncture (the proposed method), there was a significant decrease in average molecular peptides and a significant increase in the binding ability of serum albumin, which not observed when using the prototype method.

 Thus, the proposed method of treatment in the dynamics of biochemical parameters exceeds the known method.

 From table 5 it is seen that under the influence of hydrogen sulfide balneotherapy (group I), a reliable positive dynamics of two of the seven indicators was observed. Basically, only a tendency to normalize the number of suppressor cells was observed in patients. In general, activation of the T-cell link should be noted. In the system of humoral immunity, significant changes in functions were not observed. At the same time, the application of the proposed method of treatment has a more pronounced immunomodulating effect, providing a multidirectional effect on various indicators of the immune system. So, a marked decrease in the initially elevated indices of T-, B-lymphocytes and T-suppressors. Moreover, changes in B-lymphocytes and T-suppressors were reliable in nature, and an increase in the initially reduced T-helper and IgA indices, while a significant restoration of class M immunoglobulins was noted. Thus, the proposed method of treatment is superior to the known method in the dynamics of immunological parameters.

 Comparing the results of the rheographic data against the background of the treatment, it can be concluded that the most pronounced effect was obtained as a result of the treatment according to the proposed method (group II), where a pronounced significant change in all rheographic parameters was noted (see table. 6). The reographic index recovered on the left: 1.76 0.098; P <0.001: 2.2 0.12. The elastic modulus gradually normalized on both sides: FmS - 19.6 0.81: P <0.001 16.1 0.73: Fmd-17.1 0.62: P <0.01: 14.9 0.62. Diastolic index decreased to normal numbers on both sides FmS-71.6 1.83: P <0.01: 64.6 1; Fmd-66.5 2.34: P <0.01: 62.2 1.32. The dicrotic index changed according to the general positive picture: FmS-70.3 1.87: P <0.001: 61.2 1.72; Fmd-65.9 2.63: P <0.05: 61.4 1.57. All these changes reflect an improvement in blood supply to the vessels of the brain, restoration of the elastic properties of blood vessels, a decrease in vascular tone and normalization of venous circulation, and the elimination of congestion. At the same time, under the influence of the prototype (group I), the rheographic parameters changed slightly, although there was a significant decrease in the elastic modulus on the right: 19.7 0.74: P <0.001: 15.5 0.86, while the vessels became more elastic and dicrotic index 75.8 1.2 P <0.05: 71.2 1.90 on the right, which is responsible for reducing the tone of small arteries. All other indicators had only a tendency to unreliable normalization. Thus, according to the results of the encephalograms, the proposed method is more effective.

 The analysis of table 7 revealed a higher therapeutic effect from the application of the proposed method of treatment (group II), where 60% were prescribed with a significant improvement, and with an improvement of 40% of patients, which is a total of 10% higher than in the treatment of these the same patients according to the prototype method.

 The prototype treatment course is 10 total hydrogen sulfide baths and is designed for 24 days of treatment, at the same time, the proposed method consists of 8 baths and is designed for 18 days of treatment, which is 2 baths less and 6 days shorter, which means more economical.

 To study the long-term results of treatment according to the proposed method: during the year, patients did not apply for medical care at the place of residence for the main diagnosis and were not issued sick leave, with a remission of 13 months.

 Thus, the proposed method for the treatment of patients in contact with thiol poisons (heavy metals, their salts and metal-containing pesticides) in production, who developed asthenic-neurotic syndrome in combination with vegetovascular dystonia as adaptive disorders of the body, has a pronounced therapeutic effect, allows to reduce the term of treatment is up to 18 days, save material costs, extend the period of remission up to 13 months.

Sources of information
1. Gogilov N. P. The use of hydrogen sulfide waters for balneotherapy and ultrasonic inhalations in the rehabilitation of people working at risk of intoxication with heavy metals, having adaptive disorders in the form of astheno-neurotic reactions. / Information mail. - Sochi. - 1995. - 10 p.

 2. Pirutin A.A. Complex balneotherapy of patients with autonomic dystonia syndrome of neurotic nature. // Diss. Cand. honey. sciences. - Sochi. - 1991 .-- 125 s.

 3. Ulyanova L.A. Prolonged neurosis and their treatment in resorts with sulfide iodine-bromine and carbonic-arsenic waters. // Abstract of the dissertation for the degree of doctor med. sciences. - Leningrad. - 1991 .-- 37 p.

Claims (1)

A method of treating asthenoneurotic syndrome in combination with vegetovascular dystonia in people working at risk of intoxication with heavy metals and metal-containing pesticides, including carrying out common hydrogen sulfide baths, characterized in that after a two-day adaptation, ultrasonic inhalations of sodium chloride-hydrocarbonate-sodium with fluorine content of 6 are performed daily, 2 mg / dm ^{3 with} mineral water, in the amount of 10 procedures per course, total hydrogen sulfide baths are carried out every other day, starting from the fourth day of treatment, in the amount of eight procedures per course, and acupuncture by introducing needles into corporal acupuncture points for 30-40 minutes according to the second inhibitory option is carried out daily, starting from the fifth day of treatment, for a course of 8 procedures.

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