RU2217139C1 - Method for stimulation of motor activity of intestine - Google Patents

Abstract

FIELD: medicine, surgery. SUBSTANCE: method involves using the preparation "Dalargin" that is infused to patients after carrying out operation in intestine in 4- 6 h and 24 h in the dose 26 mcg/kg x 24 h per 200 ml of sodium chloride physiological solution. Method allows acceleration of recovery of motor activity of intestine. Invention can be used in patients with traumatic damages and diseases of abdomen. EFFECT: enhanced stimulation method. 1 ex

Description

 The invention relates to medicine, namely to surgery, and can be used in patients with traumatic injuries and diseases of the abdomen.

 There is a method of drug stimulation of motor activity of the small intestine using the introduction of chlorpromazine and other drugs of the antipsychotic series (V. K. Gostischev et al. Peritonitis. M .: Medicine, 1992, p. 161). The mechanism of action of drugs is based on blocking the influence of the sympathetic nervous system, which leads to an improvement in intestinal blood flow and, as a result, motor activity.

 The disadvantage of this method is the reduction of blood pressure, which is unacceptable in critically ill patients.

 A known method of stimulating motor activity of the intestine using cerucal and other prokinetics. The mechanism of their action is associated with a central influence on the trigger zones of the brain stem (Mashkovsky M.D. Medicines. M: Medicine, 1984, p. 212).

 The disadvantage of using these drugs is their lack of effectiveness in the presence of severe trauma to the abdominal cavity, intestinal surgery.

 The closest set of essential features to the claimed invention is a method of stimulating motor activity of the intestine with proserin (prototype). The mechanism of action of the drug is anticholinesterase action, which leads to increased intestinal motility (Mashkovsky MD Medicines. M: Medicine, 1984, p. 215).

 The disadvantage of using the drug is an electrolyte imbalance, a sharp release of potassium into the blood, which complicates its correction. In addition, proserin exerts its positive anti-paretic effect for a short time - only on the first day of the postoperative period (V.K. Gostischev et al. Peritonitis. M: Medicine, 1992, p. 161).

 The claimed invention is aimed at solving the problem of developing a method for stimulating intestinal motor activity in the postoperative period in patients with severe abdominal trauma after a surgical operation.

 The solution to this problem will improve the results of treatment of patients with severe abdominal trauma.

 To achieve this technical result, the invention includes the administration to patients with severe abdominal trauma in the postoperative period of the drug "Dalargin" at a dose of 25 μg / kg • day.

 The totality of these common essential features is supplemented with the following particular distinguishing features: the administration is carried out in a stable condition of the patient (the criteria are the absence of a deficit in the volume of circulating blood), the administration is carried out intravenously, per 200 ml of physiological sodium chloride solution.

 In contrast to the prototype, the claimed invention has the following distinctive features: as a medicine, "Dalargin" is used, which is infused into the patient after an operation on the intestine after 4-6 hours and 24 hours at the rate of 25 μg / kg • day per 200 ml of physiological chloride solution sodium.

 The mechanism of action of the drug is multifaceted: when using the drug, blood circulation improves at the level of the microvasculature. Experimental studies (Slepushkin V.D., Pavlenko V.C., Khlystov V.V. et al. // Bull. All-Union Cardiological Scientific Center of the Academy of Medical Sciences of the USSR. - 1986. - 2. - P. 54-55.) Showed an improvement microcirculation in the stomach and small intestine of rats given dalargin. It has an antistress effect, suppressing the production of all stress hormones (ACTH, cortisol, thyroxine, vasopressin, etc.), catecholamines (Elsky V.N., Slepushkin V.D., Samsonenko R.A. et al. // Pat. Fiziol . - 1985. - 6. - P.15-19., Prum I.A., Lishmanov Yu.B., Slepushkin V.D. // Bull. Expert biol. - 1984. - 7. P.18- 19.). In addition, "dalargin" has a direct effect on the enkephalin receptors of the enterin system (Loginov A.S., Parfenov I.A., Ruchkina I.N. Debridate - an effective tool in the treatment of irritable bowel syndrome // Ros. Gastroenterological Journal - 1996. - 4. - P.41-45.).

 To implement this method, dalargin at a dose of 25 μg / kg • day is dissolved in 200 ml of physiological solution of sodium chloride and infused to the patient intravenously for 15-20 minutes 4-6 hours after surgery on the intestine. A second similar dose of dalargin is similarly administered 24 hours after surgery.

 The condition for using the method is the absence of a deficit in the volume of circulating blood, an indicator of which are normal blood pressure, central venous pressure, diuresis.

 To determine the effectiveness of the use of the invention, a study was conducted in 2 groups of victims with a gunshot wound to the abdomen with intestinal damage. All patients were treated in a clinical emergency hospital in Vladikavkaz from 1985 to 2000. The first (control) group consisted of 30 wounded with gunshot injuries of the abdomen, with damage to various parts of the intestine. The second group consisted of 34 patients with similar injuries. In the postoperative period, patients of group 1 were administered proserin in generally accepted dosages. In the postoperative period, patients of group 2 were given dalargin, no proserin was administered, otherwise the therapy in the postoperative period did not differ in the groups. The average severity of damage, assessed by retrospective analysis on the VPH-P (RR) scale in group 1, was 8.4 ± 0.9 points, in the second group, 8.3 ± 0.6 points. The average severity of the condition of the wounded at the time of admission according to the VPH-SP scale was estimated in the first group of 24.3 ± 0.7 points, in the second group of 24.2 ± 0.8 points. The selected groups of patients are representative in terms of gender and age, terms from the moment of injury, the severity of shock, the degree of blood loss, the nature of the injury, the severity of damage and condition, which makes a comparative analysis possible. The assessment of intestinal motor activity was carried out auscultatory and with the help of electrogastrointestinography (EGIG) using an EGS-4 electrogastrograph. Using clinical methods for recording intestinal peristalsis, it was found that in group 1 patients, single, uncoordinated intestinal noises appeared on day 2 after surgery in 7 (23, 3%) of patients, on day 3 - in 17 (56.7%), on day 4 - in 6 (20.0%). Full intestinal peristalsis was heard on the 3rd day in 5 (16.7%) patients, on the 4th day - 13 (43.3%), on the 5th day - in 10 (33.3%), in 2 (6.7%) ) the wounded full peristaltic noises began to be heard on the 6th day. Gas evacuation for up to 3 days after surgery was noted in 13 (43.3%). The EHIG data confirmed the results of clinical studies: the presence of waves with a frequency of 0.012-0.2 Hz with an amplitude of up to 350-550 μV in most patients was noted on days 4-5.

 In patients of group 2, single, uncoordinated intestinal murmurs appeared on the 2nd day after surgery in 9 (26.5%) patients, on the 3rd day in 24 (70.6%), and on the 4th day in 1 (2.9%) . Full intestinal peristalsis was heard on day 3 - in 8 (23.5%) patients, on day 4 - 22 (64.7%), on day 5 - in 4 (11.8%). Gas evacuation for up to 3 days after surgery was observed in 22 (64.7%). EGIG data confirmed the results of clinical studies: the presence of waves with a frequency of 0.012-0.2 Hz with an amplitude of up to 350-550 μV in most patients was noted on 3-4 days. Thus, the average duration of intestinal paresis in patients who received dalargin in the complex of therapeutic measures was one day shorter than in the group of patients without its use.

 This means that this method of treating the disease is the most effective compared to that used in modern practical medicine.

 According to the information available to the authors, the set of essential features characterizing the essence of the claimed invention is not known from the prior art, which allows us to conclude that the invention meets the criterion of "novelty."

 According to the authors, the essence of the claimed invention does not follow explicitly from the prior art for a specialist, since the above effect on the obtained technical result is not revealed from it - a new property of the object of the totality of features that distinguish the claimed invention from the prototype, which allows us to conclude compliance with the criterion of "inventive step".

 The set of essential features characterizing the essence of the invention, in principle, can be repeatedly used in surgery, with the result in the form of accelerated recovery of intestinal motor activity, which allows us to conclude that the invention meets the criterion of "industrial applicability".

Concrete example
Patient A., 25 years old, was hospitalized 02.20.2002 at 21.10. in KBSP complaining of pain in the wound and throughout the abdomen. 20 minutes before admission, under unknown circumstances, received a gunshot wound in the abdomen. On examination, the diagnosis was established: penetrating through gunshot (bullet) wound of the abdomen, internal bleeding. Upon receipt of blood pressure 90/60 mm RT. Art., pulse 138 beats. in 1 minute. The operation was performed: median laparotomy, resection of the small intestine (40 cm) with an end-to-end anastomosis, resection of the sigmoid colon with the formation of a double-barreled colostomy, debridement and drainage of the abdominal cavity, surgical treatment of the wound. Blood loss of about 1.5 liters. In the postoperative period, conventional treatment was carried out, including infusion-transfusion, antibacterial, prophylactic anticoagulant, cardiotropic therapy, etc. By the fifth hour of the postoperative period, the patient's condition stabilized: AD-130/80 mm RT. Art. , CVP-80 mm of water. Art., diuresis - 60 ml per hour. The patient was given the drug "Dalargin" at the rate of 25 mcg / kg • day (2000 mcg), diluted in 200 ml of physiological sodium chloride solution. A second, similar dose of the drug was administered after 24 hours. Proserine, antipsychotics, cerucal were not used. By the end of the second day, the patient had peristaltic noises, and on the third day, active intestinal peristalsis, gas discharge was determined. The postoperative period later proceeded without complications, the patient was discharged on day 12 for outpatient treatment.

Claims (1)

A method of stimulating intestinal motor activity, including the use of drugs, characterized in that "Dalargin" is used as a drug, which is infused into the patient after surgery on the intestine after 4-6 hours and 24 hours at a rate of 25 μg / kg · day per 200 ml physiological solution of sodium chloride.