RU2240101C1 - Method for complex treatment of gestosis at pregnancy - Google Patents

Abstract

FIELD: medicine, obstetrics.

SUBSTANCE: it is necessary to perform medicinal therapy. Additionally, one should affect with waves of millimeter range, wave length being 7.1 mm to affect biologically active points F2 and E 36 due to autonomous applicator-emitter with heparin. Course lasts for24 h and consists of 10 procedures. The method normalizes hemostasiological parameters and rheological blood properties.

EFFECT: higher efficiency of therapy.

1 ex, 4 tbl

Description

The invention relates to medicine, namely to obstetrics and perinatology, and can be used for the treatment of gestosis of the second half of pregnancy of mild to moderate severity in conditions of antenatal clinics and pregnancy pathology departments of maternity hospitals.

According to various authors, the frequency of gestosis varies from 1.5 to 23.2% of cases. Gestosis is characterized by a deep disorder of all types of metabolism, changes in the activity of the cardiovascular and nervous system, impaired functions of the placenta, kidneys and other vital organs, which entails an increase in maternal and perinatal mortality (1). At present, a large number of pharmacological preparations have been proposed aimed at correcting these disorders, however, intensive drug therapy is not indifferent to a pregnant woman, fetus, and newborn. From this perspective, it is promising to develop new methods for the treatment of gestosis using preformed physical factors well tolerated by patients, accessible to a wide range of medical institutions and not inferior in effectiveness to traditional treatment regimens.

Closest to the proposed method is a method for the treatment of late gestosis of pregnancy by the method of acupuncture (RF patent No. 2154446, A 61 F 7/00 of 08/20/2000), which consists in influencing biologically active points (F ₂ , E ₃₆ ) with microneedles for 2-3 weeks, which was chosen as a prototype. However, this method has several disadvantages:

1) a negative psycho-emotional attitude to the procedure (the introduction of the needle is painful);

2) the method is invasive, which is unfavorable in conditions of high probability of infection with HIV, hepatitis and other hematogenous infections;

3) the duration of treatment;

4) adverse reactions and complications are possible: dizziness, sweating, hypotension, collaptoid states;

5) for the procedure, a specialist in acupuncture is required;

6) this method does not have a positive effect on the parameters of central hemodynamics and indicators of the hemostatic system.

The problem solved by the invention is to increase the effectiveness of the treatment of gestosis, reducing side effects, reducing the number of perinatal complications.

The problem is solved due to the fact that they additionally conduct waves of the millimeter range, a wavelength of 7.1 mm, on biologically active points F ₂ and E ₃₆ using an autonomous applicator-emitter with heparin, in the amount of 10 procedures, lasting 24 hours.

Experience in the practical use of millimeter-wave electromagnetic waves of extremely high frequencies (EHF) has shown their beneficial effect on biologically active points and reflexogenic zones, which helps to improve the trophism of target organs, activate the antioxidant system, increase the nonspecific resistance of the body, and mobilize its internal reserves. Treatment with millimeter-wave electromagnetic radiation is possible as monotherapy, however, when combined with drugs, the therapeutic effect is potentiated, even with a decrease in the daily dose of pharmaceuticals (2, 3).

The method is as follows.

The background resonance effect on biologically active points F ₂ , E _{36 is} carried out using an autonomous applicator-emitter from the Stella-1 EHF therapy apparatus (manufacturer of the Spinor ICP, Tomsk, State Registration Number 95 / 311-198), consisting of power supplies, control units and miniature wave generators of millimeter range of various frequencies operating in a pulsed mode. The preparation of the applicator-emitter is carried out using a biologically active preparation of heparin. The applicator-emitter is connected to the power supply unit of the Stella-1 device using an adapter and brought into contact with the drug - heparin, while at the same time (for 1-2 seconds) the power supply unit is turned on. The emitter is sequentially placed in contact on biologically active points, the operator briefly turns on the device at each contact, then the emitter is disconnected from the adapter, closed with a cap made of a polymer material. The emitter applicators prepared in this way are fixed with a band-aid on biologically active points for 24 hours before the next procedure. The course of treatment is 10 sessions. The duration of exposure was determined by monitoring the effectiveness of treatment of patients. With a decrease in the duration of exposure, a stable therapeutic effect was not achieved, with an increase in therapeutic effectiveness, it decreased.

Under observation were 50 women with a pregnancy of 24 to 36 weeks, complicated by gestosis of mild to moderate severity. The severity of gestosis was determined by the classification of I.S. Sidorova (4). There were 28 nulliparous, nulliparous - 22. The age of patients ranged from 20 to 36 years, averaging 24 ± 0.5 years. The first group (main) consisted of 30 women, whose treatment was carried out using background resonance radiation against the background of limited drug therapy (trental + magnesia).

The second group (control) consisted of 20 women, the treatment of which was carried out in the usual medical way.

In the presence of extragenital pathology, appropriate treatment was prescribed.

All studies in pregnant women were performed before and 10 days after the end of treatment.

In the study of the hemostasis system, the following parameters were investigated: activated partial thromboplastin time (APTT) according to Larrien modified by S. S. Barkagan, recalcification time (ABP), prothrombin index (IPT) according to Quick, thrombin time (TV) according to Biggs, platelet aggregation with ADP on Here with gravimetric registration, antithrombin 3 according to Abildgaard etal.

In order to determine the effect of millimeter-wave electromagnetic background resonance radiation in the treatment of gestosis on the state of central hemodynamics, the following indicators were studied: systolic and diastolic blood pressure (Ade and Add), heart rate, heart rate (UO), cardiac output (MOS), dynamic mean arterial pressure (DM).

In order to determine the effect of millimeter-wave electromagnetic radiation in the treatment of hypertension on the state of blood circulation in the mother-placenta-fetus system, Doppler studies of blood flow in the umbilical and uterine arteries were performed using only a qualitative assessment of blood flow velocity curves, with the calculation of the so-called “coal-independent” indices: systolic-diastolic ratio and resistance index.

Echographic and Dopplerometric studies were performed using sophisticated scanning devices: the Aloka-1700 apparatus (Japan) and the SIM 5000 plus (Italy), which had a Doppler unit and sensors with a frequency of 3.5 and 5 MHz.

The content of total protein, protein fractions, creatinine, total bilirubin, urea in the blood of pregnant women, as well as hematocrit, were determined by conventional methods.

All data obtained were processed by methods of variation statistics with the calculation of the Student criterion and the nonparametric χ-square criterion. Differences were evaluated as significant at P <0.05.

The data obtained (Table 1) prove the positive effect of millimeter-wave electromagnetic radiation on central hemodynamics in women with hypertension. Comparison of the treatment results of the main (using the proposed method) and the control group (without using this method) shows that in the main group the decrease in Ade and Add with a simultaneous decrease in the average diastolic pressure (SBP) occurred 1.5 times faster than in the control the group

As can be seen from the table. 2, after a course of therapy for background resonance therapy with millimeter-wave electromagnetic radiation in pregnant women, the level of peripheral vascular resistance in the uteroplacental (p <0.001) and fetal-placental (p <0.01) blood flow was significantly lower than in pregnant women, treated in the traditional way. Therefore, the use of millimeter-wave electromagnetic radiation in the treatment of gestosis of pregnancy helps to improve blood circulation in the mother-placenta-fetus system.

The data obtained (Table 3) prove the positive effect of millimeter-wave electromagnetic radiation on the hemostasis system in women suffering from gestosis of pregnancy, in particular, on a decrease in the activity of factors “internal” (p <0.01) and “external” (p <0.05 ) blood coagulation pathways. During treatment, the number of the main blood coagulation substrate, fibrinogen, significantly decreased in pregnant women of both groups (p <0.05), and in pregnant women of the main group this decrease occurred in a short period of time. The action of the known method (prototype) does not have a significant effect on the activity of the procoagulant link of the hemostatic system, on the other hand, the aticoagulant and fibrinolytic properties of the latter were confirmed by the treatment by our proposed method. This led to a decrease in the hypercoagulation characteristic of the chronic DIC syndrome accompanying gestosis and manifested by polythromboses in the microcirculation system. This is confirmed by the dynamics of thrombin time, which characterizes the final stages of thrombin formation and with a greater degree of significantly increasing in the main group, compared with the control (p <0.05).

Compared to women in the control group, fetal hypoxia (p <0.05) was found in women of the main group compared with women in the control group, and intrauterine growth retardation was detected 5.0 times less often (p <0.01). In the group of women treated with the proposed method, 1.25 times lower frequency of cesarean section. Thus, the positive influence of millimeter-wave electromagnetic radiation on the hemostatic system, hormonal levels, metabolic processes, and adaptation indicators in the body of a pregnant woman contributed to the optimization of the gestational process and a favorable outcome of pregnancy. Therefore, the use of millimeter-wave electromagnetic radiation in the complex therapy of pregnant women with PHB is pathogenetically substantiated.

EXAMPLE 1

Pregnant V., 30 years old, was hospitalized in the department of pregnancy pathology of the maternity hospital 4 of Krasnoyarsk from 12.11.02 to 12.02 (medical history 2148). Diagnosis at admission:

Pregnancy 31 weeks, combined gestosis of moderate severity against the background of hypertensive vegetative-vascular dystonia, chronic fetoplacental insufficiency with impaired uteroplacental blood flow, grade 1 B, subcompensated form, grade 1 anemia, chronic pyelonephritis, remission, chronic cholecystitis, remission. Upon receipt, the pregnant woman did not show complaints. From the anamnesis it was established: in childhood I had chickenpox. Somatic diseases notes: chronic cholangitis, chronic cholecystitis, urolithiasis.

Menses from 14 years old, established immediately, for 5 days, after 28 days, regular, painless. M - 04/10/02. Sexual life since 18 years. The husband is healthy, smoking is noted from bad habits. This pregnancy is the first. Estimated date of birth January 17, 02

On admission: satisfactory condition, skin and visible mucous membranes are clean, normal color. In the lungs, vesicular breathing, no wheezing. Heart sounds are clear, rhythmic, Ps-110 in ', blood pressure - 160/100, 150/100 mm Hg The abdomen is increased in volume due to the pregnant uterus. VDM - 30 cm. On palpation, the abdomen is soft, painless, there are no symptoms of peritoneal irritation. The uterus is normotonic, painless. The heart tones of the fetus are clear, rhythmic 140 '. The symptom of striking is negative on both sides. Swelling of the legs of the first degree. Physiological administration is normal. In a bimanual study: the external genitalia are formed correctly, the perineum without features, the vagina is capacious. The cervix is formed, the vaginal part is 3.0 cm, the external pharynx is closed. The uterus is enlarged up to 30 weeks of pregnancy, in normotone, painless. Appendages are not determined, the pelvis is capacious, without exostoses and deformities. The discharge is normal.

Upon receipt, the following analyzes were received:

• OAK: Hb - 106 g / l, Er - 3.2 * 10 ¹² , Le - 5.3 * 10 ⁹ (e-3%, pb-11%, sya-66%, l-18%, m-2%), Ht-40%, VR - 5'20-5'52.

• Fractional composition of blood serum: total protein - 52 g / l, protein fractions - 55.2 - 17.2 -20.7 - 6.9. Creatinine - 58 mmol / l, uric acid - 3.2 mmol / l, bilirubin - 7.5 mmol / l, potassium - 2.9.

• Hemostasiogram: platelets - 180 * 10 ⁹ , fibrinogen - 5.2 g / l, PTI - 76%, PTV - 21 ", recalcification time - 58", APTTV - 31 ".

• OAM: beats. weight - 1008, B - 108 mg / l, Le - single, Er - 0-2.

• Daily loss of protein - 180 mg / l.

• GARDEN 120 mm Hg, pulse blood pressure 60 mm Hg

• Ultrasound of the fetus from 11/13/02: the uterus has one living fetus, is located longitudinally, it has a head, SB (+), BPR - 73 mm, LPR - 96 mm, DB - 61 mm, J - 75 mm. The placenta along the front wall, 3.1 cm thick, maturity degree "2", amniotic fluid sufficient. According to biometric indicators, the fetus corresponded to 30 weeks of pregnancy.

• Dopplerometry from 11/13/02 in the uterine arteries: IR-0.52, in the umbilical artery: IR - 0.84. Conclusion: violation of the uteroplacental blood flow 1B degree.

• Ophthalmologist examination dated 11/14/02: hypertensive retinal angiopathy of the first degree is determined on the fundus.

• Examination by a neurologist from 11/14/02: a hypertensive type of vegetovascular dystonia syndrome is detected in a pregnant woman. There is no acute neurological symptomatology.

Given the data of an objective examination and laboratory analyzes of the pregnant woman, a course of treatment was carried out in accordance with the claimed method (by exposure to BAT: F ₂ and E ₃₆ with millimeter wavelengths, wavelength 7.1 mm, using a stand-alone applicator-emitter with heparin. The applicator was fixed 24 hours before the next procedure.The course of treatment was 10 sessions). Exposure to electromagnetic radiation was carried out in combination with drug therapy (trental, magnesia). The pregnant woman tolerated the therapy well. After treatment, the woman felt satisfactory, no complaints.

When viewed from 11/28/02:

The abdomen is increased in volume due to the pregnant uterus. VDM - 32 cm. On palpation, the abdomen is soft, painless, there are no symptoms of peritoneal irritation. The uterus is normotonic, painless. The heart tones of the fetus are clear, rhythmic 140 '. The symptom of striking is negative on both sides. There are no visible edema. Physiological administration is normal. In a bimanual study: the external genitalia are formed correctly, the perineum without features, the vagina is capacious. The cervix is formed, the vaginal part is 3.0 cm, the external pharynx is closed. The uterus is enlarged up to 33 weeks of pregnancy, in normotone, painless.

Appendages are not determined, the pelvis is capacious, without exostoses and deformities.

The discharge is normal.

Repeated examination:

• OAK: Hb - 120 g / l, Er - 3.8 * 10 ¹² , Le - 6.0 * 10 ⁹ (e-1%, p-6%, sy-55%, l-33%, m-1%), Ht-34%, VR - 4'40-6'0.

• Fractional composition of blood serum: total protein - 61 g / l, Creatinine - 58 mmol / l, uric acid - 3.3 mmol / l, bilirubin - 8.0 mmol / l, potassium - 3.0.

• Hemostasiogram: platelets - 200 * 10 ⁹ , fibrinogen - 3.0 g / l, IPT - 94%, PTV - 17 ", recalcification time - 58", APTT - 31 ".

• OAM: beats. weight - 1015, B - negative, Le - single, Er - 0-2.

• Daily loss of protein - 44 mg / l.

• GARDEN 80 mm Hg, pulse blood pressure 40 mm Hg. Art.

• Ultrasound of the fetus from 11/27/02: there is one living fetus in the uterus, it is located longitudinally, the head is due, SB (+). The placenta along the front wall, 3.1 cm thick, maturity degree "2", amniotic fluid sufficient. According to biometric indicators, the fetus corresponded to 33 weeks of pregnancy.

• Dopplerometry from 11/27/02 in the uterine arteries: TS - 0.58, in the umbilical artery: TS - 0.52. Conclusion: no violations.

• Ophthalmologist examination dated 11/27/02: there are no changes in the fundus.

• Examination by a neurologist from 11/27/02: a pregnant woman has a hypertensive type of vegetative-vascular dystonia syndrome.

After discharge, the pregnant woman was under the supervision of a female doctor. There were no complications. It was delivered in 38 weeks by urgent delivery in the front view of the occipital presentation. As a boy, m = 3 kg, height - 53 cm, without asphyxiation, with an Apgar rating of 9B.

Thus, the appointment of millimeter-wave electromagnetic radiation to pregnant women with gestosis allows normalizing hemostasiological parameters and improving the rheological properties of blood. The advantages of the proposed method are

1) accessibility and minimal costs (physiotherapeutic departments of hospitals and physiotherapeutic rooms of clinics are equipped with devices that generate electromagnetic waves of the millimeter range);

2) non-traumatic application (cutaneous);

3) lack of side effects;

4) lack of need for a specialist reflexologist;

5) the use of this method has a positive effect on the procoagulant part of the pregnant hemostasis system, in particular, a significant decrease in fibrinogen;

6) reducing the duration of the course of drug therapy, which significantly reduces the pharmacological load on the pregnant woman and the fetus;

8) a decrease in the frequency of operative delivery.

Literature

1. Kustarov V.N., Linde V.A. // Gestosis. - St. Petersburg: Hippocrates, 200 g.

2. Betsky OV // The use of low-intensity magnetic waves in medicine: millimeter waves in biology and medicine. - 1992. - No. 1. - p. 5-12.

3. Blinkov I.L., Gedeminov L.E., Levitsky E.F. // The use of background resonance radiation therapy for the relief of pain in neurovertebrogenic diseases. - M. - 1999

4. Sidorova I.S. // Late gestosis. - M. - 1996

Claims (1)

A method for the complex treatment of gestosis of pregnancy, including drug therapy, characterized in that it additionally carries out exposure to millimeter-wave waves of 7.1 mm wavelength on biologically active points F2 and E36 using an autonomous applicator-emitter with heparin, in the amount of 10 procedures, lasting 24 hours