RU2254890C1 - Method for stimulating motor intestinal activity in patients with vertebral traumas - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: one should introduce solution "Rheamberin 1.5%"intravenously with infusomates at the dosage of 5 ml/kg/d during the next 5 d. Then, 1-2 h later, one should infuse intravenously "Dalargin" at 30 mg/kg/d dissolved in 60 ml 0.9% sodium chloride at the rate of 120 ml/h for 5 d. Additionally, 4-5 h after "Dalargin" injection it is necessary to perform daily intravenous He-Ne laser irradiation of blood beginning since the first day at wave length being 0.63 mcm, power 1 mW, exposure 50-60 min, course lasts for 5 d. The method enables to interrupt intestinal paresis in case of vertebral traumas and wounds in earlier terms.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to surgery, resuscitation and intensive care, and can be used in patients with gunshot and mine-blast wounds and spinal injuries.

A known 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. Gostishchev 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 consequence, 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 effect on the trigger zones of the brain stem (Mashkovsky MD / Medicines. Medicine, 1984, p. 212).

The disadvantage of using these drugs is their lack of effectiveness in the presence of severe spinal injury.

A known method of stimulating motor activity of the intestine with proserin (Mashkovsky M.D. / Medicines M., Medicine, 1984, p. 215). The mechanism of action of drugs is anticholinesterase action, which leads to increased intestinal motility.

The disadvantage of using drugs is electrolyte imbalance, a sharp release of potassium into the blood, which makes it difficult to correct. 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 literature describes a method of stimulating motor activity of the intestine in patients after intestinal surgery with the drug "Dalargin" (Hestanov A.K. et al., 2003, Patent No. 2217139, B.I. No. 33 of 11/27/2003, Application No. 2002113978 dated May 28, 2002).

The disadvantage of using this drug in the form of monotherapy is the low treatment effectiveness and short duration of action in patients with severe gunshot and mine blast injuries and spinal injuries.

The claimed invention is aimed at solving the problem of developing a method for stimulating motor activity of the intestine in patients with spinal injuries, as well as with gunshot and mine-blast wounds and spinal injuries.

The solution to this problem will significantly increase the effectiveness of treatment of patients with this pathology, improve treatment results and reduce the time of patients in hospital.

To achieve this technical result, the claimed invention contains the following essential features: use a Reamberin solution of 1.5%, administered by intravenous infusion at a dose of 5 ml / kg / day, during the first 2-3 hours after injury and daily, once in the morning in the following 5 days, then after 1-2 hours, Dalargin is infused at a rate of 30 mcg / kg / day, diluted in 60 ml of 0.9% physiological sodium chloride solution at a rate of 120 ml / hour for 5 days, additionally after 4- 5 hours after the introduction of "Dalargin" pro daily, starting from the first day, intravenous helium-neon laser irradiation of blood with a wavelength of 0.63 μm, a power of 1 mW, an exposure of 50-60 minutes, a course of 5 days is worn out.

Between the distinguishing features and the result there is the following causal relationship: use a Reamberin solution of 1.5%, administered intravenously with an infusomat in a dose of 5 ml / kg / day. During the first 2-3 hours after the damage and then daily, once in the morning for the next 5 days.

The drug "Reamberin" has a neuro-, cardio-, hepato- and nephroprotective, antihypoxic, detoxification and antioxidant effects. The main pharmacological effect of the drug is due to the ability to enhance the compensatory activity of aerobic glycolysis, to reduce the degree of inhibition of oxidative processes in the Krebs cycle under conditions of hypoxia with an increase in the content of ATP and creatine phosphate. "Reamberin" activates the antioxidant system of enzymes and inhibits lipid peroxidation in ischemic organs, exerting a membrane-stabilizing effect (V.A. Isakov, T.V. Sologub, A.L. Kovalenko, M.G. Romantsov "Reamberin in the treatment of critical conditions ", St. Petersburg, 2001). The same authors recommended Reamberin 1.5% as a metabolic corrector. "Reamberin" 1.5% reduces the level of free radical processes in the brain and spinal cord, weakens the destruction of the membrane elements of neurons and contributes to the complete restoration of their functions and structure. A.L. Kovalenko, A.Yu. Petrov, M.G. Romantsov “Biological action and pharmacological activity of UC.” St. Petersburg, 2000. Then, after 1-2 hours, “Dalargin” was infused intravenously at a rate of 30 mcg / kg / day, diluted in 60 ml of 0.9% physiological solution of sodium chloride at a rate of 120 ml / hour for 5 days.

The drug "Dalargin" has an antistress effect, suppressing the production of stress hormones (ACTH, cortisol, thyroxin, vasopressin, etc.), catecholamines (Yelsky V.Kh., Slepushkin V.D., Samsonenko R.A. et al. / Pathophysiology, 1985, No. 6, pp. 15-19; Prum I.A., Slepushkin V.D., Lishmanov B.I. “Bulletin of Experimental Biology”, 1984, No. 7, pp. 18-19). In addition, "Dalargin" has a direct effect on the enkephaline receptors of the enterin system (Loginov A.S., Perfenov I.A., Ruchkina I.N. "Dalargin" effective in the treatment of irritable bowel syndrome / Ros. Gastroenterological journal, 1996 ., No. 4, p. 41-45).

Experimental studies (Khlystov V.V., Pavlenko V.C., Slepushkin V.D. / Biol. All-Union. Cardiol. Scientific Center of the Academy of Medical Sciences of the USSR, 1986, No. 2, pp. 54-55) showed an improvement in microcirculation in the stomach and thin intestines of rats to which "Dalargin" was prescribed.

4-5 hours after the administration of Dalargin, daily, starting from the first day, intravenous helium-neon laser irradiation of blood is performed with a wavelength of 0.63 μm, a power of 1 mW, an exposure of 50-60 minutes, a course of 5 days.

The biological effect of low-intensity laser irradiation on the human body is realized in the form of activation of enzymes in red blood cells, improvement of blood rheological properties, normalization of lipid peroxidation processes, changes in the immune system, normalization of the body’s energy balance (K. Gamaleya, “Lasers in experiment and clinic,” M., 1972).

Laser radiation can significantly increase the effectiveness of treatment due to immunocorrection, which eliminates the immune imbalance that occurs in patients with spinal injuries.

When using Reamberin, Dalargin and laser intravenous blood irradiation in the complex, it is possible to stop intestinal paresis in case of injuries and injuries of the spine.

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 - increasing the efficiency of treatment of patients with injuries and wounds of the spine, reducing their time in hospital conditions, which allows to conclude that the criterion of "inventive step".

The set of essential features characterizing the essence of the invention in principle, can be repeatedly used in surgery, resuscitation and intensive care, 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".

The inventive method of stimulating the intestines with gunshot and mine-explosive wounds and injuries of the spine is carried out as follows: a study was conducted in two groups of victims with gunshot and mine-explosive wounds and injuries of the spine. All patients were treated in intensive care wards of the intensive care unit of the Vladikavkaz military hospital of the Ministry of Defense, which were received directly from the combat zone in Chechnya.

The condition of the victims was assessed as severe (8.3 ± 0.7 points on the VPH-P (RR) scale).

36 patients were included in the first control group, 38 patients in the second main group. The selected groups were representative in terms of gender and age, from the time 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.

An examination revealed that paresis of the first degree manifests itself in 36.3%, the second degree in 54% of cases, and the third degree in 9.7% of cases.

The assessment of intestinal motor activity was carried out auscultatory and by recording an electromyenterograph (EEMG-4M).

The criterion for the restoration of intestinal motility was the appearance on the EEMG of waves with an amplitude of 350-550 μV, a frequency of 14-18 per min, which was clinically accompanied by gas exhaustion, listening to full intestinal motility, and a decrease in signs of intoxication.

The victims of group I received therapy using a standard technique, including cerucal and proserin. The restoration of adequate intestinal motility occurred on average 5-6 days.

In patients of group II, intestinal motor activity was stimulated by the proposed method using a Reamberin 1.5% solution, administered intravenously with an infusomat at a dose of 5 ml / kg / day for the first 2-3 hours after the injury and once daily in the morning the next 5 days, then, after 1-2 hours, Dalargin was infused at a rate of 30 μg / kg / day, diluted in 60 ml of 0.9% physiological sodium chloride solution at a rate of 120 ml / hour for 5 days, additionally after 4-5 hours after administration of "Dalargin" Daily, starting from the first day, intravenous helium-neon laser irradiation of blood with a wavelength of 0.63 μm, a power of 1 mW, an exposure time of 50-60 minutes, and a course of 5 days was performed.

Restoration of intestinal motility occurred on average 3-4 days.

Thus, the elimination of the manifestation of intestinal paresis in patients of group II by the proposed method took place 1-2 days earlier than in group I. This allows us to conclude that the proposed method of stimulating the motor activity of the intestine in patients with spinal injuries is more effective compared to those known in modern practical medicine.

An example of a specific application.

Patient V., 19 years old, was hospitalized 02/18/2001 at 4 hours 15 minutes in the intensive care unit of the intensive care unit of the Vladikavkaz military hospital. The diagnosis was “Gunshot bullet wound to the back. Gunshot fracture of the spinous process and arches of the 12th thoracic vertebra. Shock of the second degree. ”

Two hours before admission, he was wounded while on combat duty, and was urgently taken to the stage of providing qualified assistance by air transport.

The condition at admission is regarded as serious (8.6 points on the VPH-P (OR) scale), A / D 90/60 mm Hg, heart rate - 120 per minute. The wounded was placed in the intensive care unit, anesthesiology and resuscitation department. Auscultation and electroenteriography revealed the presence of intestinal paresis of the second degree. The department carried out intensive therapy aimed at stopping shock (administration of analgesics or general anesthesia, carrying out infusion-transfusion measures using Reamberin 1.5% solution at a dose of 5 ml / kg / day). Two hours after admission, the patient's condition stabilized - A / D rose to 120/80 mm Hg. Infusion "Dalargin" is connected to therapy intravenously at the rate of 30 μg / kg / day, diluted in 60 ml of 0.9% physiological solution of sodium chloride at a rate of 120 ml / hour. At the same time, it was decided to conduct an audit of the area of the wound, including the removal of destroyed tissues and bone fragments, the creation of decompression of the spinal cord and stopping bleeding. During the intervention, multicomponent ketamine-fentanyl anesthesia was performed without any complications.

5 hours after the end of the Dalargin infusion, a helium-neon laser irradiation of blood with a wavelength of 0.63 μm, a power of 1 mW, and an exposure time of 50 min was performed through a subclavian catheter using a flexible light guide of the ALOK-1 apparatus.

Later, for five days, conventional treatment was carried out, including infusion-transfusion, antibacterial, preventive anticoagulation, antimicrobial, cardiotropic therapy. Every day, in order to enhance the intestinal motor activity, the above triad was used in the indicated sequence. Proserine, antipsychotics, and cerucal were not used.

On the second day, an increase in electric potential was observed on the EEMG, and by the end of the third day, active intestinal peristalsis and gas discharge were determined, which was confirmed by the presence on the EEMG of waves with a frequency of 0.05-0.2 Hz with an amplitude of 400-500 μV. The period of stabilization and normalization of the functions of vital organs proceeded without complications, which made it possible to transfer the victim to the next stage of rehabilitation treatment earlier.

Claims (1)

A method of stimulating the motor activity of the intestine in patients with spinal injuries, characterized in that they use the Reamberin 1.5% solution, administered intravenously with an infusomat at a dose of 5 ml / kg / day for the first 2-3 hours after the injury and once a day in the morning time for the next 5 days, then, after 1-2 hours, “Dalargin” is infused at the rate of 30 mg / kg / day, diluted in 60 ml of 0.9% physiological sodium chloride solution at a rate of 120 ml / h for 5 days, an additional 4-5 hours after the introduction of "Dalargin" produce hedgehog -today, starting with the first of the day, intravenous helium-neon laser exposure of blood with a wavelength of 0.63 micron, 1 mW, exposure 50-60 min, 5 days a course.