RU2256449C1 - Method for treating chronic occluding diseases in arteries of inferior limbs - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: medicinal mixture consisting of 10 ml 0.25%-novocaine, 1 ml 1%-emoxypin and 64 c.u. lidase should be injected strictly subcutaneously per 1 ml for each point of injection into the center of plantar surface of nail phalanx of every toe, and for the first inter-toe space - subcutaneously in plantar and rear directions, then, after injections, it is necessary to carry out massage in area if injection with stretching and stroking movements in proximal direction for 10-15 sec, moreover curative seances should be performed every other day , the course being of 5-10 procedures, at repeating this course 3-6 mo later. The present innovation enables to activate transcapillary exchange due to pathogenetically proved impact onto surface and deep lymphatic network of inferior limbs.

EFFECT: higher efficiency of therapy.

1 cl, 2 ex

Description

The invention relates to medicine, in particular to surgery and methods for the treatment of chronic occlusive diseases of the lower limb arteries (HOZANK).

Closest to the proposed method for the treatment of HOZANK is a method consisting in catheterizing lymphatic vessels on the rear of the foot in the first interdigital space, fixing in this case a polyvinyl chloride catheter in the lumen of the vessel, through which a drug mixture, including 0.5 % novocaine solution, 1% nicotinic acid solution, 2% papaverine solution, heparin [1].

However, this method has a number of disadvantages:

- technical complexity and invasiveness of the method;

- the inability to conduct a course of treatment in an outpatient setting;

- the need for infusion of special equipment (injection dispenser);

- a high probability of injury to a catheterized vessel directly by a catheter during physical movements of the patient or when the infusion rate is exceeded;

- the presence of a catheter mounted on the rear foot of the patient, significantly limits his physical activity;

- there is a high probability of the formation of a pressure sore and infection of the standing position of the catheter, especially in patients with impaired peripheral circulation;

- with the indicated method of administering the drug mixture, the therapeutic effect is exclusively on the deep network of the lymphatic system of the lower extremities, while both the deep and the superficial networks of the lymphatic system of the lower extremities are involved in the pathological process with HOZANK.

A new technical task is to increase the efficiency of treating patients by expanding the field of influence of drugs and reducing the number of complications.

The problem is solved by a new method for the treatment of chronic occlusive diseases of the arteries of the lower extremities, which consists in introducing a drug mixture containing novocaine into the foot area, and the drug mixture consisting of 10 ml of 0.25% novocaine, 1 ml of 1% emoxipine and 64 UE lidase, injected strictly intradermally, in a volume of 1 ml per each point of introduction into the center of the plantar surface of the nail phalanx of each toe, and in the first interdigital space subcutaneously in the plantar and dorsal directions, then after injection they massage the area of administration in the form of kneading and stroking in the proximal direction movements for 10-15 seconds, and treatment sessions are carried out every other day with a course of 5-10 procedures, with a repeat of the course after 3-6 months, also with severe pain or swelling limbs, the introduction of the drug mixture is carried out, starting with 0.5 ml, gradually bringing up to 1 ml at each injection point.

The route of administration is as follows.

1. The foot, from the back and plantar surfaces, from the terminal phalanges to the middle third of the metatarsal bones, is processed according to the method of Grossikh-Filonchikov.

2. The plantar surface of the nail phalanx of the finger is compressed with two fingers for 2-3 seconds until a white spot appears.

3. The injection needle is injected to the depth of its cut into the skin and the drug is administered in a volume of 0.5 to 1 ml, focusing on the patient’s sensations, until a “lemon peel” is formed, while the principle of a “dry” injection is observed when the injection needle is introduced.

4. After removing the needle, massage is performed with kneading and stroking in the proximal direction at each injection point for 10-15 seconds.

5. In the first interdigital space, the injection is performed in the back and plantar directions strictly subcutaneously.

The manipulation is considered to be correctly performed if a white spot of the “lemon peel” type appears at the injection site (this indicates that the injection was carried out intradermally), and when the needle is removed, there is no appearance of blood.

As a rule, patients feel a feeling of numbness of the toes for 5 to 20 minutes, and then a slight itching sensation lasting from 20 minutes to 2 hours, turning into a feeling of warmth throughout the foot and higher depending on the severity of the pathological process. The preservation of a sense of warmth also depends on the severity of the pathological process and lasts from 2 hours during the first manipulation up to 6 months after the end of the course of treatment.

The proposed regimen is selected based on the study of literature data on normal and pathological people, normal and pathological histology of a person, pharmacokinetics and pharmacodynamics of drugs in the human body [2, 3, 4, 5] and the results of observation of 37 patients who, based on complaints, history data, objective and instrumental examination was diagnosed with Obliterating atherosclerosis of the vessels of the lower extremities, with varying severity of arterial blood insufficiency oobrascheniya (classification AV Pokrovsky-Fontana): IIa stage - 6 people, IIb-IIIa - 23 people, IIIb - 7 people, one patient - with critical ischemia. The effectiveness of the treatment was evaluated on the basis of clinical data, changes in the distance of the pain-free path and rheovasography data.

Justification of the regime.

1. Place of administration: the introduction of the drug mixture intradermally is justified by the presence of a pronounced network of shunting vessels of the skin, providing an adequate transcapillary exchange between tissues. In particular, for the described technique, skin vessels act as a heat exchanger. The additional blood flow to the skin helps not only to get rid of the feeling of freezing of the feet and legs, but later to provide additional blood delivery to the skeletal muscles, the most suffering from hypoxia. This conclusion can be considered pathogenetically substantiated due to the fact that the skin is able to deposit a significant amount of blood and, if necessary, supply it to skeletal muscles.

2. The need to introduce the mixture into the plantar surface of the toes of the feet is justified by the largest accumulation in this area of arteriovenous anostomoses and free nerve endings forming thermoreceptors in the skin of the plantar surface of the fingers. In addition, the technique allows for adequate outflow through the lymphatic capillaries, the terminals of which blindly end in the deep layer of the epidermis, which is the trigger in the treatment of HOSANK. And also one cannot neglect the fact that lymphovenous insufficiency is one of the components of the pathogenesis of HOSANK, and the lymphatic capillary is one of the important components of the structural and functional unit of any organ, including skin and skeletal muscles.

3. The composition of the drug mixture is justified by the fact that novocaine, in the first place, is a local anesthetic and a solvent for lidase with intradermal administration.

Emoxipin is an antioxidant with antihypoxic, angioprotective and antiaggregatory activity. The drug is successfully used in diseases accompanied by increased lipid peroxidation and hypoxia. This is especially important because free radical oxidation plays an important role in the pathogenesis of HOZANK.

Lidase is a drug that has the most pronounced lymphotropic property, able to penetrate the wall of the lymphatic capillary and accelerate the absorption of drugs, especially substances with a large molecular structure and not able to penetrate through the vascular wall (the so-called lidase buffering property).

4. The need to massage the area of administration of the drug mixture is justified by the fact that the lymphatic capillary is deprived of the muscle layer and mechanical movements contribute to a faster and deeper penetration of the mixture from interstitium into the lymphatic capillary.

5. The need for 5-10 procedures is connected with the fact that carrying out less than 5 procedures does not give a lasting clinical effect, and conducting more than 10 procedures is not advisable due to excessive drug load on the patient's body. Conducting procedures every other day is most optimal, since the injected mixture has a cumulative effect and is completely removed from the injection area after no less than 36 hours. In addition, most patients suffering from HOSANK have edema of the affected tissues, and excessive tissue tension with the introduction of the drug mixture causes pain.

Clinical example No. 1

Patient K., born in 1930, was admitted for treatment with complaints of freezing and numbness of both feet and legs, pain in them when walking up to 100 meters. According to the patient, the above complaints worry about 6-7 years. He was treated on an outpatient basis irregularly. On examination: the skin of both feet and legs is pale, cold to the touch, there is no hair, the pulsation is preserved on the femoral artery on both sides, below it is absent. Based on complaints and objective examination data, laboratory and instrumental examination, the diagnosis was made: “Obliterating atherosclerosis of the vessels of both lower extremities, BPS occlusion on both sides, KHAN stage III.” When rheovasographic examination of the lower extremities: rheovasographic index (RI) on the right (at the level of the legs) - 33, on the left - 56. Venous outflow is difficult. The value of peripheral vascular resistance (PSS) is increased. The following traditional course of treatment has been prescribed:

- intravenous drip - a solution of reopoliglyukin, pentoxifylline on physiological saline;

- blockade of the sympathetic ganglia L 3-L 4;

- blockade of the calf muscles of both legs with the introduction of antihypoxic cocktail;

- disaggregants.

Additionally, endolymphatic administration of the above drug mixture is prescribed. Given the absence of puffiness of the feet and the reduced sensitivity of the fingers, the patient from the first procedure was injected with 1 ml of the mixture at each injection point. After the procedure, the patient noted the appearance of itching of the feet and lower third of the leg. After 20 minutes, the itching sensation was replaced by a rush of warmth to the toes, which lasted for 2 hours. By the third procedure, the itching feeling is insignificant, for 3-5 minutes, the feeling of warmth in the feet persists throughout the day, noted a significant improvement when walking, an increase in the painless path to 150 meters. To consolidate the effect obtained, 3 more procedures were performed against the background of traditional treatment. At the time of discharge, complaints remained of moderate pain in the calf muscles with intensive walking over 200 meters, quickly passing when stopped. The feet and lower legs are warm, the sensitivity of the skin of the feet has recovered. The rheovasographic index on the left is 60, on the right - 53. Venous outflow is normal. The value of PSS is reduced.

Clinical example No. 2

Patient S., born in 1945, was admitted for treatment with complaints of freezing and severe pain in both feet and legs when walking up to 50 meters. Moves with a cane, and over long distances only accompanied by relatives. According to the patient, the above complaints worry about 10 years. In the anamnesis: frostbite of feet about 12 years ago. Treated outpatiently, irregularly. He refused the surgical treatment proposed 7 years ago. On examination: the skin of the legs is pale, pasty, the feet are cyanotic, cold to the touch, the toes on palpation are painful, the pain reaction to the compression of the fingers is especially pronounced. Peripheral pulsation is not detected. On the basis of complaints and objective examination, laboratory and instrumental examination, the diagnosis was made: "Obliterating atherosclerosis of the vessels of both lower extremities. Occlusion of the ileo-femoral segment on both sides. KHAN stage IIIb". When reovasographic examination of the lower extremities: RI at the level of the lower legs on the right - 10, on the left - 18. Venous outflow is difficult. The value of PSS is increased.

Assigned to a traditional course of treatment and additional treatment according to the proposed method. During the first procedure, the patient complained of increased pain in the fingers when injecting the drug mixture. For this reason, the volume of the mixture was limited to 0.5 ml. The pain disappeared immediately after removing the needle. Over the next three procedures, the volume of the injected mixture was brought to 1 ml. It should be noted that for the first time, itching in the toes appeared after 3 procedures, and a slight appearance of heat after 5 procedures, while the patient noted a slight decrease in pain when walking. A pronounced appearance of heat in the feet appeared after the 7th procedure, the patient independently passed over 50 meters. At the end of the course of treatment, the feet and lower legs are warm, finger palpation is painless, passes independently with a cane over 100 meters. At the time of discharge, complaints remained about the appearance of pain in the legs, a compressive character, passing after rest. RI on the left - 40, on the right - 22. Venous outflow is normal. The value of PSS is reduced.

Thus, the proposed method allows to increase the effectiveness of treatment of HOSANK in patients of all ages, various degrees of arterial insufficiency due to pathogenetically substantiated effects on the superficial and deep lymphatic networks of the lower extremities, followed by activation of transcapillary metabolism.

The advantages of the method:

- the method is not technically complicated and less traumatic;

- easily performed on an outpatient basis;

- does not limit the physical activity of patients;

- allows you to act on both deep and superficial lymphatic networks of the lower extremities;

- the used drug mixture is pathogenetically substantiated;

- for the introduction of the drug mixture does not require special equipment.

Sources of information used in compiling the description

1. Lokhvitsky S.V., Gulyaev A.E., Kuderinov S.K. Lymphatic vasodilator therapy of obliterating diseases of the arteries of the lower extremities // Problems of the sanogenic and pathogenic effects of environmental effects on the internal environment of the body. Mat. IV international symposium and Vth scientific-practical. Conf. The 70th anniversary of Academician Yu. I. Borodin and the 60th anniversary of the Kyrgyz Medical Academy. - Bishkek, 1999 .-- T.1. - S.196-199.

2. Agadzhanyan N.A., Tel L.Z., Tsirkin V.I., Chesnokova S.A. Human physiology. M .: Medkniga, 2003 .-- S.265-267.

3. Bunny A.Sh., Churilov L.P. Fundamentals of general pathology. - SPb., 1999. - ELBI. - S.197 - 226.

4. Mashkovsky M.D. Medicines Part II. - M.: Medicine, 1994. - S. 71, 215.

5. Ulumbekov EG, Chelysheva Yu.A. Histology. M .: Publishing house GEOTAR-Med, 2001. - S.498-502.

Claims (2)

1. A method of treating chronic occlusive diseases of the arteries of the lower extremities, which consists in introducing a drug mixture containing novocaine into the foot area, characterized in that the drug mixture consisting of 10 ml of 0.25% novocaine, 1 ml of 1% emoxipine and 64 UE lidase 1 ml is injected strictly intradermally at each point of introduction into the center of the plantar surface of the nail phalanx of each toe, and in the first interdigital space, subcutaneously in the plantar and dorsal directions, then after the injection they massage the region these injections with kneading and stroking in the proximal direction movements for 10-15 s, and treatment sessions are carried out every other day with a course of 5-10 procedures, with a repeat of the course after 3-6 months. 2. The method according to claim 1, characterized in that with severe pain or swelling of the extremities, the administration of the drug mixture is carried out starting from 0.5 ml, gradually increasing the volume to 1 ml at each injection point.