RU2290955C1 - Method for interrupting abstinence syndrome in patients at opium narcomania - Google Patents

Abstract

FIELD: medicine, narcology.

SUBSTANCE: it is necessary to determine ACTH blood level just at entering and 4 h after patient's staying at the hospital. If ACTH level value in case of repeated estimation exceeds initial one by 2 or more times it is necessary to fulfill acute blood exfusion at the volume ranged 10-20% against total blood volume depending upon the duration of narcotic intake and its daily dosage. The innovation widens the quantity of preparations for interrupting abstinence syndrome in patients at opium narcomania.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, in particular to narcology, and can be widely used for the relief of withdrawal symptoms in patients with opium addiction.

There is a method of stopping withdrawal symptoms in drug addicts, which use intramuscular injection of sulfosin, pyrogenal, pyroxene, calcium chloride, sodium thiosulfate, unitiol and other means that increase body temperature, which are combined with therapeutic procedures (sauna, bathtubs, souls) (see Morozov VG, Bogolepov NN "Morphinism. Moscow: Medicine, 1984, pp. 145-150).

The disadvantage of this method of relieving withdrawal symptoms is a prolonged, at least 7 days, overcoming the patient’s suffering - anxiety, stress, agitation, salivation, vomiting, diarrhea, pain in bones and joints, tachycardia and other symptoms of “breaking”.

A known method of relieving withdrawal symptoms, selected as the closest analogue, including the implementation of one session of general controlled hypothermia to a level of 42.0-43.6 ° in conditions of intratracheal anesthesia with mechanical ventilation (mechanical ventilation) (see patent RU No. 2142762, IPC A 61 F 7/00; A 61 H 33/00; A 61 M 21/02, publ. 12/20/1999).

The objective of the known method is to force (in 5 hours) the withdrawal of withdrawal symptoms and physical dependence on drugs from drug addicts, which eliminates the manifestation of withdrawal symptoms and physical dependence immediately after one session of general controlled hyperthermia, reduce the duration of the hospital period to 2-3 days, and eliminate the suffering of the addict during and after the known method.

The use of anesthesia and mechanical ventilation in patients is dictated by the requirement to ensure the safety of the method in connection with the occurrence of heat stress and increasing oxygen demand during physical warming of the patient to a level of 42.0-43.6 ° (in the esophagus).

Despite the fact that this method allows you to reduce the duration of the hospital period to 2-3 days, to exclude the suffering of the patient during the relief of withdrawal symptoms, it is not safe and difficult technologically. So, drugs used for the implementation of the known method (fentanyl, arduan, anesthetics (hexanal or calypsol in doses that turn off consciousness) can cause allergic reactions, and also have various side effects: worsening of blood coagulation, increased pressure, and cardio deterioration -vascular system. The use of a temperature of 46 ° C in the known method can lead to coagulation of proteins in the patient’s body, while the use of the anesthesia in the known method does not exclude complications associated with x with its use.In addition, for the implementation of the known method requires special facilities, in particular operating rooms, as well as special equipment and medical staff (anesthesiologist, resuscitator), which makes this method quite expensive.

Thus, the technical result, which this invention is directed to, is to simplify the method and increase its safety.

The specified technical result is achieved by the fact that in the known method of relieving withdrawal symptoms in patients with opium addiction, including exposure to his body as a stress factor, according to the invention, the level of ACTH is determined upon admission and after four hours the patient is in the hospital and if the value of the level of ACTH is repeated the definition exceeds the original two or more times, carry out acute blood exfusion in a volume of 10 to 20% of the total blood volume, depending on the duration of use and su the exact dose of the drug.

Determining the level of ACTH of blood upon admission of the patient to the hospital and after four hours of his stay in the hospital is completely safe for the patient.

At the same time, the author experimentally established that it is a two-fold or more increase in the level of ACTH in the blood four hours after admission of the patient to the hospital compared with the level of ACTH in the patient's admission to the hospital is a signal for the implementation of acute blood exfusion.

The author found that acute massive blood loss (from 10 to 20% of the total blood volume), being a powerful stress factor, sequentially activates a number of humoral factors. So, in the hypothalamus, mainly in the supraoptic and paraventricular nuclei, an ejection of CRF occurs, which, through the portal vein system, reaches the anterior pituitary gland and stimulates the release of ACTH and β-endorphin. Thus, acute hemorrhage causes physiological secretion of β-endorphin, which is a key point in the relief of withdrawal symptoms.

The author experimentally established that the best results were obtained with the volume of evacuated blood from 10 to 20% of the total blood volume, depending on the duration of use and the daily dose of the drug.

This is due to the fact that blood loss in an amount of 10 to 20% of the total blood volume causes a compensated shock, which the patient overcomes independently with the restoration of the evacuated blood volume due to the release of blood from the depot (muscles, liver, kidneys).

The inventive method is as follows.

The blood volume in men is 77 ml per 1 kg of weight, in women - 65 ml per 1 kg of weight.

Depending on the duration of use, frequency of use and the amount of dose used per day, patients with opium addiction are divided into three groups by the author:

Group 1: the duration of use is not more than six months, not more than 1 time per day, the dose used is not more than 0.1 g. In this group of patients, blood exfusion is carried out in a volume of 10% of the total blood volume.

The author refers patients to the 2nd group who have exceeded one or two indicators of the first group: or the duration of use is more than 6 months; or the patient takes drugs more than 1 time per day; or the amount of drug taken is more than 0.1 g.

In this group of patients, the volume of evacuated blood is 15% of the total blood volume.

The author categorizes patients into the 3rd category who have exceeded all three indicators: both the duration of use is more than 6 months, and drug use more than 1 time per day and the daily dose is more than 0.1 g. The volume of evacuated in the 3rd group of patients blood 20% of the total blood volume.

When a patient enters a hospital, after assigning him to a particular group, he determines the baseline level of ACTH in the blood. Then after 4 hours, the patient re-determined the level of ACTH. If the value of the redefined level of ACTH of the blood exceeds the initial 2 or more times, the procedure for blood exfusion is prescribed. Before the procedure for blood exfusion, the patient assesses the state of cardiac activity (heart rate, heart rate and blood pressure) and determines the volume of evacuated blood according to the formula

For men:

the volume of blood taken = (77 ml × body weight of the patient) × K / 100,

where K is 10 or 15, or 20%, respectively, for the 1st, 2nd and 3rd groups of patients.

For women:

the volume of blood taken = (65 ml × body weight of the patient) × K / 100,

where K is 10 or 15, or 20%, respectively, for the 1st, 2nd or 3rd groups of patients.

The exfusion procedure is carried out in a patient in bed with a thick needle for intravenous injection from the ulnar or any accessible peripheral vein. Blood is drained into a container with a volume scale.

The evacuated blood volume is calculated separately for each patient according to the above formulas. Blood exfusion is carried out under the control of heart rate and blood pressure. Improvement of well-being is noted after 3-5 hours. Improvement is assessed by the sensations of the patient himself and by the testimony of heart rate, blood pressure and respiratory rate (respiratory rate), the color of the skin and mucous membranes.

The next day, the patient is ready for discharge.

Many patients go to the hospital about the relief of withdrawal symptoms more than once, which indicates the absence of side effects of the proposed method. According to patients who repeatedly relieve withdrawal by the claimed method, this method is much more effective and faster than the previously known other methods of stopping them. In addition, after the implementation of the proposed method, the patient normalizes sleep faster and in the event of further non-use of some time drugs, the weight is restored faster and the color of the skin and visible mucous membranes is normalized. Moreover, it is much cheaper, which is not unimportant for this category of patients.

The method is illustrated by examples of specific performance.

Example No. 1. Patient J. Diagnosis: Opium addiction 2 tbsp. Upon admission to the hospital complained of slight chills, moderate sweating, headache, general weakness, unstable sleep, irritability, unexpressed aching in the lower back, loose stools. He takes drugs for about 5 months, 1 time per day, the single dose taken is less than 0.05 g. The patient has a moderate degree of opium withdrawal syndrome. The patient is assigned to the 1st group of patients. Patient weight 56 kg.

The baseline ACTH level was determined at 96 pg / ml. After 4 hours, the patient re-determined the level of ACTH - 204 pg / ml. Since the level of ACTH increased more than 2 times, the patient began to prepare for the exfusion procedure. Heart rate heart rate - 100 beats per minute, blood pressure - 140/100 mm Hg

The volume of blood produced was determined by the formula:

blood volume = (65 ml × 56 kg) × 10% / 100% = 364 ml

In a patient in bed, 364 ml of blood was evacuated from the ulnar vein, which is 10% of the patient’s total blood volume.

The state of cardiac activity during bloodletting: heart rate - 126 beats per minute, blood pressure - 140/100 mm Hg.

The state of cardiac activity after bloodletting in a patient: heart rate - 120 beats per minute, blood pressure - 110/70 mm Hg

Three hours after the blood loss, the patient looked weakened, inactive, often drank water. All signs of cancellation were absent.

Three hours after blood loss, the state of the cardiovascular system: heart rate - 76 beats per minute, blood pressure - 120/80 mm Hg.

After 5 hours, the color of the skin and mucous membranes was restored to their level upon admission.

Five hours later, ACTH was 60 pg / ml.

The patient was discharged from the hospital the next day in satisfactory condition.

Example No. 2. Patient G. Diagnosis: Opium addiction 2 tbsp. Upon admission, he complained of headache, pain in the spine and joints, palpitations, loose stools, depressed mood, poor sleep, runny nose. Immediately before treatment, the patient did not use drugs for about 28 hours.

The weight of the patient is 76 kg. The patient takes drugs for more than 10 months, twice a day, daily dose of 0.1 g.

The patient is assigned to the 2nd group of patients.

The basic level of blood ACTH upon admission is 144 pg / ml, heart rate is 100 beats per minute, blood pressure is 140/100 mm Hg. Four hours later, the ACTH level of blood was 302 pg / ml. The volume of evacuated blood was determined by the formula:

evacuated blood volume = (76 kg × 77 ml) × 15% / 100% = 877.8 ml

The patient underwent exfusion from the ulnar vein in a volume of 877.8 ml.

Immediately after blood exfusion, heart rate in a patient is 128 beats per minute, blood pressure - 118/70 mm Hg.

4 hours after the bloodletting of the patient’s heart rate, 74 beats per minute, blood pressure - 118/78 mm Hg The blood ACTH level after 4 hours was 40 pg / ml. After 5 hours, overall health improvement was noted. Many manifestations of withdrawal symptoms disappeared.

After 6 hours, the color of the skin was restored to the level upon admission of the patient, there are no withdrawal symptoms.

The patient left the hospital the next day without warning.

Regarding relief of abstinence, he applied to the hospital more than once.

Example No. 3. Patient E. Diagnosis: Opium addiction 2 tbsp. Was admitted to the hospital with complaints of headache, intense pain in the muscles of the lower back and lower extremities, sweating, chills, fever, palpitations, nausea, lack of appetite, depressed mood, tearfulness.

Diagnosed with severe withdrawal symptoms.

The patient takes drugs for more than 1.5 years, 3 times a day, the daily dose of 0.2 g. The patient is assigned to the 3rd group.

Patient weight 68 kg. Upon admission, the baseline blood ACTH level is 124 pg / ml, heart rate is 106 beats per minute, blood pressure is 146/100 mm Hg.

After 4 hours, the blood ACTH level is 280 pg / ml. The volume of evacuated blood was calculated by the formula:

evacuated blood volume = (68 kg × 65 ml) × 20% / 100% = 884 ml

Blood exfusion was carried out in a volume of 844 ml. Immediately after blood exfusion, indicators of cardiac activity: heart rate - 124 beats per minute, blood pressure - 110/70 mm Hg. The patient is weak, asks to drink a lot.

Five hours after blood exfusion, the patient has indicators of cardiac activity: heart rate - 82 beats per minute, blood pressure - 122/84 mm Hg. The blood ACGT level five hours after exfusion was 52 pg / ml. After 5 hours, an improvement was noted in general, many manifestations of withdrawal symptoms disappeared.

After 6 hours, the patient recovered to the level at her admission, the color of the skin and mucous membranes. Symptoms of withdrawal are absent.

The patient was discharged from the hospital on the 2nd day in a satisfactory condition.

Example No. 4. Patient Sh., 23 years old. Suffers from opium addiction for 4 years. Over the past year, the drug has been systematically taken 2-3 times a day. The daily dose of 0.5 g, depending on the situation and the availability of the drug. I tried to quit repeatedly, but withstood withdrawal symptoms for a maximum of 1-2 days, due to very severe psychophysical manifestations of withdrawal symptoms, I started taking drugs again. He sought help 10-12 hours after the last drug with withdrawal symptoms: dilated pupils, worsening general condition, lacrimation, runny nose, joint pain, general discomfort.

The patient is assigned to the 3rd group.

Patient weight 71 kg. Upon receipt, the baseline ACTH level of blood is 136 pg / ml. Indicators of cardiac activity: heart rate - 132 beats per minute, blood pressure - 160/100 mm Hg

4 hours after admission, the blood ACTH level is 312 pg / ml.

The volume of evacuated blood was determined by the formula:

evacuated blood volume = (70 kg × 77 ml) × 20% / 100% = 1078 ml

The patient was performed blood exfusion in a volume of 1078 ml. Immediately after exfusion, indicators of cardiac activity: heart rate - 140 beats per minute, blood pressure - 110/70 mm Hg.

After 5 hours, the level of ACTH in the patient is 40 pg / ml. Indicators of cardiac activity: heart rate - 70 beats per minute, blood pressure - 124/82 mm Hg

Five hours later, the patient noted an improvement in the condition as a whole, catarrhal phenomena, joint pains disappeared, and mood improved.

Discharged the next day in satisfactory condition.

Claims (1)

A method of stopping withdrawal symptoms in patients with opium addiction, including exposure to his body by a stress factor, characterized in that the level of ACTH in the blood is determined upon admission and after four hours of the patient being in the hospital, and if the value of the ACTH level when re-determined is two and more than once, they carry out acute blood exfusion in a volume of 10 to 20% of the total blood volume, depending on the duration of use and the daily dose of the drug.