RU2293567C2 - Method for treatment of intestine dysbacteriosis - Google Patents

Abstract

FIELD: medicine, gastroenterology.

SUBSTANCE: method involves insertion of elastic tube into sigmoid intestine of a patient in position on the side followed by administration of eubiotic solution at temperature 25-34°C through this tube by the drop route. The eubiotic solution is infused in the volume 1.5-2.0 ml/kg of a patient body mass in the rate 30-39 drops/min. After termination of infusion a tube is removes in 15-20 min, and after removing a tube a patient is stayed in horizontal position for 30 min, not less. In the presence of pathogenic microflora in intestine 7-12 days after onset of treatment method involves using a complex of eubiotics before normalization of intestine microflora. Method provides effectiveness of treatment based on delivery of eubiotics to the largest (preferred) pathology focus in dysbacteriosis and improved postponed results of treatment. Invention can be used in treatment of intestine dysbacteriosis.

EFFECT: improved method of treatment.

3 cl, 2 ex

Description

The invention relates to medicine, in particular to the treatment of adult patients with intestinal dysbiosis.

Dysbacteriosis, dysbiosis, imbalance of microbial ecology - the designation of one pathology, which is sometimes replaced by the terms "microecological imbalance" or "microbial ecology is normal and pathological" (B.A.Shenderov. Medical microbial ecology and functional nutrition. M., "Grant" . 2001. Volume 2, p. 11). Dysbacteriosis is not only a manifestation, but also a consequence of many diseases and is detected in 87% of patients with chronic colitis, in 90-92% of patients with acute bacterial intestinal diseases, in 97.3% of adults with rotovirus gastroenteritis, in 73% of patients with tuberculosis, in 95, 3% of patients with reactive arthritis have 80% of those professionally employed in the production of antibiotics (B.A. Shenderov. Ibid. Volume 2, pp. 12-13). Since the incidence rate of intestinal dysbiosis in the population of Russians has reached 90%, there is an urgent need to stop the further destruction of the microecological status of the inhabitants of our country (B.A.Shenderov. Medical microbial ecology and functional nutrition. M., Grant. 2001. Volume 3, p.14). Dysbacteriosis in a sick person often manifests itself over several months and even years (V.I. Pokrovsky, ND Yushchuk. Bacterial dysentery. M., "Medicine", 1994, p. 47). The significant frequency and duration of the pathology increases the urgency of the problem, which prompts the development of new, more effective methods of treating dysbiosis.

A known method of treating intestinal infections using antibiotics (S. Ya. Yakovlev. Clinical chemotherapy of bacterial infections. M., 1997).

The disadvantage of this method of treatment is that antibiotics contribute to the development of dysbiosis and slow the repair of the intestinal mucosa (ND Yushchuk, L.E. Brodov. Acute intestinal infections: diagnosis and treatment. M., "Medicine", 2001, p. 257). Among pharmacological preparations, antibiotics have the most pronounced damaging effect on the normal microflora (B.A. Shenderov. Ibid. Volume 3, p.12). The disadvantage of this method of treatment is the lack of signs of improving the quality and expanding the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the supply of therapeutic agents to the largest focus of pathology.

A known method of treating intestinal dysbiosis with the use of the biological drink "Em-kurunga", which is given to children 50-100 ml 3 times a day for 20 days (T.A.Dobryak, N.K. Perevozchikova, G.P. Torochkina, V.Yu. Vedutov, O.Yu. Bolotnikova. Application of new technologies in the treatment of intestinal dysbiosis. Collection of materials of the scientific-practical conference "Modern technologies in healthcare as an effective way to improve the quality of medical care. Problems and solutions." February 24-27 2004 Kemerovo, p.227).

The disadvantage of this method of treatment is the lack of signs of improving the quality and expanding the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the supply of therapeutic agents to the largest focus of pathology.

In the treatment of intestinal dysbiosis, eubiotics are widely used (classic eubiotics: colibacterin, bifidumbacterin, lactobacterin; self-eliminated eubiotics: bactisubtil, biosporin, sporobacterin; combined eubiotics: bifilong, acybolynbibliosis, normal microbes, . Moreover, eubiotics are prescribed in combination with enzymes and antihistamines. The best known method of treating intestinal dysbiosis with lactobacterin (lyophilisate of live lactobacilli) by prolonged use by mouth 30-40 minutes before meals 3-5 times up to 10 doses per day (N.D. Yushchuk, L.E. Brodov. Ibid., p. 246-249).

The disadvantage of this method of treatment is the lack of signs of improving the quality and expanding the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the supply of therapeutic agents to the largest focus of pathology.

A known method of treatment for bacterial dysentery, accompanied by dysbiosis, the use of dry colibacterin at 2-6 doses per day in 2 doses by mouth for 2-3 months (V.I. Pokrovsky, ND Yushchuk. Ibid., P.213 ) With salmonellosis in patients with dysbiosis, colibacterin is prescribed 5-10 doses per day or bifidumbacterin 5 doses per day for 2 or more months (V.I. Pokrovsky, V.A. Kilesso, N.D.Yushchuk, R.A. Rashidova , V.V. Pokrovsky. Salmonellosis: etiology, epidemiology, clinic, prevention. Tashkent, "Medicine", 1989, p.329).

The disadvantage of this method of treatment by oral administration of eubiotics is the contraindication for use in infectious toxic shock; dehydration of the second or third degree with unstable hemodynamics; indomitable vomiting, loss of fluid with vomiting and diarrhea of more than 1.5 liters; oligoanuria; diabetes and glucose absorption disorders (Yushchuk N.D., Brodov L.E. Ibid., p.200). The disadvantage of this therapy is the lack of methods for improving the quality and expanding the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the delivery of therapeutic agents to the largest focus of pathology.

A known method of treating intestinal dysbiosis according to the patent of the Russian Federation No. 2092167, including implanting with a colonoscope a culture of normal intestinal microflora in the logarithmic phase of growth in its various departments: lactobacilli in the ascending section, bifidumbacteria in the transverse section, colibacteria in the descending section of the colon.

The disadvantages of this method of treatment are the need for a colonoscope, equipment to obtain an implantable culture of living normal microflora, as well as additional costs for staff time. The disadvantage of this method of treatment is the lack of signs of improving the quality and expanding the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the supply of therapeutic agents to the largest focus of pathology.

A known method of treating intestinal dysbiosis according to the patent of the Russian Federation No. 2159626. The method includes cleansing enemas for 2 days with a neutral electroactivated anolyte solution with a pH of 6-6.5, in the next 5 days, washing the intestines with a catholyte solution with a pH of 9-9.5. For patients with a hypomotor form of the disease, the temperature of the solution is 18-20 ° C, with hypermotor 35-40 ° C. After a cleansing enema with a solution of catholyte, electroactivated aqueous solutions with Ca ++ or Ca ++, K +, Mg ++ ions are introduced rectally through a catheter.

The disadvantage of this method of treatment is the need for equipment to determine the pH and additional costs of staff time. The disadvantage of this method of treatment is the lack of signs of improving the quality and expanding the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the supply of therapeutic agents to the largest focus of pathology.

A known method of treating intestinal dysbiosis according to the published application for the invention of the Russian Federation No. 98118881, which includes preparing the intestine by means of cleansing enemas and subsequent separate implantation of drugs from living microorganisms of the normal intestinal microflora in the logarithmic phase of bacterial growth by coloscopy (in the ascending part of the colon - lactobacilli, in the transverse department - bifidobacteria, colibacteria - in the descending department - colibacteria, 20 ml in each department). Moreover, preliminary antiseptic preparation of the intestine in the form of cleansing enemas is carried out during the first two days with a neutral electroactivated aqueous solution of catholyte (EVR-K) with a pH of 9-9.5, while the temperature of the solution for patients with a hypomotor form of the disease is 18-20 ° C and for patients with hypermotor 35-40 ° C.

The disadvantages of this method of treatment are the need for a colonoscope, equipment for obtaining an implantable culture of living normal microflora, equipment for determining the pH and the additional cost of working time of qualified personnel. The disadvantage of this method of treatment is the lack of signs of improving the quality and expanding the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the supply of therapeutic agents to the largest focus of pathology.

The closest in technical essence to the proposed method is the last method for the treatment of intestinal dysbiosis according to the application of the Russian Federation No. 98118881, which we take as a prototype, and its disadvantages are described above.

The technical result of the invention is to improve the quality and expand the possibilities of treating patients with intestinal dysbiosis by simplifying and accelerating the supply of therapeutic agents to the largest focus of pathology.

The technical result is achieved by the fact that the method of treating intestinal dysbiosis includes a cleansing enema and daily daily injection of a therapeutic solution into the colon rectally through an elastic tube at a temperature of 18-40 ° C. In this case, the treatment solution is infused with eubiotics. After the end of the infusion, the tube is removed after 15-20 minutes and after removing it the patient is kept in a horizontal position for at least half an hour.

In a preferred embodiment of the method, a daily dose of eubiotic, immediately before use, diluted in a 0.25% sodium chloride solution, is poured into the intestinal lumen in a volume of 1.5-2.0 ml per kilogram of patient’s body weight at a rate of 30-40 drops per minute .

In another preferred embodiment of the method, in the absence of restoration of normal microflora in the intestine 7-12 days after the start of treatment, a solution with a complex of eubiotics is infused until the normal biocenosis in the intestine is restored.

A specific example of the method. A patient weighing 80 kg and a height of 180 cm was hospitalized with clinical manifestations of salmonellosis of mild course. A bacteriological examination of feces for dysbiosis revealed a sharp decrease in the content of Escherichia coli and Bifidumbacterium and a high content of S.enteritidis. The patient was prescribed tavegil and festal, 1 tablet 3 times a day and eubiotics. Before use, eubiotic bificol (bifidumbacterin with colibacterin) was diluted in a 0.25% sodium chloride solution at a temperature of 38 ° C. The patient was laid on his side and through the sphincter and rectum, the end of the elastic tube was introduced into the distal section of the sigmoid colon to a depth of 25 cm. It is known that the length of the pelvic part of the rectum of an adult varies from 12 to 15 cm, and the anal - 2.5-3, 7 cm, i.e. the entire rectum has a length of 14.5-18.7 cm (Lysenko N.K., Bushkovich V.I., Prives M.G. Textbook of normal human anatomy. Medgiz. Len. department 1958, p. 347). Therefore, at a depth of 25 cm, the end of the tube is in the distal section of the sigmoid colon. 150 ml of bificol solution was slowly poured through a tube into the intestinal lumen at a rate of 30-40 drops per minute. After the end of the infusion, the tube was removed after 16 minutes, after which the patient was in a horizontal position for another half hour. A similar daily injection of bificol solution into the large intestine was repeated until the clinical symptoms disappeared at a stable normal body temperature. During bacteriological examination for dysbiosis on the twelfth day after the start of treatment, normal intestinal biocenosis was restored and no salmonella was found.

Another specific example of the method. A patient weighing 60 kg and an increase of 170 cm was hospitalized with acute dysentery of a moderate form of colitis. A bacteriological examination of feces for dysbiosis revealed a sharp decrease in the content of Escherichia coli and Bifidumbacterium and a high content of the bacterium Flexner 2-A. Furozolidone 0.1 was prescribed four times a day, misimfort 1 tablet 3 times a day, letizen 1 tablet at night and eubiotic. Before the introintestinal administration, eubiotic colibacterin was diluted in 100 ml of a 0.25% sodium chloride solution with a solution temperature of 18 ° C. It is known that cold solutions are absorbed much more slowly in the intestines (Yushchuk ND, Brodov L.E. Ibid., P. 199) and the duration of exposure to the intestines of a therapeutic agent in such a solution is lengthened. Then, when the patient was lying on his side, through the sphincter and rectum, the end of the elastic tube was inserted into the distal section of the sigmoid colon to a depth of 20 cm and a colibacterin solution was infused into the intestinal lumen at a rate of 30-40 drops per minute. After the end of the infusion, the tube was removed after 15 minutes, and after removing it, the patient continued to be lying on his side for another half hour. A similar daily injection of colibacterin solution into the intestines was repeated until stool normalized, abdominal pain disappeared and body temperature returned to normal. 8 days after the start of treatment, a repeated bacteriological examination of feces for shigillosis of bacteria of the genus Schigella was not found, and a study on dysbiosis revealed a reduced content of Escherichia coli. The course of treatment was continued by the introduction of a combination of eubiotics of bifidumbacterin with colibacterin and bificol in solution. Three weeks after the start of treatment during bacteriological examination for shigillosis, bacteria of the genus Schigella were not found, the contents of E. coli and Bifidumbacterium were normal. During the follow-up bacteriological examination, no pathogenic microflora was found in the intestine in the following days, the biocenosis was normal, and a stable recovery began.

The significance of the differences of the claimed method is as follows. Eubiotics are dry preparations that can be transported to district and rural hospitals, taken with them to long-distance ships, and used in any conditions. It is known that oral administration of eubiotics, primarily bifidobacterin (bifidumbacterin, bifikol), is effective only when prescribed in significant doses (5-10 doses per day) and long-term administration (at least 3-4 weeks) (V.I. Pokrovsky, N.D. Yushchuk, ibid., P. 256). Colibacterin is a dry lyophilisate of living bacteria of E. coli M-17, taken orally for 4-8 doses per day for 3 weeks - 2 months (N.D. Yushchuk, L.E. Brodov. Ibid., P. 248.). The use of dry colibacterin in bacterial dysentery of 2-6 doses per day in 2 divided doses can last even 2-3 months (V.I. Pokrovsky, ND Yushchuk. Ibid., P. 213). In the invented method, the intra-intestinal use of therapeutic agents expands the possibilities to treat patients with dysbacteriosis more efficiently and in a shorter time, including in district and rural hospitals, clinics, in outpatient and even at home. Pouring a therapeutic solution into the colon with eubiotics accelerates the approach to the focus and the therapeutic effect of the drug directly on the affected tissue. It is known that the pathogenic process with dysbiosis is most pronounced in the large intestine. In the lower intestine of an adult, a total of more than 1 kilogram of microorganisms is contained (B.A. Shenderov. Ibid. Volume 1, p.22. Volume 3, p.10). In the distal colon of the human colon, the intraepithelial reproduction of Shigella and the infectious process last longer (Pokrovsky V.I., Yushchuk N.D. Ibid., Pp. 26 and 30). It is known that with an additional direct introduction of fluid into the large intestine, for example, with an enema, a reaction to release occurs - a liquid bowel movement, more often observed in an upright position. According to the claimed method, the removal of the tube from the intestine 15-20 minutes after the end of the infusion and the patient’s horizontal position for at least half an hour after the removal of the tube prevents the body from reacting to release the intestine from the volume of fluid increased by the infusion and contribute to the retention of the injected solution in the large intestine. In the claimed method, the volume of fluid injected into the intestine is limited to 1.5-2.0 ml per kilogram of body weight of a particular patient and slowly infused at a rate of 30-40 drops per minute. This technology prevents the occurrence of a reaction to bowel release, the drug solution is not lost, and the accuracy of the dose is maintained. The criteria for the effectiveness of the treatment of dysbiosis are the subsidence or disappearance of the clinical manifestations of the disease - flatulence and pain, normalization of stool after 7-10 days and normalization of intestinal microflora after 3-4 weeks (N.D. Yushchuk, L.E. Brodov. Ibid., p.250). In a preferred method, in cases where there is no restoration of normal microflora in the intestine 7-12 days after the start of treatment, the infusion of a solution with a complex of eubiotics to restore normal biocenosis in the intestine increases the effectiveness of the complex of therapeutic agents with minimal consumption and reduced duration of use.

Thus, the claimed method in the aggregate of its features simplifies and accelerates the delivery of therapeutic agents to the largest focus of pathology, accelerates the elimination of pathogenic intestinal microflora and the restoration of normal biocenosis in it, which helps to improve the quality and expand treatment options for patients with intestinal dysbiosis and improves long-term results, leading to the economic effect.

The application of the invention is possible in pediatric and field therapy.

Claims (3)

1. A method of treating intestinal dysbiosis, including the rectal administration of a tube and infusion of an eubiotic solution through it when the patient is on his side and holding the patient in a horizontal position after the end of the treatment procedure, characterized in that the eubiotic solution is injected through an elastic tube at a temperature of 25-34 ° C drip into the sigmoid colon. 2. The method according to claim 1, characterized in that the eubiotic is poured in a volume of 1.5-2.0 ml per kilogram of the patient’s body weight at a rate of 30-39 drops per minute, after the end of the infusion, the tube is removed after 15-20 minutes, and after removing the tube from the intestine, the patient is kept in a horizontal position for at least half an hour. 3. The method according to claim 1, characterized in that in the presence of pathogenic microflora in the intestine 7-12 days after the start of treatment until normalization of microflora in the intestine, a solution of a complex of eubiotics is used.