RU2300376C2 - Method of treatment in alcoholic delirium - Google Patents

Abstract

FIELD: medicine, narcology.

SUBSTANCE: method involves sampling venous blood in volume less 10-155% of total circulating blood for the first 24 h of disease and cellular mass of blood is separated from plasma. Mexidol in the dose 3 mg/kg of body mass is added to one portion and sibazon in the dose 0.25 mg/kg of body mass is added to another portion. Each portion is incubated separately and infused in a patient being mexidol-containing portion is infused firstly and then sibazon-containing portion is infused at temperature of a patient body. Method provides accelerating elimination of intoxication syndrome and reducing the treatment period based on the fixed therapy. Invention can be used in treatment of alcoholic delirium.

EFFECT: enhanced effectiveness of treatment.

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Description

The invention relates to medicine, in particular to toxicology. Alcoholic delirium - hallucinatory confusion with a predominance of true visual hallucinations, visual illusions, figurative delirium, motor excitement with the preservation of self-consciousness (Bleicher V.M., Kruk I.V. Explanatory dictionary of psychiatric terms. In 2 volumes, Rostov-on Don: Publishing house "Phoenix", 1996). Alcoholic delirium is distinguished: abortive, typical, mussitising, atypical: systematized, with verbal pseudogallucinosis, with transient onyroid, mental automatisms. Alcoholic delirium is one of the most frequent urgent conditions that usually occur with withdrawal syndrome, and requiring emergency specialized care (Bacherikov A.N., Kuzminov V.N., Petryuk P.T., Yurchenko N.P. Application of antipsychotic clopixol-acuphase in the treatment of alcohol withdrawal with delirium (Journal of Psychiatry and Medical Psychology. 2002. No. 1, pp. 98-102). Against the backdrop of modern therapy, including stopping psychomotor agitation and fighting insomnia, alcohol delirium lasts 5-10 days, subsequent transformation of delirium into hallucinosis, paranoid or chronic encephalopathy is possible (Altshuller V.B. Guide to narcology. Edited by N.N. Ivanza, Volume 2. Medical practice. - M. S.25-26). Delaying psychomotor agitation leads to the depletion of neurotransmitter systems, is accompanied by a deepening of impaired consciousness, swelling and swelling of the brain and leads to death (Anokhina I.P. Biological mechanisms of dependence on psychoactive substances (pathogenesis). Lectures on narcology. Edited by N. N. .Ivanza. M. Nolidzh. 2000, p. 16-40). Therefore, the search and development of new accelerated methods of therapy for alcoholic delirium remain relevant.

There is a method of treating alcohol delirium by detoxifying the body by forced diuresis, for example, using lasix, with a preliminary water load (Guide to narcology. Edited by N.N. Ivants. M. Medpraktika, 2002, v.2, p.24- 27).

The disadvantage of this method is the lack of signs of intensification of therapy for alcoholic delirium by reducing the severity of intoxication syndrome, reducing complications and the duration of treatment.

There is a method of treating alcohol delirium by administering drugs of the benzodiazepine series, in particular, intravenously diazepam (sibazon) for stopping psychomotor agitation (Hoffman A.G. Treatment of patients with alcoholic psychoses. Breast cancer, 2002, volume 10, No. 12-13, p. 566-558 ; Fridman L.S., Fleming N.F., Roberta D.X., Hyman S.E. Narcology .-- Transl. From English .-- M .; St. Petersburg: Binom-Nevsky Prospect, 1998.- 318).

The disadvantage of this method is the low efficiency of the doses of diazepam (sibazon) used according to the instructions in stopping psychomotor agitation. The proposed large doses of diazepam exceed the maximum allowable, recommended for use, and are toxic. Excess medication load contributes to the progression of liver failure, increased exogenous intoxication syndrome and leads to depression of the respiratory center and the lack of normal enteral nutrition (Entin G.M. Treatment of alcoholism. - M .: Medicine, 1990). There are also foreign reports that diazepam in stopping psychomotor agitation is not effective enough (Walilevwski D. et al. Assessment of diazepam loading dose therapy of delirium tremens // Alcohol and Alcoholism. - 1996. - Vol.31, No. 3. - P.273 -278). Excess drug loading of patients with diazepam, leading to the possible progression of liver failure, exacerbates exogenous intoxication syndrome and leads to respiratory depression (instruction on the use of sibazon. Approved by the Ministry of Health of the Russian Federation Yu.G. Bobkov on 02.27.87). The disadvantage of this method is the lack of signs of intensification of therapy for alcoholic delirium by reducing the severity of intoxication syndrome and reducing complications and the duration of treatment.

The known method according to the application No. 2003113477, including plasmapheresis with the release of red blood cells, while the resulting red blood cells in the apparatus "Source" is exposed to ultraviolet rays with a wavelength of 256 nm (lamp source DRB-8) for 15-20 minutes, followed by modification antibiotic and return to the patient.

The disadvantage of this method is the absence of signs of intensification of therapy for alcoholic delirium in it by reducing the severity of intoxication syndrome and reducing complications and the duration of treatment.

In addition, there is a known method for the treatment of alcoholic delirium by conducting discrete plasmapheresis (Guide to narcology. Edited by N. N. Ivants. Medical practice, M, volume 2, 2002), which includes taking two portions of blood, processing it, and sequentially pouring portions into the bloodstream (Kostyuchenko A. L. Efferent therapy in the complex treatment of internal diseases. St.Pet. Publishing house "Foliant". 2003, p. 43).

The disadvantage of this method is the lack of positive dynamics in the mental status of the patient, the growth of liver failure. In this method, there are no signs of intensification of therapy for alcoholic delirium by reducing the severity of intoxication syndrome and reducing complications and duration of treatment.

Closest to the claimed method is the last method of treatment with discrete plasmapheresis, which we take as a prototype.

The technical solution is to accelerate the elimination of intoxication syndrome, reduce complications and reduce the duration of treatment by more rapid treatment of alcohol delirium.

The technical solution is achieved in that the method of treatment for alcoholic delirium involves sequentially extracting blood from the patient’s venous bed in two portions in the first two days of the disease in a volume of at least 10-15% of the circulating blood volume. Then separation of the cell mass from the plasma, incubation of the cell mass in a thermostat and return to the bloodstream. In this case, mexidol is added to one portion of the cell mass at the rate of 3 mg per kg of patient body weight, and to another sibazon at a dose of 0.25 mg per kg of patient body weight, then each portion is incubated separately and the patient is first infused with mexidol, then with with a sibazon.

In a preferred embodiment, the cell mass with the therapeutic agent is incubated and returned to the bloodstream at a temperature equal to the patient’s body temperature.

A specific example of the method. Patient R. was hospitalized in the Department of Toxicology with a diagnosis of alcohol withdrawal syndrome, alcoholic psychosis. Alcohol consumed for a month in large quantities. At the time of admission, abstinence from alcohol was 24 hours. During hospitalization, pronounced psychomotor agitation, biochemical parameters within normal limits. On the day of hospitalization, blood is sequentially extracted in two portions from the patient’s venous bed in an amount of at least 10-15% of the circulating blood volume. Blood sampling is carried out in two plastic containers with sodium citrate. Apheresis of each portion of the extracted blood is sequentially carried out on a TsLP-3.5 centrifuge at 2000 rpm for 25 minutes. Then the plasma is separated from the cell mass. Mexidol is added to one portion of the cell mass at the rate of 3 mg per kg of patient body weight, and to another, sibazon at a dose of 0.25 mg per kg of patient body weight. Each portion is separately incubated for 30 minutes in a thermostat and the patient is first infused with mexidol, then with sibazon. At the same time, the cell mass with the therapeutic agent is incubated and returned to the bloodstream at a temperature equal to the patient’s body temperature. The clinic of alcoholic psychosis was stopped on the first day, after which there was a prolonged sleep. By the middle of the third day, the patient was released home in satisfactory condition.

The significance of the differences of the invented method is as follows. Extraction of blood from the patient’s venous bed in the first two days of the disease in the amount of at least 10-15% of the circulating blood volume in two portions in succession allows each portion to be enriched with different drugs and administered separately in the proper sequence. Separate incubation of each portion provides the possibility of introducing portions sequential without interruptions, which eliminates the mixing of drugs in the infused media. The addition of 3 mg per kg of the patient’s body weight to one portion of the cell mass of mexidol allows mexidol to be introduced into the bloodstream of the patient without mixing with another drug. Mexidol is known to improve cell metabolism by activating the energy-synthesizing functions of metochondria. Succinate, which is part of Mexidol, is included in the respiratory chain, increasing its effectiveness. Mexidol models the receptor complexes of brain membranes, in particular benzodiazepine, GABAergic, acetylcholine receptors, inhibits the free radical oxidation of lipid membranes by binding lipid peroxides, increases the activity of antioxidant enzymes, in particular superoxide dismutase (Voronina T.A. Mexidol main effects, mechanisms of action, application. Moscow. 2004). Adding 0.25 mg per kg of the patient’s body weight to another portion of the cell mass of sibazon allows it to be introduced into the patient’s body separately from mexidol. It is known that sibazon actively affects GABAergic systems, potentiating the central inhibitory effect of aminobutyric acid, has a calming effect on the central nervous system, causing muscle relaxation, as well as anticonvulsant effect, in therapeutic doses gives a mild hypnotic effect. The effect of the drug is due to a decrease in the excitability of the amygdala formations of the anterior temporal lobes (amygdala complex) at the diencephalic and limbic levels. Sibazon blocks the transmission of impulses in the region of intercalated neurons, causing relaxation of skeletal muscles and does not disrupt (like curariform-like substances) the transmission of excitation in synapses (Entin G.M. Treatment of alcoholism. - M .: Medicine, 1990). Incubation and return to the bloodstream of the cell mass with a therapeutic agent at a temperature equal to the patient’s body temperature, reduces the body’s reactions to a different temperature of the infused medium than in the body. Treatment of alcohol delirium using methods of active detoxification of the body accelerates the relief of mixed intoxication syndrome with impaired liver function and liver failure, intoxication with alcohol metabolites. Thus, the totality of the features of the invented method enhances the effect of drugs due to the synergistic effect, accelerates the elimination of intoxication syndrome, reduces the duration of treatment for alcohol delirium and the patient’s hospital stay, leading the institution to savings, and reduces the patient’s likelihood of complications from alcohol delirium.

Claims (1)

A method of treatment for alcoholic delirium, including plasmapheresis, characterized in that the blood is taken in two portions from the patient’s venous channel in the first two days of the disease in a volume of at least 10-15% of the circulating blood volume, and the cell mass is separated from the plasma, while Mexidol is added to one portion of the cell mass at the rate of 3 mg per 1 kg of the patient’s body weight, and to another sibazon at a dose of 0.25 mg per 1 kg of the patient’s body weight, then each portion is incubated separately and the patient is first infused with Mexidol, s those with Sibazonum at a temperature equal to the patient's body.