RU2315600C2 - Method for preventing optic nerve atrophy in closed craniocerebral injury cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves carrying out arterial blood pressure monitoring. Mean systolic blood pressure, mean diastolic blood pressure are determined. Eye fundus condition is examined. Lysinoton is administered at a dose of 20 mg once a day and Tanacan at a dose of 40 mg 3 times a day when taking meals during 3 weeks, if mean systolic blood pressure≥140 mm of mercury column, mean diastolic blood pressure≥90 mm of mercury column and retinal blood vessel size ratio changes as A:B=1:4 and retinal disks obliteration takes place.

EFFECT: improved vision function.

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Description

The invention relates to medicine, in particular to ophthalmology, and is proposed for the prevention of the development of optic atrophy after a closed craniocerebral trauma (CCT).

In recent years, the frequency of CCMT of a combat, criminal and domestic nature has increased. According to a number of authors, in case of brain injury with brain contusion, vision loss is mainly due to the development of optic atrophy (Gogoryan SF "On the analysis of the effects of traumatic brain injury." // Actual issues of neurology and neurosurgery - Rostov-on-Don, 2002. - P.63-64., Dobrokhotova TA "Outcomes of a traumatic brain injury" // Neurotraumatology-Rostov-on-Don, 1999, - p.114-116., Wildberber N. Visually evoked cortical potentials in optic dysfunctions after neurotraumatic. // Kein. Mdl. Augenheilk - 2002 - vol. 168 - p. 98-107)

The following factors are significant in the mechanism for reducing vision in CCTV:

- violation of autoregulation of cerebral blood flow, which is manifested by an increase in the tone of arteries and a decrease in the tone of veins, which, in turn, leads to insufficiency of arterial blood flow (hypoxia of the brain tissue and intracranial section of the optic nerve) and venous stasis with the development of edema of brain tissue;

- violation of cerebral hemodynamics leads to a deterioration of trophism and bioenergy of the visual analyzer;

- with the long-term existence of these factors (for a month or more), vision decreases, atrophy of the optic nerve develops.

In this regard, the development of a method for preventing the development of optic atrophy in patients with CCI is an urgent and socially significant task of ophthalmology.

Known methods for treating patients with optic atrophy through the use of a wide range of traditional medications: vasodilating action (nicotinic acid, compliance, cavinton), vitamin preparations, nootropics. (N.I. Shpak, L.I. Fedorova and others. "The effectiveness of local use of compliance and ATP in the treatment of patients with primary and secondary atrophy of the optic nerve." Ophthalmological Journal, 1985, No. 3, pp. 10-16) . However, the prescription of medications is often empirical in nature, without taking into account the pathogenesis of optic nerve damage, and therefore is not effective enough. In this regard, to improve the effectiveness of the treatment of optic atrophy in recent years, methods of treatment with the inclusion of magnetic and electrical stimulation of the optic nerve have been proposed. A known method of treating partial atrophy of the optic nerve (RF Patent 2146909, Bull. Invent. 2000 - No. 3). The essence of the method is to conduct electrical stimulation on the eyeballs in combination with laser irradiation of the retina. The course of treatment is 15 sessions.

The disadvantage of this method is its local effect on the orbital part of the optic nerve and retina, while with closed traumatic brain injury, pathological changes are localized mainly intracranially.

A known method of treating optic atrophy by electrophoresis with electrical stimulation (RF Patent 2147216, Bull. Invent. 2000 - No. 4), which provides for the introduction of an operative route of a collagen infusion system to the posterior pole of the eye through which drugs are administered (nicotinic acid 1%, xanthinol nicotinate 15%). In addition, a button-shaped flexible electrode is inserted into the cavity of the orbit to the anterior optic nerve, through which electrostimulation of the optic nerve is performed.

The disadvantage of this method is the trauma due to surgical technique, and the potential risk of complications of an inflammatory nature in the tissues of the orbit.

A known method of treating hypoxia, ischemia and partial atrophy of the optic nerve (RF Patent 2191559, Bull. Invent. 2002 - No. 10) by exposure to magnetic field pulses on the edges of the orbit, temporal and occipital projection of the optic nerve and tract.

The disadvantage of this method is only a vasodilating effect, while in case of CCI in the early period, edema of brain tissue predominates with a deterioration in the transmission of a nerve impulse through the optic tract.

We have taken for the prototype "A method for the treatment of partial optic atrophy" (RF Patent 2192817, Bull. Inventor 2002 No. 11), in which the drug treatment is sequentially performed by pterygopalatine blockade with a solution of lidocaine, xanthinol nicotinate and dexon, after 5 minutes magnetostimulation is performed and through 20-30 minutes - a session of hyperoxybarotherapy.

The disadvantage of this method is the complexity, the need for a pressure chamber, which complicates the use of this method in wide medical practice.

The purpose of the invention is the improvement of visual functions and the prevention of the development of optic atrophy with closed traumatic brain injury. This goal was achieved with medication aimed at reducing arterial hypertension, cerebral hypoxia with lysinotone, improving venous blood flow, reducing swelling of brain tissue and optic nerve with tanakan.

The method is as follows.

A patient with CCI, a bruise of the brain, is monitored for blood pressure (blood pressure is measured 3-5 times a day), the mean systolic pressure (SDAS), the average diastolic blood pressure (SDAD) are determined, the condition of the fundus is examined, with an ASD ≥140 mm Hg, SDAD≥90.0 mm Hg, changing the ratio of the caliber of the retinal vessels as A: B = 1: 4 and (or) the blurring of the boundaries of the optic nerve head (optic nerve disc) appoint lisinotone (20 mg) once a day and tanakan 1 tablet (40 mg) 3 times a day with meals for 3 weeks.

The choice of these drugs is explained by their pathogenetic orientation in CCI.

Lysinotone is the new only hydrophilic ACE inhibitor (angiotensin-converting enzyme) of the 3rd generation of long-acting. Taking the drug once a day ensures the normalization of blood pressure, maintaining the physiological circadian rhythm of blood pressure.

Lisinoton improves blood flow by reducing peripheral vascular resistance Lanagtry N.D., Markham A. Lisinopril. A review of its pharmacology and clinical efficacy in patients // Drugs Aging 1997, Feb. 10 (2) 131-66.

Tanakan has a venotonic, decongestant effect, improves cerebral circulation and brain metabolism (Russian Drug Register 2005, p. 900).

The use of these drugs improves cerebral and ocular hemodynamics, leads to an increase in the bioelectrical activity of the visual analyzer, normalization of the fundus picture and visual functions.

The effectiveness of the method is illustrated by a clinical example.

Example. Patient B., 22 years old, was admitted to the neurotrauma department of BSMP No. 2 with a diagnosis of closed craniocerebral trauma, moderate brain contusion. The patient was taken by ambulance after a traffic accident. Clinical examination data. A history of loss of consciousness within 10 minutes. At admission: general state of moderate severity, consciousness preserved, dizziness, headache, nausea, vomiting once. Blood pressure monitoring: SSAD = 156 ± 0.3 mm Hg, SDAD = 92.4 ± 0.5 mm Hg Heart rate (HR) - 84-92 beats per minute.

Ophthalmic examination 3 days after admission. Visual acuity: right eye = 0.8 n / a, left eye = 0.9 n / a. The fundus of both eyes: the optic nerve disc is pale pink, the borders are stained more in the right eye, the arteries are narrowed, the veins are significantly dilated, convoluted. The ratio of the caliber of the retinal vessels A: B = 1: 4. The fundus picture indirectly indicates the presence of edema of the brain tissue, difficulty in the venous outflow into the cranial cavity.

Electrophysiological studies: threshold of retinal electrophysiology (electrical sensitivity):

right eye - 13 8 μA,

left eye - 126 μA.

Considering that the norm for the patient's age is up to 80 μA, it can be stated that the threshold of the retinal echocardiography is increased 1.7 times in the right eye and 1.5 times in the left eye. These data indicate a violation of retinal electrogenesis.

Threshold EL (electrical lability) of the optic nerve:

right eye - 28 Hz,

left eye - 30 Hz.

Since the norm of EL in the optic nerve is 35 Hz and higher, in a patient the bioelectric conductivity of the optic nerve is reduced in the right eye by 20% and by 15% in the left eye.

Rheoencephalography (REG), performed on the 4th day after CCT, showed that the rheographic index in the carotid pool is 0.08 and 0.06 in the vertebral pool, which is 34% lower than normal.

Peripheral vascular resistance (PSS) is increased by 126% in the carotid pool and 98% in the vertebral pool, which is higher than the physiological norm by 76% and 48%, respectively.

Venous outflow is difficult by 72%.

Thus, the REG data indicate arterial insufficiency and a slowdown in venous blood flow.

According to the proposed methodology, the patient was treated with lysinotone 20 mg 1 time per day and tanakan 40 mg 3 times a day with meals.

Clinical examination data at discharge after 3 weeks: visual acuity of both eyes = 1.0

EFI data:

retinal echo threshold: right eye 82 μA, left eye 80 μA;

optic EL threshold: right eye 38 Hz,

the left eye is 39 Hz, which indicates the normalization of the bioenergy of the visual analyzer at the level of the retina and pathways.

The fundus of both eyes: optic nerve disc pale pink, the borders are clear, the ratio of the caliber of blood vessels normalized A: B = 2: 3.

According to this method, we treated 18 patients (36 eyes) with a diagnosis of CCI, a brain contusion of mild to moderate severity, arterial hypertension. Since patients with CCI, a mild and moderate brain contusion are hospitalized for 3 weeks (time of the acute period), we conducted studies in the first days after the injury and upon discharge, after 3 weeks. Ophthalmological examination revealed the presence of arteriovenous dysfunction of the retinal vessels in 10 patients and the initial congestive optic disc in 8 patients. The dynamics of clinical indicators are presented in the table.

Table. Clinical indicators of patients with CCI before and after treatment. Indicators Before treatment After treatment SSAD 157.2 ± 2.35 126.0 ± 1.0 For rent 93.0 ± 1.0 79.6 ± 0.67 Visus
0.5-0.7 n-number of eyes
16 n-number of eyes
- 0.8-0.9 twenty 6 1,0 - thirty Retinal Emission Threshold (μA) 132.5 ± 1.66 78.7 ± 1.24 Optic EL threshold (Hz) 29.9 ± 0.61 33.8 ± 0.45 REG Rheographic Index 0,07 ± 0,003 0.12 ± 0.009 PSS (%) 117.7 ± 4.1 66.7 ± 2.8 Venous outflow difficult (%) 97.4 ± 2.33 58.9 ± 2.49

The data in the table indicate that in 83.3% of cases, visual acuity recovered to 1.0; while the indicators of the functional activity of the optic nerve (thresholds of EC and EL) improved by 59.4% and 13%; cerebral arterial blood flow rates improved by 71.4% and 76.5%. Venous blood flow increased by 65%.

Thus, the selected pharmacotherapy regimen is pathogenetically argued for, easy to implement at a medical institution of any level, does not cause complications and stops factors that negatively affect the vital activity of the optic nerve.

Claims (1)

A method for the prevention of optic atrophy in closed craniocerebral trauma by medical treatment, characterized in that blood pressure is monitored, mean systolic blood pressure (SBP), mean diastolic blood pressure (SBP), fundus fundus is examined, and with SBPT 1 140 mm Hg, SDAD≥90.0 mm Hg, changing the ratio of the caliber of the retinal vessels as A: B = 1: 4 and the blurring of the borders of the optic nerve head, lysinotone is prescribed at a dose of 20 mg once a day and tanakan at a dose40 mg 3 times daily with meals for 3 weeks.