RU2315636C1 - Method for treating patients for vibration disease aggravated with vertebrobasilar insufficiency syndrome - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying therapy with central vasodilators and group B vitamins. Transcranial electrostimulation and laser radiation therapy are additionally applied. Transcranial electrostimulation is carried out using Transair 01B apparatus operating on feeble currents of rectangular or bipolar pulsating current with pulse duration of 3.5-4 ms and optimum treatment frequency of 77 Hz. Electrodes are placed over frontal region and mastoid processes. Laser radiation therapy is carried out with Ricta 04/4 M2 2D apparatus 30 min later after having accomplished transcranial electrostimulation procedure. Paravertebral zones are irradiated on cervical and upper thoracic segments on both sides. Drug therapy is applied every other day at least 1 h earlier before applying physiotherapeutic treatment.

EFFECT: reduced complaints and irritability; improved general health state, cerebral blood circulation and vibration sensitivity.

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Description

The invention relates to medicine, in particular to occupational medicine, neurology and physiotherapy, and can be used in the treatment of patients with vibrational disease (VB) with vertebral-basilar insufficiency syndrome (VBI).

Currently, vitamins of group B (B ₁ , B ₆ , B ₁₂ ) (milgam N), folic acid, ascorbic acid, nicotinic acid, analgesics (novocaine), central vasodilators (actovegin, trental) are used to treat patients with VB with VBI syndrome. , ganglioblockers (benzohexonium), anticholinergics (difacil), small doses of anticholinergics (chlorpromazine, amisil), bupatol, anti-adrenergic drugs (dopegyt), antispasmodics (no-spa, papaverine) in combination with physical factors: electrophoresis of the above substances, UHF low thermal dose on the collar area, total ultraviolet radiation at suberythemic doses, paraffin, ozokerite on the joints and hands, mud therapy, various types of bathtubs (hydrogen sulfide, radon, oxygen) (Artamonova V.G., Mukhin N.A. Occupational diseases, 4th published by Moscow, Medicine, 2004, p. 589, p. 167-170). There is evidence of the use of substances such as unitiol, D-penicylamine, anticoagulants (heparin), in combination with physical effects: microwave, galvanic baths with naphthalan oil, laser therapy (Izmerov N.F. Manual for Occupational Diseases. Moscow, Medicine, vol. II, 1983, p. 344, p. 156-157).

Based on the closest technical essence, as a prototype, we have chosen the following method for treating patients with WB: Milgama N - 2 ml + 5 ml of 10% Actovegin solution per 200 ml of 5% Glucose solution - iv drip, 15 procedures every other day, 1% nicotinic acid solution, starting with 0.5 ml and gradually increasing the dose to 2 ml. The course is 30 days. In combination with UHF on the collar zone in a low thermal dose, for 10 minutes, 15 procedures every other day. Electrophoresis of a 5% solution of novocaine and 2% sodium bromide solution on the collar area. Novocain is administered from the positive pole, bromine - from the negative. The current strength is 10-15 A, the duration of exposure is 10-15 minutes, 15 procedures per treatment course are carried out every other day. Electrophoresis of a 2% aqueous solution of benzohexonium on the hands. Current 10-15 A, exposure duration 10-15 minutes, 15 treatments per day, every other day (Artamonova V.G., Mukhin N.A. Occupational diseases, 4th ed. Moscow, Medicine, 2004 , p. 169-170).

The use of such a treatment regimen is not effective enough, because after the course of treatment (30 days) complaints about numbness, whitening of the fingers in the cold, aching pains in the hands, dizziness and soreness in the cervical spine persist; in the clinical picture of the disease, the polyneuritic type of sensitive and vegetative-trophic disorders is preserved. When using additional laboratory and instrumental methods of examination, vibration testing of the upper extremities, transcranial dopplerography (TCD) of the vessels of the brain and brachycephalic trunk, rheoencephalography, after a course of treatment, circulatory disorders in the vertebral and main arteries of the brain persist, there are violations of vibration sensitivity.

The objective of the invention is to increase the effectiveness of treatment of patients with VB with VBI syndrome by improving the basic clinical and electrophysiological parameters, as well as reducing treatment time.

The problem is solved by the fact that they carry out a medication effect, including central vasodilators and B vitamins and include transcranial electrical stimulation and laser therapy, and when physiotherapy is applied, transcranial electrical stimulation is initially performed from the Transair 01B apparatus with weak rectangular currents or bipolar pulse currents of 3 pulse duration , 5-4 ms, with an optimal exposure frequency of 77 Hz by applying electrodes to the frontal region and mastoid processes, current strength from 1 to 2 mA. The duration of the initial procedure is 5 minutes; during the treatment, the duration of the procedure is increased to 40 minutes. Not less than 30 minutes after transcranial electrical stimulation, laser therapy is performed from the Rikta 04/4 M 2 2D apparatus by irradiating the paravertebral zones on the cervical and upper thoracic levels on both sides, and initially the zones located at the level of the projections of the large occipital nerve are irradiated, then - zones of paravertebral points located at the level of C3-C5 and paravertebral points at the level of C7-D2 for 2 minutes per zone from a distance of 2 cm, the output power is 8 W, the average output radiation power is 60-30 mW, ling wave 0,8-0,91 microns; the course of treatment is 12-14 days, transcranial electrical stimulation and laser therapy are carried out according to 1 procedure daily, drug exposure is carried out every other day, and not less than an hour before physiotherapy.

The method is as follows.

Drug exposure is carried out every other day. On the day when intravenous drip of Actovegin and Milgam is carried out, the patient comes to the treatment room, where he is given an intravenous drip infusion of the above drugs. The position of the patient during the procedure - lying on the couch. After the dropper, the patient goes into the rest room, where he is at least an hour. There are couches and chairs in the rest room. The position in which the patient is resting is determined by him. At the request of the patient, calm classical music can be included. After resting, the patient's blood pressure level is measured, after which transcranial electrical stimulation from the Transair 01B apparatus is performed with weak rectangular or bipolar pulse currents, with a pulse duration of 3.5-4 ms, with an optimal exposure frequency of 77 Hz, by applying electrodes to the frontal region and mastoid processes (pads under the electrodes are slightly moistened with water). The frequency and duration of the pulse, as well as the location of the electrodes are standard and determined by the developer of the device. The current strength is selected individually, according to the subjective sensations of the patient (until a tingling sensation appears under the electrodes) and ranges from 1 to 2 mA. The duration of the procedure was selected individually according to the subjective sensations of the patient, starting from 5 minutes, and with good tolerance, increased to 40 minutes by 3-4 procedures. If you experience fatigue, weakness, discomfort or burning under the electrodes, the procedure should be discontinued. The position of the patient during the procedure or lying on his back, or sitting on a chair, at the request of the patient. At the request of the patient, calm classical music can be included. After transcranial electrical stimulation, the patient again goes to the rest room, which is located next to the physiotherapy department, where there is at least half an hour. The position in which the patient is resting is determined by him. At the request of the patient, calm classical music can be included. After resting, the patient is re-measured with blood pressure and, in the absence of contraindications, laser therapy is performed with the Rikta 04/4 M2 2D apparatus by irradiating the paravertebral zones on the cervical and upper thoracic levels on both sides, initially zones located at the level of the projections of the large occipital nerve are irradiated. paravertebral points located at the level of C3-C5 and paravertebral points at the level of C7-D2 for 2 minutes per zone from a distance of 2 cm, output power 8 W, average output radiation power - 60-30 mW, for 0,8-0,91 microns in wavelength. The position of the patient sitting on a chair, resting his head on his hands on the back of the chair, which provides good access to the areas affected. After the procedure, the patient should also rest for at least half an hour either in the rest room, or sitting on a couch in the corridor, at the patient’s request, which is necessary to exclude possible complications in the form of myositis, which can occur during sudden cooling due to the patient going out immediately after the procedures.

Distinctive essential features of the proposed method are:

1. Exposure to transcranial electrical stimulation from the Transair 01B apparatus with weak rectangular currents or bipolar pulsed currents, with a pulse duration of 3.5-4 ms, with an optimal exposure frequency of 77 Hz, by applying electrodes to the frontal region and mastoid processes, the current from 1 to 2 mA, the duration of the procedure is 5-40 minutes. The duration of the initial procedure is 5 minutes; during the treatment, the duration of the procedure is increased to 40 minutes. The operating mode of the apparatus and the electrode application area provide a selective action of the current on the endorphin structures of the brain, which increases the concentration of β-endorphins, which leads to an analgesic effect, accelerates reparative processes, including nerve endings, and also increases microcirculation in the central nervous system.

2. No less than 30 minutes after transcranial electrical stimulation, laser therapy is performed. A break between transcranial electrical stimulation and laser therapy is necessary for the patient to relax in order to prevent overwork of the central nervous system and avoid possible unwanted side effects from exposure to physical factors, manifested primarily in changes in blood pressure. A physiological pause of at least 30 minutes is sufficient for the patient to rest.

3. The impact of laser therapy with the apparatus "Rikta 04/4 M 2 2D" by irradiating the paravertebral zones on the cervical and upper thoracic levels on both sides, the zones located at the level of the projections of the large occipital nerve, then the zones of paravertebral points located at the level C3- C5 and paravertebral points at the level of C7-D2 for 2 minutes in each zone from a distance of 2 cm, the output power is 8 W, the average output power is 60-30 mW, the wavelength is 0.8-0.91 microns, sequentially affect 6-7 fields in 2 minutes and each field.

The selected exposure parameters and the irradiation area can enhance microcirculation both in the central nervous system and on the periphery, enhance the oxygenation processes of the underlying tissues, reduce edema involved in the pathological process of nerve roots, and also obtain a stable analgesic effect.

4. Conducting drug therapy 1 hour before exposure to physical factors.

A time interval of 1 hour between drug therapy and exposure to physical factors is necessary to prevent hyperinfluence on the vessels of the central nervous system, that is, the paretic expansion of the central vascular link, and, as a result, lower blood pressure, increase vascular congestion of the membranes of the brain and reduce headaches.

5. The number of drug therapy procedures is 6-7.

6-7 procedures of drug therapy, in contrast to 15 used in the prototype method, are sufficient to achieve a positive effect.

6. The number of transcranial electrical stimulation and laser therapy procedures per treatment course is 12-14.

12-14 procedures that make up the course of treatment, in contrast to the 30 electrophoresis procedures used in the prototype method, are enough to achieve a positive effect.

The set of distinctive essential features is new and can significantly improve the main clinical and electrophysiological parameters of treatment, as well as reduce treatment time by 16-18 days.

Clinical examples

Example No. 1. Patient N., born in 1943. A pensioner, formerly an electric welder of Izhorskiy Zavod OJSC, work experience of 27 years, was in rehabilitation from 10/17/2005 to 11/11/2005. Diagnosis: Persistent residual effects of vibration disease, occupational myofibrosis of the forearm muscles. A course of treatment was carried out using milgam N, Actovegin, in the form of intravenous droppers every other day, No. 6; transcranial electrical stimulation from the Transair 01B apparatus and laser therapy from the Rikta 04/4 M 2 2D apparatus with exposure to the paravertebral zones at the cervical and upper thoracic levels, daily No. 12 (the parameters of laser therapy and transcranial electrical stimulation are presented in Table 1). The results of treatment of the patient are presented in table 2. As can be seen from the data presented in the table, as a result of treatment, the patient's complaints according to the questionnaire data decreased, the indicators of cerebral blood flow in the vertebral and main arteries of the brain according to TCD. Vibration sensitivity indicators have improved according to the results of vibration testing.

Example No. 2. Patient K., born in 1952, polisher of Izhorskiy Zavod OJSC, work experience of 18 years, was undergoing rehabilitation from September 19, 2005 to October 4, 2005. Diagnosis: Vibration disease 2 stages from exposure to local vibration (peripheral angioedema syndrome with attacks of angiospasm vessels of the upper extremities, autonomic-sensory polyneuropathy of the upper extremities). A course of treatment was carried out using milgam N, Actovegin, in the form of intravenous droppers every other day, No. 6; transcranial electrical stimulation from the Transair 01B apparatus and laser therapy from the Rikta 04/4 M 2 2D apparatus with exposure to the paravertebral zones at the cervical and upper thoracic levels, daily No. 12 (the parameters of laser therapy and transcranial electrical stimulation are presented in Table 1). The results of treatment of the patient are presented in table 3. As can be seen from the data presented in the table, as a result of treatment, the patient’s complaints according to the questionnaire data slightly decreased, the indicators of cerebral blood flow in the vertebral and main arteries of the brain according to TCD. Significantly improved indicators of vibration sensitivity according to the results of vibration testing.

Example No. 3. Patient P., born in 1961, castor of Izhorskiy Zavod OJSC, work experience of 7 years, former molder, fitter for shaft cleaning of Izhorskiy Zavod OJSC, work experience of 15 years, was in rehabilitation from September 19, 2005 to October 4, 2005 Diagnosis: Stage 1-2 vibrational disease from local vibration (peripheral angioedema with attacks of angiospasm of the vessels of the upper extremities, autonomic-sensory polyneuropathy of the upper extremities). A course of treatment using milgam N, Actovegin, in the form of intravenous droppers every other day, No. 7; transcranial electrical stimulation from the Transair 01B apparatus and laser therapy from the Rikta 04/4 M2 2D apparatus with exposure to the paravertebral zones at the cervical and upper thoracic levels, daily No. 12 (the parameters of laser therapy and transcranial electrical stimulation are presented in Table 1). The results of the patient’s treatment are presented in Table 4. As can be seen from the data presented in the table, the patient’s complaints according to the questionnaire data significantly decreased, the indicators of cerebral blood flow in the vertebral and main arteries of the brain according to the TCD, and the vibration sensitivity according to the results of vibration testing, normalized.

An example of the prototype method.

Patient K., born in 1947, mechanic of assembly work at Izhorskiy Zavod OJSC, 35 years of work experience, was in rehabilitation from October ₄ , 2004 to _{November 1} , 2004. Treatment was carried out: vitamins of group B (B ₁ , B ₆ , B ₁₂ ) (Milgama N), folic acid, analgesics (Novocaine), central vasodilators (Actovegin), ganglion blockers (Benzohexonium), in combination with physiotherapy. UHF to the collar zone at a low thermal dose, electrophoresis of 5% novocaine solution and 2% sodium bromide solution to the collar region. Electrophoresis of a 2% aqueous solution of benzohexonium on the hands. The results of the treatment course are presented in table 5. As can be seen from the data presented in the table, as a result of treatment, the patient's complaints slightly decreased according to the questionnaire, the cerebral blood flow in the vertebral and main arteries of the brain according to TCD remained practically unchanged. Slightly worsened indicators of vibration sensitivity according to the results of vibration testing.

The inventive method is tested on 101 patients suffering from VB with VBI syndrome. The control group (prototype method) was 50 people.

Positive dynamics was achieved in 96 patients (95, 04%), which manifested itself in a decrease in complaints, irritability, and an improvement in overall well-being, which follows from the results of subjective self-assessment according to the results of questioning of patients before and after the course of treatment, as well as an improvement in cerebral blood flow according to TCD and improving vibration sensitivity during vibration testing. Positive dynamics in the control group was achieved in 27 people (54.0%).

Improving the clinical picture of the disease in the form of reducing the neurological symptoms of autonomic sensory polyneuropathy of the upper extremities and VBI, improving cerebral blood flow in the vertebral and main arteries of the brain according to TCD was observed in 64 patients (63.37%) and 22 patients (44.0%) of the control groups, respectively, improved vibration sensitivity during vibration testing in 89 patients (88.11%) and 27 patients (54.0%) in the control group, respectively.

The duration of treatment according to the claimed method is 12-14 days, and according to the prototype method - 30 days. The duration of treatment according to the claimed method is reduced by 16-18 days.

As a result, as can be seen from the above data, the claimed method for the treatment of patients with VB with VBI syndrome is much more effective in comparison with the prototype method both in clinical electrophysiological parameters and in terms of treatment.

Claims (1)

A method of treating patients with a vibrational disease with vertebral-basilar insufficiency syndrome, which consists in medication, including central vasodilators and B vitamins, and a physiotherapeutic effect, including transcranial electrical stimulation and laser therapy, and with physiotherapy, transcranial weak electrical stimulation is initially performed rectangular or bipolar currents of a pulse current with a pulse duration of 3.5-4 m , with an optimal frequency of exposure to 77 Hz by applying electrodes to the frontal region and mastoid processes, the current strength is from 1 to 2 mA, the duration of the initial procedure is 5 minutes, during treatment the duration of the procedure is increased to 40 minutes, not less than 30 minutes after transcranial electrical stimulations carry out laser therapy with the Rikta 04/4 M2 2D apparatus by irradiating the paravertebral zones on the cervical and upper thoracic levels from two sides, and initially the zones located at the projection level are irradiated about the occipital nerve, then the zones of paravertebral points located at the level of C3-C5 and paravertebral points at the level of C7-D2 for 2 min per zone from a distance of 2 cm, the output power is 8 W, the average output radiation power is 60-30 mW, length waves 0.8-0.91 microns; the course of treatment is 12-14 days, transcranial electrical stimulation and laser therapy are carried out according to 1 procedure daily, drug exposure is carried out every other day, and at least an hour before physiotherapy.