RU2321433C1 - Method for treating patients after removing gallbladder - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves prescribing conservative training motor activity and feeding diet No 5 with low mineralization low carbonic acid concentration sulfate and hydrocarbonate sodium-calcium mineral water being taken. Mineral water baths with low mineralization low carbonic acid concentration sulfate and hydrocarbonate sodium-calcium mineral water are given at 36-37°C during 12-15 min with 8-10 procedures per treatment course. 2.5% succinic acid solution electrophoresis is additionally applied to interscapular zone from cathode with the other washer - anode being placed on liver and right hypochondrium projection zone using current of 15-25 mA during 15-25 min daily with 10-12 procedures per treatment course.

EFFECT: reduced intensity of digestion disorder syndrome manifestation; stabilized peroxide homeostasis; increased organism adaptation capability.

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Description

The method relates to medicine, namely to the section of gastroenterology, and relates to the treatment of physical factors of patients with biliary tract diseases.

The development of treatment methods for patients after cholecystectomy is an urgent problem of modern medicine. The prevalence of gallstone disease and, accordingly, an increase in the number of cholecystectomies performed, a decrease in the working capacity and quality of life of patients who underwent surgery, necessitates the search for effective methods of treatment for this pathology. The multiple organ damage of the digestive organs after surgery, the complexity of their pathogenesis and the versatility of clinical manifestations, combined by the collective term “postcholecystectomy syndrome”, make it difficult to achieve a therapeutic effect, and the treatment is mainly symptomatic.

A known method of treating patients after cholecystectomy using a gentle-training regimen of motor activity, diet, ingestion of mineral water, mineral baths at a water temperature of 36-37 ° C for 12-15 minutes, 8-10 procedures per treatment course (Balneology and physiotherapy, 1985, v. 2). This treatment method is a prototype for this invention.

However, this method is not effective in relation to the correction of impaired digestion and energy metabolism as a manifestation of a violation of the adaptive reactions of the patient’s body in the new anatomical and physiological conditions that have developed after removal of the gallbladder.

Data from scientific observations and the practical work of sanatorium doctors indicate that even when clinically appropriate treatment complexes are prescribed, the resort has negative results - digestive upset with the development of diarrhea, increased clinical manifestations of concomitant diseases that developed before or after surgery (pancreatitis, duodenal dyskinesia , peptic ulcer, gastroesophageal reflux disease). This fact can be explained by the fact that the appointment of a medical complex is carried out without taking into account the violations of adaptation processes and energy metabolism that are available for this category of patients.

The technical result of the proposed method is to increase the effectiveness of rehabilitation treatment of patients after removal of the gallbladder by correcting digestive disorders, reduced adaptive reserves of the patient’s body and energy metabolism in new anatomical and physiological conditions that have developed after the operation. The indicated technical result is achieved by the fact that succinic acid electrophoresis is used in the spa treatment complex as a method of complex exposure to galvanic current and, against its background, succinic acid introduced by the phoretic route, one of the oxidation substrates in the Krebs cycle, which improves energy metabolism in the body.

The method is performed as follows: for the first 3 days of staying at the resort, patients are prescribed a regimen with a restriction of motor activity as one of the elements of adaptation and restoration of the body’s energy capabilities by reducing energy costs. Subsequently, the mode of motor activity is replaced by a sparing and sparing-training. Dietary nutrition according to diet No. 5. An internal intake of mineral water of low-carbonate hydrocarbonate-sulfate sodium-calcium low mineralization (Slavyanovskaya) is prescribed at a temperature of 55 ° C, starting with small doses of 120.0-150.0 ml per dose (2.5 g per 1 kg of patient body weight ), bringing to a dose of 3.3 g of water per 1 kg of patient weight (200.0-250.0 ml per dose) for 3-4 days. Patients take mineral water 45 minutes before a meal.

Mineral baths are prescribed at a water temperature of 36-37 ° C for 12-15 minutes, every other day, 8-10 procedures per treatment course.

In order to correct the violations of adaptation processes and energy metabolism present in patients after cholecystectomy, succinic acid electrophoresis is additionally prescribed, which is carried out as follows: a hydrophilic cathode pad (-) with an area of 250-280 cm ^{2 is} impregnated with 2.5% succinic acid solution and placed in the interscapular region (D ₄ -D ₁₀ segments), anode pad (+) with an area of 200 cm ^{2 is} impregnated with tap water and placed on the area of the liver and right hypochondrium. The current strength is 15-25 mA (with a slight burning sensation under the electrodes), the duration of the procedure is 15-25 minutes (gradually increases in the first days of treatment), the effects are carried out daily, for the course of treatment 10-12 procedures. The methodology is substantiated by data on the important therapeutic role of the effects of galvanic current and succinic acid (oxidation substrate in the Krebs cycle), especially since in this category of patients disturbances in energy metabolism were detected (see data in Table 2). The location of the electrodes is due to the need to influence both the general condition of the body and the functional state of the liver.

The method can be illustrated by the following examples.

Patient T.L.V., 47 years old, medical history No. 446. Diagnosis at admission: ZhKB. Cholecystectomy in 1998. Chronic biliary-dependent pancreatitis in the phase of incomplete remission. Upon admission, she complained of severe general weakness, fatigue, headaches, bitterness in the mouth, nausea, aching pains in the upper abdomen, and constipation with loose stools.

On palpation of the abdomen, moderate pain was noted in the right hypochondrium and in the epigastric region. The liver protrudes from the edge of the costal arch by 1.5-2 cm, sensitive to palpation. Blood analysis; the number of leukocytes - 4 · 10 ⁹ / l, lymphocytes - 22%, neutrophils - 68%, monocytes - 10%, eosinophils - 0. Blood bilirubin - 12.1 μmol / l, cholesterol - 8.4 mmol / l, alkaline phosphatase - 156 U / L, the level of MDA in plasma is 1.268 μmol / L. The total energy deficit was revealed: the ATP level in erythrocytes is 508 μmol / l, AMP is 68 μmol / l, the energy charge is 0.80, the activity of LDH in lymphocytes is 1055 units, and a-GPDH is 530 units. lactate - 1.89 mmol / l, pyruvate - 0.966 mmol / l. The treatment was carried out - sparing mode of motor activity, diet nutrition No. 5, internal intake of mineral water from the Slavyanovsky spring, mineral baths (8), electrophoresis of 2.5% succinic acid solution according to the method described above, 10 procedures per treatment course. When discharged from the clinic, she did not show any complaints, pain in the abdomen during palpation was not determined. The size of the liver decreased to normal. Examination data after treatment: the number of leukocytes - 4.6 · 10 ⁹ / l, lymphocytes - 27%, neutrophils - 65%, monocytes - 5%, eosinophils - 2%. Blood bilirubin - 10.1 μmol / L, cholesterol - 4.4 mmol / L, alkaline phosphatase - 136 U / L, plasma MDA - 1.090 μmol / L, ATP in red blood cells - 584 μmol / L, AMP - 38 μmol / l., energy charge - 0.89 units. The activity of LDH is 1090 units, a-GFDH is 570 units, lactate is 1.36 mmol / l, pyruvate is 0.061 mmol / l. Thus, as a result of the treatment, there is a positive dynamics of both subjective symptoms and laboratory research methods, indicating an improvement in the functional state of the liver, energy metabolism, and adaptation processes.

Patient S.N.N., 55 years old, medical history No. 944. Diagnosis at admission: ZhKB. Cholecystectomy in 2005. Chronic biliary-dependent pancreatitis in the phase of incomplete remission. Complaints at admission: general weakness, fatigue, pain in the epigastric region and around the navel shortly after eating, bloating, constipation. On palpation of the abdomen - moderate soreness in the epigastric region, in the projection of the pancreas and in the right hypochondrium. The liver at the edge of the costal arch is painless.

Blood analysis; the number of leukocytes - 3.5 · 10 ⁹ / l, lymphocytes - 20%, neutrophils - 68%, monocytes - 8%, eosinophils - 2. Blood bilirubin - 29 μmol / l, cholesterol - 3.6 mmol / l, alkaline fascatase - 124 U / L, the level of MDA in plasma is 1.16 μmol / L. ATP in red blood cells - 600 μmol / l, AMP - 60 μmol / l, energy charge - 0.82 units, LDH activity in lymphocytes - 1025 units, a-GPDH - 525 units, lactate - 2.9 mmol / l, pyruvate - 0.080 mmol / l, which is typical for a deficiency in energy metabolism. The treatment was carried out: sparing mode of motor activity, diet nutrition No. 5, internal intake of mineral water from the Slavyanovsky spring, mineral baths (10) electrophoresis of 2.5% succinic acid solution according to the method described above, 10 procedures per treatment course. At discharge from the clinic did not show complaints. On palpation, abdominal tenderness was not detected. The liver is not enlarged. Blood test: the number of leukocytes - 6.2 · 10 ⁹ / l, lymphocytes - 33%, neutrophils - 59%, monocytes - 4%, eosinophils - 2%. Blood bilirubin - 17.2 μmol / L, cholesterol - 3.6 mmol / L, alkaline phosphatase - 101 U / L, plasma MDA - 0.84 μmol / L, ATP in red blood cells - 680 μmol / L, AMP - 43 μmol / l, energy charge - 0.89 units, SDH activity in lymphocytes - 1070 units, a-GPDH - 560 units, lactate - 2.0 mmol / l, pyruvate - 0.070 mmol / l. Thus, an improvement in clinical examination data was noted against the background of an improvement in the functional state of the liver and energy metabolism and the state of adaptation. Discharged from the clinic with improvement.

Patient Z.G.A., 52 years old, medical history No. 1543. Diagnosis: cholelithiasis. Cholecystectomy in 2003. Chronic gastroduodenitis with preserved secretory activity in the phase of incomplete remission. Complaints at admission: general weakness, decreased performance, irritability. Aching pain in the upper abdomen 1 hour after eating, heaviness in the right hypochondrium, heartburn, bitterness in the mouth, belching of the air, bloating, bowel movements, and constipation with loose stools. Blood test: the number of leukocytes - 3.7 · 10 ⁹ / l, lymphocytes - 18%, neutrophils - 70%, monocytes - 8%, eosinophils - 2. Blood bilirubin - 18.1 μmol / l, cholesterol - 4.8 mmol / l, alkaline phosphatase - 211 U / l, the level of MDA in plasma - 1.29 μmol / l. The total energy deficit was revealed: the ATP level in erythrocytes is 524 μmol / l, AMP is 72 μmol / l, energy charge is 0.08, units. the activity of LDH in lymphocytes is 1095 units, a-GPDH - 580 units, lactate - 2.44 mmol / l, pyruvate - 0.09 mmol / l. The treatment was carried out - sparing mode of motor activity, nutrition according to diet No. 5, internal intake of mineral water from the Slavyanovsky spring, mineral baths (10), electrophoresis of 2.5% succinic acid solution according to the method described above, 12 treatments per treatment course. When discharged from the clinic, she did not show any complaints, pain in the abdomen during palpation was not determined. The liver contracted to normal size. As a result of the treatment, the patient's condition improved, abdominal pain, dyspepsia disappeared, stool became more regular, bloating decreased, appetite, sleep improved, she became more alert, general weakness decreased.

Examination data after treatment: the number of leukocytes - 7.8 · 10 ⁹ / l, lymphocytes - 23%, neutrophils - 65%, monocytes - 7%, eosinophils - 3%. Blood bilirubin - 13.1 μmol / L, cholesterol - 4.1 mmol / L, alkaline phosphatase - 136 U / L, plasma MDA - 0.86 μmol / L, ATP in red blood cells - 582 μmol / L, AMP - 48 μmol / l, energy charge - 0.83 units. The activity of LDH is 1040 units, a-GFDH is 550 units, lactate is 1.42 mmol / l, pyruvate is 0.049 mmol / l. As a result of treatment, positive dynamics of the clinical manifestations of the disease, as well as laboratory data (hematological indicators, functional liver tests, indicators of the state of adaptation and energy metabolism) were noted.

The method was tested in the conditions of the Zheleznovodsk clinic - a branch of the Federal State Institution Pyatigorsk State Research Institute of Health and Social Development of Roszdrav on two groups of patients — the main group (20 people) and the control group (25 people) who received treatment according to the method of the invention and prototype, respectively. The clinical characteristics of patients are presented in table 1.

Table 1
Clinical characteristics of the main and control groups of patients Indicator The main group n = 20 number -% Control group n = 25 number -% Floor male 3-15 5-20 female 17-85 20-80 Age 20-30 years - - 31-40 years old 1-5 - 41-50 years old 9-45 13-52 over 50 years 10-50 12-48 Dates after surgery up to 3 years 6-30 12-48 3-5 years 6-30 3-12 more than 5 years 8-40 10-40 Accompanying illnesses YABDK 2-10 2-8 Chr. pancreatitis 18-90 15-60 Ischemic heart disease 1-5 1-4 Arterial hypertension 2-10 3-12

According to the data in Table 1, the distribution of patients according to the main clinical indicators in the main and control groups was identical.

We have revealed significant disturbances in energy metabolism in patients after cholecystectomy. The data of these indicators in comparison with healthy individuals are given in table. 2.

table 2
Blood energy metabolism in patients after cholecystectomy and healthy individuals Indicator I II R healthy faces (n = 15) sick persons (n = 45) I-II ATP, micromol / l 689.87 ± 25.64 472.9 ± 6.16 <0.05 AMP, µmol / l 28.39 ± 2.4 74.07 ± 0.79 <0.05 Energy charge, units 0.84 ± 0.006 0.624 ± 0.0133 <0.05 ATF / AMF 24.3 ± 0.01 7.17 ± 0.12 <0.05 LDH, units active 1071.13 ± 4.51 1246 ± 6.40 <0.05 a-GFDG, units 555.0 ± 5.96 597.4 ± 9.49 > 0.05 MDA plasma, µmol / l 1.03 ± 0.02 0.98 ± 0.03 > 0.05 Lactate, mmol / L 1.26 ± 0.03 3.78 ± 0.149 <0.05 Pyruvate, mmol / l 0,07 ± 0,001 0.072 ± 0.002 > 0.05

The lack of energy supply for a significant part of patients after cholecystectomy necessitates this fact to be taken into account both when prescribing the motor regimen and the degree of load with medical procedures, and when additional medical factors are included.

The dynamics of the clinical manifestations of the disease in the main and control groups are shown in table. 3.

Table 3
The dynamics of clinical symptoms and objective data as a result of applying the method of the invention (I) and prototype (II) Indicator I main group (n = 20) II control group (n = 25) reference rate positive dynamics reference rate positive dynamics R Pain syndrome 12-60% 8-66.7% 15-60% 5-33.3% <0.05 Dyspeptic syndrome 16-80% 11-68.8% 19-76% 9-47.4% <0.05 Asteno-neurotic syndrome 14-70% 12-85.7% 17-68% 14-82.4% > 0.05 Hepatomegaly 11-55% 7-63.6% 15-60% 7-46.7% > 0.05 Pain on palpation of the abdomen 6-30% 5-83.3% 7-28% 3-43% <0.05

Given in the table. 3 data indicate that the positive dynamics of the main manifestations of the disease was more pronounced in the main group compared with the control - this refers to pain and dyspeptic syndrome and normalization of liver size.

According to a laboratory study, the following dynamics of the main indicators of the functional state of the liver, lipid peroxidation, and energy metabolism in the main and control groups were noted (Tables 4, 5).

Table 4
Biochemical blood parameters before and after treatment in the main and control groups of patients Indicator I main group (n = 20) M ± m II control group (n = 25) M ± m p before treatment after treatment before treatment after treatment I-II Bilirubin, μmol / L 22.3 ± 0.09 18.3 ± 0.05 23.4 ± 0.08 21.8 ± 0.01 <0.05 Cholesterol, mmol / L 6.0 ± 0.12 5.9 ± 0.12 6.3 ± 0.02 6.1 ± 0.02 > 0.05 Alkaline phosphatase, E / L 123.3 ± 5.0 115.7 ± 4.2 123.2 ± 4.9 121.1 ± 4.8 > 0.05 MDA in plasma, μmol / L 1.03 ± 0.04 0.85 ± 0.03 0.94 ± 0.03 0.91 ± 0.03 <0.05

Table 5
Indicators of energy metabolism before and after treatment in the main and control groups of patients Indicator I main group (n = 20) II control group (n = 25) p before treatment after treatment before treatment after treatment I-II ATP, micromol / l 473.2 ± 8.74 524.9 ± 10.30 472.6 ± 8.78 484.3 ± 6.86 <0.05 AMP, µmol / l 76.1 ± 0.92 59.4 ± 1.38 72.4 ± 1.12 65.5 ± 1.42 <0.05 Energy charge, units 0.61 ± 0.02 0.89 ± 0.02 0.63 ± 0.02 0.72 ± 0.01 <0.05 ATF / AMF 7.14 ± 0.163 11.01 ± 0.295 7.19 ± 0.17 9.42 ± 0.33 <0.05 LDH, units 1246 ± 8.314 1068 ± 26.960 1245 ± 9.56 1128 ± 25.64 > 0.05 a-GFDG, units 623.7 ± 9.99 532.5 ± 10.92 576.4 ± 13.88 548.5 ± 9.15 > 0.05 Lactate, mmol / L 3.49 ± 0.195 3.87 ± 0.558 4.01 ± 0.21 3.9 ± 0.43 > 0.05 Pyruvate, mmol / l 0.073 ± 0.003 0.061 ± 0.002 0.072 ± 0.003 0.070 ± 0.002 <0.05

The results of the study indicate an improvement in the functional state of the liver, lipid peroxidation and energy metabolism. When comparing the results of treatment in both groups, there was a pronounced advantage of the treatment complex using succinic acid electrophoresis. In contrast to the control group of patients in the main group, the level of blood bilirubin and MDA in plasma significantly decreased, the level of ATP and energy charge significantly increased, the level of AMP and pyruvate decreased.

Thus, in patients who underwent cholecystectomy, significant violations of the general condition are observed in the form of pain, dyspeptic and astheno-neurotic syndromes, as well as violations of the functional state of the liver and adaptation processes according to hematological parameters, lipid peroxidation and energy metabolism.

To increase the effectiveness of the rehabilitation treatment of patients after gallbladder removal at the stage of spa treatment, along with the intake of low-carbonated, low-mineralized sulfate-bicarbonate calcium-sodium mineral water and mineral baths, the appointment of electrophoresis of 2.5% succinic acid solution according to the developed method is recommended, it helps to reduce the severity of disturbed digestion syndrome after surgery, stabilizes peroxide homeostasis and improves adaptation s abilities of the body, including energy metabolism.

Claims (1)

A method of treating patients after removal of the gallbladder, including a gentle or gentle-training regimen of motor activity, nutrition according to diet No. 5, ingestion of low-mineralized, low-carbonate sulfate-sodium-calcium mineral water and mineral baths with the use of low-carbonate sulfate-sodium-calcium carbonate water at a temperature of 36-37 ° C for 12-15 minutes, 8-10 procedures per treatment course, characterized in that electrophoresis of a 2.5% solution of amber is additionally carried out molecular weight acid in the interscapular area with the cathode at the other location pads - anode - on the area of projection of the liver and the right hypochondrium at a current of 15-25 mA for 15-25 min daily, a course of treatment procedures 10-12.