RU2327474C1 - Method of alcoholic abstinence syndrome reduction - Google Patents

Abstract

FIELD: medicine; psychiatry.

SUBSTANCE: method of alcoholic abstinence syndrome (AAS) reduction includes pharmacotherapy, that is oral introduction of sorbent powder suspension Polysorb MP in amount 50-150 ml of concentration 1-1.5 g of powder per kg of body weight. Then 1000 ml of plasma-substituting agent Plasma-lyt 148 or Rheamberyn is drop-by-drop intravenously introduced in daily dose 10 mg/kg. It is accompanied with hydrocolonotherapy with Polysorb MP concentrated not more than 100-200 mg per 1 kg of body weight followed with rectal insufflations of gaseous ozone-oxygen mixture containing ozone concentrated 10-60 ml/l and volume up to 150 ml. Intravenous injection of Plasma-lyt 148 or Rheamberyn is accompanied with additional intravenous bolus injection of polyvitamin agent Cernevit in 5 ml of injection water or 5% glucose solution. Additionally psychopathological and neurovegetative disorders are corrected.

EFFECT: more rapid elimination of disorders associated with abstinence syndrome without by-effects and complications.

5 cl, 1 ex

Description

The invention relates to medicine, namely to psychiatry - narcology, and can be used to relieve alcohol withdrawal syndrome (AAS).

The methods of relieving alcohol withdrawal syndrome, including the use of drugs aimed, in particular, at restoring the activity of enzyme systems inhibited by the action of alcohol on the body, are widely used. Some approaches to the treatment of alcoholism include the appointment of tranquilizers, antipsychotics, psychostimulating drugs and antidepressants.

A known method of stopping alcohol withdrawal symptoms through drug therapy, including a single intravenous drip of 200-400 ml of polyamine. (RF patent for the invention No. 2022556, IPC: A61K 31/195).

However, the use of polyamine is contraindicated in acute hemodynamic disorders and does not correct metabolic disorders, including heart rhythm disturbances, often found in AAS of moderate and high severity. In addition, the use of polyamine does not make up for a pronounced deficiency of vitamins in AAS.

There is also a method of stopping alcohol withdrawal syndrome, alcohol delirium, acute alcohol hallucinosis, including parenteral administration of naloxone in a dose of 0.4-0.8 mg per dose after 0.25-4.0 hours before the onset of drug sleep with continued administration of naloxone after waking up before regression of clinical symptoms. (RF patent for the invention No. 2215527, IPC: A61K 31/44, A61P 25/32).

However, the frequent use of the drug naloxone (every 0.25-4.0 h) until the desired effect increases the risk of side effects: increased tremors, seizures, increased blood pressure, increased tachycardia, nausea, vomiting, which is especially dangerous for patients with history of traumatic brain injury, myocardial infarction, arterial hypertension, epileptiform seizures. In addition, the use of naloxone does not exclude increased anxiety, mental arousal, the appearance of hallucinations, which significantly increases the risk of developing alcoholic psychosis or severe depression with suicidal thoughts. The use of naloxone does not completely stop somato-neurological disorders expressed in AAS, and can significantly increase the duration of treatment.

A known method of treating withdrawal symptoms in patients with chronic alcoholism, including the introduction of drugs and enterosorbent based on activated carbon. As an enterosorbent, enterosorbent is used, pre-saturated with 40% alcohol in combination with relanium on a 40% glucose solution. (RF patent for the invention No. 1186221, IPC: A61M 1/03).

However, the drug Relanium used in the method of treatment has a toxic effect on the central nervous system and has a number of contraindications, which limits the possibility of wider use of this drug. In addition, the method is characterized by a long period of relief of withdrawal symptoms, which is more than 3 days. The use of activated carbon is contraindicated while prescribing antitoxic substances, the effect of which develops after absorption, the drug weakly adsorbs acids and alkalis, which often leads to the development of dyspeptic disorders. Activated carbon reduces the absorption of fats, proteins, vitamins, hormones, nutrients from the gastrointestinal tract, which is especially dangerous at the time of pronounced metabolic disorders that occur with AAS. A high risk is the development of hypocalcemia, because increased convulsive readiness of the brain in patients with a history of epipressure or traumatic brain injury. The use of an alcoholic sorbent can have a damaging effect on the mucous membrane of the stomach and intestines and increases the risk of exacerbation of gastric ulcer and duodenal ulcer in patients with a history of such diagnoses. Against the background of the use of this sorbent, hematological parameters may deteriorate, metabolic parameters may be impaired, which is especially dangerous with moderate and severe AAS.

There is a method of stopping withdrawal symptoms by medication on a patient, including vitamin therapy (vitamins B6, B12), detoxification therapy (unitiol, glucose, hemodez), the introduction of psychotropic drugs (seduxen, haloperidol). (Alcoholism. Edited by G.V. Morozov. M.: Medicine. 1985, p. 314-321).

However, this method is also characterized by long periods of relief of the syndrome - 3-5 days. The use of seduxen can lead to the development of side effects, and the possibility of drug addiction and a painful addiction to the drug is not ruled out. In addition, seduxen has a widespread use restriction due to the presence of contraindications. The use of haloperidol can cause complications, manifested in extrapyramidal and neurovegetative disorders. The introduction of unitiol requires its repeated use. The use of glucose solution is not effective enough, because the solution does not contain sodium, magnesium, potassium, necessary to eliminate metabolic disorders. The use of hemodesis is contraindicated in bronchial asthma, traumatic brain injury with increased intracranial pressure, and heart failure, which significantly limits the possibility of its use in patients with chronic alcoholism with AAS and does not exclude a side effect in the form of increased tachycardia and lowering blood pressure, which may represent danger against the use of psychotropic drugs.

Also known are complex methods of treating a hangover-withdrawal syndrome with the removal of the craving for alcohol, using drug therapy in combination with reflexology. For example, there is a known method, including the use of needles on corporal and auricular acupuncture points, autoheterosuggestive effect, provoking a desire to drink, liver massage with 10-15 massage movements and drug therapy in the form of a single intramuscular injection of pyrogenal and cordiamine solution and oral administration of bearberry, and in the case of bearberry increase in blood pressure - a single injection of hypothiazide. In this case, if the patient has a feeling of uncertainty every other day, electrocranostimulation with the IEM-0-2 apparatus is additionally performed. (RF patent for the invention No. 2029541, IPC: A61H 39/08, A61N 1/32).

However, despite the rather high efficiency of this method, it does not provide for the elimination of the basis of the disease - bioenergetic imbalance in the body. In addition, the known method involves the use of expensive equipment and drugs that give unwanted side effects. The use of the pyrogenal preparation does not exclude the risk of overdose and the appearance of headache, vomiting, chills, fever, which is especially dangerous in the case of high blood pressure in the patient and impaired thermoregulation that occurs with AAS.

A known method of treating alcohol withdrawal syndrome by prescribing a drug and exposure to a physical factor. SUMS-1 enterosorbent is used as a medicine, and microwave resonance therapy as a physical factor. Treatment begins in the first 36 hours after the last alcohol consumption, affects the AT55 auricular biologically active point through a dielectric waveguide for 30-40 minutes for 5-7 days, in parallel with 10-30 g of SUMS-1 sorbent 3 times a day day no earlier than 1.5 hours before or after eating food. (Application of the Russian Federation for invention No. 2004101218, IPC: А61Н 39/00, A61N 5/02, А61К 33/44).

However, the use of enterosorbent does not completely eliminate the metabolic disorders that develop in chronic alcoholism, including those associated with poor nutrition of alcoholics and malabsorption of amino acids, lipids, carbohydrates and vitamins in the intestines. In addition, the use of this drug has practically no effect on psychopathological disorders, often significantly pronounced with AAS of moderate and high severity, which increases the risk of developing delirium tremens and prolongs the time for the patient to withdraw from a hangover.

Closest to the proposed invention is a method for optimizing the treatment of alcohol withdrawal syndrome, including conducting sessions of extracorporeal irradiation of blood with blue light (EOK SS) daily for 3 days by the jet method using a Janet syringe, while the blood is irradiated twice during exfusion and reinfusion with a power density of 0 , 16 mW / cm ² and an exposure time of 5-10 minutes, additionally, medication is prescribed on the first day, including the administration of drugs with a vegetative stabilizing effect, and injections of detoxification solutions, and on the second day a hydrocolonotherapy session, then one month and three months after the first course, one session of EOK SS is carried out. (RF patent for the invention No. 2262963, IPC: A61N 5/06).

However, this method of optimizing AAS therapy is of little use for patients with poor venous access, the proposed drug therapy practically does not include detoxification therapy and is not effective enough for severe AAS and pre-delirious conditions.

The objective of the present invention is to create a more effective method of stopping alcohol withdrawal syndrome, which ensures the restoration of body functions impaired by the metabolism of ethanol and its detoxification to normalize homeostasis while reducing treatment time, reducing the amount of drug therapy during AAS relief, and reducing the possibility of side effects and complications.

The problem is achieved in that in a method of stopping alcohol withdrawal syndrome, including drug therapy and hydrocolonotherapy with a sorbent solution, an aqueous suspension of Polysorb MP sorbent powder in an amount of 50-150 ml with a concentration of 1-1.5 g of powder per oral is used as a drug therapy. kg of the patient’s body weight, after which the plasma-substituting agent Plasma-lit 148 in an amount of up to 1000 ml or Reamberin in a daily dose of up to 10 mg / kg is administered dropwise intravenously, while hydrocolonotherapy is carried out with the last blowing rectal insufflation, ozone-oxygen gas mixture. Along with drug therapy, psychopathological and neurovegetative disorders are corrected using psychotropic drugs — tranquilizers, such as Phenazepam, nootropics, such as Piracetam, Nootropil, Picamilon, Fezam, “soft” antipsychotics, such as Chlorprotixen, Sonapax, and also selective anoxazolite, such as anoxazolite . With the intravenous administration of a plasma substitute, Plasma-Lit 148 or Reamberin, the multivitamin preparation Cernevit is dissolved intravenously, dissolved in 5 ml of water for injection or 5% glucose solution. As a sorbent during hydrocolonotherapy, Polysorb MP is used in a concentration of not higher than 100-200 mg per 1 kg of body weight. Rectal insufflation of the ozone-oxygen mixture is carried out with a Janet syringe with an ozone concentration in the ozone-oxygen mixture of 10-60 mg / l and a volume of up to 150 ml. These procedures can be repeated for 3 days, depending on the severity of AAS.

Polysorb MP is an inorganic, non-selective, multifunctional enterosorbent based on highly dispersed silica. Possessing pronounced universal sorption properties, Polysorb MP in the lumen of the gastrointestinal tract binds and removes endo- and exotoxins from the body, including alcohol. Polysorb MP also sorbes some metabolic products of the body, including excess bilirubin, cholesterol, substances responsible for the development of metabolic toxicosis, has a pronounced adaptogenic and membrane-stabilizing effect, does not violate hematological parameters in AAS and immunological status, has no side effects . Enterosorbent has a high sorption capacity, does not break down and is not absorbed in the gastrointestinal tract and is excreted unchanged.

The inventive method of stopping alcohol withdrawal syndrome is as follows.

Upon admission, a clinical, biochemical, psychological examination and diagnosis of the severity of AAS are carried out in accordance with modern standards of medical care. After the examination, a suspension of 1-1.5 g of Polysorb MP sorbent powder in 1 / 4-1 / 2 glasses of water (50-150 ml) is orally prescribed.

Then, a plasma-substituting agent Plasma-Lit 148 in an amount of up to 1000 ml or Reamberin in a daily dose of up to 10 mg / kg, which correct the acid-base state, make up for the deficiency of fluid and electrolytes, reduce metabolic acidosis, improve microcirculation, increase diuresis, are intravenously administered. have detoxification and anti-shock effects.

Simultaneously with drug therapy, correction of psychopathological and neurovegetative disorders can be carried out using psychotropic drugs - tranquilizers, for example Phenazepam, nootropics, for example Piracetam, Nootropil, Picamilon, Fezam, “soft” antipsychotics, for example Chlorprotixen, Sonapenx, and also non-selective anolytic, and also non-selective anolytic and non-neuropathic drugs for example Afobazole. Depending on the severity of the disturbances, Phenazepam is prescribed mainly in the maximum daily dose of up to 6-8 g, which is divided into 3 doses and Chlorprotixen in the maximum daily dose of up to 30 mg, which is divided into 2 doses.

To enhance the detoxification effect, activate metabolism and anti-inflammatory optimization of antioxidant systems, monitor bowel cleansing (hydrocolonotherapy) is performed on the device AMOK-2A with the addition of Polysorb MP antitoxic agent in the wash water at a concentration of not more than 100-200 mg per 1 kg of body weight and subsequent rectal insufflation of a gaseous ozone-oxygen mixture. Rectal insufflation of the ozone-oxygen mixture is carried out with a Janet syringe. The ozone concentration in the ozone-oxygen mixture is 10-60 mg / l, and its volume is up to 150 ml. After 6-8 hours after rectal insufflation of the ozone-oxygen mixture, taking into account the patient’s condition, the Polysorb MP suspension in the amount of 50-150 ml is re-administered orally and, under the control of hemodynamic parameters, the Plasma-Lit 148 solution is administered intravenously in an amount of up to 1000 ml and the bolus is administered intravenously multivitamin preparation Cernevit, dissolved in 5 ml of water for injection or 5% glucose solution in order to correct vitamin deficiency and reduce neuro-vegetative disorders.

The use of Plasma-Lita 148, containing magnesium ions, along with Cernevit and psychotropic drugs, has a preventive effect on the development of alcoholic delirium. Many patients with alcoholism, especially with chronic massive alcoholization, develop a significant deficiency of magnesium ions due to inhibition of their intake from the intestines and accelerated kidney excretion. The clinical picture of acute withdrawal symptoms in alcoholism can be partially determined by the deficiency of magnesium ions. Magnesium ions are essential components of intensive care for alcoholic hangover during detoxification. The main clinical effects with its administration are sedative, anticonvulsant and moderate hypotensive. In addition, magnesium ions potentiate the effect of neurotropic drugs used in detoxification programs.

Depending on the severity of AAS, the listed procedures can be repeated for up to 3 days.

Thus, with the complex treatment of AAS, alcohol intoxication is removed, and hepatic-renal functions are improved.

This method of stopping AAS allows you to most effectively and in a short time eliminate the effect of factors contributing to the development of AAS: ethanol deprivation in tolerant individuals, intoxication with products of oxidative metabolism of ethanol, metabolic disorders that develop with AAS, including associated with malnutrition in patients with alcoholism and malabsorption of amino acids, vitamins, lipids, carbohydrates in the intestines, as well as reduce the dose of prescribed psychotropic drugs. Hydrocolonotherapy with rectal insufflation of a gaseous ozone-oxygen mixture is necessary to obtain local and general detoxification, anti-inflammatory and immunomodulating effects. The ozone-oxygen mixture, rapidly absorbed through the intestinal mucosa, also has a general metabolic effect. This treatment complex reduces the risk of developing emergency conditions that occur during the period of alcohol withdrawal, provides relief of the main somatoneurological disorders in AAS and potentiates the effectiveness of the subsequent anti-relapse therapy of chronic alcoholism by known methods. The method is implemented in a day hospital and allows you to quickly restore the patient's ability to work.

An example implementation of the method.

Patient E., 36 years old, primary vocational education. Heredity burdened - father abused alcohol. Suffers from arterial hypertension 2 tbsp., Antihypertensive drugs uses occasionally. Alcohol abuse began at age 18. It was alcoholized mainly with vodka with an increase in tolerance of up to 1 liter per day, often mixed with beer. Sometimes he used moonshine and diluted alcohol of unknown origin. AAS was formed from 28 years old, pseudo bouts lasting up to 10-14 days were repeated at intervals of up to 2-3 weeks. In a state of intoxication, he is brutal, angry, sometimes aggressive, he entered into fights on the street. He noted the palimpsest after alcoholic excesses. The structure of withdrawal syndrome was dominated by: asthenia, sleep disturbances, appetite, sweating, palpitations, tremor of the fingers, uncontrolled craving for alcohol, anxiety. When handling, the period of abstinence from alcohol was one day. He complained of general weakness, weakness, sweating, headache, lack of appetite, thirst, active attraction to alcohol, "trembling" in the hands, restless sleep. Objectively: a state of moderate severity, low nutrition, hyperemic skin, single telangiectasias on the cheeks and wings of the nose, dry tongue, white plaque, hyperhidrosis, cardiac sounds are rhythmic, muffled, tachycardia up to 106 beats per minute, blood pressure - 160/100 mm Hg, vesicular breathing. The abdomen is soft, painless, the liver 2 cm below the costal arch. In the Romberg position unstable, tremor of the tips of the fingers of outstretched arms, tongue. Formally critical of his condition, he is oriented comprehensively correctly, eagerly reveals his experiences, is depressed, emotionally labile, fussy. She does not express suicidal and delusional ideas, disturbances of perception and thinking are not noted, behavior is adequate to the situation. When examining on an ECG: sinus tachycardia up to 92 beats per minute, violation of intraventricular conduction. Biochemical analysis of blood: total bilirubin - 34 μmol / l, direct - 6.0 μmol / l, ALT - 0.62 μmol / l, ACT - 0.72 μmol / l. In the general analysis of blood: hemoglobin - 128 g / l, platelet count - 162 · 10 ⁹ / l. After assessing the severity of AAS and obtaining patient consent, a course of treatment procedures was carried out for one day in a day hospital; An aqueous suspension of the Polysorb MP sorbent was used in an amount of 100 ml orally 2 times a day, a plasma-replacing drug Plasma-Lit 148 in an amount of 1000 ml was administered intravenously and a multivitamin preparation Zernevit, dissolved in 5 ml of water for injection, was injected bolus, followed by hydrocolonotherapy with addition Polysorb MP sorbent in washing water followed by rectal insufflation of a gaseous ozone-oxygen mixture with an ozone concentration of 40 mg / L. At the same time, correction of psychopathological disorders was carried out by 2-fold intramuscular injection of the drug Phenazepam in 2.0 ml.

In the dynamics against the background of the therapy, the patient's condition progressively improved: there was an improvement in overall well-being, increased mood, headache, anxiety, thirst decreased, and craving for alcohol decreased. Objectively: satisfactory condition, hyperemia of the skin of the face decreased, heart rate - 84 beats per minute, blood pressure - 130/80 mm Hg Rational psychotherapy was carried out to form a further orientation to sobriety, recommendations were given regarding nutrition and lifestyle, Afobazole was prescribed 1 tablet (10 mg) 3 times a day for 1 month. When re-examined after 1 month, the patient did not complain, abstained from drinking alcohol.

Within three months, studies have been conducted of the proposed method of stopping AAS. During this period, 66 patients asked for help, and in 49 cases (74.2%) AAS of moderate and high severity was verified. AAS was successfully stopped in all 66 treated patients, complications and side effects, including allergic reactions, were not noted, there was not a single case of an aggravation of the condition of patients with the formation of delirium or other alcoholic psychoses, which should be considered a very satisfactory result.

Claims (5)

1. A method of stopping alcohol withdrawal syndrome, including drug therapy, hydrocolonotherapy with a sorbent solution, characterized in that as a drug therapy, an aqueous suspension of Polysorb MP sorbent powder is used orally in an amount of 50-150 ml with a concentration of 1-1.5 g of powder per 1 kg of the patient’s body weight, after which the plasma-replacing agent Plasma-lit 148 in an amount of up to 1000 ml or Reamberin in a daily dose of up to 10 mg / kg is administered dropwise intravenously, while hydrocolonotherapy is carried out using a sorbent olisorb MP in a concentration of not more than 100-200 mg per 1 kg of body weight, followed by rectal insufflation, ozone-oxygen gas mixture. 2. The method according to claim 1, characterized in that they additionally carry out the correction of psychopathological and neurovegetative disorders using psychotropic tranquilizers, for example Phenazepam, nootropics, for example Piracetam, Nootropil, Picamilon, Fezam, “soft” antipsychotics, for example Chlorprotixen, Sonapaks, as well as selective anxiolytics of the non-benzodiazepine series, for example Afobazole. 3. The method according to claim 1, characterized in that when the plasma-substituting agent Plasma-Lit 148 or Reamberin is intravenously administered, the multivitamin preparation Cernevit is dissolved intravenously, dissolved in 5 ml of water for injection or 5% glucose solution. 4. The method according to claim 1, characterized in that the rectal insufflation of the ozone-oxygen mixture is carried out with a Janet syringe with an ozone concentration in the ozone-oxygen mixture of 10-60 mg / l and a volume of up to 150 ml. 5. The method according to claim 1, characterized in that the above procedures can be repeated for three days.