RU2372887C1 - Method of treating children suffering from functional intestinal upset - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine and physiotherapy. The method involves ultrasound exposure through native mud. Therefor, ultrasound of frequency 0.88 MHz and power 0.6 Wt/cm² is used in continuous mode. Exposure is contact, labile at rate 1 cm/sec during 10 minutes and combined with pressing in a projection of ascending, transverse and descending colon. Therapeutic course numbers 8 procedures.

EFFECT: method ensures sustained resoponse in patients with chronic intestinal upsets, disappearance of clinical symptoms already after monthly therapeutic course.

2 ex, 5 tbl

Description

The invention relates to medicine, namely to physiotherapy, and is of great relevance.

Functional bowel disorders in children are more common than expected. First of all, this is malabsorption syndrome, malabsorption and cleavage in the small intestine, defects in enzyme systems leading to disruption of metabolic processes. Malabsorption syndrome suggests the presence of enteric syndrome and malnutrition.

Primary forms are inherited in an autosomal recessive manner. Secondary are the result of damage to the intestinal epithelium due to various diseases of the gastrointestinal tract.

The most common enterocellular malabsorption, namely disaccharidase deficiency: lactase, sucrose, isomaltase deficiency. Attempts to treat these disorders with diet therapy and medications do not always give positive results, remission lasts up to 3 months, no more, accompanied by periodic breakdowns.

To this end, we tried to prolong the remission of these disorders, increasing the activity of intestinal enzymes and eliminating the autoimmune inflammatory process in it with the help of physiological agents. One such remedy is peloid therapy. This method is known and therefore we decided to modify it by phonophoresis of peloids. The method is more economical and aesthetic and, according to our assumptions, more efficient. The clinical characteristics of patients are presented in table 1.

The prototype method is as follows: peloids in the form of a mud cake are placed on the entire abdomen t = 38 °, 10-15 'depending on age, the procedures are carried out every other day, on a course of 8-10 procedures (Stepanenko V.M., Tarverdyan T.A., Vasilenko A.B. et al. “Resort and preformed factors in the treatment of chronic enterocolitis in children.” V Congress of balneologists and physiotherapists, Odessa, October, 1991).

Together with the internal intake of mineral water, peloid therapy causes an increase in the activity of intestinal enzymes, eliminates stasis in the vessels and improves blood circulation in it (Tables 2, 3).

The disadvantage of this method is that the method can only be used in specialized sanatoriums with a base of peloids.

The technical result of the proposed method is the achievement of stable remission, the disappearance of the clinical symptoms of the disease after a month of treatment.

The specified technical result is achieved in that a method of treating children with chronic intestinal diseases, including exposure to ultrasound and native mud, is characterized in that exposure to ultrasound is carried out through native mud with a frequency of 0.88 MHz in a continuous mode with a power of 0.6 W / cm ² , contact , labile, with compression in the projection of the ascending transverse colonic and descending sections of the large intestine at a speed of 1 cm / s, for 10 minutes per course of 8 procedures.

The proposed method is as follows: through native mud, mechanical vibrations of the medium are carried out with an ultrasonic frequency of 0.88 MHz in a continuous mode with a power of 0.6 W / cm ² , using a 4 cm ² ultrasonic therapy emitter, contact, labile, with compression in the upward transverse projection - of the free and descending sections of the large intestine at a speed of 1 cm / s for 10 minutes, every other day, in a course of 8 procedures.

With this pathology, pelophoresis is performed for the first time.

The method allows to reduce or eliminate the main symptoms of the disease due to the impact on the pathogenetic links of the disease, improves absorption in the small intestine, eliminates impaired cleavage and thereby normalizes digestion.

It is known that any heat in this case, peloids eliminates vascular stasis, improves blood circulation and metabolism in the cell of the organ of influence (tab. 2, 3, 4, 5)

The method is illustrated by the following examples (control)

Observation I. Ratmir N.V., 14 years old, medical history 2230, 2006. He was in the clinic from December 5, 2006 to January 3, 2007. He was admitted with complaints of abdominal pain, nausea, loss of appetite, unstable stool (diarrhea constipation), headaches, dizziness, fatigue. Sick for 3 years.

From the anamnesis: on artificial feeding from 3 months, from birth unstable stool, more often diarrhea. He gained weight poorly, had a weight of 7 kg a year, and lagged behind in physical development - height and weight.

On admission: general condition is satisfactory, pale, low nutrition (weight 42 kg), the abdomen is soft, slightly swollen, painful in t. Kera and throughout the intestines. The liver protrudes 1.5 cm from the edge of the costal arch. There are no visible pathologies from the organs and systems. The tongue is coated with white plaque.

Ultrasound from 12/22/2006 - echo signs of gallbladder deformity, multiple constrictions of the gallbladder. Reactive changes in the head of the pancreas, swelling of the head.

In peripheral blood, Hb-107 g / l, otherwise unchanged: there is no pathology in the urine; PAT before treatment 0, after treatment 1:40 (dilution) (normal 1: 160; 1: 320). Test with D-xylose from 12/20/2006, I portion 7.1; II - 8.9; III - 8.4% before treatment. After treatment, I portion - 6.0; II portion - 7.8; III serving - 5.3%.

Catalase before treatment was 11.9 μkat / L (decreased), after treatment was 16.0 μkat / L (increased to normal), blood albumin from 12/26/2006 was 47.41%; after treatment - 48.61% (increased). Cholesterol was increased to 5.38 mmol / l, after treatment it decreased to normal 4.6.

Sugar loading tests:

with glucose - 4.9; 6.4; 3.8 mmol / l

with sucrose - 4.7; 6.8; 3.96 mmol / L

with lactose - 3.4; 3.8; 4.89 mmol / L

with maltose - 4.3; 6.6; 5.3 mmol / l

Iron in the blood is 13.6 mmol / L before treatment, 8.1 after treatment (norm 10-27), phosphorus 1.21 before treatment, after 1.37 mmol / l (norm 0.8-1.48). Ca - 2.48 before treatment, 2.46 mM / L - after (normal). Coprogram from 10.12.2006, pH 6.0 - creatorrhea, amilorrhea, steatorrhea before treatment, after treatment - amilorrhea, pH 5.5 (acid diarrhea).

Clinic diagnosis:

main DZHVP on a hypomotor type, chronic gastroduodenitis, incomplete remission

donkey Impaired absorption syndrome, lactase deficiency. Secondary reactive pancreatitis.

In the clinic, the child received diet therapy with the exception of milk, carbonic chloride-bicarbonate-sulphate sodium-calcium mineral water (source No. 24), exercise therapy. The basic therapy was peloids for the whole abdomen t 38 °, 15 ', every other day №8.

After a single treatment in the clinic, the child's health improved, her appetite returned to normal, and abdominal pain disappeared.

On ultrasound from 12.30. pancreatic edema disappeared. In the blood, Hb increased from 107 to 120 g / l, the proteolytic activity of trypsin in feces increased from 0 to 1:40. The absorption of the sample with D-xylose has not changed.

Catalase increased to normal, which indicates an increase in the oxidative defense of the body. Serum albumin increased from 47.4 to 48.61%. Elevated cholesterol 5.38 mmol / L decreased to normal 4.6 mmol / L. Load tests are not repeated, as preliminary studies have shown that improvement of these indicators occurs only after a year.

Cleavage processes according to the coprogram improved, creatorrhea, amylorrhea disappeared, and creatorrhea remained.

According to clinical indicators, the child has reached complete remission, according to paraclinical - a significant improvement, intestinal absorption has not changed. It is known that paraclinical indicators always lag behind clinical ones.

Observation II. Teimuraz X., 13 years old, Case history No. 840, was in the clinic from May 14 to June 12, 2007. Complaints of infrequent abdominal pain, nausea, unstable stool.

From the anamnesis: from birth I was on artificial feeding, after the introduction of mixtures, loose stools appeared, which alternated with constipation, distended bloating, increased rumbling in the intestines.

Upon receipt, the general condition is satisfactory, asthenic physique. All groups of lymph nodes up to 1 cm are palpated. In the lungs and heart without features. Pulse 78 beats / min, BP 100/60 mm Hg The tongue is covered with a dirty white coating, the abdomen is slightly swollen, soft upon palpation, painless. Liver at the edge of the costal arch, spleen not palpable, stool 3-4 times a day. Ultrasound from 04.06.2007 - echoes of hepatomegaly, reactive changes in the pancreas, chronic cholecystitis. Paraclinical indicators: Нb-120 g / l, red blood cells - 3.8 × 10 ¹² g / l, urine analysis without pathology; PAT in feces 1:10 (dilution) before treatment and 1:80 after treatment (normal 1: 160). The increase in serum catalase levels is 23.9 mkkat / l (N 16-22), after treatment - 26.6 mkkat / l, which is probably associated with an improvement in antioxidant protection. Before treatment, albumin is 41.92%, after 43.03%; serum iron before treatment 24.1 μmol / L, after 18.9 (N 10-27 μmol / L), phosphorus up to 1.7 mmol / L, after 1.62 (N 0.8-1.48 mmol / L); calcium before treatment 2.15 (N 2.15-2.5 mM / L), after 2.1 mM / L; magnesium 0.84 mmol / L (N 0.8-1.0), after 0.81 mmol / L.

Exercise tests: with glucose 4.3-6.0-12.4 mmol / l (potential diabetes); with lactose 4.5-5.5-5.2 mmol / l; with maltose 5.4-7.95-5.95 mmol / l; with sucrose 4.9-7.1-5.3 mmol / l, which corresponds to glucose intolerance. Coprogram from 05/17/2007 acid diarrhea pH 5.5 before treatment, after treatment pH 6.0; expressed creatorrhea, amylorrhea, steatorrhea; after treatment - violations of the processes of splitting in the small intestine were not found. Sample with D-xylose 1 serving 5.5%; 2 serving 3.9%; 3 portion 6.0% (N 16-35%), after treatment I portion 10.1; II portion 7.8; III portion 12.6%.

Diagnosis: biliary dyskinesia of the hypomotor type, chronic cholecystitis, incomplete remission. Malabsorption syndrome, lactase deficiency, glucose intolerance. VVD puberty

In the clinic, the child received the following treatment: an individual diet without milk, carbonic chloride-bicarbonate sulphate sodium-calcium mineral water of Pyatigorsk spring No. 24. Pelophonophoresis was carried out as follows: mechanical vibrations of the medium were carried out through peloids with an ultrasonic frequency of 0.88 MHz in a continuous mode with an intensity of 0.6 W / cm ² using a radiator with a head area of 4 cm ² contact, labile with compression in the projection of the ascending, transversely oblique and descending departments of the large intestine at a speed of 1 cm / s, for 10 minutes, every other day №8-10 per course.

After the treatment, the child’s condition improved, she feels well, subjective and objective abdominal pains disappeared, stools returned to normal, the liver decreased to normal, indicators after treatment of the coprogram without pathology, the proteolytic activity of trypsin in feces increased from 1:10 to 1:80 (dilution) from 41.92 to 43.03%, antioxidant protection according to the level of catalase from 23.9 to 26.6 µkat / l, the level of albumin in the blood serum increased, absorption significantly improved from 15.4 to 30.5.

In dynamics, indicators of calcium, phosphorus, serum iron did not change, since they were not reduced.

After treatment by the proposed method, circulating immune complexes in the blood decreased from 39.72 ± 3.66 to 36.09 ± 5.54 P <0.05; Ig A increased from 1.81 ± 0.11 to 2.046 ± 0.16 P <0.007; FAL from 51.64 ± 1.37 to 58.47 ± 2.15 P <0.01; PHIL (%) 0.96 ± 0.09 to 1.38 ± 0.15 P <0.06, i.e. in children after treatment by pelophonophoresis, immunogenesis is stabilized.

The long-term results were studied in both children after 6 months. It was noted that the second child did not have an exacerbation of the disease after pelophonophoresis, in the second case, remission lasted 3 months.

The given case histories clearly illustrate the advantage of pelophonophoresis.

Testing of the proposed method was carried out in the clinic of the Federal State Institution "Pyatigorsk State Research Institute of Roszdrav". The test was conducted in two groups of patients. There were 22 children in one (control), 36 children in the main group.

According to the results of treatment by known and proposed methods, the advantages of the second are revealed, which are manifested in achieving a lasting therapeutic effect.

Claims (1)

A method of treating children with chronic intestinal diseases, including exposure to ultrasound and native mud, characterized in that the exposure to ultrasound is carried out through native mud, a frequency of 0.88 MHz, in continuous mode, with a power of 0.6 W / cm ² , contact, labile, with compression in the projection of the ascending, transverse colon and descending sections of the large intestine, at a speed of 1 cm / s, for 10 minutes, for a course of 8 procedures.