RU2387468C2 - Method of treating chronic constipation in children - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: anterior abdominal surface of the patient is exposed to triangular magnetic pulse train generated by the apparatus "Seta-1" with a surface induction 0.75 T to 1.25 T, number of pulses - 6, pulse separation 60-100 msec, pulse train repetition frequency 30 per minute. An inducer 1 is placed in the right iliac region above the blind intestine and ascending colon; while the inducer 2 is arranged within the descending colon. At the first procedure, induction is 0.75 T, after 2-3 procedures, it is increased to 1.25 T; exposure time is 8-10 minutes. The procedures are carried out daily. Therapeutic course is 8-10 procedures.

EFFECT: method of treating chronic constipation in children allows improving the psychoemotional condition, stool consistence, normalising a regular bowel habits, and also prolonging remission to 6-8 months.

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Description

The invention relates to medicine, in particular to pediatrics, namely to gastroenterology, coloproctology, to the treatment of chronic constipation in children, and can be used in a clinic, hospital, sanatorium.

It is known that the problem of the prevention and treatment of constipation in children is one of the urgent in modern pediatrics, due to the high prevalence (10-25%), the possibility of complications (secondary colitis, calomazany, rectal fissures, paraproctitis) and an adverse effect on growth and development a child.

Known methods of medical and physiotherapeutic treatment of disorders of the motor function of the colon (chronic constipation) in children (A.I. Lenyushkin. Pediatric coloproctology. M .: Medicine, 1990, T.V. Karachentseva. Guide to physiotherapy and physioprophylaxis of childhood diseases. M. : Medicine, 1987).

The disadvantage of drug therapy, in particular the use of diet therapy, enzymes, antispasmodics, laxatives, is the development of resistance to a number of drugs, the possibility of adverse reactions to medications and an increase in the allergy of the child’s body.

Methods of physiotherapeutic treatment of chronic constipation in children are also known: drug electrophoresis, pulsed currents, local darsonvalization, ultratonotherapy (A.N. Razumov, M.A. Khan, L.A. Krivtsova, V.I.Demchenko. Physiotherapy in pediatrics. 2003 ), inductothermy, UHF electric field, mud therapy, balneotherapy (E.B. Vygodner, 1993), cryotherapy (O.F. Kuznetsov, PMFilimonov, S.N.Serebryakov, E.M. Styazhkina, 2003), but they do not have sufficient effectiveness, do not reduce the treatment time. At the same time, an increase in the number of patients and the insufficient effectiveness of both drug and physical methods of treatment require the further development of new methods for the treatment of chronic constipation in children.

The closest in technical essence to the proposed method is a method for the treatment of chronic constipation in children, which consists in the use of magneto-infrared laser therapy from the MILTA apparatus by exposing the zone of the 4th intercostal space to the left at the edge of the sternum with a frequency of 5 Hz for 5 minutes, on the right ileal region, the projection of the hepatic angle of the colon, the area between the navel and the xiphoid process, the navel, the projection of the splenic angle of the colon, the left ileal region with a frequency of 5 Hz, for 2 minutes, paravertebral from the level I angle of the shoulder blades to the fifth sacral vertebra, scanning with a frequency of 1000 Hz, 3 minutes each, for a course of 10-12 procedures (Avdoshin VP, Gaydamakina AM, Grabovschiner F.Ya. et al. Methodical recommendations for the use of the MILTA quantum therapy apparatus 5th edition. M. 1999).

The disadvantage of the prototype magneto-infrared laser therapy is an unstable clinical effect and short periods of remission.

The technical result of the proposed method for the treatment of chronic constipation is to increase the therapeutic effect, persistent clinical effect and increase the period of remission.

The specified technical result is achieved by the fact that against the background of drug therapy, the patient is affected by a pulsed magnetic field on the front surface of the abdomen with a series of triangular magnetic pulses on the inductor surface from 0.75 T to 1.25 T, the number of pulses in the series is 6, the interval between pulses in series of 60-100 ms, the pulse sequence repetition rate per minute is 30, while the inductor 1 is installed in the right ileal region above the cecum and ascending colon, and the inductor 2 is placed on the descending part of the colon. The parameters for the first procedure are 0.75 T, after 2-3 procedures they are increased to 1.25 T, the exposure time is 8-10 minutes, the procedures are carried out daily, the course is 8-10 procedures.

Description of the treatment method.

After preliminary clinical, laboratory, radiological and ultrasound studies, they begin treatment.

The patient is placed on a couch in the physiotherapy room with his stomach up, he frees the abdomen from clothing. Then carry out the impact of a pulsed magnetic field of large amplitude from the apparatus "SETA-1". Inductors with dimensions of 215 × 11 × 30 mm are imposed on the front surface of the abdomen, previously disinfected by thoroughly wiping them twice with a cloth of calico or gauze moistened with a 70% solution of ethyl alcohol. Inductor 1 is installed in the right ileal region above the cecum and ascending colon in contact, inductor 2 on the descending part of the colon. Then the inductors are pressed with a bag of sand. Then they turn on the device, set the exposure parameters and the procedure time on the timer, depending on the age of the patient by highlighting the numbers on the digital indicators of the control unit using the "h / w" and "int" buttons.

In the first procedure - 0.75 T, after 2-3 procedures they increase to 1.25 T, the exposure time is 8-10 minutes, the procedures are carried out daily, the course is 8-10 procedures.

Examples of the method.

Example 1: A patient, Andrei I., aged 7, was admitted to the gastroenterological department of the Moscow City Clinical Hospital with a diagnosis of Chronic constipation against the background of an anomaly in the development of the colon (dolichosigma). Reactive pancreatic changes.

From the anamnesis it is known that a child is from 2 pregnancies, from 2 normal births, proceeding without complications. Early development by age. Past diseases: rubella. Allergic history is not burdened. From the age of 5, there is a lack of stool up to 3 days. According to the parents, an independent chair on the 4th day of large diameter and volume, dense consistency without pathological impurities. The act of defecation is accompanied by painful phenomena. In 2006, the child was examined at the Russian Children's Clinical Hospital, where, after irrigography, the diagnosis was made: Chronic constipation on the background of an abnormality of the colon. Dolichosigma. Left-sided colitis. A laxative diet, hypertensive salt cleansing enemas, and a course of dufalac are recommended. Against the background of treatment, stool 1 time in 2 days, the nature of the stool has not changed.

Upon admission to the department, the state of moderate severity of the underlying disease, the state of health does not suffer. Active Appetite is reduced. Complaints about a long (up to 3-4 days) lack of stool without the urge to defecate. In the absence of stool for more than 3 days, calomazany phenomena are noted. Weight 25 kg, height 123.5 cm. The skin and visible mucous membranes are clean. Free breathing through the nose. In the lungs, vesicular breathing, no wheezing, RR 22 per min. Heart sounds are clear, rhythmic. Pulse 96 per minute. HELL 110/60 mm Hg The tongue is coated at the root with a white coating, moist. Bad breath. The abdomen is soft, not swollen, with deep palpation - painful along the sigmoid colon. The liver is at the edge of the costal arch, the spleen is not palpable. Constipation up to 3-4 days. Encopres 1 time in 4 days. There are no dysuric phenomena. Inspection per rectum .: rectal ampoule is moderately expanded. Call saved. The sphincter tone is normal.

When examining the department:

- Irrigography: the colon was quickly filled with a solution of barium suspension in tannin. The sigmoid colon is elongated with the formation of an additional loop, which projects under the transverse colon and in the splenic corner. The haustration is deep. Emptying is satisfactory. The relief of the folds of the mucosa is not changed. Conclusion: dolichosigma.

- Ultrasound of the abdominal cavity: The gall bladder is not enlarged (53 × 15 mm), the walls are not sealed. The pancreas is enlarged (14 × 12 × 16 mm), the echogenicity of the parenchyma is increased. The liver is not enlarged, homogeneous, not changed. The spleen is not enlarged (71 × 38 mm), the parenchyma is homogeneous.

Ultrasound of the colon: the rectum is moderately dilated.

The sigmoid colon is atonic. The walls are not changed.

In the department, the child received treatment: laxative diet, mezim-forte, duphalac, exercise therapy course, as well as magnetic pulse induction. The impact of the pulsed magnetic field on the anterior abdominal wall was carried out from the apparatus "SETA-1" using inductors. Inductor 1 was installed in the right ileal region above the cecum and ascending colon in contact, inductor 2 was placed on the descending part of the colon, during the first procedure - 0.75 T, after 3 procedures increasing to 1.25 T. The exposure time is 10 minutes. Procedures were carried out daily for a course of 10 procedures.

After 2-3 procedures, the child stopped pain in the descending sections of the intestine, stool 1 time in 2 days, soft consistency, decorated. By the end of the course of treatment, an independent chair was established, daily, soft consistency, decorated, encopresis was not observed. When conducting a test enema, a test for residual feces is negative.

Examination 2 months after the course of treatment showed positive dynamics according to intestinal ultrasound: the rectum was not expanded, the muscle layer was 2.2 mm, homogeneous.

Follow-up observation after 6 months showed that the condition of the child is still satisfactory, stool delays were no longer noted.

Example 2: A patient, Vitaliy M. .. 10 years old, was admitted to the gastroenterological department of the ICHCR with a diagnosis of Chronic constipation on the background of dolichosigma. Chronic gastroduodenitis, exacerbation. Biliary dyskinesia.

From the anamnesis it is known that a child is from 1 pregnancy, 1 urgent birth. Weight at birth 3500 g, length 50 cm. On artificial feeding from birth. Early development by age. At the age of 4 years there were complaints of recurrent abdominal pain that was not associated with eating, stool retention of up to 2-3 days. The stool is large in diameter, without pathological impurities. According to the parents, after taking laxatives, dieting, cleansing enemas, a short positive trend was observed for 1-2 months. Stool 1 time in 1-2 days, decorated without pathological impurities.

Upon admission to the department, the state of moderate severity for the underlying disease. Weight 39 kg, height 138 cm. The skin is clean, pale. Zev is calm. Free breathing through the nose. In the lungs, vesicular breathing, no wheezing. BH 18 / min. Heart sounds are clear rhythmic. Heart rate 78 beats / min. The tongue at the root is covered with a white coating. The abdomen is of the usual form, soft, with superficial palpation moderately painful in the epigastric region and the projection point of the gallbladder, rumbling along the intestine. With deep palpation, soreness along the large intestine. Liver at the edge of the costal arch. The spleen is not palpable. Stool 1 time in 4-5 days, large diameter, without pathological impurities. Urination is not impaired. Inspection per rectum.: The rectal ampoule is moderately expanded, in the lumen there are dense feces, the sphincter tone is preserved.

When examining the department revealed the following deviations from the norm:

- Irrigography: hypotension of the ampoule of the rectum and lower third of the sigmoid colon. Sagging of the transverse colon. The angles are fixed. Dolichosigma.

- Ultrasound of the abdominal cavity: gall bladder: size - 74 × 20 mm, walls - the oval shape is not thickened.

- Ultrasound of the intestine: the rectum is enlarged, the muscle layer is 6 mm, homogeneous.

- EGDS esophageal mucosa is pink, vascular pattern is clear, cardia closes completely, peristalsis is active. In the stomach there is an abundance of turbid mucus, folds are thickened in the body, the mucous membrane is diffusely hyperemic in the body, in the antrum it is mottled, active peristalsis, the pylorus is fully closed. The duodenum: the bulb is not deformed, the mucous membrane is hyperemic, pasty. Postbulbar departments correspond to changes in the bulb. Vater's nipple is not changed. The jejunum is unchanged. Conclusion: common gastritis. Duodenitis.

In the department, the child was prescribed treatment: laxative diet, cholensim, motilium, duphalac, maalox, as well as the boy received an exercise therapy course, as well as a magnetic pulse induction course. The impact of the pulsed magnetic field on the anterior abdominal wall was carried out from the apparatus "SETA-1" using inductors. Inductor 1 was installed in the right ileal region above the cecum and ascending colon, inductor 2 was placed on the descending part of the colon, in the first procedure - 0.75 T, after 2 procedures increasing to 1.25 T. The exposure time is 10 minutes. Procedures were carried out daily for a course of 10 procedures.

After 5-6 procedures, the boy showed improvement in general condition, pain at the point of the gallbladder stopped, stool 1 time in 2 days, soft consistency, decorated. By the end of the course of treatment, the chair is independent, daily, soft consistency, decorated. When conducting a test enema, a test for residual feces is negative.

When examined 4 months after the course of treatment, positive dynamics was noted according to intestinal ultrasound: the rectum was not expanded, the muscle layer was 2.0 mm, homogeneous.

Follow-up observation after 7 months showed that the condition of the boy is still satisfactory, stool delays were no longer noted.

The proposed method of treatment was applied in the gastroenterological department of the IHCH in 45 patients aged 3-16 with chronic constipation.

As a result of the application of the proposed method, there was a pronounced positive dynamics of the main clinical symptoms by the end of the course of treatment. All patients showed an improvement in their psycho-emotional state, relief of abdominal pain, improvement in the consistency of the stool and the establishment of an independent, regular, designed stool.

Thus, the proposed method for the treatment of chronic constipation in children can normalize the regular rhythm of defecation and improve the consistency of the stool, and also prolongs the period of remission up to 6-8 months, improves the quality of life.

Claims (1)

A method of treating chronic constipation in children by exposure to a magnetic field, characterized in that the patient is exposed from the Seta-1 apparatus to the front surface of the abdomen with a series of triangular magnetic pulses by induction on the surface of the inductor from 0.75 to 1.25 T, quantity pulses in a series - 6, the interval between pulses in a series of 60-100 ms, the repetition rate of a series of pulses per minute 30, while the inductor 1 is installed in the right ileal region above the cecum and the ascending intestine, inductor 2 is placed on the descending part of the second cancer, induction of the first procedure - 0.75 T, 2-3 procedures increased to 1.25 T, exposure time 8-10 min, procedures are performed daily in the course of 8-10 procedures against the background of drug therapy.