RU2440089C1 - Method of treating chronic salpingo-oophoritis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely gynaecology, physiotherapy. It involves a hydrosulphuric balneotherapy in the form of vaginal irrigations and general baths. The baths are taken either every second day, or two days running with a pause for one day in a sine-wave hydrogen sulphide concentration mode 50-100-150 mg/l. The course involves 8 baths. After the third balneotherapy procedure, paired reflexogenic points R-12 and BM-46 to the left and to the right are exposed daily. The exposure represents an extra-high frequency therapy at wave length 5.6 mm. Each point is exposed for 10 minutes with localisation of the exposure changed every second day. The hydrosulphuric balneotherapy is combined with daily transcranial electrostimulation generated by Transair-03 apparatus by a frontooccipital technique. The current strength of the first procedure is set 0.5-1.0 mA to provide vibration sensations. With every next procedure, the current strength increases within 0.2 to 0.4 mA, however no more than 2.0 mA. The duration of the first two procedures is 15-20 minutes; the duration of the following procedures is 30 minutes. A therapeutic course includes 8 balneological procedures and 6-8 physiological procedures.

EFFECT: method provides higher clinical effectiveness ensured by analgesic, anti-inflammatory and defibrinolytic actions, normalising immunobiological processes, lipid peroxidation, higher body responsiveness.

1 ex, 4 tbl

Description

The invention relates to medicine, namely to physiotherapy and gynecology, and can be used in practical health care in the treatment of women with inflammatory diseases of the female pelvic organs and, in particular, with chronic salpingo-oophoritis.

In the structure of gynecological morbidity, the proportion of inflammatory processes of the internal genital organs is from 60 to 70%. PIDs in women occur more often at a young age and in many cases acquire a severe or protracted course, as a result of which women often lose not only the ability to bear children, but also their ability to work. The chronic stage of PID is characterized by periods of exacerbation, remission, and residual events. The greatest reversal of patients during VZOT remission is associated with the consequences and complications of the chronic inflammatory process of the internal genitalia - infertility, habitual miscarriage, ectopic pregnancy, menstrual irregularities, chronic pelvic pain, dyspareunia. When examining such patients, a polysystemic disorder in VZOT with involvement of the nervous, cardiovascular, digestive, urinary systems, and musculoskeletal system in the pathological process is often noted. At the level of metabolic and metabolic reactions and immunity reactions, CVDs flow against the background of a constant release of toxins, decay products and biologically active substances into the body, which in general create a pool of under-oxidized products and, on the one hand, lead to a distortion of lipid peroxidation processes, overwork mitochondrial liver enzymes, and on the other - to a distortion of the immune response with the formation of autoimmune processes. Chronic overexertion in the work of liver cells and a violation of the autonomic regulation of the biliary tract lead to hepatopathy, and the latter leads to a disruption in the transformation of ovarian hormones, which entails relative hyperestrogenia, hypoprogesteroneemia and the proliferative hyperplastic processes in target organs resulting from them.

At various stages of the complex treatment of chronic inflammatory diseases of the pelvic organs, not only anti-inflammatory and absorbable therapy are relevant, but also the restoration of the patient's psycho-emotional state, correction of the neuroendocrine regulation of the reproductive system, compensation or elimination of metabolic and metabolic disorders. Despite certain successes achieved in the treatment of patients with VZOT, the effectiveness of therapy remains extremely low.

One of the urgent tasks of rehabilitation medicine is the development of new effective methods of treating patients with chronic inflammatory diseases of the organs of the female reproductive system and their complications. A known method of treatment of VZOT by using common hydrogen sulfide baths and vaginal irrigation with a gradual increase in the concentration of hydrogen sulfide in combination with EHF-therapy.

The choice of physical factors, in particular hydrogen sulfide balneotherapy, is justified in connection with their anti-inflammatory, analgesic, ovarian estrogenic activity increasing effects, active influence on microcirculation and rheology, peripheral and central hemodynamics, as well as the possibility of normalizing immunobiological and compensatory-adaptive processes, increasing the body's reactivity .

Due to the bioresonance effect on the cells of the human body, electromagnetic waves of extremely high frequency (EHF EHF) stimulate the protective systems of homeostasis, normalize the immune status, increase antioxidant defense, and contribute to the normalization of local reparative processes.

The disadvantage of this method is that the effectiveness of its use is relatively low due to insufficient normalizing effect on homeostasis of women with chronic salpingo-oophoritis.

It is known to use a new modern method of physiotherapeutic treatment - transcranial electrical stimulation (TES), which has a pronounced analgesic, antioxidant, immunoregulatory effect, correction of psychosomatic and neurovegetative disorders. There is literature data on the effectiveness of using this method in the treatment of endocrine infertility.

The combined use of these factors allows during treatment of patients with VZOT to achieve:

- pronounced anti-inflammatory, absorbable, analgesic, immunostimulating and immunocorrective effects;

- a harmonizing effect on the neuropsychic sphere and autonomic regulation;

- A stimulating effect on ovarian function, restoration of the neuroendocrine regulation of the menstrual cycle.

The technical result of the invention is a significant increase in the effectiveness of treatment due to analgesic, anti-inflammatory and defibrinolytic actions, normalization of immunobiological processes, lipid peroxidation, ovarian function, increased reactivity of the body.

The technical result is achieved by the fact that after 2 days of the period of adaptation against the background of hydrogen sulfide balneotherapy in the form of vaginal irrigation and common baths dispensed in a sinusoidal mode, the concentration of hydrogen sulfide is 50-100-150 mg / l, carried out every other day or two days in a row with a break day 8 baths, and exposure to paired reflexogenic localized points R-12 and BM-46 left and right daily EHF-therapy with a radiation wavelength of 5.6 mm for 10 minutes for each point, changing the localization of exposure released after the third procedure every other day balneotherapy is additionally carried out simultaneously with hydrogen sulfide balneotherapy daily transcranial electrical stimulation from the apparatus "Transair-03" according to the fronto-occipital technique with the current strength of the first procedure to the sensation of vibration of 0.5-1.0 mA, with an increase in each subsequent procedure from 0.2 up to 0.4 mA, but not more than 2.0 mA, the duration of the first and second procedures is 15-20 minutes, the following procedures - 30 minutes per course of 8 balneotherapy and 6-8 physiotherapy.

Table 1 Scheme of vacation procedures for the proposed method. Days of treatment Hydrogen sulfide balneotherapy Thermal Power Station from Transair 03 EHF-therapy on BAP (paired) irrigation, 150 mg / l, T39-40 Time (min) Shared baths Amperage (in mA) Time (min) Point (right, left) Time (min) Concentration (mg / L) Time (min) 1-2 ADAPTATION, SURVEY 3 fifteen fifty 6 05-1.0 15-20 four 07 (0.9) -1.2 (1.4) 15-20 5 fifteen one hundred 8 Up to 2.0 thirty 6 Up to 2.0 thirty 7 fifteen 150 10 Up to 2.0 thirty 8 Up to 2.0 thirty 9 fifteen one hundred 12 R-12 10 + 10 10 VM-46 10 + 10 eleven fifteen fifty fifteen R-12 10 + 10 12 VM-46 10 + 10 13 fifteen one hundred fifteen R-12 10 + 10 fourteen VM-46 10 + 10 fifteen fifteen 150 fifteen R-12 10 + 10 16 VM-46 10 + 10 17 fifteen one hundred fifteen

The method is as follows: on the third day of the patient’s stay in the clinic, after 2 days of adaptation, transcranial electrical stimulation from the Transair-03 apparatus is prescribed according to the frontooccipital technique. Monopolar pulse current up to 2 mA. The first session of electrical stimulation is carried out at a current strength of not more than 0.5-1.0 mA (subjective sensations may be absent). In each subsequent procedure, the current strength is increased by 0.2 to 0.4 mA until vibration is felt, the duration of the first and second procedures is 15-20 minutes, the following procedures - 30 minutes, daily No. 6.

The day after the 6th procedure of TES therapy, EHF therapy with a wavelength of 5.6 mm is prescribed for BAT along the anterior abdominal wall:

- the mouthpiece of the installation is applied to the area of the skin point R-12, 2-2.5 cm above the pubic joint, retreating 1.5-2 cm from the midline to the right; exposure time 10 min. Then the horn is transferred to a similar position on the left, exposure time 10 minutes. The total procedure time is 20 minutes.

- the next day, the mouthpiece of the installation is applied to the area of the point of the uterine appendages, located 4-5 cm above the middle of the right inguinal ligament, approximately on the line separating the hypo- and mesogastrium and the corresponding acupuncture extrameridian point VM-46; exposure time 10 min. Then the horn is transferred to a similar position on the left, exposure time 10 minutes. The total procedure time is 20 minutes.

The procedures are carried out daily, every other day, changing the localization of the effects of the uterus-appendages, on a course of 6-8 procedures.

Hydrogen sulfide balneotherapy is prescribed simultaneously with TES therapy after 2 days of adaptation in the form of vaginal irrigation with a constant concentration of hydrogen sulfide of 150 mg / l, a water temperature of 38-40 degrees. C, lasting 15 minutes and common baths dispensed in a sinusoidal mode with a concentration of hydrogen sulfide from 50-100-150-100-50-100-150-100 mg / l, water temperature 36-37 degrees. C, lasting from 6-15 minutes.

For a course of 8 balneotherapy procedures every other day and for 6-8 physiotherapy procedures carried out daily (Table 1).

Example. Patient I., 28 years old, was admitted to the clinic of the center on 10/14/09, was discharged on 11/03/09.

From the anamnesis: At the age of 19, acute salpingo-oophoritis, exacerbations 1-2 times a year, was first performed. Anti-inflammatory treatment only during exacerbation. Last exacerbation in December 2008. In 2008, the treatment of mycoplasmosis. In 2005, she applied for secondary infertility. The last examination in 2009: rectal temperature is monophasic, according to hormones within normal limits, GHA tubes are impassable in the ampullar sections.

Upon admission to the clinic, the patient complained of periodic pain in the lower abdomen and lumbosacral region, irregular (after 30-40 days) and painful menstruation.

During the examination, the diagnosis was made: Chronic 2-sided salpingoophoritis (adhesive form) in the stage of unstable remission. Violation of the menstrual cycle as opsomenorrhea. Infertility II.

Blood test: hemoglobin - 126 g / l, erythrocytes - 52 × 10 ¹² / l, color indicator - 0.87, leukocytes - 6.65 × 10 ⁹ / l, segmented neutrophils - 61%, stab - 4%, eosinophils - 5%, monocytes - 10%, lymphocytes - 20%, which corresponds to an inferior reaction of training according to Garkavi.

Urinalysis is within normal limits.

Immunogram: white blood cells - 9.0 × 10 ⁹ / L, lymphocytes - 45% - 3825 / μl, monocytes - 10%, T-lymphocytes - 67% - 2562 / μl, B-lymphocytes - 24% - 918 / μl, T helpers - 31% - 992.6 per μl, T-suppressors - 37% - 1184 / μl, IRI - 0.84, PSA negative, immunoglobulins: M - 1.5 g / l, A - 1.6 g / l, G - 14.0 g / l.

FLOOR: diene conjugates of plasma lipids (DC) - 3.33 rel. units, erythrocyte malondialdehyde (MDA) - 52.1 nmol / ml er., serum catalase (KS) - 58.2 μkat / l.

KRG: moderate increase in parasympathetic influence.

According to the initial examination, an inferior training reaction, a violation of the functional activity of the ANS, tension in the LPO system, relative lymphocytosis, a decrease in IRI due to an imbalance in the cellular immunity link were revealed.

The patient was prescribed a course of treatment according to the proposed method (table 1). During treatment, the patient felt good, no complaints. After 2 TES procedures, pains in the lower abdomen went away, the study became less painful. At the end of treatment, genital examination was painless. Menstruation came on the 34th day of the cycle, painless. Rectal temperature - NLF.

According to a gynecological examination, the diagnosis was made: Residual effects of left-sided salpingo-oophoritis. Ovarian Dysfunction (NLF).

Final survey data:

Complete blood count: hemoglobin increased slightly - 126.5 g / l, monocytes decreased to 8%, segmented neutrophils - up to 46%, lymphocytes increased to 37% (defective reaction of increased activation).

Urinalysis: no pathology.

Immunogram: white blood cells 8.5 × 10 ⁹ / L, lymphocytes - 32% - 3008 / μl, monocytes - 8%, T-lymphocytes - 64% - 1601.0 μl, B-lymphocytes - 33% - 591.4 μl, T-helpers - 37% - 1147 / μl, T-suppressors - 31% - 961 / μl, IRI - 1.19, immunoglobulins: M - 1.36 g / l, A - 2.0 g / l, G - 14.4%. According to the immunogram, positive dynamics of both cellular and humoral immunity was noted. Due to an increase in T-helpers and a decrease in T-suppressors, IRI increased, B-lymphocytes, immunoglobulins M decreased, and the level of immunoglobulins G. increased slightly.

FLOOR: Reducing stress in the LPO and AOD system: diene conjugates of plasma lipids (DC) - 1.33 rel. units, erythrocyte malondyldehyde (MDA) - 42.1 nmol / ml er., serum catalase (KS) - 48.2 μkat / l.

KRG: normotonic nature of regulation.

Thus, after the treatment, anti-inflammatory, analgesic, immunomodulating effect, decreased LPO activity, normalization of the ANS activity, and improvement of ovarian function were achieved. The patient was discharged with significant improvement. A month after treatment, the woman became pregnant in the clinic.

In total, 47 women in two groups were examined and treated in the clinic of the center.

The first group - the prototype - 32 women received hydrogen sulfide balneotherapy in the form of vaginal irrigation and common baths in a sinusoidal mode of concentration of hydrogen sulfide 50-100-150 mg / l, carried out every other day or two days in a row with a break for a course of 8 baths, and the effect on paired localized reflexogenic points R-12 and BM-46 on the right and left daily with EHF-therapy with a radiation wavelength of 5.6 mm for 10 min per point, changing the localization of exposure after the third balneotherapy procedure every other day to a course of 8 balneotherapy and 10 physiotherapy R.

The second group - the proposed method - 15 women, received, after 2 days of adaptation, daily transcranial electrical stimulation from the Transair-03 apparatus according to the frontooccipital technique with the current of the first procedure until the vibration senses 0.5-1.0 mA, with an increase for each subsequent procedure, from 0.2 to 0.4 mA, but not more than 2.0 mA, the duration of the first and second procedures is 15-20 minutes, the following procedures are 30 minutes, simultaneously with hydrogen sulfide balneotherapy, where EHF-therapy was released after the third daily balneotherapy procedures for a course of 8 balneotherapy and 6-8 physiotherapy zedur.

At the end of treatment, patients of both groups noted an improvement in their general condition. Pain in the lower abdomen and lumbosacral region disappeared in 90% of patients of the first group and in all women of the second group. A decrease in pain during menstruation was observed in 92% of patients in the first group and in 95% in the second group, with painless menstruation in 53% of women in the first group and in 75% of the second. According to the vaginal examination, at the end of treatment, a more distinct positive dynamics was revealed in the group of patients who received TPP and EHF-therapy in combination with hydrogen sulfide balneotherapy. The bimanual study became painless and the disappearance and softening of adhesions were recorded in 87% and 75% (respectively) of the women of the first group, and in 92% and 100%, respectively, of the women of the second group.

table 2 Characterization of rectal thermometry in various treatment
complexes (in %%) Rectal temperature THERAPEUTIC COMPLEXES proposed prototype Before treatment After treatment Before treatment After treatment 2 phase 33.3 50,0 23.5 28.5 Monophasic 44.5 14.3 23.5 28.5 NLF 22.2 35.7 53.0 43.0

According to rectal temperature data, a more pronounced normalization of ovarian function was recorded in the second group, where the number of women with 2-phase temperature increased from 33.3% to 50% (Table 2).

In the course of the studies revealed a positive dynamics of adaptive blood reactions in both groups. An increase in body resistance was more significant in the second group, where the number of women with a reaction of increased activation increased by 9.6%, and in the first group it decreased by 8.8% (Table 3). Moreover, the number of inferior reactions before treatment was 32.1% more in the second group than in the first. After treatment, the number of inferior reactions decreased in the first group by 14%, and in the second - by 24.7%, which may indirectly indicate the normalization of the functioning of the endocrine glands when exposed to the combined use of TES and EHF-therapy in combination with hydrogen sulfide balneotherapy.

Prior to treatment, both groups showed significant tension in the LPO and AOP system. The level of primary (diene conjugates) and final (malondialdehyde in the stroma of red blood cells) lipid peroxidation products was increased in 83% -73% and in 43% -36% of patients in the first and second groups, respectively. The concentration of serum catalase before treatment was increased in all patients in the first group, in 86% of cases in the second group.

Table 3 Dynamics of adaptive reactions (in %%) REACTIONS THERAPEUTIC COMPLEXES proposed prototype Before treatment After treatment Before treatment After treatment Training - - 6.1 3.6 Trainers. (inferior.) - - - - Total: - - 6.1 3.6 Calm activation 20,0 42.8 18.3 32.1 Calm asset. (incomplete) 40,0 14.3 6.1 3.6 Total: 60 57.1 24.4 35.7 Increased activation 25.8 28.6 54.3 60.7 Increased asset. (incomplete) 5.2 14.3 15,2 - Total: 33.3 42.9 69.5 60.7 Chronic stress 6.7 - - - Total inferior 53.3 28.6 21,2 7.2

During the treatment according to the proposed method, the initially elevated level of diene conjugates significantly decreases from 2.81 ± 0.29 units. up to 1.57 ± 0.38 units (p <0.05), and malondialdehyde in the stroma of red blood cells with 51.9 ± 4.36 nmol / ml erythritol. masses up to 34.07 ± 5.32, nmol / ml erythr. masses (p <0.05). When prescribing the first treatment complex, these indicators decrease in 24% and 17% of cases, respectively.

The activity of AOD at the end of treatment tended to decrease in all treatment groups. Thus, the number of women with a high content of serum catalase, responsible for the destruction of hydrogen peroxide, decreased from 95% to 72% in the first group and from 86% to 42% in the second group.

Positive dynamics of immunological parameters in both groups was noted. However, a more significant positive trend was noted in the second group. Thus, a reduced level of T-lymphocytes increased at the end of treatment in 75% of women of the second group, in the first group - only in 50% of cases. The immunoregulatory index (IRI) was lower than 1.5 in 46% of women of the first group and in 45.5% of patients of the second group due to a decrease in the level of T-helpers and an increase in T-suppressors. At the end of treatment, the initially reduced IRI increased in the first group from 1.0 to 1.48, and in the second from 1.28 to 2.02.

The percentage of B-lymphocytes was increased in 33% of women of the first group, averaging 15.9 ± 1.64% and in 72% (18.0 ± 3.76%) of the second group. At the end of treatment, in the first group, a decrease in the initially elevated level of B-lymphocytes was noted only in 15% of cases, and in the second group in 100% of cases from 19.7 ± 2.69% to 15.8 ± 3.60% (p <0 , 01).

On the part of the humoral link, the largest changes were made for class M immunoglobulins, which reflect the severity of the inflammatory process. Their content was increased in 33% of women of the first group and in 36% of the second. At the end of treatment, initially elevated class M immunoglobulins are normalized under the influence of both treatment complexes.

According to cardiac rhythmography, the normal autonomic reaction before treatment was in 19% of women of the first group and in 25% of the second group, and after treatment this indicator in the groups increased to 58% and 57.8%, respectively. However, according to the active orthostatic test, the degree of adaptation increased in the second group from 50% to 71% of cases, and in the first group from 45% to 60% of cases.

Based on the analysis of the data obtained, the effectiveness of treatment by the proposed method was higher than in the prototype (table. 4).

Table 4 Therapeutic efficacy of the proposed treatment complex Method of treatment IN PERCENTAGES In points Value improve. Enhanced. Negligible improve. No change Proposed method 46.7 46.7 6.6 - 2,4 Prototype 33.0 48.8 18.2 - 2.2

Thus, the use of a comprehensive spa method, including hydrogen sulfide balneotherapy with transcranial electrical stimulation followed by EHF radiation in the treatment of women with chronic salpingo-oophoritis, allows to achieve a significant anti-inflammatory, defibrinolytic and analgesic effect, increase nonspecific resistance of the body, normalize the indices of normal cellular resistance the state of the autonomic nervous system and LPO, ovarian function.

Claims (1)

A method for the treatment of chronic salpingo-oophoritis, including hydrogen sulfide balneotherapy in the form of vaginal irrigation and common baths in a sinusoidal mode of concentration of hydrogen sulfide 50-100-150 mg / l, carried out every other day or two days in a row with a break, for a course of 8 baths, and exposure to paired reflexogenic local action points R-12 and BM-46 on the right and left, daily, by EHF-therapy, with a radiation wavelength of 5.6 mm, 10 min for each point, changing the localization of exposure after the third balneotherapy procedure every other day, characterized in that after two days of adaptation, simultaneously with hydrogen sulfide balneotherapy, transcranial electrical stimulation is performed daily from the Transair-03 apparatus according to the frontooccipital technique, with the current of the first procedure until the vibration senses 0.5-1.0 mA, with an increase on each subsequent procedure from 0.2 to 0.4 mA, but not more than 2.0 mA, the duration of the first and second procedures is 15-20 minutes, the following procedures - 30 minutes, for a course of 8 balneological and 6-8 physiotherapy procedures.