RU2448675C1 - Method of treating and improving quality of life in patients with chronic pancreatitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly gastoenterology, reflexotherapy, physiotherapy. It involves a conventional drug-induced therapy of chronic pancreatitis. It is added with the antidepressant azaphen 75 mg daily in clinically apparent affective disorders, 50 mg daily in subclinically apparent affective disorders for 30 days. Magnetic laser puncture is performed with considering a vegetative balance state. One biologically active point is exposed to modulated wave length 1.3 mcm, frequency 2.4 Hz, magnetic induction 50 mT for 10-30 seconds. Sympathicotonia requires sequential sedation of the point GI 4 and toning of the points. E 25, E 36, MC 6. Vagotonia requires toning of the point GI 4 and sedation of the points E 25, E 36, MC 6. It is accompanied with transcutaneous magnetic laser exposure at wave length 0.89 mcm with using a magnetic tip 150 mT. A solar plexus area, a projection of pancreas, a projection of gall bladder are covered for 2 minutes. In manifested pain syndrome, the exposure starts at the frequency of 820 Hz to be decreased to 80 Hz. In weak pain syndrome, the frequency of 360 Hz is gradually decreased to 80 Hz. In the absence of pain syndrome, the exposure is applied at the frequency of 80 Hz.

EFFECT: method normalises a psychoemotional sphere, daily chronobiorhythms, vegetative balance state, reduced length of treatment, prolongs a remission period.

2 ex, 2 tbl

Description

The invention relates to medicine, namely to gastroenterology, and can be used in the treatment of chronic pancreatitis (CP).

A known method of treatment of CP, consisting in drug therapy using analgesics, antispasmodics, H2-blockers of histamimine, multi-enzyme preparations (Grigoryev P.Ya., Yakovenko EP Diagnosis and treatment of diseases of the digestive system. - M., 2005, 463 from.). For example, famotidine - 20 mg 2 times a day, creon 1-2 capsules at each meal, antispasmodics (Grigoryev P.Ya., http: gastrosite.ru/articles/article.aspx?id=366&rid=68).

It is known that in patients with chronic pancreatitis, changes in the psychoemotional sphere are revealed, that the correction of affective disorders helps to increase the effectiveness of therapy (Kharkina D.N. Non-psychotic mental disorders in patients with chronic pancreatitis and their correction. // Abstract. Thesis ... Ph.D. - Voronezh, 2007 - 18 p.).

Standard therapy of CP does not affect the psycho-emotional sphere, vegetative balance, daily chronobiorhythms, prolonged remissions, decreased relapse, and the quality of life of patients. Such therapy does not affect the patient's general adaptation systems. Meanwhile, being a powerful link in secondary prevention, the state of regulatory systems largely determines the effectiveness of therapy, the relapse rate and prognosis for CP, as well as the quality of life of patients.

The technical result of the proposed method of treatment is a reduction in the term of relief of clinical symptoms, a decrease in the duration of exacerbation, a prolongation of remissions, a decrease in the frequency of relapses, an increase in the quality of life due to the correction of the state of general adaptation systems of the body - daily chronobiorhythms, the psychoemotional sphere and vegetative balance, elimination of disorders of the contractile ability of the gall bladder, reduce the drug load on the patient’s body.

The specified technical result is achieved by the fact that patients with CP after a standard examination conduct sequentially additional examination, choice of exposure options, complex treatment.

To assess anxiety and depressive disorders, questionnaires are conducted on the following test questionnaires: the Hamilton scale for determining anxiety (HARS), the Hamilton scale for determining depression (HDRS). When interpreting the data, the total score for all issues was taken into account, which determined the severity of the disorders: from 0 to 7.0 on the HARS scale and from 0 to 8.0 points on the HDRS scale - no symptoms of anxiety and depression; more than 7.0 to 16.0 on the HARS scale and more than 8.0 to 20.0 points on the HDRS scale - subclinically expressed signs of anxiety and depression; more than 16.0 points on the HARS scale and more than 20.0 points on the HDRS scale - clinically expressed anxiety and depression.

When prescribing a course of the antidepressant azafen, the following possible options are taken into account, based on the results of processing the response options for test questionnaires:

if there is clinically pronounced anxiety and depression, then azafen is prescribed at a dose of 75 mg per day;

if there is subclinically expressed anxiety and depression, then azafen is prescribed at a dose of 50 mg per day.

The course of treatment with azafen is 30 days.

To assess the autonomic balance, daily monitoring of heart rate variability is carried out using a device, for example, Cardio Tens 01 (Meditech, Hungary), taking into account the recommendations of ESC / NASPE (Standards of Heart rate Variability. Circulation. Vol. 93. No. 5, March 1, 1996) and subsequent and cosineranalysis (F.I. Komarov, S.I. Rapoport. Chronobioloia and chronomedicine. - Moscow: Triad-X, 2000, - 488 p.).

When assigning a course of laser laser puncture, the following possible options are taken into account:

if the patient has initial sympathicotonia (RMSSD less than 15, LF / HF more than 3.5), with reflexotherapy, use sedation of the GI 4 point and toning of the points E 25, E 36, MS 6;

if vagotonia predominates in the patient in the vegetative status (RMSSD is greater than 35, LF / HF is less than 1), with magnetolaseropuncture point GI 4 tones and points E 25, E 36, MS 6 sedate.

The choice of points for the correction of the vegetative state is based on experimental data (Non-traditional methods of diagnosis and therapy / Edited by I.Z.Samosyuk. - Kiev: Health, 1994. - 142 p.). The exposure time for one BAP: with sedation - 30 seconds, with toning - 10 seconds. On a course of 10-12 daily procedures.

When prescribing transcutaneous magnetic laser therapy, the severity of the pain symptom is taken into account:

if the patient has a pronounced pain syndrome, the transcutaneous magnetic laser effect begins with a frequency of 820 Hz, followed by a gradual decrease in frequency as the clinical manifestations of the disease subside to 80 Hz;

if the pain syndrome is weak, the transcutaneous magnetic laser effect begins with a frequency of 360 Hz with a decrease to 80 Hz;

if there is no pain, the transcutaneous magnetic laser effect is carried out at a frequency of 80 Hz.

The transcutaneous magneto-laser effect is carried out on the following zones: on the region of the solar plexus, on the projection of the pancreas, on the projection of the gallbladder.

For transcutaneous therapy, physiotherapeutic laser exposure devices are used, for example, LTA "Mustang-23", for laser puncture, for example, LTA "Moth-reflex".

To assess the contractile function of the stomach, an ultrasound of the stomach is performed with a functional test (test breakfast - 2 raw yolks). Contractility is assessed by changes in% of the volume of the stomach on an empty stomach.

To assess the quality of life using the questionnaire SF-36.

Then, complex treatment is carried out, including, in addition to standard therapy, parallel co-administration:

antidepressant therapy with azafen once a day in the evening with clinically pronounced affective disorders at a dose of 75 mg, with subclinically expressed affective disorders at a dose of 50 mg for 30 days;

of a course of 10-12 procedures of magnetic laser puncture with a wavelength of 1.3 μm in a modulated mode with a frequency of 2.4 Hz by a magnetocupuncture nozzle of 50 mTl for 10-30 s per biologically active point sequentially, and with sympathicotonia, sedation of the GI 4 point and toning of the E 25 points are sequential E 36, MS 6; with vagotonia, the GI 4 point tones in sequence and the E 25, E 36, MS 6 points sedate;

a course of 10-12 procedures of transcutaneous magnetic laser therapy with a wavelength of 0.89 microns, a magnetic nozzle of 150 mT, 2 min per solar plexus, onto the projection of the pancreas, onto the projection of the gallbladder, and with severe pain from a frequency of 820 Hz, decreasing to 80 Hz; for mild pain from a frequency of 360 Hz with a decrease to 80 Hz; in the absence of pain at a frequency of 80 Hz.

For transcutaneous therapy, physiotherapeutic laser exposure devices are used, for example, LTA "Mustang-23", for laser puncture, for example, LTA "Moth-reflex".

The examination and treatment of this method of treatment, the analysis of relapses and remissions during the year in 30 patients with CP. The control group consisted of 20 patients treated according to the known standard method of treatment (famotidine - 20 mg 2 times a day, creon 1-2 capsules at each meal, antispasmodics). The results are presented in table 1, 2.

Table 1
Analysis of the results of this method of treatment (main group) in comparison with standard therapy (control group). Patient groups Control group Main group Number of patients twenty thirty Clinical symptoms of symptoms (day) 7.4 ± 1 4.1 ± 0.4 Normalization of the contractile ability of the gallbladder (% of patients) 38% 90% Normalization of the autonomic balance after treatment (% of patients) 10% 90% Recovery of daily chronobiorhythm after treatment (% of patients) 10% 90% Lack of affective disorders twenty% one hundred% Relapses during the year (% of patients) 80% 0% Remission during the year (% of patients) twenty% one hundred%

table 2
Dynamics of quality of life for this method of treatment (main group) in comparison with standard therapy (control group). Scales SF-36 Before treatment After treatment main group control group Physical Function (PF) 66.3 ± 6.1 88.0 ± 11.1 * 64.8 ± 6.7 Physical Role Functioning (RP) 62.3 ± 5.6 82.0 ± 13.8 * 66.8 ± 8.9 Physical pain (BP) 57.5 ± 7.8 83.4 ± 9.7 * 67.4 ± 8.4 General Health (GH) 42.7 ± 4.6 * 76.5 ± 8.9 * 49.9 ± 7.3 Life Force (VT) 53.3 ± 5.1 67.5 ± 7.4 59 ± 8.6 Social Functioning (SF) 65.7 ± 7.1 85.0 ± 12.8 63.5 ± 7.7 Emotional role-playing function. (RE) 64.6 ± 6.4 67.0 ± 9.3 65.6 ± 6.9 Mental Health (MH) 63.1 ± 8.3 77.6 ± 8.9 65.6 ± 8.9

Example 1. Patient U., 42 years old, went to a polyclinic at the place of residence to a gastroenterologist on March 5, 2009 with complaints of pain in the left hypochondrium of herpes zoster, nausea, once - vomiting, liquefied stool, complaints were disturbed for 2 years , was treated on an outpatient basis.

Examination data: General analysis of blood, urine - without pathology. Endoscopy - without pathology. Ultrasound of the gastrointestinal tract - signs of chronic pancreatitis.

Vegetative balance taking into account daily monitoring of heart rate variability: RMSSD = 45.4, LF / HF = 0.8, which indicated vagotonia. Daily chronobiorhythm is poorly expressed, the acrophase is shifted, the amplitude is 7%.

Test questionnaire data: HARS = 16.9, HDRS = 19.8. The quality of life (according to the questionnaire F - 36) is reduced on 1-4 and 8 scales.

Ultrasound ZhP with funkts. breakdown. Conclusion - signs of hypomotor type gallbladder dyskinesia

Diagnosis: Chronic parenchymal pancreatitis, exacerbation. Hypomotor dyskinesia of the gallbladder.

The patient received standard therapy, as well as a course of treatment, including in addition to traditional drug therapy, the appointment of azafen at 50 mg per day for 30 days, 1 time per day during one session with a course of 10-12 procedures of transcutaneous magnetic laser therapy with a wavelength of 0.89 μm, with a magnetic nozzle of 150 mT, 2 min per solar plexus region, onto the projection of the pancreas, projection of the gallbladder from a frequency of 820 Hz with a decrease to 80 Hz and magnetolaser puncture with a wavelength of 1.3 μm in a modulated mode with a frequency of 2, 4 Hz magnetoacupuncture nozzle 50 mT for 10-30 s: toning of the GI 4 point and sedation of the points E 25, E 36, MS 6 (according to the HRV data on vagotonia) for 10 days.

Examination data after treatment. Clinical symptoms disappeared on the 4th day.

Vegetative balance: RMSSD = 27.5, LH / HF = 1.4 (which indicated normotonia); daily chronobiorhythm - normalization.

Data from test questionnaires: HARS = 4.9, HDRS = 5.4. The quality of life according to the F - 36 questionnaire increased in all 8 scales.

Ultrasound ZhP with funkts. breakdown. Conclusion - the contractile function of the gallbladder within the physiological norm.

There were no relapses during the year.

Example 2. Patient 3., 41 years old, went to a polyclinic at the place of residence to a gastroenterologist on March 3, 2009 with complaints of pain in the left hypochondrium of herpes zoster, dry mouth, nausea, vomiting once, stool with a tendency to constipation , complaints bother for 2 years, was treated on an outpatient basis.

Examination data: General analysis of blood, urine - without pathology. Endoscopy - without pathology. Ultrasound of the gastrointestinal tract - signs of chronic pancreatitis.

Vegetative balance taking into account daily monitoring of heart rate variability: RMSSD = 12.1, LF / HF = 5.8, which indicated sympathicotonia. Daily chronobiorhythm - acrophase shift, decrease in amplitude and mesor.

Test questionnaire data: HARS = 14.8, HDRS = 18.2. The quality of life (according to the questionnaire F - 36) is reduced by 1-4.7, 8 scales.

Ultrasound ZhP with funkts. breakdown. Conclusion - signs of dyskinesia of the gallbladder in a hypomotor type.

Diagnosis: Chronic parenchymal pancreatitis. Hypomotor dyskinesia of the gallbladder.

The patient received standard therapy.

Examination data after treatment. Clinical symptoms disappeared on the 7th day.

Vegetative balance: RMSSD = 12.6, LH / HF = 5.6 (which indicated sympathicotonia); daily chronobiorhythm - without dynamics.

Data from test questionnaires: HARS = 14.2, HDRS = 18.6. The quality of life according to the questionnaire F - 36 - without dynamics.

Ultrasound ZhP with funkts. breakdown. Conclusion - signs of dyskinesia of the gallbladder in a hypomotor type.

After 2 months, the patient recurred.

Thus, the application of the proposed method for the treatment of CP leads to the normalization of contractile ability of the GP, mental status, daily chronobiorhythms, autonomic balance, correction of affective disorders, acceleration of relief of clinical symptoms, lengthening remissions, reducing the frequency of relapses, improving the quality of life of patients.

Claims (1)

A method for improving the quality of life and treatment of patients with chronic pancreatitis, including complex therapy, characterized in that the antidepressant azafen is additionally prescribed for clinically pronounced affective disorders at a dose of 75 mg per day, for subclinically expressed affective disorders at a dose of 50 mg per day for 30 days ; taking into account the individual characteristics of the state of the vegetative balance, sequential magnetic-laser puncture is carried out at a wavelength of 1.3 μm in a modulated mode, a frequency of 2.4 Hz, a magnetotuncture nozzle of 50 mT, 10-30 s per biologically active point; moreover, with sympathicotonia, sequentially sedation of the point GI 4 and toning of the points E 25, E 36, MS 6; during vagotonia, the GI 4 point is tinted successively and the E 25, E 36, MS 6 points and the transcutaneous magnetic laser action with a wavelength of 0.89 μm, a magnetic nozzle of 150 mT for 2 min per region of the solar plexus, projection of the pancreas, and projection of the gall bladder are sedated moreover, with severe pain, they start from a frequency of 820 Hz with a decrease to 80 Hz, with mild pain they start from a frequency of 360 Hz with a decrease to 80 Hz, in the absence of pain, the whole procedure is carried out at a frequency of 80 Hz.