RU2527905C1 - Method of treating tuberculous spastic microcystis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: treating tuberculous spastic microcystis with underlying anti-tuberculosis chemotherapy requires peridural anaesthesia 5-7 days long. That is combined with the exposure to a laser light at a wave length of 632 nm of power 12 mW covering a biologically active point of the urinary bladder on a hand. The 4-minute exposure is daily for 5-7 days.

EFFECT: higher clinical effectiveness by the fast reduction of pain syndrome, higher urinary bladder capacity, avoiding the need of surgical intervention and disability.

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Description

The invention relates to medicine, namely to phthisiourology.

Genitourinary tuberculosis in more than half of cases is complicated by damage to the bladder (Diseases of the bladder / under the editorship of E.V. Kulchaven, V.A. Krasnov. - Novosibirsk: Nauka, 2012 - 187 p.); untimely diagnosis and / or lack of pathogenetic therapy leads to the development of microcystis, wrinkling of the bladder up to its complete obliteration.

According to the classification of tuberculosis of the bladder (Kulchavenya E.V. Selected issues of phthisiourology / E.V. Kulchavenya, V.A. Krasnov. - Novosibirsk: Nauka, 2010. - 142 p.) There are 4 stages in its course:

1 - tubercular-infiltrative;

2 - erosive and ulcerative;

3 - spastic cystitis (false microcystis) - essentially an overactive bladder (OAB);

4 - true wrinkling of the bladder up to complete obliteration, the formation of true microcystis.

Spastic microcystis is a borderline form, very prone to transition to true microcystis, which means disability of the patient.

It is known that laser therapy is used to treat bladder tuberculosis when, in order to reduce treatment time, the mucous membrane of the bladder is additionally irradiated with light of a helium-neon laser with a power density of 0.8-1.6 mW / cm ² for 10-15 minutes daily for 5-12 days (AS No. 1392699). However, the known method is effective only against ulcerative tuberculosis of the bladder and is ineffective in the 3rd stage - spastic tuberculous cystitis.

The analgesic effect of low-intensity laser radiation in children with cardiac pain is also known (Kurochkin A.A., Anikin V.V. Influence of low-intensity laser radiation on the condition of children with cardiac pain syndrome // Laser Medicine. - 1997. - T.1, vol. .1. - Page 21-23). However, in this method, biologically active points were exposed to radiation of 630 nm and a power of 6 mW simultaneously with magnetotherapy and the action of an infrared laser with a power of 2.6 mW, in addition, with the known method, pain relief is achieved only with cardialgia.

The closest analogue adopted by us for the prototype is “A method for preventing the development of microcystis in patients with bladder tuberculosis” (RU 2372910 C1, 11/20/2009), which means that anti-TB drugs, namely isoniazid, are administered by an indirect lymphotropic method by creating a local lymphostasis, and rifampicin - as part of a drug cocktail - novocaine 0.5% 50 ml + rifampicin 0.6 - dimexide 5 ml - microclyster, an additional 15 mg spasmex is prescribed 2 times a day for 3 months. However, despite the fact that the use of spasmex in the complex of treatment for patients with stage 3 bladder tuberculosis significantly increased the capacity of the bladder, reduced the number of urinations and prevented the formation of true microcystis, dysuria persisted in some patients, complete restoration of the bladder function did not occur.

In order to increase the effectiveness of treatment, to quickly relieve pain and increase the capacity of the bladder, a method for treating spastic tuberculosis microcystis with anti-TB chemotherapy is proposed, characterized in that they additionally carry out epidural anesthesia lasting 5-7 days and are also exposed to 12 mW laser radiation with a wavelength of 632 nm per biologically active point of the bladder on the hand daily for 4 minutes for 5-7 days.

The method is as follows.

Catheterize a vein and carry out preliminary infusion therapy to prevent the development of hypotension due to sympathetic block. The patient can sit or lie on his side, spinous processes aligned in a vertical or horizontal plane and maximally diluted (the chin is brought to the sternum, and the knees to the stomach). If necessary, sedation (midazolam) can be started.

A horizontal line is drawn between the iliac crests to determine the level of the spinous process L _IV . A line is drawn between the lower corners of the shoulder blades to determine the level of the spinous process of Th8. Palpate the interspinous spaces, choose the widest or closest to the desired level of anesthesia.

After processing the hands (as for surgical intervention), the skin is treated at the site of the proposed puncture, anesthesia of the skin is performed (lidocaine solution 2% 2-4 ml) and the field is limited to sterile underwear.

An epidural needle is inserted along the midline through the site of skin anesthesia until a sensation of increased ligament resistance. The stylet is removed and a syringe is attached with 3-4 ml of air or saline. While the needle tip is in the ligaments, it is necessary to clearly feel the resistance through the syringe plunger.

Periodically pre-sending several milliliters of solution, advance the syringe forward. The yellow ligament is often described as tough, “sandy” or simply as a feeling of increased resistance. This is the last layer in front of the epidural space. As soon as the needle passes through the yellow knit and enters the epidural space, a feeling of popping or sinking is very often observed, fluid or air in the syringe is easily introduced, as the tissue resistance decreases sharply.

The syringe is removed; firmly holding the pavilion of the sludge with one hand, a catheter 3-5 cm into the epidural space is inserted with the second working hand. The epidural needle is carefully removed so as not to accidentally entrain the catheter. After the injection port is attached to the catheter, an aspiration test is required to detect blood. If the test is negative, a test dose of a local anesthetic (2% lidocaine solution 2 ml) is administered. Then the catheter is attached to the skin; through an infusomat provide a continuous flow of anesthetic into the epidural space for 5-7 days.

After that, the biologically active point of the bladder on the hand is determined and exposed to it with laser radiation with a power of 12 mW with a wavelength of 632 nm every day for 4 minutes for 5-7 days.

The duration of treatment is determined by the condition of the patient; in the absence of imperative urges and pain when filling the bladder for 3-4 days, you can complete the treatment after 5 days; while complaints persist, therapy is continued for up to 7 days.

The inventive method demonstrate two examples.

Example 1. Patient K., 37 years old. Diagnosis: bilateral tuberculosis papillitis, stage 3 bladder tuberculosis, MBT-.

Upon admission - pain when filling the bladder with a strength of 7 points, rapid urination during the day (24 times) and at night (3 times). The bladder capacity was 68 ml. The patient was also prescribed standard chemotherapy with anti-TB drugs, spasmex, however, pain, decreased bladder capacity and rapid urination continued.

The patient was treated according to the claimed method. Against the background of constant epidural anesthesia and laser stimulation of the biologically active point of the bladder, positive dynamics was noted by the 3rd day, which allowed us to limit ourselves to a 5-day course, since by this time the pain syndrome was completely stopped. Pain after treatment - 0 points, bladder capacity - 208 ml, daily urination - 11, nightly - 1.

Example 2. Patient C., 34 years old. Diagnosis: tuberculosis papillitis on the right, stage 3 bladder tuberculosis, MBT +.

On admission, he complained of pain when filling the bladder (8 points), frequent urination during the day (27 times) and at night (3 times). The bladder capacity was 72 ml. The patient was prescribed standard chemotherapy with anti-TB drugs, spasmex, however, pain, decreased bladder capacity and rapid urination continued.

The patient was treated according to the claimed method. Against the background of constant epidural anesthesia and laser stimulation of the biologically active point of the bladder, the pain in the bladder area decreased, nocturia stopped by the 5th day, by the 7th day the pain was completely stopped, which allowed to complete the treatment. Pain after treatment - 1 point, bladder capacity - 215 ml, daily urination - 12, night - 0.

In the urogenital clinic of the FSBI "NNIIT" of the Ministry of Health of the Russian Federation, the claimed method was tested in 12 patients. The effectiveness of treatment was assessed by the intensity of pain, determined by a 10-point analog-visual scale, bladder capacity and urinary frequency day and night. The results are presented in the table.

Table The effectiveness of the method of treatment of tuberculous spastic microcystis, n = 12 Sign Before treatment After treatment P Pain 9.3 ± 0.8 2.4 ± 0.2 <0.05 Bladder capacity 64.9 ± 12.1 193.8 ± 6.5 <0.05 Urinary frequency during the day 38.3 ± 2.4 11.7 ± 1.3 <0.05 Urinary frequency at night 18.7 ± 0.9 1.9 ± 0.7 <0.05

Thus, the claimed method is highly effective, safe, helps to prevent the need for surgical treatment and disability of patients with bladder tuberculosis.

Claims (1)

A method of treating spastic tuberculosis microcystis with anti-tuberculosis chemotherapy drugs, characterized in that they additionally carry out epidural anesthesia lasting 5-7 days, and also apply laser radiation with a power of 12 mW with a wavelength of 632 nm to the biologically active point of the bladder on the hand every 4 minutes for 5 minutes -7 days.