RU2557425C1 - Method for integrated treatment of vascular complications of diabetes mellitus in obukhovskiy resort - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: integrated resort treatment is conducted. A patient takes carbonic sodium chloride mineral water. The mineral water is heated to a temperature of 37°C before use and taken at 3 ml per 1 kg of body weight 3 times a day 40 minutes before meals. The therapeutic course makes 18 days. The patient also takes "dry" carbon dioxide baths with the CO₂ concentration of 1.2-1.4 g/l at the water temperature of 35°C. The water temperature is reduced to 32°C by the end of the course. The procedure length is 15-20 minutes. CO₂ is supplied from a balloon into a special box compartment at a rate of 15-20 l/min. The gas mix temperature ranges from 28°C to 38°C. The procedures are performed every second day. The course of 8-10 procedures is required.

EFFECT: method provides normalising the complete blood count, blood sugar, common urine analysis, improving the visual analysis health, renal blood flow, ophthalmic parameters by the integrated intake of mineral water and dry carbon dioxide baths, optimum regimen and length of the therapeutic course.

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Description

The present invention relates to medicine, namely to restorative medicine, urology, ophthalmology, internal medicine, and is intended for the treatment of diabetic microangiopathy.

There is a method of treating various diseases with drinking mineral waters in patients (Patent for the invention of the Russian Federation No. 2076713) and can be used in the treatment of gastritis with reduced, increased secretory function, chronic colitis, cholecystitis, diseases of the operated stomach, gastric ulcer and 12 duodenal ulcer, pancreatitis chronic hepatitis, pyelonephritis, chronic adnexitis, prostatitis without exacerbation, as well as diseases of the central nervous system, hypertension, coronary heart disease, pulmonary tuberculosis without exacerbation in obme disease on substances (diabetes, oxaluria, obesity). Patients are prescribed the natural mineral bischofite diluted in distilled water in various ratios (1:38 600; 1:38 - 58; 1:59 - 230; 1: 231 - 460; 1: 461 - 600). The disadvantage of this method is the need for laboratory manipulations with the active agent (dilution of bischofite in various concentrations), the availability of data on the effects of the proposed treatment method (diuretic, choleretic and disinfectant) in the absence of information on the pathogenetic effect on the underlying disease.

A known method of preventing the progression of impaired glucose tolerance using mineral waters of the Essentuki type (Patent for the invention of the Russian Federation No. 2162697), the essence of which is that the mineral water Essentuki No. 4 is taken in a dose of 200 ml for 15-20 minutes before eating for 30 days. The method allows to normalize the glycemic curve, increase the early phase of insulin secretion, improve lipid metabolism. This increases the effectiveness of disease prevention. Despite its effectiveness, the method has a highly specialized preventive orientation and does not characterize the effect on vascular changes in patients with diabetes mellitus.

A known method for the prevention and treatment of mineral water (Patent for the invention of the Russian Federation No. 2235547), in which, as a medicinal-drinking mineral water, a natural sludge solution isolated from fresh-water therapeutic sapropels is used, which in its characteristics relates to low-saline hydrocarbonate sodium-magnesium-calcium solutions. The solution is obtained by dehydration and enrichment of therapeutic sapropel with a moisture content of 97-93% to a moisture content of 80 to 60% by the method of gravity-hydraulic action, with the mineralization of the natural silt solution of at least 0.33 g / dm ³ . As a mineral table water, a single dose of consumption is recommended 100-200 ml 3-4 times a day with a course of 21-28 days. As table water or a mineral refreshing drink, a single dose of consumption is recommended up to 250 ml or up to 1.5 l for up to 30 days. The disadvantage of this method is the complex process of preparing the dosage form, the lack of data on specific nosologies and the lack of data on complex balneotherapy.

The closest way to the proposed one is the method of correction of metabolic disorders in patients with diabetes mellitus (Patent for the invention of the Russian Federation No. 2157692). The method is intended for the treatment of metabolic disorders in patients with diabetes mellitus by a spa treatment, including taking ascorutin in a dose of 100 mg three times a day along with taking Essentuki No. 4 mineral water 200 ml 20-30 minutes before meals with diet therapy ( 9, 9a), sugar-lowering drugs (insulin and (or) sulfonylurea) according to indications, carbon-mineral baths for a course of 10 procedures for 30 days. The method allows to improve carbohydrate, protein, water-salt metabolism, lipid peroxidation. Despite the high results of the known method for treating patients with diabetes mellitus, this method does not have data on the dynamics of ophthalmic parameters, while the organ of vision is one of the most susceptible anatomical structures of the body to metabolic disturbances in diabetes mellitus. Reliable data on the effect of the proposed treatment regimen, and not the general complex of balneological factors, are not presented.

Actual is the need to further improve the methods of combined treatment of diabetic microangiopathy.

The technical result consists in improving the condition of the urinary system and organ of vision in patients suffering from microangiopathy against diabetes mellitus, which contributes to the improvement of renal function and ophthalmic parameters (visual acuity, visual fields, state of the retinal vessels).

Significant differences of the claimed method are:

1) The use of Obukhovskaya hydrocarbonate-sodium chloride mineral water in combination with a course of “dry” carbon dioxide baths in the Obukhovsky sanatorium for the treatment of diabetic angiopathy, which ensures the normalization of general urinalysis and analysis according to Nechiporenko and blood sugar.

2) Improving the state of the visual analyzer (visual acuity, indicators, improving visual fields) in patients with diabetic retinal angiopathy after treatment with Obukhovskaya hydrocarbonate-chloride-sodium mineral water in combination with “dry” carbonic baths in the conditions of the Obukhovsky sanatorium.

3) Improvement in renal hemodynamics (increase in maximum systolic and diastolic blood flow velocity (Vmax, Vmin) and decrease in resistance index (RI) and pulsation (PI) at the level of the main and peripheral vessels).

The specified technical result is achieved by the fact that the claimed method for the correction of vascular disorders in patients with diabetes mellitus by conducting a comprehensive spa treatment, including the intake of carbonic acid bicarbonate sodium chloride mineral water, characterized in that the mineral water is taken heated to a temperature of 37 ° C at the rate of 3 ml per 1 kg of body weight 3 times a day for 40 minutes before meals, a course of 18 days, appoint "dry" carbon dioxide baths according to the following scheme: concentration of CO ₂ - 1.2-1.4 g / l, water temperature 35 ° C with a decrease to conc rate to 32 ° C, duration of the procedure 15-20 minutes, CO ₂ is fed from a cylinder in a special cabin box at a rate of 15-20 l / min, the temperature of the gas mixture from 28 ° C to 38 ° C, the procedure is carried out every other day, for course of 8-10 procedures.

The advantage of the claimed method is the use of mineral water "Obukhovskaya", which has the following characteristics:

Organoleptic properties: odorless, colorless. Transparent.

The basic chemical composition of the Obukhovskaya mineral water is described by the indicated formula:

CI78 HCO ₃ 21SO ₄ 1

C org. up to 0.010 M _1.97 (Na + K) over 95 Ca 3 Mg 2

pH = 7.69

A study of the quality and composition of Obukhovskaya mineral water has been monitored for many years at the Federal State Budgetary Institution Yekaterinburg Medical Scientific Center for Prevention and Health Protection of Industrial Workers.

In the main ionic composition of water, hydrocarbonate and chloride ions and sodium cations predominate, which is typical for the waters of the Obukhov deposit and allows us to classify this water as hydrocarbonate-sodium chloride. The mineralization of water varies from 1.92 to 1.96 g / dm ³ , which allows us to consider them as low-mineralized.

Along with the basic chemical composition, the healing properties of Obukhovskaya mineral water are associated with the biologically active substances present in them, mainly represented by organic substances. In addition, due to the predominance of organic substances in the composition: alcohol resins, humic substances, the content of which varies from 2 to 7 mg / dm ³ , this type of water seems possible to attribute to mineral waters with a high content of organic substances of the humic type.

In addition to humic substances, the presence of neutral bitumen (oils, neutral resins, petroleum hydrocarbons) in the amount of 1.6-3.5 mg / dm ³ , as well as acidic bitumen (naphthenic acids, light, medium and acidic resins, acidic bitumen) - 1.0-1.4 mg / dm ³ . The total content of organic substances as a whole varies from 10.0 to 20.0 mg / dm ³ . Moreover, the highest content of organic substances is observed in the water of well 10-D (C org. From 5.19 to 11.74 mg / dm ³ ), which is operated and used for medicinal and drinking purposes by the Obukhovsky sanatorium.

In terms of the content of organic substances - “C org”, regulated by GOST 13273-88 “Mineral drinking water, medicinal and medicinal-table” (C org. Up to 10 mg / dm).

In addition to organic substances, the therapeutic properties of Obukhovskaya water are determined by the following therapeutically active components present in it in relatively small concentrations:

- metasilicic acid - 40.9-43.2 mg / dm ³ ;

- orthoboric acid - 26.3-26.6 mg / DM ³ ;

- bromine - 3.94-4.26 mg / dm ³ ;

- iron - up to 0.1 mg / dm;

- hydrogen sulfide - up to 5.0 mg / DM ³ ;

- iodine - 0.68-0.85 mg / dm ³ .

A study of the main physiological groups of bacteria in the Obukhovskaya water showed that nitrifying, denitrifying and butyric acid bacteria predominate in it, and a fewer amount of ammonifying bacteria are present.

Long-term observations of the content of trace elements in Obukhovskaya mineral water, which have toxic concentrations in certain concentrations (cobalt, vanadium, barium, zinc, copper, arsenic, chromium, etc.) or have an adverse effect on organoleptic properties, show that their content in 10D well water is in concentrations acceptable for mineral drinking medicinal-table waters.

From the above it follows that the Obukhovskaya mineral water from well 1 OD, used for internal intake in the sanatorium, has favorable chemical, toxicological, microbiological and organoleptic characteristics, and also has a pleasant taste.

In combination with the Obukhovskaya mineral water treatment course, a course of “dry” carbonic baths is prescribed, which uses carbon dioxide CO ₂ as a biological irritant that acts in isolation from hydrostatic pressure and a kind of thermal irritation associated with biphasic water -gas, according to the following treatment method: CO _{2 is} supplied from the cylinder to a special box-box with a speed of 15-20 l / min, the temperature of the gas mixture is from 28 ° C to 38 ° C, the duration of the procedure is 15-20 minutes every other day, on a course of 8-10 procedures. Dosing of baths is carried out according to the concentration of carbon dioxide, water temperature, its volume and duration of the procedure. In diabetes mellitus with concomitant microangiopathy in the conditions of the Obukhovsky Sanatorium, the following scheme for prescribing "dry" carbonic baths is used: the concentration of CO ₂ is 1.2-1.4 g / l, the water temperature is 35 ° C, with a decrease to 32 by the end of the course ° C, as the temperature decreases, the duration of the procedure increases from 5-7 minutes to 12-15 minutes.

The clinical effect is the physiological reaction of the body to carbon dioxide - the expansion of all capillaries and blood vessels, as well as an increase in oxygen in the blood, which in combination with the intake of mineral water "Obukhovskaya" provides an improvement in the general analysis of urine, ultrasonic parameters of renal blood flow, as well as basic ophthalmological parameters .

Clinical example

As an example of the treatment of diabetic microangiopathy, we give an outpatient treatment scheme for a patient A., born in 1962, who was admitted to the Obukhov sanatorium with complaints of weakness, fatigue, decreased working capacity, headaches, dry mouth, thirst, polydipsia. From 02/03/2014 to 02/21/2014 was observed in the endocrinology center of Yekaterinburg on the basis of MAU “City Clinical Hospital No. 40” with a diagnosis of Pancreatogenic diabetes mellitus, first detected. Chronic pancreatitis in remission. Diabetic microangiopathy: initial cataract, retinal microangiopathy in both eyes. Diabetic nephropathy stage of microalbuminuria. CKD 1 ".

In November 2013 she suffered an exacerbation of chronic pancreatitis, underwent conservative treatment in a hospital setting. 02/03/2014 arrives in a planned manner in the city endocrinological center, during the examination revealed diabetes mellitus. She underwent conservative treatment: Rosinsulin C 28 U + 16 U, Rosinsulin Π (penfil) 12 + 12 + 12 U.

The results of the examination before treatment: February 24, 2014. Blood sugar: 8: 00-9: 00 - 8.4 mmol / L, 11:00 - 11.3 mmol / L. Urinalysis: Specific gravity 1008, protein - 0.5 g / l, glucose - 0.5 g / l, pl. epithelium - 8-10 in s / sp, white blood cells - 10-12 in s / sp.

Indicators of renal blood flow on the main artery (a. Hep.):

Vmax - 53.8 cm / sec

Vmin - 16.4 cm / sec

S / D-3.28

PI - 1.3

RI-0.7

Indicators of renal blood flow at the periphery (a interlob.):

Vmax - 21.3 cm / sec

Vmin - 6.1 cm / sec

S / D - 2.53

PI - 1.36

RI - 0.71

Additionally, an examination by an ophthalmologist:

Refractometry OD s -0.75. Cyl -0.25, ax 123

OS s -0.75. Cyl -0.75, ax 5

TWG OD = 18, TWG OD = 18

VOD = 0.9 n / a, VOS = 0.85 s -1.0 = 0.9

02.24.2014. On admission to the Obukhovskiy Sanatorium, he notes complaints of weakness, fatigue, decreased working capacity, headaches, dry mouth, veil before the eyes.

Objective data: satisfactory condition. Consciousness is clear. The skin is of normal physiological color. No swelling. The tongue is wet, coated with a white coating. The abdomen is soft, slightly painful in the epigastric region. The kidneys are not palpable, Pasternatsky’s symptom is negative on the right, weakly positive on the left. Weakening pulsation of the arteries of the lower extremities is noted. Height - 164 cm, body weight - 89 kg, body temperature - 36.6 ° C, blood pressure - 130/80 mm Hg

In the conditions of the sanatorium, patient A. was prescribed to receive directly from the source weakly mineralized mineral water with a high content of organic substances: hydrocarbonate-chloride-sodium mineral water "Obukhovskaya". The water was taken heated to a temperature of 37 ° C at the rate of 3 ml per 1 kg of body weight 3 times a day 40 minutes before meals, course of 18 days. In addition, the patient received diet food table No. 9 + additional meals, exercise therapy, “dry” carbonic baths (concentration of CO ₂ 1.2-1.4 g / l, temperature 35 ° C, duration 7-12 minutes) No. 10 , massage on the collar zone No. 10 every other day, whirlpool baths on the upper and lower extremities No. 10 every other day, magnetotherapy on the lower limbs No. 10 every other day.

Control examination was carried out on the 8th and 14th day of stay in the sanatorium.

8th day of treatment. General urine analysis and Nechiporenko analysis are within normal limits. Blood sugar: 8: 00-9: 00 - 7.6 mmol / L, 11:00 - 9.5 mmol / L.

Ophthalmologist consultation: Refractometry OD s -0.75. Cyl -0.25, ax 123

OS s -0.75. Cyl -0.75, ax 5

TWG OD = 18, TWG OD = 19

VOD = 0.9 n / k, VOS = 0.9 n / k

14th day of treatment. General urine analysis and Nechiporenko analysis are within normal limits. Blood sugar: 8: 00-9: 00 - 5.82 mmol / L, 11:00 - 8.12 mmol / L. Ophthalmologist consultation:

Refractometry OD s -0.75. Cyl -0.25, ax 123

OS s -0.75. Cyl -0.75, ax 5

TWG OD = 18, TWG OD = 19

VOD = 1.0, VOS = 0.95

Indicators of renal blood flow in the main artery (a. Ren.):

Vmax - 60.9 cm / sec

Vmin - 19.7 cm / sec

S / D - 3.09

PI - 1.25

RI - 0.68

Indicators of renal blood flow at the periphery (a interlob.):

Vmax - 25.3 cm / sec

Vmin - 8.1 cm / s S / D-3.01

PI - 1.31

RI 0.68.

Claims (1)

A method for correcting vascular disorders in patients with diabetes mellitus by conducting a comprehensive spa treatment, including the intake of carbonic acid bicarbonate chloride-sodium mineral water, characterized in that the mineral water is taken to be heated to a temperature of 37 ° C at the rate of 3 ml per 1 kg of body weight 3 times a day 40 minutes before meals, a course of 18 days, conduct "dry" carbon dioxide baths according to the following scheme: the concentration of CO ₂ is 1.2-1.4 g / l, the water temperature is 35 ° C with a decrease to 32 ° C by the end of the course, the duration of the procedure is 15-20 minutes, CO _{2 is} fed from b allon into a special cabin-box with a speed of 15-20 l / min, the temperature of the gas mixture from 28 ° C to 38 ° C, the procedures are carried out every other day, for a course of 8-10 procedures.