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INVENTION
Patent of the Russian Federation RU2161972
METHOD OF INTEGRATED PATHOGENETIC THERAPY OF PATIENTS WITH OPTICOPRICULTURE
The name of the inventor: Khachatryan Ashot Papikovich; Khachatryan Robert Grishaevich
The name of the patent holder: Khachatryan Ashot Papikovich; Khachatryan Robert Grishaevich
Address for correspondence: 630007, Novosibirsk-7, PO Box 34, Khachatryan A.P.
Date of commencement of the patent: 1998.10.16
The invention relates to medicine, in particular to gastroenterology, and can be used for complex treatment of opisthorchiasis. Preliminary diagnostic testing is carried out. During the first three days, drink electro-activated aqueous solution of EVR-K is prescribed. It is prepared by adding 20 ml of a 10% solution of CaCl 2 , 25 ml of a 5% solution of MgSO 4 , 15 ml of a 4% solution of KCl to a small anode capacity of the Espero apparatus, and 50 ml of 0 in a large cathode capacity, 01% KMnO 4 solution. Rectal microclysters are made using a heated neutral solution of EOB-A (anolyte) with addition of 1/3 teaspoon of table salt to the anodic zone. Anthelminthic drugs are prescribed on day 5 according to the standard scheme with a one-third reduction in single and total course dose. The next day, a duodenal rinse with plant solutions is carried out.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, in particular to gastroenterology, and can be used for the complex treatment of parasitic diseases, for example, opisthorchiasis, in different clinical forms.
At present, the successful solution of the problem of systemic diseases, in particular opisthorchiasis, is determined not so much by their early detection, as by the improvement of the methods of therapy. The wide prevalence of helminthiases on large enough territories makes their study an actual problem. The opisthorchiasis clinic is characterized as a sign of defeat of the parasitic organs of the opisthorchis (liver, bile duct, gall bladder, pancreas), and changes from the gastrointestinal tract. This explains the need to develop a comprehensive stage-by-stage rehabilitation of patients with the inclusion of therapeutic measures of anti-inflammatory, stimulating nature, conducting preparatory therapy to create conditions for more effective treatment of the disease using known chemical drugs, and potentiating their action and subsequent correction of functional disorders of digestive organs , Persisting after deworming.
As a rule, the treatment of parasitic diseases is carried out only in the presence of those infected by opisthorchami of those or other violations on the part of the organs of the digestive system. Thus, with chronic opisthorchiasis, the liver and liver ducts, the pancreas, the duodenum, the small and large intestines are constantly involved in the pathological process.
In the chronic phase of the disease, opisthorchis in the amount of several copies to tens of thousands mechanically damage the sections of the mucosa of the biliary system. These changes lead to dyskinetic disorders of the gallbladder and biliary tract, which in turn leads to the development of the inflammatory process. Differential diagnosis and subsequent treatment of various forms of cholecystitis, biliary dyskinesia, cholangitis is carried out mainly according to cholecystography, echolocation, duodenal sounding. Modern methods of treatment of parasitic diseases include primarily etiotropic drugs aimed at suppressing invasion, etching parasites with specific chemotherapy drugs. It is known that the dehelminthization of patients with chronic opisthorchiasis, which contributes to stopping the progression of the process, in some cases does not lead to complete recovery.
For the treatment of chronic opisthorchiasis currently used two major drugs - biltricid and chloroxyl and their analogs, including foreign ones. However, with satisfactory tolerability of patients with many of these drugs, side reactions are inevitable: headache, frequent stools, dizziness, dyspepsia, pain in the right upper quadrant, nausea, heartburn, itching, urticaria. Moreover, many of these drugs are contraindicated in patients with cardiovascular insufficiency, renal and other chronic diseases (Pal'tsev AI Clinic, diagnosis, treatment of pancreato-duodenal lesions in opisthorchiasis .-- Candidate's thesis - 1983. - P. 147-153).
Most chemicals have many contraindications because of their side effects. Moreover, some authors note the absence of positive clinical dynamics after specific chemotherapy and the development of organ pathology after the use of such drugs as, for example, chloroxyl. In order to ensure the possibility of reducing the side effects of chemical preparations, it is suggested that pathogenetic preventive therapy with special emphasis on arresting the manifestations of the main pathogenetic syndromes is suggested. But the known means of preventive therapy do not solve the problem of reducing the toxic effects of chemicals.
There are known methods of treatment of parasitic diseases, including pathogenetic preventive therapy with the use of antibiotics, sedatives, anabolic steroids, prednisolone, vitamins. (AI Pal'tsev, Diseases of the Digestive System in Chronic Opisthorchiasis (Clinic, Diagnosis, Treatment), Novosibirsk, 1996, pp. 145-146). Carrying out complex pathogenetic preventive therapy that accompanies specific chemotherapy treatment allows, according to the author's observations, to compensate for clinical, biochemical, immunological indices of various parts of the digestive system, primarily the liver, and to stop manifestations of the main pathogenetic syndromes before (or after) carrying out specific chemotherapy. However, the use of hormonal preparations and antibiotics as preventive measures does not pass without a trace for patients in whom the digestive system is already burdened with intoxication, significant changes in the immune system, etc., especially since the dosages of chemical preparations remain unchanged and do not tend To decrease.
Deworming, based on combined chemotherapy, includes demyanoids, intestinal irrigation, the appointment of anti-inflammatory drugs, cholagogue grasses. After the end of the course of deworming, the pharmacological and physiotherapeutic stimulation of the function of the biliary tract continues.
In recent years, the methods of complex treatment of opisthorchias have been developed, including the use of a new physiotherapeutic device - diadynaphoresis of a 5% solution of "dry" brine as a stage of restorative treatment after chemotherapy (EI Beloborodova et al., Chronic opisthorchiasis and digestive system .-- Tomsk 1996 - P. 22). The stage of restorative treatment is included in the course of rehabilitation measures to improve the functional state of the stomach, the changes of which inevitably persist after deworming. However, such rehabilitation measures are carried out only at the stage of restorative (sanatorium-resort) treatment, and do not precede chemotherapy.
For the prototype, a method of treatment of opisthorchiasis has been adopted, including, along with chemotherapy, the conduct of preventive pathogenetic therapy using tumbles with mineral water and intestinal irrigation. (AI Pal'tsev, Clinic, diagnosis, treatment of pancreato-duodenal lesions in chronic opisthorchiasis, Candidate's dissertation, 1983.-P. 14).
However, tjubazhi are prescribed, as a rule, after a long-term intake of a chemotherapy, for example, chloroxyl, besides the effectiveness of this procedure is low, and intestinal irrigation, most often with plant solutions, is carried out after chemotherapy.
It is an object of the present invention to arrest the manifestations of the main pathogenetic syndromes of opisthorchiasis by specific therapeutic washing, preceding chemotherapy, and to create conditions for potentiating the action of medicaments.
The goal is achieved by the fact that in the preventive pathogenetic therapy of opisthorchiasis include therapeutic washing with antiseptic and parasitotropic purposes, for which against the background of the intake of food supplements "Narine-F", electroactivated aqueous solutions (EPR) per os and in the form of rectal microclysters are prescribed for three days Stay in the hospital after diagnostic duodenal sounding and immediately before the administration (introduction) of chemotherapy and subsequent intestinal irrigation, and for drinking, prepare a solution of EBP-K (catholyte) with the addition of 1000 ml of distilled water to 20 ml of a 10% solution of CaCl 2 , 15 ml 4% KCl solution, 25 ml of 5% MgSO 4 solution to the anode zone, 50 ml of 0.01% KMnO 4 solution to the cathode zone of the Espero apparatus; For rectal washes, use a heated neutral solution of EOB-A (anolyte) with the addition of 1/3 teaspoon of salt (NaCl) to the anode zone. After chemotherapy, a therapeutic duodenal rinse is prescribed.
Drinking solutions are prescribed within 3 days following the first probing of days in hospital in a dosage of 100-200 ml 3 times a day for 20-40 minutes before meals; In the evening they perform purifying treatment enemas with a heated neutral solution of EOB-A (anolyte), activate for 12 minutes and use a solution of a larger capacity. Enemas with EBV-A have anti-inflammatory, antiseptic effects, and in conjunction with the administration of per os EVR-K, the effect of activation of the eggs of opisthorchis (parasitropic effect) is achieved. Food bioadditive "Narine-F" of a wide spectrum of action is prescribed from 1 day to the entire course of treatment in a dosage of 1 tbsp. L. 3 times a day before meals in order to reduce intoxication when taking chemotherapy.
On day 5, specific treatment is given for the administration of anthelminthic drugs (biltricid, praziquantel, chloroxyl and analogues) according to the scheme according to the instructions for use, but with reduced single and total course dosage of the chemotherapeutic agent. The next day, duodenal rinsing with plant solutions (for example, chamomile) is carried out.
Patients with massive invasion, concomitant diseases and especially with a burdened allergological anamnesis, dehelminthization of which is accompanied by toxic-allergic reactions, are prescribed intraduodenal electrophoresis with electrolysis silver and dojagil. (EE Bazhenov et al., Treatment of Chronic Opisthorchiasis with Intraduodenal Electrophoresis of Electrolysis Silver and Delagila.) Current Issues in Gastroenterology., Collection of Scientific Journals - Tomsk, 1994. - P. 14).
The analysis of various methods of treatment of common parasitic diseases, such as opisthorchiasis, carried out by a number of researchers and practical doctors, confirms the need for complex therapy aimed at more rapid detection and relief of the main clinical symptoms. The physiotherapeutic methods of treatment used, for example, tjubazhi, do not allow to achieve the effect of activation ("awakening") of the eggs of opisthorchis, which multiply in the intestines of the host in huge quantities. The change in the functional state of the integumentary epithelium caused by parasites leads to a violation of absorption of nutrients, primarily fats and fat-soluble vitamins. The use of electroactivated aqueous solutions saturated with trace elements allows, in the course of preliminary medical washing (preventive therapy), to create the possibility of activation of eggs of helminths and partial washing out of the bile ducts and gall bladder, the places of their maximum accumulation and reproduction, already at the stage preceding chemotherapy treatment. The subsequent chemical effect is more effective, because A greater number of parasites fall into the zone of action of chemotherapy drugs. Bacteriological study of feces for opisthorchiasis reveals the presence of dysbacteriosis of varying degrees in a large number of patients, which in turn leads to a decrease in the body's immune system.
The therapeutic effect is increased due to the inclusion of the Narine-F nutritional supplement and the implantation of the intestinal omniflora, which have a high bacteriostatic activity and stimulate the growth of the human microflora in the preventive therapy phase.
The preventive treatment stage of the invention allows the administration of drugs in subtherapeutic doses due to the fact that when exposed to electro-aqueous solutions in conjunction with manipulation of the stimulation of human microflora, the effect of activation of parasites, their partial elution, and the enhancement of the action of chemotherapeutic agents is achieved.
Thus, the inclusion of the Narine-F complex, the implantation of the intestinal omniflora and the appointment of electroactivated aqueous solutions in a certain scheme and in certain ratios of trace elements, makes it possible to conclude that the invention meets the criterion of "essential differences".
The method of complex pathogenetic therapy of patients with opisthorchiasis is as follows.
On the first day, medical sensing with plant solutions is prescribed, which is performed to remove inflammation of the bile ducts and active outflow of bile, which allows to open access to the places of parasite accumulation. From 2 days during the entire course of treatment, administration of per os electroactivated aqueous solution (100 ml 3 times a day for 20-40 min before meals in small sips) is prescribed, prepared according to the following formula: 1000 units are poured into Espero's small and large capacity Ml of distilled water heated to 30-40 ° C. In a small container (anode) add 20 ml of a 10% solution of CaCl 2 , 25 ml of a 5% solution of MgSO 4 , 15 ml of 4% KCl; 50 ml of a 0.01% solution of KMnO 4 are added to the cathode zone. After exposure (7 min), the solution is ready for drinking. The solution from the big capacity (catholyte) should be drunk only on the day of its preparation, the next day the solution is prepared anew.
On the same early days (every other day), in the evening before going to bed, the patients are prescribed cleansing enemas with catholyte (1-1.5 liters) of the following composition: 1/3 of a teaspoon is added to the anodic zone with distilled water heated to 45-55 ° C Table salt (NaCl); The solution is activated for 12 minutes and injected into the intestine in a warm form (t = 38-40 ° C). In this case, for washing from a large capacity of the device, a volume of liquid is taken which causes a urge to defecate, but is kept in the rectum for at least 20-40 minutes. The purpose of this manipulation is to achieve an anti-inflammatory effect, restore the integrity of the mucosa and prepare the intestine for subsequent implantation of the omniflora. "Narine-F" is prescribed from 1 day to 1 tbsp. L. 2-3 times a day for 30-40 minutes before meals for the entire course to achieve immunostimulating, bacteriostatic effect, improve metabolic processes, and to stimulate the growth of its own intestinal microflora. Diet - sour-milk, biscuits, vegetables. On day 4-8 - no-spawn on 2 tablets. 3 times a day.
On day 9, a one-day biltricidide treatment is performed, but the daily dose is divided into three doses at night: 22 hours, 2 and 6 hours. In this case, a single dose is reduced: instead of the usual single dose of 20 mg, we were prescribed 15 mg per 1 kg of body weight (the total dose is 45 mg per 1 kg of body weight). On the next (10) day, therapeutic duodenal sounding with plant solutions, for example chamomile, is prescribed to relieve intoxication due to active leaching of helminth corpses and remnants of chemotherapy drugs.
On the 11th day in the evening, a cleansing enema with anolyte (1-1.5 l) is performed, on the 15th day - with catholyte in order to obtain an antiseptic, bactericidal and bacteriostatic effect in relation to living helminths and washing them out of the intestine. On the next (12) day, the implantation of bacterial preparations (bacteriophage, bifikol, etc.) through the method developed by us (Pat. No. 2092167) is performed rectally through the probe to increase its own immune system and create a physiological balance.
The proposed method of treatment with the use of electroactivated aqueous solutions against the background of food-grade bioadditives "Narine-F" of a wide spectrum of action has obvious advantages over the known methods of treatment of parasitic diseases, including before the method adopted as a prototype. Our research has shown that the appointment of electroactivated aqueous solutions with a certain amount and ratio of active elements during the first days of stay in the hospital contributes not only to the activation of parasites, but also has an anti-inflammatory, immunostimulating and detoxifying effect and allows to significantly reduce the dose of the chemotherapeutic agent.
The effectiveness of the proposed method has been studied by the example of two groups of patients. Patients of the first group (38 people) received anthelmintic treatment with prazikvantel (biltricid), which was prescribed in a daily dose of 60 mg per kg of body weight (one-day course). Pathogenetic therapy included carrying out tumbles with mineral water (according to Demyanov) - after the completion of chemotherapy. In 18 (47.3%) patients, side effects prazikvantelya in various manifestations - from headaches, fever to pain in the joints, ECG changes, etc .; The frequency of their manifestation led to the need for the elimination of anthelmintics in 4 (10.5%) patients, 5 (13.1%) patients were symptomatically treated. Probing, conducted after treatment with prazikvantel, revealed the presence of parasites in 7 patients who were scheduled to undergo a second course after 6 months.
Patients of the second group (96 people) underwent a course of combined pathogenetic treatment according to the proposed method using the nutritional supplement "Narine-F" throughout the course and electroactivated aqueous solutions before prescribing the praziquantel.
The daily dose of prazikvantel for most patients (91 people) was reduced relative to the standard dose by 1/3 and amounted to 45 mg per 1 kg of body weight (15 mg at a time - just 3 doses per day). In 14 (14.5%) patients after chemotherapy, side effects were noted (in 6 - skin itching, face hyperemia, in 8 - dizziness, weakness). The remaining group of patients - 82 people. (85.4%) did not complain during the entire treatment course. Duodenal sounding, conducted after 6 months, revealed the absence of parasites in 96 (100%) patients.
Dynamic monitoring of patients in both groups after 3-6-12 months showed that the majority of patients in the first group (29 people - 76.3%) had no positive dynamics, in 8 patients. (8.3%) there was a clinical improvement, 1 person. For a second examination did not show up. In contrast, a larger number of patients in the 2nd group (85 people-88.5%) had a clinical improvement (see table at the end of the description).
Example 1. Patient P., 36 years old. I entered the clinic of the Interregional Center for the Correction of Human Microbiocenosis (MKKMC) with the diagnosis: opisthorchiasis, hr. Parasitic cholecystitis. In the anamnesis - hr. Gastroduodenitis, hr. tonsillitis. Complaints about pain in the right hypochondrium, flatulence, bitterness in the mouth.
When examined - the stomach is a normal configuration, painful in the projection of the gallbladder. The diagnosis: opisthorchiasis (it is revealed for the first time), hr. Parasitic cholecystitis. Art. Severity, dyskinesia of GVP by mixed type.
Purpose: Starting from the second day (the first day - diagnostic sounding) - drink with EBV-K for 3 days to 100 ml 3 times a day for 40 minutes before meals, bioadditive "Narine-F" - 1 tbsp. L. 3 times a day. On the 5th day after the cleansing enema - rectal lavage of the intestine with a warm solution of EVR-A (anolyte) with NaCl, but-shpa - 1 table. 3 times a day, continue drinking with EBC-K to 50 ml 3 times a day before meals.
On day 6 - a preparation biltricid - a one-day course in three doses (in 6 hours) of 15 mg per kg of body weight after a meal. The next day - the second duodenal sounding - washing in Vitebsk, at the end of washing - through the probe to introduce a bacteriophage (10,0).
Already on the 5th day of hospitalization, the pain in the right upper quadrant decreased. There were dyspepsia, anorexia, general weakness. The abdomen is mild, moderately painful with deep palpation. A chair once a day, decorated.
On day 7 (after taking biltricide and duodenal rinsing) parasites were not found, bitter taste in the mouth disappeared, normal state of health. It is discharged with positive dynamics.
It is recommended to continue reception of cholagogue grasses within 1 month, tjubazhi once a week, "Narine-F" - within 1 month. When probing after 6 months. Parasites are not detected.
Example 2. Patient Z., 41 years old. I entered the hospital with a diagnosis of opisthorchiasis, exacerbation. Complains of constant dull pain in the right hypochondrium, skin itching, rashes on the skin of the hands and feet, nausea. In the anamnesis - hr. Cholecystitis with exacerbations 2-3 times a year. Results of sounding: in portion "B" (60 ml.) - eggs of opisthorchis. Cal on an egg-egg is the eggs of opisthorchis. On examination, the tongue is laid, the tension in the projection of the gallbladder. The abdomen is painful when palpated. Diagnosis: opisthorchiasis at the stage of exacerbation, hypomotor dyskinesia.
Appointments: during the first 3 days after probing - drinking a warm solution of EWR-K 100 ml 3 times a day 40 minutes before a meal, the drug "Narine-F" for 1 tbsp. L. 3 times a day, suprastin - 1 table. At night.
On the 5th day - after cleansing enema - rectal lavage with a warm solution of EVR-A with NaCl. On the 6th day antiparasitic therapy - biltricide - is prescribed not more than 45 mg per 1 kg of body weight in three doses in an hour after eating. Phytotherapy - oat broth - 50 ml 3 times a day before meals. Diet - table N 5.
On day 6 - duodenal lavage in Vitebsk (with a solution of chamomile). At the end of the rinse - the introduction of bifikol - through the probe (40,0). The patient does not complain plaintively, the pain in the right upper quadrant has decreased. The headaches stopped already on the 5th day of stay in the hospital.
As a result of the study of duodenal contents and with microscopic analysis, parasites have not been identified. At day 9, the heaviness in the right hypochondrium significantly decreased, the general condition was satisfactory. Nausea does not bother, there was an appetite, a calm sleep. When palpation - the liver is not enlarged. A chair once a day, decorated.
Were discharged in satisfactory condition under the supervision of infectious diseases. It is recommended: tjubazhi - once in 10 days, within 10 days, continue the reception of cholagogue grasses.
At the next probing (after 6 months) no parasites were detected.
CLAIM
The method of complex pathogenetic therapy of patients with opisthorchiasis, including the appointment of anthelmintic drugs, characterized by the fact that after diagnostic probing with the reception of "Narine-F" for the first three days, the patient is prescribed the drink of an electroactivated aqueous solution of EBP-K, prepared by adding the device to a small anode capacity " Espero "20 ml of a 10% solution of CaCl 2 , 25 ml of a 5% solution of MgSO 4 , 15 ml of a 4% KCl solution, and 50 ml of 0.01% KMnO 4 solution and rectal Microclysters with the use of a heated neutral solution of EOB-A (anolyte) with the addition of 1/3 teaspoon of salt (NaCl) to the anodic zone, and anthelmintic preparations are prescribed on day 5 according to the standard scheme, but with a one-third reduction in a single and total course dose , The next day, a duodenal rinse with plant solutions is carried out.
print version
Date of publication 29.03.2007gg
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