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INVENTION
Russian Federation Patent RU2192847
METHOD treatment of acute pancreatitis
Name of the inventor: Legos AA .; Hunafina SN .; Lavrenteva EV .; Lavrentiev Yu
The name of the patentee: Legos Alexander A.
Address for correspondence: 450000, Ufa Centre, Lenina, 3, Bashgosmeduniversitet, patent department
Starting date of the patent: 2000.02.10
The invention relates to medicine, namely to gastroenterology, and relates to the treatment of acute pancreatitis. For this purpose, in addition to conventional therapy sodium oxybutyrate administered in a daily dose 4.8 g to normalization of diastase urine. The method improves the efficiency of the treatment of acute pancreatitis due to earlier and more complete restoration of pancreatic function.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, namely to the intensive care unit, and can be used for emergency care for patients with acute pancreatitis.
Since 1950, for the treatment of acute pancreatitis are widely used protease inhibitors: trasilol, tsalol, contrycal and others.
"Since the 80's the vast majority of surgeons prefer the conservative treatment of acute pancreatitis" (w-l Surgery 1994, 6, p.38) with the use of high doses of protease inhibitors.
It is known that for pain as a symptom in determining the diagnosis of acute pancreatitis in most cases applied subcutaneously or intravenously 2% solution of Promedol (Boger MM. Pancreatitis. Novosibirsk, 1984, p. 103). Due to severe pain in acute pancreatitis to enhance promedola action prescribed antihistamines, but even 4-6-fold administration of these drugs is not completely pain docked, often causing respiratory failure with subsequent development of multiple organ failure leading to death. Therefore, to eliminate the pain being sought to use new drugs, cocktails or blockades (w-l Surgery 1994, 6, p.38). "We must not forget that now described many cases of" promedalizma "similarly morphinism" (BE Votchal. Essays on Clinical Pharmacology. Publishing House "Medicine", 1965, s.405).
The prototype of the invention is a method for treating acute pancreatitis by intravenous administration of protease inhibitors in which "trasilol administered intravenously at 5% - 40 ml glucose solution at a dose of from 100 thousand to 1 million units per day is recommended to use higher in recent years... doses "(M. Boger. pancreatitis. Novosibirsk. 1984, p. 109).
Surgical treatment is indicated for patients who have intensive therapy is ineffective, and the operation is "frustration operations" because despite the constant expansion of the arsenal of methods and means of intensive care mortality rate remains high among operated -50-85%, and in the form of lightning 98-100% (w-l Surgery, 1994, p.38).
"In recent years, there have been reports about the lack of effectiveness of protease inhibitors in severe forms of destructive pancreatitis" (M. Boger. Pancreatitis. Novosibirsk, 1984, p. 109). "... The effectiveness of protease inhibitors in acute pancreatitis there is evidence of their effectiveness questionable or no effect in the treatment of pancreatitis." "According to some authors, the use of protease inhibitors in the treatment of acute pancreatitis does more harm than good, so it is advisable to completely reject them" (w-l Surgery, 1994, p.39).
The technical result - increasing the effectiveness of the treatment due to early and full restoration of function of the pancreas, preventing infection and its transition into a phase of pancreatic necrosis, reduced indications for surgical intervention, decrease in the percentage of mortality and reduced hospital stay.
Included in the program of intensive therapy of acute pancreatitis sodium hydroxybutyrate dictated by its multi-faceted pharmacological activity that affects many parts of pathogenesis, namely:
- Suppresses pain,
- Reduces the secretory activity of the pancreas,
- Reduces the production of enzymes,
- Reduces vnutriprotochnoe pressure
- Removes the emotional component,
- Helps relieve spasm and improvement of drainage function of the ducts,
- Antihypoxic and has an antioxidant effect,
- Limits the destruction of cell membranes,
- Protects the pancreas from necrobiotic processes.
A method for treating acute pancreatitis, is as follows:
the patient at the time of admission in filling medical history is diagnosed with the definition of severity of the condition, treatment plan and inspection plan. The survey plan include indicators diastase urine. Resuscitator pathology condition hospitalizes severity of the patient in the intensive care unit, and determines the amount of fluid therapy, which further includes sodium hydroxybutyrate:
Glucose 5% - 200.0 ml
novocaine 0,25% - 100.0 ml
platifillin 0.2% - 2.0 ml
diphenhydramine 1% - 1.0 ml
Sodium hydroxybutyrate (GHB) 20% - 10.0 ml (2.0 g)
potassium chloride 7.5% - 30.0 ml
MDS. Intravenous infusion 2-3 times per day. The daily dose of sodium hydroxybutyrate administered depending on the patient's body weight and gravity - 4.0 g - 8.0 g
This therapy is used with the first hour of admission of the patient to the hospital and in the days before the normalization of urine diastase. For example, urine diastase fell from 2048 units to 16-64 units.
Diastase urine examined twice a day every day at high rates it.
Example.
Patient R., 34 years enrolled 16.12.99 (case 16330) at 02 hours and 30 minutes in the emergency order with the diagnosis of acute pancreatitis.
Complaints of acute intense pain at the top of the stomach, the pain of a permanent nature, girdle, radiating to the back.
Acutely ill about 1:00 16.12.99 after a fatty meal. Due to severe pain patient taken by ambulance in 18 clinical hospital in the city of Ufa.
The patient's condition serious: excited, rushes from the pain. Consciousness is clear. The skin is pale, clean, dry.
Heart - sounds are muffled, rhythmic. Blood pressure 160/90 mm Hg. Art. Pulse is 100 beats per minute, rhythmic, satisfactory filling.
In the lungs vesicular breathing, no wheezing. Symptom effleurage negative on both sides.
St. Localis. Tongue dry with a white coating. Abdomen rounded, swollen. At midline of the abdomen from the xiphoid process to the umbilicus keloid scar. In the right upper quadrant - the star-shaped scar. The patient was operated in GKB 021 in 1997. for acute necrotizing pancreatitis. Palpation in the epigastric and left upper quadrant sharply painful. Symptom Ortner sharply positive. Symptom Shchetkina - negative.
Diagnosis: Acute pancreatitis.
Survey Plan:
1. Diastase urine
2. White blood cells Blood
3. ECG
4. Consultation of the therapist
5. anesthesiologist consultation
6. Observation of the dynamics
The treatment plan:
1.Infuzionno-detoxification therapy
2. antispasmodics
3. Local hypothermia
4. Analgesics
When a 02 45
Diastase urine - 1 024 units for Voyachek (norm 16-64 units)
Glucose - 6.98 mmol / l
ALT - 15.2 U / L
Total protein - 61.2 g / l
Urea 2.68 mmol / L
Bilirubin total - 10.0 mmol / l
PTI 100%
Erythrocytes 4.8 h 10 12 / l
HB - 152 g / l
White blood cells are 10.6 × 10 9 / L
% E-1, P-4%, C - 71% L - 20%, m - 2% ESR - 5 mm / h
February 30 Inspection therapist. The diagnosis is the same - Acute pancreatitis.
02 45 Inspection anesthesiologist - gravity condition is serious.
The diagnosis is the same - Acute pancreatitis.
Recommended:
1. Infusion therapy in a volume of 2 liters
Glucose 5% - 200.0
Novocaine 0.25% - 100.0
Platifillin 0.2% - 2.0
Diphenhydramine 1% - 1.0
Sodium hydroxybutyrate (GHB), 20% - 10.0 (2.0 g)
KCl, 7.5% - 30.0
Prednisolone 30 mg. Intravenous drip.
2. Adequate analgesia
3. Control diastase in urine dynamics
4. Hunger
5. Local hypothermia
To clarify the diagnosis carried out and fibrogastroskopicheskoe echographic study. The diagnosis of acute pancreatitis was confirmed.
After 30 minutes from receipt and after 2 hours from the onset of the disease carried by intravenous infusion therapy with sodium oxybutyrate.
protease inhibitors in this patient is not administered.
16.12.99. Adequate anesthesia was performed by sodium oxybutyrate 2.0 g intravenously (twice a day) and promedolom (three times) intramuscularly.
Sheets medical prescriptions in the intensive care unit 16.12.99
1. 10% Glucose - 400.0
KCl, 7.5% - 30.0
MgSO April 25% - 10.0 2 times / day
Insulin 8 units
2. Ringer rr - 400.0 2 times / day
Eufillin 2.4% - 10.0
3. Glucose 10% - 200.0
Novocaine 0.25% - 200.0
Sodium hydroxybutyrate (GHB) 20% - 10.0 (2.0 g), 2 times / day
Prednisolone 30 mg
Diphenhydramine 1% - 1.0
Platifillin 0.2% - 1.0
4. Sodium chloride 0.9% - 400.0
agapurin 5.0
5. Promedol 2% - 1.0 / m 3 times
6. Vitamins B 1 3.0 / a, B 6 3.0 I /
7. Chill in the epigastric region
8. Cleansing enema
Conducted monitoring of blood pressure, heart rate, BH, diuresis, t body. One time there was a vomiting. Inspection surgeon 16.12. Recommended conservative treatment.
16.12. resuscitator
24 00 His condition was grave. In the minds. Complaints of pain in the epigastric bloating.
t-36,6 o C
The skin is clean, normal color. Vesicular breathing, no wheezing. BP 120/70 mmHg 1 pulse in 84 min, rhythmic.
Language moist, soft belly, distended.
Peristaltic noise does not listen.
Cleansing enema without effect.
Urine output is sufficient.
17.12.99g. Resuscitator.
His condition was grave. Pain decreased.
The skin is clean, normal color.
Respiration and Hemodynamics satisfactory.
Blood pressure 120/70 mm Hg. Art. Pulse 1 min at 84.
Language moist, belly soft, moderately swollen.
Urine output is sufficient.
Diastase urine 256 units.
17.12.99.
Inspection head. surgical department.
A stable condition. Consciousness is clear, calm.
Pain in the upper abdomen. Jaundice is not. Tongue dry, coated. Pulse 1 min at 90, satisfactory filling and voltage.
Abdomen not distended, symmetrical, palpation pain in the epigastric region. No peritoneal signs. Laxation active. Diastase 128 units. Conservative therapy to continue.
17 30 Status of moderate severity. Subjectively, the patient feels better. Pain stoped.
The skin of normal color.
Tongue dry.
In the lungs vesicular breathing, no wheezing.
Heart sounds are muffled, the rhythm is correct.
BP 130/90 mmHg Pulse 1 min at 96.
Abdomen moderately swollen, peristaltic noises are heard.
Urine output is adequate.
Diastase urine decreases.
17.12.99.
24 00 The patient was transferred to the surgical department with positive dynamics. Reduced infusion therapy.
The treatment lasted for office:
1. Glucose 5% - 400.0 ml of 1p / day - 4
Insulin 4 unit
GHB 20% - 10.0 ml
Novocaine 0.25% - 100.0 ml 2
NaCl 0,9% - 200,0 ml of 1p / day - 4
Analgin 50% - 2.0 ml
Diphenhydramine 1% - 1.0
MgSO April 25% - 10.0
3. Atropine 0.1% - 1.0 subcutaneously 2p / day
4. Control blood pressure, P BH, urine diastase
12.18.99.
10 00 The duty surgeon.
The patient's condition is satisfactory. Subjectively noted improvement. The skin of normal color. Pulse 1 min at 74. Abdomen soft, painless, not swollen. The dynamics of positive. Conservative therapy to continue.
12.19.99.
12 45 Diastase urine 256 units
After the treatment the patient's condition is satisfactory. Discharged 28.12.99. Spent just to 12 / day (1 to resuscitation / day).
The diagnosis at discharge: Acute pancreatitis edematous form. Related: Erosive gastritis. Analyses on 23.12.99. Diastase urine - 64 units
Blood tests: leukocytes H 8.5 × 10 9 / l erythrocytes - 4.8 h 10 12 / l, Hb - 152 g / l.
Blood biochemistry:
Glucose - 6.1 mmol / l
Bilirubin - 10 mmol / l
Total protein - 61 g / l
Urea - 2.4 mmol / l
Urinalysis: protein (-), white blood cells - 3 n / s, the epithelium hyaline uniform. in p / 3p.
Are discharged in a satisfactory condition under the supervision of the district gastroenterologist.
The proposed method of application of sodium hydroxybutyrate in the conservative treatment of acute pancreatitis edematous form has reduced the hospital stay in intensive care (1.8 K / day) and in the hospital for 12 / day (MON - to 14 / day), after surgery for acute destructive pancreatitis - in the intensive care unit to 4.4 / day in hospital for 25.6 / day (MON - 45), without an operation - in intensive care - 3.7 K / day.
Mortality has decreased in destructive forms of acute pancreatitis: after operations - 20.6%, in the conservative treatment - 12.2%, the edematous form of acute pancreatitis mortality rate - 0.
Given the simplicity, affordability and high efficiency of the proposed method for the treatment of acute pancreatitis, you can recommend it to the active implementation of intensive therapy of acute pancreatitis in practical healthcare.
CLAIM
A method for treating acute pancreatitis, including infusion-symptomatic and detoxification, characterized in that the additionally added sodium oxybutyrate at a daily dose of 4.8 g to normalization of diastase urine.
print version
Publication date 29.03.2007gg
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