SU1651918A1 - Method for treating the cases of chronic constipation - Google Patents

Abstract

The invention relates to medicine, namely proctology. The purpose of the invention is to accelerate the time of treatment and stable normalization of the act, defecation. The goal is achieved by conducting electrical stimulation of the cecum with monopolar current pulses with a frequency of 40-60 Hz at a current of 10-20 mA for 4-5 minutes at a location active electrode in the area of the projection of the cecum followed by electrostimulation of the sigmoid colon with bundles of 80–100 Hz monopolar pulses with a pack duration of 2 s, a duty cycle of 1, a current of 15–20 mA for 4–10 min at the location of the active electrode These projections of the sigmoid colon. At the same time, sangviritrin 0.005-0.01 gx of Zraz per day for the first 4-8 days, and then 0.005 x 2 times a day for 6-10 days, are administered simultaneously into the diet. Tonus cookies are included in the dietary therapy, the daily dose is 2.5 g per 1 kg of the patient's weight, with the morning dose being i / 3, and the evening dose being the remaining 2/3 daily. The method allows to achieve a regular daily stool without pain.

Description

This invention relates to medicine, in particular to proctology.

The purpose of the invention is to accelerate the time of treatment and stable normalization of the act of defecation.

The method is carried out as follows.

All patients are prescribed diet No. 3 and at the same time daily for 8–16 days electrostimulation is performed at the location of one of the electrodes in the projection of the cecum onto the skin of the anterior abdominal wall with monopolar pulses with a frequency of 40–60 Hz at a current of 10–20 mA for 4–5 min, after which electrostimulation is continued with monopolar pulses with a frequency of 20–100 Hz

with a pulse duration of 2 s and a well of 1 with a current of 15–20 mA for 9–10 min with one of the electrodes in the region of the sigmoid colon on the skin of the anterior abdominal wall. At the same time, additionally, treatment with sanguinarine is administered orally at 0.005-0.01 g 3 times a day for the first 4-8 days, and then 0.005 g 2 times a day for 6-10 days, in addition dietary cookies include Tonus, The daily dose of which is 2.5 g per 1 kg of the patient’s mass, the morning dose being 1/3 and the evening dose the rest 2/3 daily.

During intestinal electrostimulation, the active electrode is placed on the skin.

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the abdomen in the right ileal projection of the cecum, and the passive electrode on the skin through the lumbar region. Monitoring the finding of the cecum is carried out by palpation, as well as with the help of an irrigoscopy, which is an indispensable method of research in patients suffering from chronic constipation. After that, the sigmoid colon is stimulated by placing the active electrode on the left iliac region, and the passive remains in the same place in the lumbar region. The localization of the sigmoid colon is also refined by palpation and irrigoscopy.

The intestinal electrostimulation was performed using the Endoton 1-B apparatus. The dimensions of the plate electrodes are standard for conducting electrical procedures. Their areas correspond to the areas of impact zones.

Tonus biscuits differ from other varieties of sweet liver in that part of the high-grade flour in it is replaced with wheat millet. Improves

motor-zakuatornuyu function of the intestine, helps to normalize the intestinal microflora.

Sanguirythrine - an original drug, consists of the sum of bisulfates of alkaloids Sanguirythrine and chelerythrine. Known as an antimicrobial. It also has anticholinesterase activity. The latter property is used in the method of treating constipation in order to improve the transmission of nerve impulses from the peripheral nerve to the smooth muscles of the intestine.

In the proposed method of treatment, chronic constipation is presented as a syndrome that can accompany many diseases. The proposed method aims to normalize the motor-evacuation function of the colon and in no way replaces the treatment of the underlying disease (duodenal ulcer, cholecystitis, etc.).

Treatment of chronic constipation with the proposed method not only causes an improvement in the patient's condition and normalization of the motor-evacuation function of the intestine, but also increases the efficiency of treatment of the underlying disease.

PRI me R 1. Sick 3., 48 years. . Diagnosis: Irritable bowel syndrome on the background of a pronounced hypochondro- depressive state. Complaints on admission to constipation for 4-5 days, pain in the lower abdomen of a wandering nature, intestinal distention, nausea, weakness, headache, depression. Sick for 4 years. To achieve the act of defecation, she took a long time extract of buckthorn, senade, glaxenna, magnesia sulphate, and mineral water of Junn-Janos in increasing dosages, however, the use of laxatives caused an increase in abdominal pain. Over the past year repeatedly

used rectal suppositories and cleansing enemas, which caused contact erosive sphincteritis. Outpatient and inpatient treatment using traditional methods of improvement

did not bring. With a detailed examination. (clinical, radiological, endoscopic and laboratory) no organic changes in the intestine were detected. According to electrocolonogram

(ECOLG) - pronounced decrease in intestinal motor activity. The study with the help of a multiphase personality test (MLT) confirmed the presence of a hypochondro-depressive syndrome. From the first day of treatment, the patient was prescribed a Nk 3 diet. From the second day, intestinal electrostimulation was performed using the Endoton 1-B apparatus using the above method. Inside was assigned sanguinarine according to the scheme: in the first 8

days 2 tablets of 0.005 g 3 times a day, then within two weeks 1 tablet of 0.005 g 2 times a day. Taking into account body weight (78 kg), the patient received 195 g of rich dietary liver Tonus (13 pieces per day)

in two steps: in the morning 4 pieces, in the evening 9 pieces liver.

On the fourth day of treatment, the pain and dyspeptic disorders, abdominal distension, decreased, there was a tendency to normalize the stool (the stool was self-contained every other day), and sleep and mood improved. The treatment was well tolerated. On the 10th day, the pains completely stopped, the intestinal distention disappeared, the amount of excreted feces increased, its consistency became softer. From the 14th day of treatment, constipation completely stopped, dyspeptic symptoms disappeared. By the end of the treatment, the ECOLH voltage had normalized; hypochondro-dipressive personality changes are leveled out (according to MLT).

PRI mme R 2. Sick A, 48 years old.

Diagnosis is irritable bowel syndrome, chronic cholecystitis, chronic gastritis with secretory insufficiency. On admission she complained of general weakness, feeling of heaviness in the right hypochondrium, pain in the epigastric region, abdominal distension, rumbling, constipation for 3-4 days.

Constipation suffered from childhood. In recent years, stool is possible only after the use of laxatives (senade 7-10 tablets at the same time at the reception), often resorted to enemas. In the X-ray study of the gastrointestinal tract - moderately expressed enteroptosis, hypomotor colon dyskinesia (on the third day all barium in the colon), cholecystography revealed gallbladder hypokinesia, on the electrocolonogram - a hypokinetic curve type with a pronounced spastic component. From the moment the patient was admitted to the hospital, table No. 3 was assigned to her, taking into account the patient's weight (65 kg), 162.5 165 g of dietary sweet liver Tonus was given - only 11 pieces (4 in the morning and 7 in the evening) from the third day sangviritrin tablets of 0.005 according to the scheme: in the first 3 days, 2 tablets 3 times a day, then 1 tablet 2 times a day for 8 days; daily throughout

The intestinal electrostimulation was carried out for 14 days using the Endotone-1B apparatus according to the following procedure: first, the cecum region was exposed to monopolar pulses with a current intensity

15 mA with a frequency of 50 Hz in continuous mode for 5 min, and then to the region of the sigmoid colon with monopolar pulses with a frequency of 100 Hz at a current of 15 mA in a discontinuous mode for 10 min.

On the 6th day from the start of treatment, the patient had independent stool, the pain syndrome significantly decreased, dyspeptic symptoms disappeared on the 10th day, scorological data improved (consistency of the stool became softer, pathological impurities disappeared). By the time the treatment ended (day 20), the patient had no complaints, the stool became regular (daily), with electrocolonography control, the normokinetic curve was registered,

PRI me R 3. Sick V., 57 years.

Diagnosis: irritable bowel syndrome, chronic cholecystitis. On admission she complained of constant pain in the right hypochondrium, radiating to the back, feeling of heaviness in the epigastric region, general weakness, insomnia, constipation for 4-5 days, Cholecystography - hypotension of the gallbladder, multi-stage duodenal sounding - gallbladder hypotension. An X-ray of the gastrointestinal tract revealed hypomotor disis- From the second day of the patient's stay in the hospital, she was prescribed 180 g of liver Tonus {from the calculation for

72 kg of patient weight), sanguinarine and bowel growth stimulation according to the method described above. Already on the 4th day, the patient experienced the urge to self-defecate, on the 6th day the pain syndrome significantly decreased, and on the 12th day the chair was normalized. There are no complaints by the end of treatment. With control cholecystography, the contractile function of the gallbladder

within normal limits. On the control electrocolonogram - normokinetic curve type (on admission - hypokinetic).

PRI me R 4. Patient E., 70 years.

Diagnosis: chronic enterocolitis with hypomotor syndrome. Suffer from constipation for 12 years. In recent years, an independent stool was not observed, laxatives were ineffective, recovered only after cleansing. enemas. If the stool is delayed for 5 or more days, the occurrence of intoxication (headache, nausea, retching). On admission, complained of abdominal pain, severe weakness, headache, feeling of heat, low-grade fever. Irrigography detected megasigme. Bauginia failure. X-ray of the gastrointestinal tract with the study of the passage of the bari through the intestines showed a delay of barium in the colon on the 4th day. In electrocolonography, a pronounced hypokinetic type of curve. From the first days, the patient was assigned dietary biscuits Tonus based on 69 kg of weight - 172.5 175 g (12 pieces) - 4 in the morning and 8 in the evening, szvviritrin according to the scheme and electrostimulation of the intestine with the Zndoton-1B apparatus according to the proposed method. TO

By the end of the third week, the patient had a self-standing stool, abdominal pains disappeared, the electrocolonogram curve approached the normokinetic type.

Thus, a clinical trial

showed that the proposed method of treating constipation has a fairly high efficiency, significantly improves the motor function of the large intestine, is physiological, is well tolerated by patients, is simple

use and can be recommended for the treatment of constipation in patients with irritable bowel syndrome, chronic enterocolitis, chronic cholecystitis with gallbladder hypokinesia, ulcerative

duodenal disease. PRI me R 5. Sick V., 49 years old, Diagnosis: irritable bowel syndrome, chronic cholecystitis with dyskinesia of the gallbladder hypotonic type.

On admission she complained of aching pain throughout the abdomen, most intense in the left iliac region, abdominal distension, and constipation for 3 days.

From the anamnesis, it is known that the symptoms of the disease appeared a year and a half ago. Constipation persistent, there is practically no urge to have a bowel movement, a stool only after a cleansing enema. Outpatient treatment with traditional methods (antispasmodics, laxative drugs), as well as inpatient treatment at the gastroenterology department at the place of residence with prozerin, ultrasound in the intestinal area with diet no. 3 for three weeks did not cause a significant improvement.

An objective examination of the patient: the pathology of the respiratory and cardiovascular systems was not revealed. Tongue moist, covered with a white bloom at the root. The abdomen is mildly palpable, moderately painful, more noticeable in the left iliac region, and the sigmoid colon is palpable in size. Symptoms of peritoneal irritation are absent. The liver and spleen are not enlarged. Pulse 68 beats. in 1 min A / D 110/70 mm Hg

Additional examination data: complete blood count without pathology (Hb - 159 units, er - 4.9 x 1012, leuke. - 5.6 x 109), total protein - 72 g / l, blood electrolytes are within normal limits (calcium - 5.1 mEq / l, potassium - 4.1, sodium - 140). Rectoromanoscopy: chronic atrophic procto-sigmoiditis.

The data of electrocolonographic study of intestinal motility - the voltage of the tonic waves of the cecum is 0.2 mV, the sigmoid colon is 0.21 mV.

The patient received treatment:

Electrostimulation of the colon with the help of Endoton 1-B in the following order: first, the caecum with a current of 10 mA with a frequency of 40 Hz for 5 min in continuous mode, then the sigmoid with a current of 15 mA and a frequency in the discontinuous mode of 80 Hz within 10 min;

Sangviritrin 0.005 1 t x 3 times a day - 4 days, then 1 t x 2 times a day - 6 days;

Cookies Tonus (taking into account the patient's body weight - 180 g - 12 pcs.) 6 two doses -1/3 of the daily dose in the morning and 2/3 in the evening during the entire course of treatment.

As a result of the treatment, the chair was self-contained on the day four, and from the ninth day of treatment it became daily. The pain syndrome decreased on the fourth day, at the time of discharge it was completely stopped. The dyspeptic manifestations ceased from the sixth day of treatment.

X-ray examination of the intestine served as objective methods for monitoring the effectiveness of treatment. On the sixth day from the start of treatment, after 24 hours, all sections of the colon were performed with a barium suspension, as well as an electrocolonographic study of intestinal motility on days 1 and 14 from the start of treatment — the voltage of the tonic waves of the cecum (0.53 mV) compared to baseline increased two and a half times, the voltage of the tonic waves of the sigmoid colon (0.26 mV)

5 increased by 0.15 mV. The patient was discharged in a satisfactory condition without complaints. PRI me R 6. Patient P., 57 years old. Diagnosis: irritable bowel syndrome, chronic recurrent

0 pancreatitis, chronic cholecystitis with hypotonic gallbladder dyskinesia.

On admission, complained of aching pain in the left iliac region, around

5 navel, general weakness, constipation for 4-5 days. From the anamnesis, it is known that the patient suffers from constipation for 7 years, almost constantly being treated on an outpatient basis and annually inpatient according to well-known

0 methods, however, the normalization of the intestinal motor activity could not be achieved.

An objective examination of the respiratory and cardiovascular systems - the norm is overgrown. Pulse 62 beats / min, AD-140/80 mm Hg, the tongue is wet, lined with white bloom at the root. The abdomen is soft, moderately painful, predominantly in the periumbilical region and region of the projection of the sigmoid colon. Symptoms of peritoneal irritation are absent. The liver and spleen are not enlarged.

Additional examination data: complete blood count - no pathology

5 (Hb - 148, er. - 4.9 x 1012, watering. - 4.5 x 109, ESR - 6 mm / h), total protein - 74 g / l. Recto-Romanoscopy: catarrhal proctosigmoiditis. Irrigoscopy; moderately expressed dolichosigma. Data from electrocolonography of intestinal motility - the voltage of the tonic waves of the cecum - 0.21 mV, the voltage of the tonic waves of the sigmoid colon - 0.11 mV.

The patient received treatment:

5 electrostimulation of the large intestine using the Endoton 1-B machine in the following order: first, the cecum with a current of 20 mA with a frequency of 60 Hz in a continuous mode for 5 minutes, and then the sigmoid colon with a frequency of 100 Hz and

current 20 mA in intermittent mode 10 min;

Sangviritrin 0.005, 2 tons x 3 times a day for 8 days, and then 1 tons x 2 times a day for 10 days;

Cookies Tonus (taking into account the patient's body weight is 220 g 15 pcs.) in two doses, 1/3 of the daily dose in the morning and 2/3 in the evening during the entire course of treatment.

As a result of the treatment, the tendency to normalize the stool (1 time in 3 days) appeared from the 11th day of treatment, daily defecation i with a sufficiently full bowel movement was achieved by the 22nd day of treatment, the pain syndrome was stopped by the 15th day of treatment

X-ray studies of the passage of the barium through the intestines for 18 days from the start of treatment were carried out with objective methods of monitoring the effectiveness of treatment - after 24 hours all parts of the colon were evenly performed. An electrocolonographic study of intestinal motility on day 21 from the start of treatment showed that the voltage of the tonic waves of the cecum increased by 0.6 mV, and of the sigmoid colon by 0.19 mV. those. almost 3 times.

Compared with the prototype, the proposed method accelerates the elimination of the bopic syndrome and the normalization of the intestinal function of the colon in almost all patients, helps to reduce the consumption of drugs and completely abandon imported drugs, suggests the possibility of using it in the presence of concomitant diseases of the digestive organs, no need for complex treatment methods with the participation of narrow specialists,

The method of treatment was applied in 20 patients (9 men and 11 women) suffering from constipation in the following diseases; irritable bowel syndrome (9 people), chronic enterocolitis with hypomotor syndrome (5), chronic cholecystitis (2), chronic gastritis (2), duodenal ulcer disease in the cicatrization phase (2),

All patients complained of constipation for 3 to 5 days, abdominal pain, accompanied by intestinal discomfort, and the presence of pathological impurities in the feces (blood and mucus). Almost all patients had disorders of the neuropsychic sphere, manifested by depression of mood, anxiety, suspiciousness, carcinophobia.

After prescribing a course of treatment according to the proposed method for testing, a positive effect (normalization of the act of defecation, relief of pain syndrome, leveling of septic phenomena and deviations in the neuropsychic sphere) was obtained in 19 patients. An improvement in the motor function of the colon is confirmed by electrocolonography data (increased

the voltage of the waves and the curve was close to the normo-kinematic type), as well as the radiological control of the barium passage through the intestines. No noticeable improvement was obtained in only 1 patient with chronic

enterocolitis on the background of megacolon and dolichogmy, combined with chronic cholecystitis, which is associated with the presence of gross organic changes on the part of the large intestine.

The therapeutic effect is proposed-. This way is illustrated in the table.

Long-term results were monitored in 12 patients for six months. In three patients, the treatment was repeated after 3 months due to recurrent constipation. The rest of the patients who continued systematic liver tonus / became regular stools and there were no subjective feelings of incomplete bowel movement.

Claims (1)

Formula invented and A method of treating patients with chronic constipation, including diet therapy, medicaid therapy and physiotherapy treatment, characterized in that acceleration of the treatment time and the stable normalization of the act of decontamination, daily for 8–16 days electrolyte stimulation of the cecum is carried out by monopolar current pulses with a frequency of 40–60 Hz with a force of a current of 10–20 mA for 4–5 min at the location of the active electrode E in the area of the projection of the cecum, after which electrostimulation of the sigmoid colon is carried out with bundles of monopolar pulses 80-100 Hz with a pack duration of 2 s, a duty cycle of 1 and a current of 15-20 mA for 9-10 minutes with the active electrode in the projection area of the sigmoid colon, while simultaneously by sangviritrin 0.005-0.01 g 3 times a day for the first 4-8 days, and then 0.005 2 times a day for 6-10 days, and Tonus biscuit, the daily dose of which is 2.5 g per 1 kg of the patient’s weight, with the morning dose being 1/3, and the evening dose being the remaining 2/3 daily, 11165191812 Comparative therapeutic efficacy of treating patients with chronic constipation.