The invention relates to medicine, surgery, can be used in the treatment of bronchial asthma with associated lesions of the gastrointestinal tract. A preliminary examination of a patient with bronchial asthma is carried out. Perform surgical correction of insolvency of the ileocecal obturator apparatus and chronic violation of duodenal patency when this pathology is detected. The method allows to eliminate the cause of bronchial asthma.
The invention relates to medicine and can be used for the treatment of bronchial asthma (BA) in patients with combined lesions of the gastrointestinal tract. Treatment of all forms of asthma includes two main stages: relief of asthma attacks and anti-relapse treatment. In the exacerbation phase (stage of tactical therapy), individual selection of therapeutic measures depends on the severity of the exacerbation and the presence or absence of active, clinically pronounced inflammation and includes, among other things, intravenous administration of glucocorticoid drugs, bronchodilators and membrane stabilizing agents. At the stage of strategic therapy, i.e. in the remission phase, individual therapy is carried out in accordance with the clinical and pathogenetic variants of the patient's condition. Pharmacotherapy is of primary importance in the phase of exacerbation of asthma. Supportive minimal and sufficient pharmacotherapy should be carried out in the remission phase. The disadvantage of the generally accepted standard approaches to the treatment of AD is that they do not eliminate the cause of the disease, often further aggravate the patient's condition, creating his dependence on a particular drug. In recent years, a number of publications have appeared on the relationship between the state of the gastrointestinal tract and the course of the disease in patients with asthma. In 1934, J. Bray pointed out this connection. Asthma attacks occurred after a heavy meal. He believed that this plays a role in stretching the stomach, in connection with which a vagal reflex occurs (Bray G. //Practitioner. - 1934. - Vo1.34, 4. - P. 368-370). In 1946, S. Mendelsohn observed aspiration of gastric contents into the bronchi, which caused a syndrome resembling asthma (Medelsohn C. //Amer. J. Obstet. Jynec. - 1946. - Vol.52, 2. - P.191-195) . In a number of works of a later period, a clear relationship was shown between gastroesophageal reflux (GPR) and asthma (L.K. Parkhomenko, O.S. Radbil "Gastroesophageal reflux and bronchial asthma." // Clinical Medicine. - 1994. - 6. - S.4-7). In these works, special attention is paid to the presence of hydrochloric acid in the esophagus, which causes re-irritation of the vagus nerve with subsequent bronchospasm due to pathological centripetal impulses from the organs of the gastrointestinal tract (GIT) and pathological centrifugal impulses to the smooth muscles of the bronchi. Another part of the authors also points to the connection of GPR with various pulmonary pathologies (including BA), but considers the imperceptible microaspiration of the contents into the bronchi to be the leading etiological moment. In the presence of increased reactivity of the bronchial tree and allergic restructuring of the body on the basis of these aspiration complications of the GI, BA often develops. (V. V. Stonkus, K. I. Paltanavichyus "On gastroesophageal reflux in patients with infectious-allergic bronchial asthma." // Clinical Medicine. - 1981. - 12. - S. 48-52). Others have revealed a positive effect of enterosorption in the treatment of BA, which consists in reducing the severity of the course of the disease, lengthening the period of remission, reducing the doses of medical agents used (A.V. Nikitin, E.P. Karpukhina, V.P. Silvestrov "Clinical efficacy of polyphepan enterosorbent in complex therapy of patients with infectious-dependent bronchial asthma". // Therapeutic archive. - T. 65. -1993. - 3. - S.25-26). The closest to the claimed method of treating AD is the fundoplication developed by Nissen. The authors note that surgical antireflux intervention is indicated only in cases of severe esophagitis or recurrent pulmonary aspiration. The results of this treatment suggest that fundoplication does not always cause recovery or even improvement (L.K. Parkhomenko, O.S. Radbil "Gastroesophageal reflux and bronchial asthma." // Clinical Medicine. - 1994. - 6. - S.4-7). This most common Nissen fundoplication method is carried out as follows (Imre Litmann "Abdominal Surgery", Hungarian Academy of Sciences Publishing House. Budapest. - 1970): upper median laparotomy. A fold of tissues covering the abdominal segment of the esophagus or cardia is dissected by a transverse incision, and the lower segment of the esophagus is mobilized by the surgeon's finger in a blunt way. After the esophagus is isolated, a rubber holder is placed around it, by pulling which the abdominal esophagus and cardia are lowered into the abdominal cavity. The cardia and the fundus of the stomach are mobilized by dissection on the clamps of the upper part of the gastrohepatic ligament. Then the surgeon, with one or two fingers of the right hand, brings the fundus of the stomach to the posterior wall of the esophagus so that the wall of the stomach is to the right of it, where it is captured by a soft gastric clamp or held by a holder. At the next stage, the abdominal esophagus is immersed and fixed into the sleeve formed by the fundus of the stomach, using separate silk sutures with the capture of the muscle layer of the anterior wall of the esophagus. In total, 6-7 such sutures are applied. In this case, it is necessary to ensure that the sleeve created from the stomach lies freely, without squeezing the esophagus. Layered suture of the median wound of the anterior abdominal wall. The disadvantages of the known method (fundoplication according to Nissen) are the following: 1 - often only a consequence is eliminated, namely, GPR, which may be the result of another pathology; 2 - the possibility of recurrence of GPR in case of failure of the sutures that form the cuff around the esophagus. The reasons for this are various; 3 - re-irritation of the vagus nerve can also occur due to damage to other parts of the digestive system, and not only in the pathology of the esophagus as a result of gastrointestinal tract. It can also lead to bronchospasm; 4 - endogenous intoxication is not eliminated, which is also one of the causes of BA; 5 - food allergy is not eliminated as a factor in the etiopathogenesis of AD; 6 - the state of the entire digestive system does not improve, which, according to our data, largely depends on NICA and CNDP, which underlie the etiopathogenesis of AD. Therefore, the task of the proposed invention, the authors put the elimination of the causes of the disease, improving the quality of life of the patient. The problem is solved thanks to a method for treating asthma patients with pathological disorders of the gastrointestinal tract, carried out after drawing up, based on the results of a preliminary examination, an acceptable therapeutic regimen for him, including taking drugs and other therapeutic agents and surgical intervention in the pathological zone of the gastrointestinal tract, in which, in accordance with the proposed technical solution in the detection of NICZK and often associated with chronic violation of duodenal patency (CHDDP) carry out surgical correction of the defect. Distinctive features of the claimed invention, namely the detection of insolvency of the ileocecal valve, established by clinical and radiological signs, the implementation of its surgical correction, the implementation of surgical correction as well as a chronic violation of duodenal obstruction, are essential features of the invention. The failure of the ileocecal valve is established in the presence of such clinical signs as abdominal pain, heaviness in the abdomen, nausea, belching with air, regurgitation of food, heartburn and bitterness in the mouth, constipation, diarrhea and loose stools, intolerance to milk and other foods, bad breath , bloating and rumbling in the abdomen. However, the inventor is aware of cases where clinical signs of ileocecal valve failure did not appear. Then the diagnosis was established according to the data of irrigoscopy only, namely, the flow of contrast into the ileum. And it is especially significant that the manifested malformations of the gastrointestinal tract in patients with BA are corrected surgically, which contributes to the cure of this disease. In the sources of patent and scientific and technical information, no method of treating BA with the proposed set of essential features has been identified. Therefore, the author believes that the proposed method meets the criterion of patentability "novelty". In addition, the authors believe that the relationship between the state of the ileocecal obturator apparatus, CNDP and the course of BA in patients was not obvious to specialists, as it was established as a result of many years of observation and analysis of the condition of this group of patients. Therefore, the authors believe that the second criterion of patentability is present in the proposed technical solution. A method for treating BA in patients with comorbidities of the gastrointestinal tract in accordance with the proposed technical solution is carried out as follows: if before the operation, in case of failure of the ileocecal obturator apparatus, a chronic violation of the duodenal patency of the CNDP was not detected, then a laparotomy is performed with an oblique incision according to Volkovich-Dyakonov in the right iliac region and performed bauhinoplasty according to the technique developed by us. The essence of the method is to create a semblance of a flap with its upper and lower lips, in the formation of the ventral and dorsal frenulums and in the prosthetics of the sphincters of Varolia and Busi (patent for the invention "Method of bauhinoplasty" according to application 4952905/14/056000). If prior to the operation with NICA, CNDP is detected, then a mid-median laparotomy is performed and a revision of the duodenum is performed. If preoperative diagnosis revealed arteriomesenteric compression, one of the types of CNDP, with operational confirmation of this pathology in the form of an expansion of the duodenum above its compression by the upper mesenteric vessels, then one of the types of anastomoses is applied between the initial section of the lower horizontal part of the duodenum 12 to the upper mesenteric vessels and a section of the jejunum 20-30 cm below the ligament of Treitz. Methodology: interrupted nylon sutures are placed between the indicated sections for 6-7 cm with a distance of 5-6 mm between them. Departing from the resulting suture line by 5-6 mm, the wall of the duodenum and jejunum is dissected for 2-2.5 cm. Dissected walls of the duodenum and jejunum, which are located closer to the line of previously applied serous-muscular sutures, are sutured with separate interrupted sutures, thus forming the posterior lip of the anastomosis. Also, the remaining dissected sections of the wall of the duodenum and jejunum are sutured together with interrupted sutures, forming the anterior lip of the anastomosis. This suture line is reinforced with a second row of seromuscular sutures. Thus, the output from the duodenum is normalized. Produce plastic ileocecal obturator apparatus by the developed method. If, prior to the operation, compression of the duodenum by the upper mesenteric vessels was not detected, and only the high location of the duodenojejunal part of the small intestine is determined, then there is no need to impose a duodenojejunal anastomosis. The cause of CNDP in this case will most often be a cicatricial adhesive process in the distal part of the duodenum and the proximal part of the jejunum, as well as a scar-altered ligament of Treitz, which compresses these sections of the intestine and pulls it up. These reasons disrupt the release of contents from the duodenum 12. In this case, the found scars and adhesions are dissected. Above and to the left of the duodenojejunal junction, the parietal peritoneum is dissected and the duodenojejunal section is freed from adhesions in the retroperitoneal section. The ligament of Treitz is exposed. Both her legs are taken on two clamps each and intersect between them, and then tied up. Thus, the duodenojejunal junction straightens, its sharp bend is eliminated, which normalizes the exit from the duodenum. The exposed retroperitoneal space is peritonized with separate sutures. Plastic surgery of the ileocecal obturator apparatus according to the developed technique. Layered suture of the wound of the anterior wall of the abdomen. We give an example of a specific implementation. Patient S., aged 16, was admitted to the proctology department of the Regional Clinical Hospital. ON THE. Semashko 05/17/1995 with complaints of asthma attacks, more often at night, general weakness, headache, heaviness in the abdomen after eating, regurgitation of food, a feeling of bitterness in the mouth, loose stools, rumbling in the abdomen, bad breath, weight loss. He is a disabled person of the second group due to bronchial asthma. The diagnosis of bronchial asthma was made at the age of 4 years. He was hospitalized up to 4 times a year. He was hospitalized twice in the intensive care unit for asthmatic status. Recently, asthma attacks have become more frequent, intensified, it has become more difficult to succumb to drug therapy. Without the introduction of hormonal drugs, suffocation did not stop. Often 2-3 times a night I had to call an ambulance. Bronchospasm was caused by house dust, hair of cats and dogs, smells of various herbs and plants, cold air, milk, oranges, chocolate, chicken eggs. Constantly took theofedrin, ketotifen, eufillin, diphenhydramine. I slept sitting up at night. On admission he was in a state of moderate severity. The skin is pale. Breathing is difficult. Diffuse dry rales in the lungs. Belly of the correct form. The liver, kidneys, spleen are not palpable. Pasternatsky's symptom is negative on both sides. Palpation of the abdomen is slightly painful in the right iliac region. Irrigoscopy revealed colitis phenomena, reflux of a radiopaque substance into the ileum through the ileocecal valve. Ultrasound revealed deformity and kink in the area of the body of the gallbladder, probing of the duodenum showed signs of cholecystocholangitis, sowing portion "B" showed no growth of microflora. The analysis of gastric juice revealed: hyperacidity in both phases of secretion, growth of microflora was not detected, but markers of anaerobic bacteria were determined in the first portions by gas chromatography. Coprological examination revealed muscle fibers and neutral fat. Immunological examination showed: less than the norm of immunoglobulins G, the number of leukocytes is reduced (3000), lymphocytosis - 38%, the number of B-lymphocytes is increased (36%). The level of average blood serum molecules is increased by 50% (0.36 units). The qualitative reaction of urine to indican is positive. Sigmoidoscopy: the mucosa is hyperemic, the vessels are injected. Complete blood count and urinalysis were within normal limits. With a diagnosis of "Leakage of the ileocecal valve; bronchial asthma of mixed genesis, severe course", the patient was taken for an operation on May 29, 1995, as a result of which it was revealed that the ileocecal anastomosis was expanded to 4 cm, in the mesentery of the ileum - lymph nodes 0.5 - 0.8 cm in diameter. At 5 cm from the ileocecal fistula, the ileum is sharply deformed by adhesions. Spikes are dissected. Bauginoplasty was performed with prosthetics of the sphincters of Varolia and Busi with a strip of dura mater. The postoperative period went smoothly. On June 8, 1995, the patient was discharged home. The control examination in a hospital was carried out from 22.04. on 05/17/1996. Since the operation, she has not noted asthma attacks, she does not take any medications, and signs of gastrointestinal discomfort have disappeared. However, control irrigoscopy revealed barium reflux into the ileum. Given the absence of any clinical manifestations of bronchial asthma, the patient was followed up dynamically. 6 months after this follow-up examination and 1.5 years after the operation, the patient again developed symptoms of asthma. There was an eructation of air, a smell from the mouth. Functional, laboratory parameters were within the normal range, only the level of average blood serum molecules increased to 0.32 units. Due to the recurrence of ileocecal valve failure, the patient again undergoes bauhinoplasty using a strip of vascular prosthesis. A year after the repeated bauhinoplasty, the patient underwent an inpatient examination at the Regional Clinical Hospital named after. N. A. Semashko from 11/10/97 to 11/24/97. The condition improved again: asthma attacks did not recur, he does not take medications. He enjoys winter fishing. Irrigoscopy revealed no organic pathology; the radiopaque substance does not enter the ileum with tight filling of the caecum. Immunological parameters are normal. The level of average blood serum molecules is 0.27 units. The ventilation function of the lungs was within the normal range. The patient was demonstrated at the Nizhny Novgorod Surgical Society in November 1997. Statistics
After receiving the first single positive results of the treatment of BA by the proposed method, an analysis of gastoenterocolitis complaints in 134 patients with BA was carried out in order to identify the role of the gastrointestinal tract in the etiopathogenesis of BA. These patients noted abdominal pain in 63% of cases, heaviness in the abdomen - in 61%, nausea - in 49%, belching with air - in 61%, regurgitation of food - in 45%, heartburn and bitterness in the mouth - in 74%, constipation - in 47%, diarrhea and loose stools - in 43%, intolerance to milk and other food - in 41%, bad breath - in 52%, bloating and rumbling in the abdomen - in 62% of cases. Various operations on the abdominal organs were performed in 48% of patients. All of these complaints, in our experience, are consistent with ileocecal obturator failure and CNDP. 30 patients with BA were examined; irrigoscopy revealed failure of the ileocecal obturator apparatus, of which 26 of them were found to have CNDP with duodenography without hypotension and with manometry. Duration of the disease is from 5 to 35 years, age is from 13 to 57 years. All 30 patients were operated on, they underwent plasty of the ileocecal obturator apparatus according to the proposed method, in 26 patients with simultaneous correction of CNDP (24 - dissection of the ligament of Treitz, 2 - jejunoduodenostomy). The operation was successful in 28 patients with BA - asthma attacks either do not occur at all or occur very rarely and require a single dose of bronchodilators. In 2 patients, a year later, a recurrence of ileocecal obturator valve failure developed due to a deviation from the surgical technique with the resumption of asthma attacks. A repeated operation according to the developed technique in one of them again stopped the clinic of gastroenterocolitis and BA. Chronic endogenous autointoxication with incompetence of the ileocecal obturator apparatus is inherent in the vast majority of patients. With this pathology, the qualitative reaction of urine to indican was positive in 95 cases, and negative in 95 cases after surgery for up to a year or more. Autonomic dystonia syndrome SVD was detected in 92 patients with NICA. After surgery, it disappeared in 66 patients, and in 17 cases there was a decrease in SVD. The definition of SVD was carried out according to the clinic (fatigue, dizziness, palpitations, headaches, hyperhidrosis, vasomotor lability), tabular methods and computer-processed intervalocardiography data.
CLAIM
A method for the treatment of bronchial asthma, including a preliminary examination of the patient and the implementation of surgical correction of the failure of the ileocecal obturator apparatus and chronic violation of duodenal patency when this pathology is detected.Introduction.
1. Literature review.
1.1. Broncho-obstructive syndrome: prevalence,. cause and effect.
1.2. Morphological changes in the lungs. and bronchial tree in bronchial asthma.
1.3. Immunological disorders in the pathogenesis of bronchial asthma.
1.4. Pathogenetic role of the nervous system in the course of bronchial asthma.
1.5. Symptomatic and concomitant asthma.
1.6. Methods of surgical treatment of bronchial asthma.
1.6.1. Operations on the autonomic nervous system.
1.6.2. tissue surgery.
1.6.2.1. Tissue cell transplantation.
1.6.2.2. Requirements for a porous carrier of transplant tissue.
1.6.3. Operations on the lungs to remove pathologically altered parts of the organ with denervation of the lung root.
1.6.4. Lung autotransplantation.
1.6.5. Pathogenetic principles of surgical treatment of bronchial asthma by glomectomy with denervation of the carotid sinus zone.
1.6.6. The role of novocaine blockades in the system of complex treatment of patients with bronchial asthma.
1.6.7. Immune disorders in bronchial asthma, indications for extracorporeal correction.
1.6.8. Efferent methods of treatment of bronchial asthma.
1.6.9. Immunosorption.
1.6.10. Methods of gravitational blood surgery (plasmacytapheresis) in the treatment of patients with bronchial asthma.
1.7. Infusion oxygen therapy.
1.8. Possibilities of acupuncture EHF-rehabilitation therapy.
Dissertation Introductionon the topic "Surgery", Belousov, Evgeny Valerievich, abstract
The relevance of research
Allergic diseases are generally recognized as one of the most common human diseases, among which bronchial asthma (BA) occupies a special place. According to the WHO, the incidence of BA in various countries exceeds the incidence of malignant neoplasms by 3-7 times, and by tuberculosis by 25-100 times. The total damage from the treatment of patients with asthma in the United States in 1990 alone amounted to 6.2 billion dollars. An increase in the incidence of BA is observed all over the world, especially in technically developed countries (Japan, Germany, Great Britain, USA, Russia, etc.). In Russia, BA suffers from 0.1 to 7% of the population, depending on the ecological region and place of residence, the degree of technogenic and anthropogenic environmental pollution. The epidemiological distribution of the incidence of asthma in Siberia is uneven: from 2% in Altai to 18.3% in Yakutia.
In recent years, there has been a clear trend towards an increase in the incidence of asthma, its severe and complicated forms, and an increase in mortality. The appearance of the so-called uncontrollable severe forms is noted, among which there are severe persistent and severe acute BA. These types of disease are characterized by a significant decrease in airflow, pronounced, especially in acute asthma, increasing hypoxia, frequent complications, the need for resuscitation, and a high risk of mortality. Severe persistent asthma in the period of status asthmaticus is characterized by a predominance of edematous and inflammatory changes. Neutrophils and eosinophils are most often found in sputum and bronchoalveolar fluid. The sharp narrowing of the airways is due to an increase in the number of smooth muscle cells of the bronchial tree, edema and swelling, as well as a decrease in the elastic properties of the lung parenchyma. Thus, in recent years, the incidence and severity of asthma has increased, severe drug-resistant forms of the disease have appeared, and mortality has increased, which in Mexico and Uruguay has reached 5.63 per 100,000 patients.
Conservative methods of treatment during the period of exacerbation are aimed at relieving the bronchospasm syndrome, improving the drainage function of the bronchial tree and correcting homeostasis disorders; during remission - to prevent the next relapse of the acute phase of the disease, which can be triggered by an exacerbation of ENT or dental pathology, any allergy, impaired immune status, etc. A variety of pathogenetically substantiated methods of treatment have been developed, algorithms for the prevention and treatment of asthma have been compiled and implemented in clinical practice for various types and severity of the disease. However, the regular use of hormonal and adrenomimetic drugs has obvious disadvantages and side effects, including steroid stomach ulcers, arterial hypertension, glaucoma, diabetes mellitus; osteoporosis, myodystrophy, myocardial dystrophy, etc. . Elderly patients with severe concomitant or background pathology naturally "survive" the side effects of long-term steroid therapy for asthma, including inhalation of drugs with clinical features, which requires a doctor to have special training in managing patients of gerontological age. Thus, it becomes obvious that conservative treatment is not of a radical nature and, unfortunately, is aimed at achieving only a temporary effect. With the progression of the disease, deformation of the bronchial tree is formed with a violation of the drainage function, emphysema, cor pulmonale, etc., which leads to a steady increase in the number of disabled people among people of working age and children. Thus, the high frequency and constant increase in the incidence of asthma, the working age of patients with severe forms of the disease, the low effectiveness of drug treatment, frequent relapses leading to early disability, have put forward the need for complex treatment of asthma in the section of not only medical, but also social health problems.
Based on the foregoing, it can be seen that it is almost impossible to solve the problem of treating asthma in the current conditions of the ecological crisis by using only pharmacological preparations. There is no doubt that patients with severe forms of AD need the latest effective methods of treatment.
Surgical treatment of BA, which has been used since the 20-30s, having gone through a difficult path of development from tissue therapy according to V. P. Filatov and G. E. Rumyantsev to operations on the carotid sinus zone according to Nakayama-Rutkovsky in several modifications, proved sufficient effectiveness in 64 -73% of patients. However, in some cases, there are complications in the form of bleeding from the glomus artery, which requires the improvement of the intervention using new technologies. By local high-energy electromagnetic exposure, it became possible to carry out superficial coagulation necrosis and, thus, destruction of the glomus, which reduces the likelihood of complications. Abandoned in the 50s. Due to the low efficiency, the operation of tissue transplantation has now received prospects for a revival due to the emergence of the possibility of protecting the transplanted tissue culture with a porous prosthesis made of titanium nickelide.
Currently widely used efferent methods of blood surgery are not specific for the treatment of AD. In connection with the development of physical chemistry, it became possible to create radiation-modified sorbents with predetermined sorption properties. Therefore, the scientific direction of selective immunosorption and reinfusion of purified plasma during discrete plasmapheresis is promising.
From the end of the 80s. A new direction in medical science began to develop - electromagnetic influence by low-energy currents of the millimeter range, which was called EHF-therapy. It seems appropriate to apply this method of influencing biologically active points (BAP) of the BA patient's body at various stages of rehabilitation, to substantiate the effectiveness of EHF-therapy in the experiment.
Thus, numerous literature data on the possibility of treating patients with asthma using new modern technological methods of influence indicate the relevance of this work.
To develop a system of surgical care and EHF-rehabilitation of patients in the complex treatment of bronchial asthma.
1. To develop a method for superficial coagulation destruction of the glomus during the Nakayama-Rutkovsky operation, which consists in a morphologically substantiated effect of an electric arc of metered power on the carotid sinus plexus. To study: the degree of damage to the vascular wall and paravasal structures, the coagulation properties of blood, the main carotid blood flow after this operation.
2. To determine the role of the SRS in the treatment of AD and its diagnostic value in deciding on the side of the intervention in the VHC, to provide an objective assessment of the technical adequacy of the SRS.
3. To study the modern clinical possibilities of cell and tissue transplantation of embryonic tissue in the treatment of patients with AD. To assess the morphological transformation of tissues in the pores and around the nickel-titanium carrier of the transplant tissue at various times after the operation in the experiment.
4. To develop a system of surgical immunocorrection in the complex treatment of patients with asthma. To study the sorption capacity of radiation-chemically modified sorbents for capturing CECs of blood plasma in AD in comparison with that of a carbon sorbent. To create an experimental model of a combined usherod-polymeric sorbent with a maximum immune capacity in relation to CECs in AD. To introduce into clinical practice a method of reinfusion of purified plasma after immunosorption during discrete plasmapheresis in patients with asthma.
5. To develop a method for infusion hemooxygenation based on the study of the oxygen capacity of infusion solutions and the gradient of changes in the oxygen content in them during decompression. Determine the optimal solutions for performing infusion oxygen therapy.
6. To develop a method for EHF-rehabilitation of BA patients at different times of the postoperative period. To determine adequate criteria for evaluating the effectiveness of EHF-therapy in a complex system of rehabilitation of patients with asthma.
7. To study experimentally morphological changes in the organs and tissues of animals (liver and lung) under electromagnetic irradiation with an extremely high frequency current (59-63 GHz) against the background of aerogenic-aspiration intoxication caused by the action of ether.
8. Determine individual indications for surgical treatment and EHF-rehabilitation therapy in patients with BA.
Scientific novelty
For the first time, the method of superficial coagulation destruction of the glomus and carotid sinus plexus during the Nakayama-Rutkovsky operation was studied experimentally and put into practice. Dosed coagulation of the superficial layer of the CA with nerve plexuses, ganglia and glomus bodies is carried out by an electric arc with a power of 7 W at an output voltage of 460 V at the electrode of the resonant circuit. no blood flow is observed. A scientific explanation is given for the temporary positive clinical effect of embryonic tissue culture transplantation on a titanium nickelide carrier in AD, which consists in a gradual decrease in the local cellular immunological response against the background of the formation of a fibrous capsule around the implant. For the first time in a medical experiment, radiation-modified sorbents for immunosorption were used. It has been established that the highest sorption capacity in relation to finely dispersed immune complexes of the blood plasma of patients with bronchial asthma is a modified sorbent based on a copolymer of sirol and divinylbenzene with a specific surface area of 335 m2/g, a pore diameter of 30.0 nm, and their total volume of 0.895 cm3/g; in relation to coarse-dispersed ones - a carbon sorbent with a specific surface of 80-100 m2/g, a pore diameter of 22.0 nm and their total volume of 0.385 cm3/g.
Morphological changes in the organs and tissues of animals after exposure to an electromagnetic field of the EHF range were studied. It has been established that the physiological effect of electromagnetic waves of the extremely high frequency spectrum on biological objects is explained, according to experimental studies, by the improvement of microcirculation and the activation of compensatory-adaptive processes in tissues (RF patent No. 2153904 C2 7 A 61 N 5/02 of 15.07.97).
A method for EHF-rehabilitation therapy of BA patients has been developed. The criteria for the effectiveness of rehabilitation treatment were determined: normalization of BAP values according to Voll, immune status and respiratory function, reduction in the number of high-frequency rales in the lungs.
Practical significance
Based on the results of experimental and clinical studies, the following have been introduced into clinical practice:
The method of superficial coagulation destruction of the glomus and carotid sinus plexus during the Nakayama-Rutkovsky operation;
Vassympathetic blockade for relief of bronchospasm during the onset of asthma, for planning the implementation of the Nakayama-Rutkovsky operation and determining the side of the intervention;
A method for transplanting a cell culture on a titanium nickelide carrier in AD;
Method for immunosorption and reinfusion of purified plasma during discrete plasmapheresis in patients with BA;
The method of infusion hemooxygenation in patients with BA in the attack period;
Acupuncture complex EHF-therapy of BA under the control of the state of BAP according to the Voll method.
Implementation of research results
1. The Nakayama-Rutkovsky operation in its own modification in the form of coagulation destruction of the carotid sinus zone has been introduced into the practice of treating patients with bronchial asthma in the surgical clinics of the Siberian State Medical University and the surgical department of the linear hospital of the Tomsk-2 station of the Novosibirsk railway.
2. The operation of plasma immunosorption and plasmapheresis has been introduced into the practice of treating patients with bronchial asthma in the surgical clinics of the Siberian State Medical University, the surgical department of the linear hospital of the Tomsk-2 station of the Novosibirsk railway.
3. The method of infusion oxygen therapy for bronchial asthma has been introduced into the practice of treating patients with bronchial asthma in surgical clinics of the Siberian State Medical University.
4. The method of vagosympathetic blockades under the control of the morphometry of the arteries of the first order of the fundus in bronchial asthma has been introduced into the practice of treating patients with bronchial asthma in the surgical clinics of the Siberian State Medical University, the surgical department of the linear hospital of the Tomsk-2 station of the Novosibirsk railway.
5. The method of EHF-rehabilitation of patients with bronchial asthma at various times of the postoperative period has been introduced into the practice of treating patients with bronchial asthma in surgical clinics of the Siberian State Medical University.
6. The results of clinical and experimental studies on implantation surgery, EHF-rehabilitation therapy for bronchial asthma are used in the pedagogical process at the Department of Hospital Surgery with a course of oncology and the Department of Histology and Embryology of the Siberian State Medical University.
7. Instructions for the use of the apparatus of EHF-therapy "Stella-2" with individual selection of bioresonant frequency for influencing BAP were compiled.
The instruction was approved by the Department of Scientific Institutions of the Ministry of Health and Medical Industry of Russia in 1997.
The results of the work were reported to:
The results of the work were reported at: international conference "Fundamental and applied problems of environmental protection", Tomsk, September 12-16, 1995; regional conference "Introduction of the latest technologies in the healthcare of Siberia", Novokuznetsk, 1996; Society of Surgeons of the Tomsk Region (three presentations), Tomsk, 1994, 1997, 2002; society of therapists of the Tomsk region, Tomsk, 2000; Society of Physiotherapists and Balneologists of the Tomsk Region, Tomsk, 1998; meetings of the school-seminar of EHF-therapists, Novosibirsk, 1998, Izhevsk, 1998, Moscow, 1999; medical conference of the city hospital No. 3 (pulmonology department) together with the interdepartmental meeting of the departments of hospital therapy of the PF of the Siberian State Medical University with the Department of Hospital Surgery No. 1 of the Siberian State Medical University, Tomsk, 1993; 6th All-Russian Scientific and Technical Conference "Energy: Ecology, Reliability, Safety" (two reports), Tomsk, 2000; conference "Actual Issues of Experimental and Clinical Morphology", dedicated to the 150th anniversary of the birth of Corr. RAS, professor A.S. Dogel (two reports), Tomsk, 2002; scientific-practical conference "Chemistry and chemical technology at the turn of the millennium", Tomsk, 2000; XII All-Russian Conference on Chromatography, Samara, 2002
27 printed works in central publications and local press, including 6 international publications, received a patent of the Russian Federation No. 2153904 C2 7 A 61 N 5/02 dated 15.07.97. Accepted for publication materials for the publication of the monograph: P.V. Zibarev, E.V. Belousov "Modified polymeric sorbents" (publisher: department of operational printing TGASU).
Basic provisions for defense
1. The nerve apparatus of the carotid sinus plexus, consisting of myelinated and non-myelinated nerve fibers and trunks, multiple ganglia and carotid bodies, is located in the paravasal structures and in the superficial shell of the carotid artery, up to the muscular-elastic layer, which determines the technical difficulties in performing the operation Nakayama-Rutkovsky.
2. Dosed coagulation according to the developed method provides denervation of the carotid sinus zone (CZ) without causing destructive changes in the muscular-elastic and inner layers of the artery, the development of hemodynamic disorders of the carotid blood flow, as well as hypercoagulation syndrome and parietal thrombus formation at the site of exposure .
3. Vagosympathetic blockade is an objective and reliable criterion for the potential effectiveness of pyomectomy with SHC denervation in patients with asthma. An indicator of the topographic-anatomical and technically correct implementation of the blockade is the reaction of the fundus vessels in the form of a significant expansion of the arteries of the first order.
4. Based on the study of the sorption capacity of various immunosorbents, an experimental model of a sorbent with the highest capacity for coarse and finely dispersed CECs in the blood plasma of AD patients was created, consisting of equal parts of carbon and polymer sorbents.
5. Surgical treatment by cellular implantation of embryonic tissue on a porous titanium nickelide carrier has a short clinical effect, which can be explained by a short-term immunological reaction due to the formation of a fibrous capsule around the implant.
6. The optimal infusion solutions for intravenous blood oxygenation in AD are physiological saline and polygayukin due to their highest oxygen capacity.
7. Electromagnetic radiation of the MM spectrum is an effective method of rehabilitation physiotherapy in patients with asthma at various times in the postoperative period and as an independent method of treatment.
1. Literature review
Conclusion of the dissertation researchon the topic ""Surgical treatment and EHF - rehabilitation of patients with bronchial asthma (clinical and morphological aspects)""
1. A modification of the Nakayama-Rutkovsky operation has been developed, which consists in dosed coagulation denervation of the carotid sinus zone. Dosed coagulation is carried out by an electric arc with a power of 7 W at an output voltage of 460 V at the electrode of the resonant circuit. This mode of operation of the coagulator provides complete denervation of the surface layer of the carotid artery, exposing the coagulation destruction of the nerve plexuses, multiple ganglia and carotid bodies and without causing destructive changes in the muscular - elastic and inner shells. The proposed modification of the Nakayama-Rutkowski operation is technically simple and safe, does not provoke hemodynamic and coagulation disorders of the carotid blood flow, and ensures the prevention of bleeding from the vasa-vasorum of the muscular layer of the artery.
2. Vagosympathetic blockade, which relieves an acute attack of bronchospasm, is a reliable criterion for the potential effectiveness of surgery on the carotid sinus zone in bronchial asthma, determining the optimal side of surgical intervention. An objective indicator of the correct implementation of the blockade is the reaction of the fundus vessels in the form of a significant expansion of the arteries of the first order.
3. Implantation of embryonic cell tissue culture on a porous carrier of titanium nickelide has a short clinical effect - up to two months, which corresponds to the term of the local cellular immunological response to implantation against the background of the formation of a fibrous capsule.
4. Plasmacytapheresis and sorption are indicated during exacerbation of the disease against the background of severe sensitization. The method of plasma sorption and reinfusion during discrete plasmapheresis has been introduced into clinical practice in the treatment of patients with BA. The combination of cellular immunodeficiency and an increase in the concentration of immune complexes is an indication for the combined use of efferent and quantum methods of immunocorrection. The highest sorption capacity in relation to finely dispersed immune complexes of the blood plasma of patients with bronchial asthma is a modified sorbent based on a copolymer of styrene and divinyl benzene with a specific surface area of 335 m2/g, a pore diameter of 30.0 nm, and their total volume of 0.895 cm3/g; in relation to coarse-dispersed ones - a carbon sorbent with a specific surface of 80-100 m2/g, a pore diameter of 22.0 nm and their total volume of 0.385 cm3/g.
5. Optimal solutions for infusion blood oxygen therapy are hyperoxygenated solutions of polyglucin and 0.9% NaCl. Oxygen release period - up to 4 hours, decompression period before infusion - at least 5 minutes. An indication for intravenous oxygenation of the blood is the difficulty or impossibility of intrapulmonary gas exchange, which causes bronchial obstructive syndrome in bronchial asthma.
6. A method for EHF-rehabilitation therapy of patients with bronchial asthma has been developed. Electromagnetic irradiation in the millimeter range is a pathogenetically substantiated method of influencing biologically active zones and points in the course of treatment and rehabilitation. The effectiveness of the method is confirmed by the normalization of the activity of biologically active points of the meridians according to R. Voll, a decrease in the number of high-frequency wheezing in the lungs, an improvement in immunological parameters and external respiratory functions.
7. The positive physiological effect of electromagnetic waves of the extremely high frequency spectrum on biological objects is explained, according to experimental studies on rats subjected to chronic aerogenic exposure to ether, by improving microcirculation and activation of compensatory-adaptive processes in the tissues of the lungs and liver.
8. Surgical methods of treatment for bronchial asthma should be used according to individual indications. According to the clinic A.G. Savinykh of the Siberian State Medical University, the Nakayama-Rutkovsky operation is indicated in 22%, efferent methods of treatment - in 67% of patients with bronchial asthma who applied to the surgical hospital. EHF-rehabilitation therapy has no contraindications for use.
L Dosed coagulation according to the developed method provides complete denervation of the SHC, does not cause destructive changes in the muscular-elastic and inner walls of the artery, does not provoke the development of hemodynamic disorders of carotid blood flow, hypercoagulation syndrome and parietal thrombus formation at the site of exposure. It is recommended as a modification of the method of surgical treatment of BA as an addition to the Nakayama-Rutkovsky operation.
2. SSB is an objective criterion for the potential effectiveness of glomectomy with SHC denervation in patients with asthma. An indicator of the adequacy of the implementation of the VSB is the vascular reaction of the fundus in the form of a significant increase in the diameter of the arteries of the first order.
3. The use of radiation (quantum) methods of immunocorrection is indicated for cellular immunodeficiency, the main of which is T-lymphopenia. The combination of cellular immunodeficiency and an increase in the concentration of immune complexes is an indication for the combined use of efferent and quantum methods of immunocorrection. The combination of PF with plasma sorption and reinfusion of purified plasma allows maximum preservation of homeostasis with a significant decrease in the concentration of CECs in the blood and achieve a positive clinical effect.
4. To achieve the most complete sorption, it is necessary to combine the physical sorption properties with the chemical polarity of the sorbent, which is possible with purposeful modification of the matrix material. The optimal basis for modification is a copolymer of styrene and divinylbenzene. Combined sorbent; consisting of polymer and carbon, has the highest sorption capacity and a wide range of sorption activity.
5. For intravenous blood oxygenation with hyperoxygenated solutions, physiological saline and polyglucin are recognized as the most optimal, having a maximum oxygen capacity in comparison with other infusion solutions. The decompression period should be 2-5 minutes.
6. Electromagnetic irradiation with MM waves is an effective method of rehabilitation physiotherapy and is recommended for inclusion in the program of postoperative management of patients with asthma. Criteria for objective control are indicators of BAT, phonograms of the intensity of breath sounds, indicators of respiratory function.
7. An indicator of the difficulty of bronchial breathing is the appearance of noise with a frequency spectrum of 7000-11000 Hz with a sound pressure value of up to 40 dB. In order to assess the effectiveness of treatment, phonographic indicators of the respiratory noise spectrum should be taken into account.
Conclusion
The high frequency and constant increase in the incidence of asthma (in industrialized countries, over the past 10-15 years, the number of cases of asthma has increased by 8-12 times) put forward the problem of treating this pathology in the section of not only medical, but also social health problems. According to various statistics, in Russia, this disease affects from 1.8 to 7% of the population, depending on the ecological region, the presence of occupational hazards and allergic predisposition.
Conservative methods of treatment are aimed at removing the bronchospasm syndrome, improving the drainage functions of the bronchi, suppressing broncho-pulmonary infection, and correcting homeostasis disorders. Desensitizing therapy based on the use of hormonal drugs from the earliest stages of the development of the disease is mandatory included in the algorithm for the treatment of BA. At the same time, complications after their prolonged use are well known.
To achieve the goal of the study on the development of a system of surgical care and EHF-rehabilitation of patients in the complex treatment of BA, new technologies were used that ensure the achievement of greater radicalness of surgical intervention and the prevention of postoperative complications, as well as the optimization of rehabilitation therapy.
The solution of the tasks set was carried out in the following scientific and practical areas: 1) modification of the denervation of the SKZ during the Nakayama-Rutkovsky operation; 2) determination of the clinical effectiveness of the VSB in designing a strategy for the surgical treatment of BA; 3) physical and chemical modification of sorbents for performing immunosorption in BA in order to select the most effective and capacious immunosorbent that captures circulating immune complexes in the blood of BA patients; 4) determination of the effectiveness of tissue transplantation treatment of AD with a cell culture cultivated on a porous carrier of titanium nickelide; 5) scientific rationale for optimizing infusion oxygen therapy, determining the most effective solutions for its implementation, the time of necessary decompression before infusion; 6) development of EHF-therapeutic rehabilitation of BA patients, morphological substantiation of the effectiveness of exposure to electromagnetic waves of the MM range.
In a constantly changing environmental situation and the associated increase in morbidity against the background of increasing sensitization of the population, it is impossible to solve the problem of radical treatment of this pathology. Therefore, the introduction of new pathogenetically substantiated methods of treatment is relevant and practically significant. The dynamic development of science makes it possible to solve this problem at an ever higher level.
The most common surgical treatment for asthma is the Nakayama-Rutkowski operation. This is due to the significant role of the carotid glomus in the pathogenesis of AD. Denervation of the SCZ is aimed at interrupting pathological impulses along the afferent and efferent pathways that cause bronchospasm. The complexity of the topographic and anatomical relationships of vascular and nervous formations in this area, the relative thinning of the vascular wall of the CA, the often encountered ectopic location of carotid glomus bodies in some cases lead to non-radical surgery or complications. Such complications of glomectomy are bleeding from the damaged CA, the glomus artery, as well as from the exposed vasa-vasorum system when the adventitia of the thinned artery wall is removed. According to various statistics, bleeding during the Nakayama-Rutkovsky operation occurs in 1.5-5.0% of cases. In this regard, the task of developing a method for the most complete denervation of SHC with the least likelihood of hemorrhagic complications is an urgent task. For this purpose, the method of non-contact coagulation destruction of the SA adventitia in the zone of its bifurcation with carotid bodies and nerve plexuses located in it was used. Coagulation was performed using a device developed by NPO "Nikor" (Tomsk). The principle of operation of the device is that a low-voltage high-frequency voltage is applied to the tool, tuned to a resonant frequency of 440,000 Hz, which is selected in such a way that when the voltage of the specified frequency is excited, a high-voltage voltage appears on the electrodes of the resonant circuit. The load characteristic of the circuit corresponds to the characteristic of the current source. Therefore, with an increase in load resistance corresponding to a certain arc length, the voltage across the circuit elements increases proportionally. When the load resistance reaches a critical level and its further increase, the growth of the output voltage stops and the arc breaks. To ensure dosed superficial destruction of the adventitia while maintaining the viability of the middle and inner layers of the artery, the necessary and sufficient depth of exposure to an electric arc of adjustable power was determined in the experiment. For this, the morphological structure of the paravasal structures and the CA wall itself in the area of its bifurcation, the depth of occurrence and variants of the location of the carotid bodies and nerve plexuses of the SCZ were studied. .
Our studies have shown that the paravasal structures of the common trunk of the CA, as well as the intercarotid ligament between the external and internal CA, contain a large number of nerve elements and vessels located in the connective tissue. Nerve trunks of various diameters, both myelinated and unmyelinated, are surrounded by a well-defined perineurium. At the bifurcation site, a large number of nerve ganglia of a round or elongated shape and carotid bodies are determined, near which numerous trunks of nerve fibers innervating them are visible.
Thus, it has been established that the carotid bodies are not single, richly innervated from the intercarotid nerve plexus and located in the bifurcation zone of the CA in its superficial layer - adventitia. Based on the morphological study of the SA wall and paravasal structures, the optimal depth of the coagulation destruction of the SA surface layer was established.
In the experiment, the operating mode of the coagulator was worked out, which ensures complete coagulation destruction of the adventitia with preservation of the middle and inner membranes of the CA. It has been established that an electric arc with a power exceeding 30 W, at an output voltage of more than 1000 V at the electrode of the resonant circuit, causes destructive changes in the vessel wall, up to perforative ones. An arc power of more than 10 W at a voltage of more than 500 V can cause alterative disorders of the muscular-elastic layer of the CA. To ensure the destruction of the adventitia, which carries nerve fibers, their plexuses, ganglia and carotid bodies, an arc power of 3-7 W at an output voltage of 350-460 V is quite sufficient, which corresponds to the digital indicators "1-2" on the conditional scale of the coagulator operation mode . A stable electric arc of this power operates at a distance of 0.2 - 1.5 mm between the working part of the electrode and the surface of the coagulated tissue. This distance is provided by applying an input voltage of 30-40 V. In this case, the temperature of the arc with a diameter of 0.4 mm reaches 300 - 350°C. Greater than 1.5 mm, the removal of the electrode from the tissue surface at the specified input voltage disrupts the electric arc. Approaching the tissue less than 0.2 mm reduces its power. The necessary removal of the electrode as it slides over the tissue, and thus the magnitude and power of the arc, are provided by the predetermined parameters of the arc discharge of the high-frequency resonant device. The intima and muscular membranes of the SA remain intact to the effect of the electric arc.
The main carotid blood flow after coagulation exposure to an electric arc of the specified power does not suffer. The state of hemocoagulation does not significantly differ from the control group. The dynamics of morphological changes after coagulation destruction of the SA adventitia in the indicated operating mode of the device was traced on the 1st, 5th, 30th days and after 2 years. There were no complications associated with the use of the coagulator. Bleeding from the exposed vasa-vasorum, which is often observed in the classical performance of the Nakayama-Rutkowski operation, was not observed during coagulation destruction. Sclerotic changes after coagulation are limited to the surface layer of the arteries and do not extend to its middle and inner membranes. In the clinic, coagulation denervation of the SHC was performed in 20 patients. There were no complications during the operation. Tracked long-term results up to 10 years, which are regarded as good and quite satisfactory.
Various types of novocaine blockades have been proposed for the relief of asthma attacks in BA; in addition to the VSB, pararenal, paratracheal, blockade of the stellate ganglion, epidural, etc. have received wide practical application. The most widespread in clinical practice is the cervical VSB, the implementation of which interrupts the reflex arc between the interoreceptors of the respiratory mucosa and the centers of the ANS due to temporary pharmacological neurotomy. In this case, the blocking of fibers that carry both afferent and efferent innervation occurs. Novocaine blockades can not only stop bronchospasm, but also create a background, affecting the ANS, in which sensitivity to sympathotropic drugs is restored. Therefore, novocaine blockades are used not only during the exacerbation of the process (with bronchospasm), but also in the complex treatment of BA, reducing the degree of pharmaco-resistance of the disease.
In the clinic of hospital surgery. A.G. Savinykh VSB have been performed since 1990. The effect of treatment is assessed by the results of spirography, real-time echography, clinically and anamnestically (reduction in the frequency or elimination of asthma attacks). In addition, the VSB is an indicator of the feasibility of the planned Nakayama-Rutkowski operation, as the most common surgical intervention for asthma. When removing bronchospasm after performing the blockade, surgical treatment is indicated. Lack of effect is a contraindication to surgery. The complexity of the topographic and anatomical relationships of the vascular and nerve plexuses of the neck determines the need for reliable control of the correctness of the implementation of the VSB. In order to objectively control the adequacy of the SRS in BA, the retinal vessels in patients with BA were studied before and after the SRS by photographing the fundus and assessing the diameter of arteries and veins of the first order in identical areas of the fundus using photocalibrometry.
It was found that a statistically significant difference in the diameters of the vessels before and after the SSB occurred only for the arteries. The absence of changes in the diameter of the fundus veins is explained by the fact that the volume of the venous outflow system is a passive regulator of blood filling.
Thus, the assessment of the change in the average values of the diameter of the arteries of the 1st order of the fundus is a reliable and objective method for monitoring the effectiveness and adequacy of the SRS and can be proposed for wide clinical use. The elimination of bronchospasm in BA after the implementation of the SSB determines the potential effectiveness and side of the surgical intervention in the VCS.
Until the 50s. 20th century In order to treat BA, the method of tissue therapy proposed by V.P. Filatov and widely promoted by G.E. Rumyantsev. This method was abandoned due to the short duration of the clinical effect. The rapid development of cell therapy with embryonic tissues with the possible protection of a transplanted culture on a porous carrier made of a biocompatible material (titanium nickelide) made it possible to hope for successful immunorehabilitation in AD. The applied transplantation of embryonic cells cultured on a porous carrier of titanium nickelide with a predominant pore diameter of 0.3-0.5 μm allows, according to the literature, to maintain the potential viability of implanted cells and at the same time protect them from large macrophages.
In the clinic of hospital surgery. A.G. Savinykh Siberian State Medical University transplantation of embryonic liver and lung cells on a porous nickel-titanium carrier was performed in 12 patients. In 6 patients asthma attacks stopped already on the day of implantation, although objective data on improvement in their condition were not obtained. Attacks of bronchospasm either completely eliminated, or their number decreased by 2-3 times. The subjective effect of the improvement of the condition turned out to be short-lived and did not exceed a two-month period, which coincides with the data of V.P. Filatov and G.E. Rumyantsev.
To explain the reasons for the short-term effectiveness of tissue culture transplantation, an experimental study was performed, which consisted of implanting embryonic liver and lung cells into the muscles of the back of rats on a porous carrier of titanium nickelide. The state of the transplanted tissue was assessed on the 15th, 30th, and 60th days after implantation. It was found that already on the 15th day after transplantation, the implant is surrounded by a thin layer of connective tissue, which is easily separated from the structure of the porous nickel-titanium carrier. Histological examination on the inner surface adjacent to the metal, as well as in the tissue extracted from the pores, reveals groups of rather large epithelial-like cells with polygonal, round or oval shapes. The cytoplasm of the described cells is poor in RNA, the content of glycogen and neutral glycoproteins is also low. Cells are surrounded by a basic amorphous substance and tissue fluid. There are almost no blood vessels in the connective tissue film surrounding the implant. On the 30th day, the connective tissue capsule around the metal is noticeably more pronounced. Of the cells, the most numerous are fibroblasts, lymphocytes and macrophages - single, there are unusually many tissue basophils. Previously described epithelial-like cells are found in single groups. Intensive processes of neovasculogenesis. On the 60th day, the connective tissue capsule is very pronounced, dense, it is difficult to separate from the metal. Histologically, it is represented by dense fibrous connective tissue, cellular infiltrates are found, consisting mainly of macrophages and plasma cells. Proliferation of granulation tissue is noted. Epithelial-like cells detected in the early stages after implantation were not detected. A year later, the connective tissue capsule consists of tightly packed collagen fibers. Cellular elements are represented by fibroblasts and a few macrophages without signs of pronounced functional activity.
The histological picture of the ingrowth of the porous carrier into the surrounding tissues, the observed process of the gradual organization of the connective tissue capsule around the implant, the concentration of epithelial-like cells in the tissues adjacent to the surface of the structure, the gradual decrease in inflammation indicate a pronounced reaction of the macroorganism (acceptor) in the form of a cellular immune response to transplantation. The immune response and the organization of a sufficiently dense connective tissue capsule around the implant occur within 60 days, which corresponds to the timing of the clinical effect of tissue transplantation therapy for AD. Therefore, the short-term positive results of BA treatment with this method can be explained by the period of a natural immunological reaction and the formation of a connective tissue membrane around the implant, which eliminates the immunological conflict between the graft and the macroorganism. Therefore, the method of BA implantation cell surgery can be considered ineffective today, and the clinical effect is short-term.
Airway obstruction in asthma is primarily associated with IgE-dependent activation of mast cells, macrophages, eosinophils, and others, which leads to the production of allergy mediators. At the same time, a high content of reaginic IgE antibodies and CECs is found in the blood of patients. Removal of immunocompetent cells from the blood is thus pathogenetically justified in the treatment of immune disorders in AD. Currently, the range of extracorporeal treatments used in AD is quite wide. Efferent therapy has received the greatest development. This is facilitated by the successes of fundamental sciences, including the synthesis of biocompatible artificial materials and sorbents. The search and development of selective immunosorbents is a new scientific direction, formed at the intersection of inorganic, physical, analytical, biological and polymer chemistry, as well as biology and medicine. The most promising is the creation of macroporous sorbents based on a copolymer of styrene and divinylbenzene.
For the purpose of immunocorrection in AD, efferent methods are regularly used in the clinic. A.G. Savinykh of the Siberian State Medical University since 1989. The initial parameters of the immunograms of patients are characterized by moderately severe T-lymphopenia and a sharp increase in the number of CECs in the blood. CIC-i, which provoke bronchospasm in BA, are markers of the severity of the disease. They can be removed when performing plasmapheresis or sorption. Correction of the immunodeficiency state (T-lymphopenia) is carried out by stimulating the regeneration of immunocompetent cells by ultraviolet or laser blood therapy. Immunosorption and PF in combination with UV or laser therapy is used for simultaneous blood changes (T-lymphopenia and increased levels of CECs) in one patient. Based on the analysis of immunograms of 87 patients, courses of efferent methods of treatment in combination with quantum variants of exposure proved to be effective. Almost all showed normalization of immune status disorders, which was accompanied by the achievement of remission of the disease. There was a significant increase in the number of T-lymphocytes (total) from 30±8 to 56+9 and a decrease in the number of CECs from 106±15 to 68+6 (p< 0,05).
The weak side of PF is the loss of salts, hormones and other components of blood plasma necessary to maintain homeostasis. HS dooms blood cells to their partial destruction, and the use of non-specific carbon sorbents helps to capture not only pathological blood components (CIC-and others), but also necessary and important components for the body. One of the objectives of this study was the search for a sorbent capable of selectively capturing the CEC and blood plasma of AD patients. Polymeric sorbents based on a copolymer of styrene and divinylbenzene and subjected to radiation-chemical modification were used. 3 modifiers with different physicochemical characteristics (inner surface, pore diameter, and Rorschneider polarity) were studied in comparison with a nonpolar carbon sorbent. The most immunointensive, trapping finely dispersed CEC and H sorbent with an average effective pore diameter of 30 nm and a total polarity of 12.97 (capture 55% + 4%) was chosen. Coarse-dispersed CEC-i are better than others retained by the carbon sorbent SUMS-1 (capture 52% + 4%). The maximum sorption capacity for finely dispersed CECs by the polymeric sorbent of the H series can be explained by the peculiarity of chemical modification, in which a number of active functional groups are formed that can participate in donor-acceptor bonding with CIC fragments. The superiority of SUMS-1 in capturing coarse CECs is explained by the presence of macropores (more than 100 nm), while the modifiers have very few or no such pores, and the complexes are concentrated only due to specific sorbate-sorbent interactions. The combination of the SUMS-1 carbon sorbent with the H series modification made it possible to achieve plasma purification from immune complexes up to 63% + 5%. Thus, it is possible to achieve selective adsorption of pathological impurities and regulate its strength only with a combination of physical and specific adsorption. This new scientific direction opens up prospects for the creation of sorbents with predictable properties capable of capturing toxic blood components with a known physical and chemical structure.
Oxygenation of transfusion media with their subsequent introduction into the patient's vascular system, proposed by V.P. Sukhorukov in 1972, determined a new direction in the treatment of hypoxic conditions. The advantage of this method of oxygen therapy lies in the high rate of blood oxygenation due to the additional dissolution of oxygen in the plasma. The ease of oxygen saturation of transfusion media by direct contact of oxygen supplied at a pressure of 5-7 atm with a solution contributes to the increasing use of infusion oxygen therapy in clinical practice. The clinical effect of oxygen administration by intravascular infusion of solutions is explained by the activation of biological oxidation through oxidoreductive systems and, thus, the optimization of tissue respiration, which is provided with hyperoxygenation of arterial blood to a level of 150-200 mm Hg. Art. due to oxygen, both associated with hemoglobin and dissolved in plasma. Natural is the question of the prevention of gas embolism during treatment. Therefore, the study of the process of decompression of the infusion solution after its hyperoxygenation (5 atm) is relevant, scientifically substantiated and practically significant. There are no reports of such studies in the literature. The voltammetric method was used to study infusion solutions widely used in practice: 0.9% NaCI solution, Ringer-Locke solution, polyglucin, glucose solutions (5- and 10%), etc. It was found that the most oxygen- doemkim solutions are saline and polyglucin. The ability to perceive oxygen with these solutions exceeds the capabilities of Ringer-Locke solutions - 2 times, and glucose - 3 times. Therefore, solutions of glucose, Ringer-Locke and Hemodez, having antioxidant properties, are not very suitable for intravenous oxygen therapy. The oxygen concentration was determined before, after oxygenation and during the decompression period (up to 4 hours). Based on the studies, the time of the necessary decompression of the solution before infusion was established (5 minutes). During this time, there is a sharp drop in the concentration of oxygen in the solution and the risk of gas embolism is eliminated. Solutions release oxygen gradually; polyglucin and saline hold it longer than others, providing prolonged oxygenation of the blood. In the clinic of hospital surgery. A.G. Savinykh, this method of oxygenation was used in 12 patients with BA. Treatment contributed to the removal of bronchospasm syndrome, a decrease in the number of attacks per day, and a decrease in the dose of inhaled bronchodilators. Against the background of a moderately pronounced increase in the concentration of oxygen in the blood, there was a tendency to reduce the pulse rate, the number of respiratory movements per minute against the background of stable blood pressure. Complications were not noted.
Acupuncture, vacuum therapy, acupressure, microwave therapy and other methods of physiotherapy are widely used in the treatment of BA. The microwave method is based on exposure to electromagnetic waves in the millimeter range (MM-range). The radiation flux is focused on the area of the patient corresponding to the pathological focus.
The developed method of acupuncture diagnostics of the state of BAP according to Voll allows you to select the resonant frequency in the spectrum from 59 to 63
GHz, which normalizes the activity of the point of the misaligned meridian. The indicated frequency spectrum of electromagnetic waves (wavelength 3-7 mm) corresponds to an extremely high oscillation frequency. This method of exposure is called EHF-therapy. The impact of MM-waves is aimed at the implementation and activation of the body's own reserve-compensatory capabilities and the development of adaptive processes. The use of EHF-therapy eliminates the symptoms of dysfunction of the autonomic nervous system, normalizes the psycho-emotional status, metabolic and immune parameters, the hemostasis system. The use of EHF exposure in the form of monotherapy or in combination with other physical factors and the use of pharmacological preparations makes it possible to achieve a higher efficiency of treatment.
In the clinic of hospital surgery. A.G. Savinykh, as a rehabilitation treatment, the method of EHF-therapy was applied to 35 patients with BA. Irradiation was carried out on biologically active zones (SCZ, projection of the lung root) and acupuncture on BAP meridians according to Voll. The indicators of BAP activity in the course of treatment served as the control. At the first stage, a bioresonance frequency was selected, which normalized the activity of the point. With an increased potential, the resonant frequency reduced the potential to normal, with a reduced one, it increased it. The impact was carried out only on misregulated points of the meridians, normalizing their potential. The restoration of the normal biopotential of the points was accompanied by the achievement of clinical remission of the disease. According to our data, the duration of remission is about 6 months. In AD, the following meridians are mainly subject to correction: lung, immune system and allergy, SPED, liver and triple heater. If remission occurred after the implementation of the VSB, then the VHC of the corresponding party was exposed to radiation. In the absence of the effect of the VSB, the projection of the lung root was irradiated. The session of EHF exposure did not exceed 40-50 minutes, was carried out on several fields or BAT (up to 4-5), provided that the impact on the point did not exceed 10 minutes. The course of treatment consisted of 6-10 sessions. At the first stage of treatment, when selecting the bioresonant frequency of EHF exposure, the Stella-2 microwave therapy apparatus was used, combined with the Voll unit scale. At the final stage or during outpatient treatment, the Stella-1 apparatus was used (wavelength of exposure 4.1 mm). The rehabilitation course contributed to the normalization of BAP values in the range from 55 to 65 units. Fold, which corresponds to the norm. Stable normalization of the activity of BAP meridians, which were subjected to EHF-correction, was accompanied by the achievement of stable clinical remission. When analyzing phonograms in real time, the spectrum of high-frequency wheezing disappeared (from 7000 to 1000 Hz with a maximum peak of sound pressure up to 40 dB at a frequency of 9000 Hz), clearly traceable before the start of treatment, which is an objective criterion for improving the patency of medium and small bronchi.
Thus, there is a clear correlation between the restoration of the BAP biopotential of deregulated meridians, the subjective state of patients, and a decrease in the number of high-frequency wheezing during phonographic examination of patients.
There is no experimental confirmation of the effectiveness of the impact of electromagnetic waves in the MM range on the morphological state of the liver and lungs in the literature. In an experiment on animals (rats), the effect of waves of this range on the morphological state of the liver and lungs was studied under the toxic effect of ether anesthesia for 1.5, 10 and 20 days for 20 minutes daily. Irradiation was carried out in the scanning mode at a frequency of 59 to 63 GHz. It is noted that EHF-therapy prophylactically contributes to the resistance of liver and lung cells to toxic damage by ether. By the 20th day, in the control group of animals (without irradiation with EHF waves), necrobiotic changes in hepatocytes, lung tissue cells were observed. In the experimental group of animals (in the presence of irradiation) on the 20th day, the morphological picture of changes corresponded to that on the 5th day of the control group (RF patent No. 2153904 C2 7 A 61 N 5/02 dated 15.07.97.).
Thus, thanks to the introduction of modern scientific technologies into medicine, new modifications and methods of treating bronchial asthma were recommended, which made it possible to achieve a positive result in 92.9% of hospitalized patients.
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Among patients who are indicated for operations with inhalation anesthesia, an average of 3.5% suffer from bronchial asthma. These patients are more likely to have complications during and after surgery, so it is extremely important to assess the severity and control over the course of bronchial asthma, assess the risk of anesthesia and this type of surgical intervention, as well as preoperative preparation. Consider the following factors:
- Acute airway obstruction causes ventilation-perfusion disturbances, exacerbating hypoxemia and hypercapnia.
- Endotracheal intubation can cause bronchospasm.
- Drugs used during surgery (eg, morphine, meperidine, D-tubocurarine) can provoke bronchospasm.
- Severe bronchial obstruction in combination with postoperative pain syndrome can disrupt the expectoration process and lead to the development of atelectasis and nosocomial pneumonia.
To prevent exacerbation of bronchial asthma in patients with a stable condition with regular inhalation of glucocorticoids, it is recommended to prescribe prednisone 40 mg/day orally 2 days before surgery, and on the day of surgery, give this dose in the morning. In severe asthma, the patient should be hospitalized a few days before surgery to stabilize the respiratory function (intravenous glucocorticoid administration). In addition, it should be borne in mind that patients who received systemic glucocorticoids for 6 months or more are at high risk of adrenal-pituitary insufficiency in response to operational stress, so they are shown prophylactic administration of 100 mg of hydrocortisone intravenously before, during surgery. and after it.
Complications in bronchial asthma
Pneumothorax, pneumomediastinum, pulmonary emphysema, respiratory failure, cor pulmonale.
Forecast of the course of bronchial asthma
The prognosis of the course of bronchial asthma depends on the timeliness of its detection, the level of education of the patient and his ability to self-control. The elimination of provoking factors and the timely application for qualified medical help is of decisive importance.
Clinical examination
Patients need constant monitoring by a therapist at the place of residence (with complete control of symptoms at least 1 time in 3 months). With frequent exacerbations, constant monitoring by a pulmonologist is indicated. According to the indications, an allergological examination is carried out.
Surgical treatment is sometimes used in cases of ineffectiveness of conservative therapy for bronchial asthma. Clear indications and contraindications for surgical treatment have not yet been developed. Surgical interventions for bronchial asthma can be divided into 4 types: tissue therapy, operations on the autonomic nervous system in the cervical and thoracic region, lung reimplantation and operations on the carotid sinus zone.
The method of tissue therapy proposed by V. P. Filatov (1939) and modified by G. E. Rumyantsev (1951) and others is not currently used due to low efficiency.
The first operation on the autonomic nervous system in bronchial asthma was performed by Kiimmel in 1923. He removed the upper cervical sympathetic ganglion in four patients. In subsequent years, I. I. Grekov (1925), V. S. Levit (1926) performed a two-stage operation - sympathectomy, and then vagotomy. Later, Miscoll and Rovenstein (L. Miscall, E. A. Rovenstine, 1943-1950), in order to more completely interrupt the reflex arc between the autonomic nervous system and the lungs, began to use the removal of 3-4 thoracic ganglia. However, the results of these operations were unsatisfactory.
In 1964, E. N. Meshalkin applied a new method of surgical treatment of bronchial asthma - lung reimplantation. The study of the immediate and long-term results of 20 lung reimplantations showed that this dangerous and complex operation does not solve the problem of surgical treatment of bronchial asthma.
The most widespread operations on the carotid sinus zone in various modifications: glomectomy, glomectomy with denervation and subsequent alcoholization of the carotid sinus zone, alcoholization of the carotid sinus zone, resection of the sinus nerve.
For the first time, removal of the carotid glomus in patients with bronchial asthma was performed by Nakayama (K. Nakayama) in 1942. Of the 3914 patients who underwent glomectomy, positive results (noticeable or slight improvement) were detected in 2535 patients, which is 64.7% (1958, 1961 , 1962).
According to E. S. Karashurov (1969), the results of glomectomy in terms of up to 7 years are as follows: remission and significant improvement in 32.6-44.5% of patients, improvement in 33-41.8%, no effect was obtained in 22- 26.7% of patients.
Glomectomy surgery can be performed under local anesthesia, but it is better under general anesthesia. A skin incision about 5 cm long is made along the inner edge of the sternocleidomastoid muscle. The middle of the incision should be at the level of the upper edge of the cricoid cartilage, in the projection of the division of the common carotid artery. After dissection of the subcutaneous tissue and subcutaneous muscle, the tissues are moved apart to the fascia enveloping the neurovascular bundle. After a longitudinal opening of the fascia, the common carotid artery and its branches are isolated with a dissector.
Then the glomus is removed, after ligating the small artery that feeds it. The wound is sutured in layers, leaving a rubber strip for a day.
After surgery, in cases of difficulty breathing, bronchodilators are prescribed. Doses of steroid hormones, if they were used before surgery, are gradually reduced.
- Treatment:
(Journal "Bulletin of Surgery" named after I.I. Grekov. Volume 135. No. 10. 1985. P. 3-10)
Academician of the Academy of Medical Sciences of the USSR F.G. Uglov, Ph.D. tech. V.A.Kopylov, A.I.Vazhenin, V.V.Davydenko, E.I.Dzyamidzenko
EXTERNAL PAIN IN THE TREATMENT OF BRONCHIAL ASTHMA
Department of Surgical Diseases for subordinators (Head - Academician of the USSR Academy of Medical Sciences F.G. Uglov) of the 1st Leningrad Medical Institute named after. acad. I.P. Pavlova
The problem of bronchial asthma is one of the most urgent in medicine. This is due to the prevalence of this disease, the aggravation of its course in recent years, the complexity of choosing effective therapy.
A disease that significantly reduces the ability to work, leading most of the patients to disability, forces us to look for more and more new means to combat it. Despite all the variety of available modern methods of treating bronchial asthma, all of them, ultimately, are aimed at any link in the pathogenesis of this disease - the elimination of bronchospasm, a decrease in edema, a decrease in the secretion of bronchial glands. However, acting only on the visible manifestations of the disease, these methods still do not eliminate the cause that leads to the occurrence of bronchial asthma in a person.
Conventionally, all available methods of treatment can be divided into drug (drug) and non-drug. Drug therapy almost always eventually leads the patient to drug dependence, up to hormonal dependence. It should be noted that the early use of hormonal therapy in a number of pulmonological institutions does not lead to recovery, but to the development of dysfunction of the hormonal system with its subsequent suppression. Drug therapy for this disease is long, often continuous and, without restoring the impaired function, only weakens the body.
Of the non-drug methods of treatment, acupuncture, barotherapy, spa treatment, hypnosis, aeroionotherapy, bee sting treatment, etc. are most widely used. According to various authors, the effectiveness of these methods varies widely, but most researchers consider it necessary to use them in combination with drug therapy. .
Acupuncture, of course, deserves the closest attention, as it allows you to improve the condition of patients both in complex therapy and when used in its "pure form", although the percentage of good results, according to various authors, varies widely. However, these are mostly patients with mild to moderate severity of the disease. Therefore, today only bronchial asthma of the 1st stage and pre-asthma are indications for the use of acupuncture. In the presence of symptoms of pulmonary heart failure, persistent morphological changes in the lungs (emphysema, pneumosclerosis), long-term use of corticosteroid drugs, the method is considered contraindicated.
As for other methods of treatment (barotherapy, spa treatment, hypnosis, etc.), they can only be used in the complex therapy of bronchial asthma and, due to their low efficiency, cannot be used independently.
We use a method of treating bronchial asthma with external pain exposure (EPV). It is based on the concept of the development of favorable natural neuroendocrine changes in the body, occurring under the influence of short-term dosed pain stimulation. A method that allows effective treatment in patients with any stage of bronchial asthma, which makes it possible for most of them to refuse drug therapy, opens up new prospects for the successful treatment of this serious disease.
For the first time, scientific testing of this method of treatment took place from October 1984 to February 1985 at the Clinic for Surgical Diseases for subordinators of the 1st LMI. acad. I. P. Pavlova. This was a preliminary period, when, in addition to evaluating the effectiveness of the method, knowledge of the mechanisms and causes of bronchial asthma deepened. Accordingly, material was accumulated for the preparation and implementation of subsequent stages of treatment of patients. In addition, specific methods have been developed in relation to various forms of bronchial asthma. It was a randomly recruited group of patients with different forms, severity, age and duration of the disease, of which 36 were women and 19 were men. All of them were previously treated by traditional methods, and many were treated with acupuncture (17 people), barotherapy, therapeutic fasting, were on spa treatment, however, a lasting positive effect was not obtained.
We, like some other authors, considered it tactically necessary to distinguish groups of patients with different forms of the disease, depending on the trigger mechanism (cold, physical activity). In this work, almost all variants of bronchial asthma were studied, with the exception of those when the main mechanism for the onset of an attack was a sharp change in ambient temperature (cold snap). This group was not subjected to treatment, since the methodology was not finally developed for it.
The distribution of patients according to the duration of the disease: up to 1 year - 4 people, from 1 year to 5 years - 23, from 5 to 10 years - 16, more than 10 years - 12. Distribution of patients by age: up to 15 years - 18 people, from 15 up to 30 years - 6, from 30 to 45 years - 14, from 45 to 60 years -15, over 60 years - 2. Distribution of patients according to the duration of taking corticosteroid drugs: up to 1 year - 5 people, from 1 year to 5 years - 5, from 5 years to 10 years - 1.
When distributing according to the severity of the disease, we took into account the following criteria.
Under the mild severity of the disease, we understood the presence of rare (up to 2-3 times a year) asthma attacks, long-term remissions, the absence of clinical symptoms of the disease and morphological changes in the lungs, and the absence of drug therapy during periods of remission.
To moderate severity, we attributed patients with frequent asthma attacks, short remissions, the need for frequent use of drugs, the presence of clinical and laboratory signs of bronchospasm even during remission.
We classified severe bronchial asthma as patients taking hormonal drugs, as well as those with frequent (several times a day) attacks of breathlessness, with severe morphological changes in the lungs, severe impairment of the ventilation capacity of the lungs, patients who are forced to take medication daily due to frequent seizures or difficulty breathing and having a history of status asthmaticus.
In accordance with this classification, our patients were distributed according to the severity of the disease as follows: mild degree - 9 people, moderate degree - 21, severe degree - 25.
Thus, most of the patients were presented by patients with moderate and severe severity of bronchial asthma, of which 11 people were patients taking corticosteroids for a long time.
The technique suggests the possibility of a single-stage withdrawal from drug therapy, which was successful in almost all patients, with the exception of a small part of patients taking hormonal drugs, in whom the reduction in the dose of corticosteroids was carried out gradually. Sessions were performed every other day in an amount of 15 or more for 1 month or longer, depending on the severity of the disease. All patients underwent the necessary laboratory x-ray studies, ECG before and after treatment. In 44 people, a study of pulmonary ventilation was conducted for a more rigorous and objective assessment of the effectiveness of this treatment method. Criteria for assessing the degree of violations of bronchial patency were borrowed by us from the relevant guidelines. The study of the function of pulmonary ventilation was carried out in the laboratory of the Department of Hospital Therapy of the 1st LMI using the spirographic method and the method of general plethysmography using the Breathing System - 2300 device from Ohio (USA), as well as in the clinic No. 85 of Leningrad using the spirographic method and pneumotachometry. It should be noted here that the majority of patients before the course of treatment could undergo a functional examination of pulmonary ventilation, only while on drug therapy, and some patients could not be examined at all due to the severity of the condition. In addition, this examination was not conducted in young children due to the impossibility of their correct performance of functional tests.
As a rule, subjective improvement in well-being was noted by patients immediately after the first sessions. In some patients during treatment, more often by the 5th-7th session, there was some exacerbation of the disease (increased cough, increased sputum, the appearance of asthma attacks, fever), which soon passed on its own, did not require the administration of drugs and no longer resumed.
The improvement of the condition was confirmed by objective clinical data: asthma attacks completely disappeared, shortness of breath, breathing became free, dry rales, cough decreased, and then disappeared, ECG indicators improved (tachycardia decreased, the load on the right heart was relieved), lung ventilation indicators improved. We give an example.
Patient M., aged 15, was admitted to the clinic with a diagnosis of infectious-allergic bronchial asthma, severe course. From the anamnesis it is known that she has been ill since the age of 9, when, after acute bronchitis, attacks of suffocation began to occur, often turning into asthmatic conditions. She was treated several times in hospitals. Due to the severity of the condition, she received courses of prednisolone intravenously and orally.
Upon admission, the state is akin to severity. Complains of constant asthma attacks several times a day, shortness of breath at rest, weakness, cough with a scant amount of sputum. Objectively: forced position of the body, exhalation is difficult, elongated, breathing is noisy, wheezing, can be heard at a distance. Shortness of breath at rest up to 36 in 1 min. Lip cyanosis. Pulse up to 100 beats / min, blood pressure 120/70 mm Hg. Art. Percussion sound with a box tone, auscultatory-hard breathing with an abundance of dry buzzing rales. Unproductive cough with glassy sputum. Maintenance therapy: eufillin - 2 tablets per day (0.3 g), asthmapent. There are no "light" intervals during the day.
Due to a sharp change in climate when moving to Leningrad, inadequate maintenance therapy, her condition rapidly worsened, and in this regard, she could not even undergo a functional examination of the lungs. Soon the patient was transferred to the intensive care unit in a state of asthmatic status. Immediately after the withdrawal from the asthmatic state, she was taken for treatment by the VPI method. The state of health began to improve rapidly. Soon, all drug therapy was canceled. After a monthly course of treatment of complaints of asthma attacks, there is no difficulty in breathing. There is no cyanosis on clinical examination. In the lungs, vesicular breathing, no wheezing. The performed study of the function of pulmonary ventilation revealed the normalization of indicators: VC 2772 ml (110%), FEV1 2.44 l (112%), Tiffno test 91%, FFU 2777 ml, TFR 1226 ml (109%), TFR 3998 ml (96% ), bronchial resistance 3.07, specific conductivity 0.117.
Currently, 4 months have passed since the end of treatment: he feels good, there are no asthma attacks, he does not use drugs.
In patients with a mild course of the disease, only a few sessions were enough to get a lasting positive effect.
Since we could not perform a functional study of pulmonary ventilation in all patients, the final results were evaluated according to the subjective state and data from an objective clinical examination. Evaluating the results of treatment of bronchial asthma by the method of external pain exposure, we used a three-point system: "good", "satisfactory" and "unsatisfactory".
By good results, we understood the complete disappearance of asthma attacks, as well as episodes of difficulty breathing, the disappearance of clinical signs of the disease (wheezing, shortness of breath, dry wheezing, cough with glassy sputum).
We attributed to satisfactory results those observations when the attacks of suffocation disappeared, however, there were still episodes of difficult breathing, passing on their own, the number of dry rales in the lungs significantly decreased, cough decreased or disappeared, sputum began to come off easily.
We classified all patients with no effect of the treatment as unsatisfactory results.
We considered it necessary and expedient to allocate patients who took corticosteroids on the day of the start of treatment with this method into a separate group, and evaluate the results according to a classification different from the previous one.
By good results here, we understood the "separation" of patients from corticosteroids, the disappearance of asthma attacks, the improvement of clinical parameters, and the absence of the need for drug therapy.
Satisfactory results included observations with a “disengagement” from corticosteroid drugs, the disappearance of asthma attacks, however, there were episodes of shortness of breath that passed on their own, cough with sputum discharge without difficulty, and the absence of drug therapy.
We attributed to unsatisfactory results all patients in whom it was impossible to do without hormone replacement therapy.
Given the above criteria, the results of treatment are presented in table. one.
Results of treatment of patients with bronchial asthma
Analyzing immediate results of treatment, we can say that a clear improvement in the condition was achieved in almost all patients (in 54 out of 55), while good results were obtained in 46 of them, including 8 out of 11 patients taking corticosteroids. In all 54 people, it was possible to achieve a complete abolition of any drug therapy already in the early stages of treatment.
Data from a functional study of pulmonary ventilation of 44 patients are presented in Table. 2.
Table 2. Results of a functional study of pulmonary ventilation
In general, an improvement in pulmonary ventilation was detected in 38 out of 44 examined patients, including 27 patients whose pulmonary ventilation function was fully restored. In the literature, we did not find similar results on the possibility of restoring ventilation in patients with severe bronchial asthma, especially when taking hormonal drugs.
As for the unsatisfactory result or observations when the function of pulmonary ventilation was not restored, this occurs in patients who initially had signs of severe outcomes of chronic pneumonia (emphysema, pneumosclerosis), or with severe rearrangements in the endocrine system against the background of many years of massive use of hormonal drugs. This is confirmed by the data of numerous studies by various authors. They proved that with prolonged hormonal therapy (more than 1 year), atrophy of the adrenal cortex develops.
Observations of patients with bronchial asthma, who received various doses of hormonal preparations before admission to us, showed that their course of the disease and the prognosis deteriorate sharply. The intake of hormones inevitably leads to a decrease in the function, and then atrophy of the endocrine glands: the pituitary gland, adrenal glands, gonads, which removes the patient's general resistance to adverse factors, makes him practically helpless, and all other types of treatment turn out to be little or completely ineffective. Until recently, we had to refuse treatment in our clinic for patients with hormone-dependent bronchial asthma, since any type of treatment without the use of hormones was ineffective for them, and we did not want to continue to aggravate their hopeless situation by further giving hormones. That is why we believe that in bronchial asthma, as in a number of other similar diseases, the transition to the use of hormonal drugs should be sharply limited (only for health reasons - asthmatic status), since, destroying the entire hormonal system, they lead the patient to severe disability. It is especially unacceptable and even criminal to treat children and adolescents with hormonal drugs when the endocrine system, as well as other systems and organs, are still being formed. An example is the following case history.
Patient K., aged 13, was admitted to the clinic with a severe form of infectious-allergic bronchial asthma. From the anamnesis it is known that at the age of 3 months he suffered from acute pneumonia, after which the disease often worsened. At the age of 1 year, asthma attacks appeared, bronchial asthma was diagnosed. Due to the ineffectiveness of therapy and the aggravation of the course of the disease, at the age of 8 years, corticosteroid drugs (dexamethasone, prednisolone) were first prescribed. According to his mother, there were periods when, due to the severity of his condition, the boy was forced to take up to 17 dexamethasone tablets per day (!). Upon admission, he complains of shortness of breath, cough with a meager amount of vitreous sputum. A patient of small stature, with signs of Cushingism (moon-shaped face, red striae, distribution of fatty tissue according to the female type, extreme emotional lability), with underdeveloped genital organs corresponding to 3-4 years of age, and the absence of secondary sexual characteristics. With the systematic use of hormonal drugs, the condition is relatively satisfactory. Exhalation is difficult and lengthened. Respiratory rate 20 in 1 min. Pulse 100 beats / min. Percutere: over the lungs sound with a box shade. Auscultation: hard breathing with an abundance of buzzing dry rales. Maintenance therapy: 6 mg polcortolone per day, asthmapent. The patient was examined by an endocrinologist: an assumption was made about secondary (due to hormonal therapy) pituitary dwarfism. The level of 11-OKS in the blood is 10 µg%.
Repeated attempts were made to move away from hormone replacement therapy, but the treatment did not bring success.
Only by the VPI method with great difficulties in most patients, where complete atrophy of the endocrine glands has not yet occurred, not only complete abolition of hormones was achieved, but also a significant improvement in the condition (cessation of seizures, no difficulty in breathing) and even complete normalization of the function of pulmonary ventilation . We give an example.
Patient Sh., aged 16, was admitted to the clinic with a diagnosis of severe infectious-allergic asthma. From the anamnesis it is known that in infancy he suffered acute pneumonia, after which the annual exacerbation of the disease. From the age of 3, asthma attacks appeared against the background of exacerbations of pneumonia, which tended to worsen in each subsequent case. From the age of 6, due to the severity of the condition, he was transferred to oral corticosteroid drugs (prednisolone), which was subsequently replaced by polcortolone. Upon admission, he complains of shortness of breath, weakness, asthma attacks several times a day, cough with a meager amount of sputum difficult to separate. Moderate condition. The chest is barrel-shaped, there are areas of its deformation, kyphoscoliosis. Forced posture. The exhalation is significantly lengthened, wheezing can be heard at a distance. Shortness of breath at rest up to 26 breaths in 1 min. Lip cyanosis. Pulse 120 beats / min. BP 110/60 mm Hg. Art. Percutere: a sound with a box tone over the lungs, auscultatory: hard breathing with a lot of dry rales. Maintenance therapy: 1 mg of polcortolone per day, Novodrin (inhalation) several times a day. The performed examination of the function of external respiration reveals severe violations: VC 3168 ml (77%), TRL 2387 ml (158%), TRL 5555 ml (98%), bronchial resistance 5, specific conductivity 0.051.
The treatment was carried out in 2 stages with a total duration of 3 1/2 months. In the first sessions, it became necessary to add intravenous prednisolone against the background of a decrease and cancellation of oral drugs, which was then also canceled. At discharge, the patient's condition was satisfactory. There is no shortness of breath even during physical exertion. There are no clinical data for bronchospasm. In the lungs: vesicular breathing, no wheezing. The function of pulmonary ventilation also underwent significant dynamics: bronchospastic disorders completely disappeared, only restrictive ones, caused by pneumosclerosis, limited mobility of the ribs, ossification of the costal cartilages due to rickets suffered in childhood and therefore of an irreversible nature, remain: VC 3168 ml (77%), FEV1 2.21 l (70%). TRL 1414 ml (93%), TRL 4582 ml (80%), bronchial resistance 3.27, specific conductivity 0.109.
At present, he feels well, there are no attacks of suffocation, episodes of difficult breathing. Doesn't use medicines.
Among our patients, the majority were patients with bronchial asthma of an infectious-allergic genesis (80% had the first attacks of suffocation after an exacerbation of chronic pneumonia), but the method has proven itself well in people with purely atopic bronchial asthma. An example is the following case history.
Patient A., 6 years old, has been suffering from attacks of bronchial asthma since the age of 3, when he visited Georgia in the summer. There is no history of inflammatory lung disease. Exacerbation of the disease in the autumn-spring time, as well as when going out into the cold air, during physical exertion. Constantly received aminophylline, especially before going outside. Before treatment, there was a moderate decrease in pulmonary ventilation. 30 sessions were held. I stopped using medicines from the very beginning of treatment. Neither cold nor physical activity provoke attacks. There is no difficulty in breathing. Vesicular breathing in the lungs, no wheezing. Indicators of pulmonary ventilation are normal.
It is also interesting to note that along with the improvement of pulmonary ventilation and the cessation of the clinical manifestations of bronchial asthma, there was a parallel improvement in the functions of other systems and organs: improvement in myocardial nutrition according to ECG data, cessation of extrasystoles, improvement in general well-being, normalization of sleep, increased vitality, increased efficiency.
Analyzing in general the obtained results of treatment of patients with bronchial asthma by the method of VPI, we can come to the following conclusion.
The VPI method is effective for bronchial asthma of any origin (both infectious-allergic and atopic) and for any severity of the disease, which is proved by 80% of good results in groups of patients with moderate and severe course. It is most expedient to use the method in the early stages of the disease, where drug, and especially hormonal, therapy has not yet been used, and when you can count on a quick and complete recovery of impaired functions. It gives a clear improvement even in patients with long-term use of hormonal drugs, allowing you to completely abandon the use of corticosteroids, and is promising in terms of the possibility of eliminating any drug dependence.
The VPI method is easy to use, affordable, physiological and gives positive results without the use of drug therapy. No negative side effects have been identified. In the process of treatment by the method of external pain exposure, the general condition of the patient and the functions of various systems and organs improve.
LITERATURE
- Bulatov P.K., Fedoseev G.B. Bronchial asthma. L., Medicine, 1975..
- Bulatov P.K., Uspenskaya E.P. Treatment of patients with bronchial asthma in a pressure chamber. - Ter. arch., 1974, No. 5, p. 125-128.
- Golub N.A. Acupuncture in the treatment of patients with infectious-allergic form of bronchial asthma. - Abstract. cand. dis. M., 1976.
- Guvakov I.A., Okhotsky B.A. Experience in the treatment of bronchial asthma by bee stings in combination with climatotherapy. - Doctor. case, 1972, no. 8, p. 110-111.
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- Guidelines for practical exercises on internal diseases (analysis of a patient with chronic bronchitis). Ed. G.B. Fedoseeva, V.V. Stavskoy, V.A. Almazova, N.N. Zubtsovskaya, E.P. Uspenskaya (1st LMI). L., 1980.
- Nezabudkin SN Pathogenetic aspects of acupuncture of atonic bronchial asthma in children. - Abstract. cand. dis. L., 1982.
- Osipova N. Reflexotherapy in bronchial asthma. - Med. newspaper, 1985, 16 Jan.
- Sergeeva K.M., Uspenskaya E.P. Bronchial asthma in children. L., Medicine, 1984.
- Skurlatova Z.S. The use of acupuncture in the complex treatment of patients with bronchial asthma. - In the book: Morphology, physiology and pathology of the respiratory organs (1st LMI). L., 1968, p. 184-187. 13. Uglov F.G., Kopylov V.A. Pain as a stimulator of protective and reparative processes. - Vestn. hir., 1985, No. 6, p. 17-22.
- Gershwin M.E. Bronchial asthma (translated from English). M., Medicine. 1984.
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