RU2342169C1 - Therapy method for vessels obliterating diseases of lower extremities - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: conservative therapy and electrostimulation are conducted. Electrostimulation is conducted by sinusoidal modulated current at 10-20 mA, with modulation frequency 30 Hz, passing through gastrocnemius muscles. Three first seances are conducted at current modulation depth 75%, following ones at current modulation depth 100%. Seance duration is 20 minutes. Therapy course includes 10 procedures.

EFFECT: reduction of pangs intensity in gastrocnemius muscle regions when moving, walked distance elongation before pangs onset, return of sensation in toes, disappearance of pathologic cold sensitivity symptom.

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Description

The invention relates to medicine, namely to the treatment of vascular diseases, and can be used as an independent method for the treatment of arteriosclerosis obliterans of the lower extremities (OASNK).

Obliterating atherosclerosis of the vessels of the lower extremities is a polyetiological disease associated with a violation of the adaptive reactions of the vascular system, a change in metabolism, coagulation and a manifesting ischemic syndrome due to obliteration of the lumen of blood vessels (I. Makshanov, Thromboblastic diseases of the arteries of the lower extremities. - Minsk: Belarus, 1975, p. 38, 40). The disease is characterized by a progressive type of course. Severe ischemia and trophic changes develop after 5-15 years from the onset of the first clinical symptoms (Shalimov A.A., Dryuk N.F. Surgery of the aorta and major arteries. - Kiev: Health, 1979, p.208). Atherosclerosis progresses faster in patients older than 50 years, as well as those suffering from diabetes. Based on this, the percentage of patients with disabilities is high. The second stage of the disease is an indication for determining the 3rd group, and in some cases the 2nd group of disability (I. Makshanov, p. 144).

Conservative and surgical methods are used to treat atherosclerosis obliterans of the lower extremities. Of the conservative methods, drug treatment, physiotherapy methods, physiotherapy exercises, balneotherapy, hydrotherapy, barotherapy are widespread.

Of the medical methods, the most widely used are vasodilator drugs, vitamin therapy, treatment with anticoagulants and hormones. Perirenal novocaine blockades, intravenous infusions of polyglucin, intra-arterial administration of drugs are used.

However, the results of drug treatment are mixed. Vascular-dilating agents often worsen the general condition, trophism in patients with diabetes mellitus, can weaken the activity of the heart, deepen ischemic, trophoparaletic complications (Bondarchuk A.V. Disease of peripheral vessels. - L .: Medicine, 1969, p. 220-222). Long-term use leads to adrenal hypoplasia (Akulova RF, Chronic arterial and venous insufficiency. - M .: Medicine, 1975, p. 153). Novocainic blockade can lead to multiple thrombembolic blockages (Bondarchuk A.V., p. 220-222). Polyglukin can produce severe anaphylactic reactions. An increase in tissue temperature during balneotherapy leads to a narrowing of blood vessels and aggravates roundabout blood flow (I. Makshanov, p. 118, 114).

Thus, existing drugs that affect metabolic processes in tissues in case of obliterating diseases are not very specific and are not effective in all patients (Shalimov A.A., Dryuk N.F., p. 288).

Surgical interventions, used according to strict indications, are elements of complex therapy, since without the subsequent conservative treatment they give only a temporary effect (Makshanov I.Ya., p.99). Of the surgical treatments, the most common lumbar sympathectomy. It is known that with complete denervation of the limb, blood flow in the vessels increases by 2 times, while working muscle requires an increase in blood flow by 10-15 times. Therefore, sympathectomy is not enough for the normal functioning of a limb (I. Makshanov, p. 99). After a certain time, a complete or almost complete restoration of innervation occurs (Makshanov I.Ya., p. 100). With the development of severe ischemia, its use is undesirable, since it does not prevent the development of gangrene and does not lead to a decrease in the level of amputation (Klimov V.N. Herald of surgery, 1984, No. 9, p. 54).

An equally common method of surgical treatment are various reconstructive operations on the vessels. But reconstructive operations do not stop the main process, and during the first two years approximately 25% of patients have repeated occlusion, and after 5-8 years, transplants function only in 10% of patients (I. Makshanov, p. 103,104).

An epinephroectomy operation is used, which gives a certain positive effect. But partial removal of the adrenal glands has only a temporary effect, since compensatory hypertrophy of the remaining part of the adrenal gland occurs. The total removal of both adrenal glands leads to dire consequences (I. Makshanov, p. 101).

Thus, the treatment of vascular diseases is a complex problem of clinical medicine. The lack of effectiveness of therapeutic measures even with their complex use does not allow to stop the development of the pathological process, which leads to the need to perform amputations, the frequency of which can reach from 15.5 and up to 68% in patients with obliterating diseases (Vishnevsky A.A., Krakovsky N. I., Zolotarevsky V.Ya. Obliterating diseases of limb arteries, M., 1972, p.147). Various physiotherapeutic methods are used to stimulate blood flow (I. Makshanov, p. 118). These methods are not strictly specific in the nature of their action. They are used in alternation or courses of diathermy of the lumbosacral region, longitudinal diathermy, UHF on the feet and lower legs, electrophoresis, ultrasound, phonophoresis, amplipulse, hydrotherapy. The listed methods are used as additional and are contraindicated in many concomitant diseases.

Experience in the treatment of OASN with acupuncture is small. The use of various methods does not give a satisfactory result (Zhu-lian. Guide to modern Zhen-jiu therapy: Acupuncture and cauterization, St. Petersburg: Comet: Irlen, 1992, p.271). Therefore, the search for new effective and inexpensive treatment methods is very important.

The main clinical symptoms of atherosclerosis obliterans of the vessels of the lower extremities: intermittent claudication, weakening or absence of pulsation of the arterial vessels of the foot, popliteal region, trophic disorders of limb tissues. In the later stages of the disease, ulceration, more often in the area of the toes, and gangrene join.

A known method of treatment of obliterating atherosclerosis of the vessels of the lower extremities (OASNK), including the impact on the paravertebral and reflexogenic zones, selected depending on the location of the lesion (see, for example, Bondarchuk A.V., p. 224, 225).

There is a method of treating atherosclerosis obliterans of the vessels of the lower extremities, in which they act on biologically active points and areas that are associated with the peripheral and central nervous system and normalize metabolic processes in the body, external pain (VVB): successively alternating pressure with fingers with an effort of at least effort causing the appearance of pain and response muscle tension, and no more than the maximum pain tolerance of the patient, for which the latter is laid on the veins from and as biologically active points, paravertebral (right, left, or both sides) and interspinous zones of the cervical, thoracic, and lumbosacral spine, as well as zones and points on the legs along the interested channels (liver, kidneys, spleen, urinary tract) are used bladder, gall bladder, stomach), and each effect is carried out for 1-3 seconds from 1 to 5 times, with the response of the local muscle tension of the patient at the time of external pain and breath holding. The procedures are carried out every other day until 10-12 per course (RF patent No. 2071761, IPC ⁶ A61H 23/06, A61K Z1 / 045).

This invention aims to use the internal hidden reserves of the body. The invention is based on the theoretical developments of V. A. Kopylov, presented by him in the work “Functional abilities of the nervous system and its role in physiological processes”, USSR State Committee for Science and Technology, VINITI, No. 1953-85, Dep. Moscow, 1985.

However, this method is quite painful when used, and in addition, it is not effective enough, since the pain syndrome remains, and the distance of painless walking remains small.

Closest to the claimed invention is a method of treating patients with chronic arterial ischemia of the lower extremities (RU 2021832 C1, 10.30.1994), including conservative therapy and electrical stimulation of the muscles of the lower extremities. This method is also not effective enough.

The claimed invention solves the problem of creating a method of treating an obliterating disease of the lower extremities, when using which the patient would significantly increase the distance of painless walking.

When walking a patient suffering from an obliterating disease of the lower extremities, spasmodic muscle sections form along the calf muscles, which, as a result of the duration of this condition, can no longer relax. Biochemistry of metabolic processes in these areas is approaching fibro-cicatricial conditions. Their nutrition volume is sharply reduced in relation to normally functioning muscles. Therefore, from these sites in the central nervous system there is disinformation of a constantly acting nature, which contributes to the inadequate response of the central nervous system to the entire calf muscle. The characteristics of the nerve impulse going through the conductors of the spinal cord to these fibro-cicatricial seals change, which contributes to the dysfunction of the conductors that carry information. Violation of the innervation of organs and tissues leads to the development of a pathological process in the body.

The main criterion for the effectiveness of the treatment of atherosclerosis obliterans of the lower extremities is a decrease in the strength of a pain attack in the calf muscles during movement, an increase in the distance traveled before the onset of this attack, as well as restoration of sensitivity in the toes, and the disappearance of the symptom of pathological sensitivity to cold.

It is known that the functional state of the calf muscles depends on the development of compensation mechanisms: the degree of collateral circulation in tissues and the resistance of muscle tissue to ischemia. The latter may be associated with low oxygen consumption by the muscles due to the peculiarity of the ratio of “red” and “white” muscle fibers. Moreover, "red fibers" have a lower oxygen demand. In the calf muscles, white fibers predominate. It is known that exposure to calf muscles with an electric current leads to histochemical, biochemical and physiological changes in muscle fibers, as a result of which white and red fibers turn into white (BC Chekanov, A.A. Krakovsky, D. Dumchus "Thoracic and cardiovascular surgery , 1990, No. 8, pp. 30-36. However, the parameters of the impact on the muscle tissue of the calf muscles with electric current in obliterating disease of the lower extremities are not known.

The technical result of the proposed method is to increase the distance of painless walking with obliterating disease of the lower extremities.

This technical result is achieved in that the treatment of obliterating atherosclerosis of the lower extremities is carried out by conservative therapy and electrical stimulation, while the gastrocnemius muscles are electrostimulated by acting on them with a sinusoidally modulated current of 10-20 mA, a modulation frequency of 30 Hz, with the first three procedures the depth of current modulation is 75%, the following procedures with a current modulation depth of 100%, the duration of one procedure is 20 minutes, the course of treatment includes 10 procedures.

The method is as follows.

Before starting treatment, a thorough collection of complaints, anamnesis, an objective examination are carried out, if necessary, laboratory tests and additional examination methods (blood, urine, ECG, ultrasound of the limb vessels, etc.) are prescribed, i.e. An accurate topical diagnosis of the nature and level of vascular damage is carried out.

Treatment begins with standard conservative therapy. After that, the calf muscles are exposed by electrostimulation by the action of a sinusoidally modulated current of 10-20 mA, a modulation frequency of 30 Hz. Moreover, the first three procedures are carried out at a current modulation depth of 75%, and subsequent procedures at a current modulation depth of 100%, the duration of one procedure is 20 minutes, the course of treatment includes 10 procedures.

The above method is used on the basis of the Department of Vascular Surgery No. 1 in the "RKD" GUZ Cheboksary. A group of people suffering from atherosclerosis obliterans of the vessels of the lower extremities underwent the above treatment with a simultaneous examination before and after the course. The examination took into account the distance that the patient is able to travel to before a pain attack in the calf muscle region; patients' complaints were evaluated: the strength of the pain attack. An ultrasound examination of the vessels of the lower extremities was performed in all patients to confirm the diagnosis, as well as in a number of patients before and after treatment to determine the dynamics. On a bicycle ergometer, the maximum load on the lower extremities was measured until the first pain of characteristic localization appeared. The group of patients suffering from atherosclerosis obliterans of the vessels of the lower extremities consisted of 20 people, all men, aged 44 to 83 years. Most had a variety of concomitant pathologies. The main criterion for the effectiveness of treatment of atherosclerosis obliterans of the vessels of the lower extremities is a decrease in the strength of a pain attack in the calf muscles during movement, an increase in the distance traveled before the appearance of this attack.

In this group of symptoms, improvement was detected in 90% of treated patients. The distance to the appearance of pain in the calf muscles increased by more than 2 times. In some patients, when moving at a moderate speed, a pain attack does not occur at all. Results such as regional systolic pressure and the ankle-brachial index did not significantly change, which is consistent with data that the effectiveness of conservative treatment affects the results of exercise tests, including increasing the distance of painless walking (I.I. Zatevakhin, M. Sh. Tsitsiashvili, VN Zolkin "The use of the treadmill test in the diagnosis and treatment of chronic lower limb arterial insufficiency").

Examples of specific performance of the method.

Example 1. Patient I.I.A., born in 1923, a disabled person of the 2nd group for a general disease. He complained of pain in both lower extremities - from the heel to the knee joint on the back surface, associated with movement, as a result of which in a straight line can not go more than 200 meters. After a short rest, the pain goes away. Pain is combined with numbness of the toes. An ultrasound study confirmed the diagnosis: atherosclerosis obliterans of the vessels of the lower extremities. Blood circulation disturbance in the stage of subcompensation was revealed. Also worried about abdominal pain, bloating, heartburn, belching, constipation. The concomitant diagnosis is chronic gastritis, chronic colitis. Conducted conservative therapy: 0.9% sodium chloride 400.0 + 0.25% solution of novocaine 150.0; saline + trental 2% - 5.0, reopoliglyukin 400 intravenously. Nicotinic acid intravenously according to the scheme (from 1.0 to 10.0 iv and from 10.0 to 1.0 iv), myotropic antispasmodics + analgesics (analgin 50% - 20 + papaverine 2% - 4.0 on 200.0 - 0.9% NaCl) intravenously, xanthinol nicotinate 15% - 2.0 intramuscularly 2 times a day, vitamin B1 and B6 1.0 intramuscularly, alternating with vitamin B12 500 μg intramuscularly once a day. Antiplatelet agents: 0.5 times aspirin once daily orally.

Conducted electrical stimulation of the calf muscles with the Amplipulse-5 apparatus. Small plate electrodes with an area of 3 × 3 cm with pads moistened with water were fixed: one on the motor point (the site of entry of the motor nerve into the muscle), the second in the region of transition of the muscle into the tendon. The patient was lying on his stomach. Type of current - sinusoidally modulated. The operating mode is non-rectified. The modulation frequency is 30 Hz. The modulation depth - 75% - in the first three procedures, in the subsequent - 100%. The current strength was 10-20 mA (selected according to the patient’s sensations: as soon as the sensations became unpleasant, the current strength decreased, and if not palpable enough, it increased). Duration of exposure is 20 minutes. Course - 10 procedures. Moreover, each time an assessment of complaints, objective status was carried out.

After treatment, pain during movement in a moderate rhythm did not occur. When moving with a quick step in a straight line after 1000 meters, an unpleasant sensation was felt in the calves. For ten months, the general condition of the patient did not worsen. I did not take any medications. According to the patient, he leads an active lifestyle.

Example 2. Patient O.D.ZH., born in 1950, sick about two years. He complained of pain in the left lower limb when moving in the calf muscle, the sensitivity of the feet to cold was increased, for the appearance of pain in the left lower limb, it was enough to walk 100 meters. Myocardial infarction suffered in 1998.

Conservative therapy was carried out: IV infusion therapy 4: reopoliglukin 400.0 IV 10; 0.9% NaCl 200.0 + trental 5.0 10, iv nicotinic acid according to the scheme (from 2.0 to 10.0 iv and from 10.0 to 1.0 iv), glucose-cocaine mixture : 5% glucose 400.0 + 0.25% novocaine 150.0, iv papaverine per 200.0 ml nat. solution. Also, intramuscularly nicotinol xanthinate 15% - 2.0 ml 2 times a day 20, vitamin B1 and B6 at 1.0 v / m once a day, alternating with vitamin B12 at 500 mcg / m once a day, antiplatelet therapy: chimes at 0.025 per os 4 times a day, trombonyl at 1 t. 3 times a day. After conservative therapy, the condition improved significantly, but pain, intermittent claudication after passing 100 meters, persisted. Electrical stimulation was performed, as in the previous example.

As a result of treatment, the intensity of pain in the left lower limb decreased, the appearance of pain in the calf muscles occurs after passing more than 300 meters in a straight line. Hypersensitivity to cold has disappeared. The general condition has improved.

After the treatment: the general condition improved, the distance to the appearance of a pain attack in the calf muscles increased by 3 times, the intensity of the pain attack decreased, cold intolerance of the feet and numbness of the toes disappeared.

In total, 20 patients with atherosclerosis obliterans of lower limb arteries and with chronic arterial ischemia of the lower extremities were treated in this way. Some of them had undergone reconstructive operations on the arteries of the lower extremities earlier, not less than in a year. In addition to electrical stimulation of the calf muscles, everyone underwent standard conservative therapy. To compare the effectiveness of treatment, the second control group of 20 patients with obliterating atherosclerosis and the same degree of limb ischemia was taken. In this group, only standard conservative therapy was performed.

After treatment, in the second control group, an increase in painless walking distance was observed in 40% of patients (8 out of 20 people).

Based on the foregoing, we can conclude about the effectiveness of the proposed method of treatment.

Claims (1)

A method of treating atherosclerosis obliterans of the lower extremities, including conservative therapy and electrical stimulation, characterized in that they stimulate the calf muscles by exposing them to a sinusoidally modulated current of 10-20 mA, a modulation frequency of 30 Hz, the first three procedures being carried out at a current modulation depth of 75 %, and subsequent procedures at a current modulation depth of 100%, the duration of one procedure is 20 minutes, the course of treatment includes 10 procedures.