RU2262924C1 - Method for biorhythmical pharmacotherapy - Google Patents

Abstract

FIELD: medicine, biorhyhthmic pharmacotherapy.

SUBSTANCE: the present innovation deals with introducing either one or several necessary medicinal preparations into interval of dominating functional activity of 12 "major organs": at 11 p.m. - cholagogue preparations, at 1 a.m. - 3 a.m. - hepatotropic preparations, at 3 a.m. - 5 a.m. - antitussive preparations, broncholytics, mucolytics, adrenal hormones, at 5 a.m. - 7 a.m. - remedies that normalize intestinal activity, at 7 a.m. - 9 a.m. - remedies that influence gastric functions and ferric preparations, at 9 a.m. - 11 a.m. - preparations that regulate pancreatic functions, antidiabetic ones and those that affect hemogenesis and blood clotting, at 11 a.m. - 1 p.m. - hypotensive, antianginal, antiarhythmic, vascular, psychotropic preparations and those of thyroid hormones, at 1 p.m. - 3 p.m. - vitamins, preparations of microelements, purgative, anthelmintic preparations, at 3 p.m. - 7 p.m. - diuretic, uterotropic preparations and prostate-affecting ones, at 7 p.m. - 9 p.m. - hypotensive, antianginal, antiarhythmic, vascular, psychotropic preparations, sedative and soporific ones, at 9 p.m. - 11 p.m. -preparations that affect the tonicity of autonomic nervous system, libido, potency and immunomodulators, as well. The innovation provides restoration in synchronization of hypothalamus activity and, thus, normalization of functional activity of affected organ.

EFFECT: higher efficiency.

2 dwg, 2 ex, 2 tbl

Description

The invention relates to medicine, in particular to pharmacotherapy.

Known methods of drug therapy: prophylactic use of drugs, etiotropic therapy, symptomatic therapy, replacement therapy. The above methods of pharmacotherapy are characterized by the use of one drug (monotherapy) or two or more pharmacological preparations (combined treatment). In this case, the most important criteria for therapeutic approaches are dose selection (single, daily, course, etc.), maintaining the necessary concentration of drugs in the patient’s blood throughout the day, minimizing possible side effects (allergic reactions, idiosyncrasy, toxic effect).

The disadvantages of modern principles of drug therapy (figuratively speaking, “one tablet three times a day”) are the “cost” of exposure to the body (the initially defective (diseased) system should work with the same load during the day), the depletion of the functional capabilities of the affected organ, the need increasing the exposure dose over time, the transition of the pathological process into a chronic one with an outcome in decompensation and structural changes in organs and tissues.

If patients have several nosological forms, then curation is carried out by doctors of different specialties (therapist and gynecologist, cardiologist and gastroenterologist, etc.). The drug therapy recommended by different specialists is not in good agreement, or the pharmaceutical prescriptions are generally contradictory, which does not contribute to a successful recovery. At the same time, the total number of drugs by name alone can be significantly more than ten.

It cannot be denied that for most diseases the clinical picture is determined by a number of functional disorders, the nature of which is caused by reflex disorders that are reversible, and it is logical to use methods based on the principles of reflexology to correct these disorders.

The most developed section of reflexology - traditional acupuncture - is based on three most important theoretical provisions [2, 5, 9]:

1. In the human body, 12 "main organs" should be distinguished: "lungs", "large intestine", "stomach", "spleen and pancreas", "heart", "small intestine", "bladder", "kidney" , "Pericardium", "three heaters", "gall bladder", "liver".

2. "The main organs" in the process of vital functions of a healthy organism enter into a system of complex interactions among themselves, providing stimulating and restraining effects on each other (Fig. 1).

3. During the day, each of the 12 "main organs" has a 2-hour interval of time of the dominant functional activity in a strictly regular sequence (figure 2). During these hours of the so-called “vegetative solo”, the organs are most sensitive to both pathogenic and therapeutic effects.

Functional daily cyclicity from day to day is energetically constant in conditions of complete clinical health (clear daily biological rhythms of the main functional systems are the main condition for homeostasis, which means they suggest stability of weight, blood pressure, etc.).

The rhythm of functional activity (one of the most important characteristics of a living system) ensures the stability of the periodic replacement of “functioning” and “resting” units (biological quanta) in a certain sequence. Periodic processes are necessary to achieve the ideal state that all biological systems strive for - maximum efficiency with minimum energy consumption.

Physiological parameters respond differently to a particular effect depending on which phase (point) of the biological rhythm it is carried out. In the process of evolution, a human developed a rhythmic process control system, the leading role in which, according to modern concepts, is given to the hypothalamus [1, 3, 20].

From the standpoint of modern neurophysiology, the “main organs” are vegetatively controlled, their interaction is also vegetatively determined and, ultimately, determined by the hypothalamus and the structures of the central nervous system (CNS) associated with it. The hypothalamus controls the state of the internal environment of the body, supporting the most important biochemical, hormonal and other parameters of homeostasis within normal values.

The importance of feedbacks cannot be denied: if the hypothalamus regulates the normal activity of internal organs, then obviously, through feedback systems, internal organs determine the normal activity of the hypothalamus itself.

Knowing the global role of biological rhythms in determining the state of an organism’s health, it is necessary to agree that “unhealth”, and even more so a disease, should be manifested primarily by desynchronoses - biorhythm disturbances, changes in the energy constancy of the cyclicity of the main functional systems (as a rule, in the direction of increasing cost - increasing entropy).

Clinically, the state of desynchronization can manifest itself from a mild prodrome to gross violations of the biorhythms of the basic vital functions (for example, an increase in blood pressure).

If we normalize or synchronize the activity of organs and systems in the necessary sequence and taking into account functional activity, as well as taking into account the patterns of mutual stimulating and restraining influences, then by means of feedback we can “prompt”, “remind” the hypothalamus of its function of internal synchronizer and thus ensure the state of functional harmony of the body [7]. Systems of external synchronizers are created for the "main organs", and through afferent connections, for the hypothalamus and the structures of the central nervous system associated with it. Thus, through a system of external synchronizing influences (biorhythmic pharmacotherapy - BRFT) on 12 “main organs” that have phylogenetically powerful vegetative support, a perfect feedback system and a 2-hour time interval of dominant functional activity, we use afferentation as information channels that synchronize activity of the hypothalamus, which can be expressed in enhancing or decreasing the functional activity of a particular functional system as a result of targeted lek rstvennogo impact.

The objective of the invention is to reduce the side effects of the effects of drugs, reduce the doses of basic drugs, increase the therapeutic effect.

This problem is solved by the method of biorhythmic pharmacotherapy, which consists in prescribing in the necessary sequence of drugs (one or several) that specifically act on the “main organ” in accordance with a 2-hour interval of its functional activity (during treatment, it is possible to exert targeted drug effect on one or several - up to twelve - basic organ-forming functional systems), while for influencing the functional systems of the gallbladder and liver (time intervals f nktsionalnoy activity 23.00-01.00 and 01.00-03.00 respectively) designate hepatotropic and cholagogue drugs; to influence the functional system of the lungs (time of functional activity 03.00-05.00), antitussive drugs, bronchodilators, mucolytics, adrenal hormones are prescribed; to influence the functional system of the large intestine (time interval of functional activity 05.00-07.00), drugs are prescribed that normalize the bacterial flora of the large intestine, antidiarrheal, laxatives; to affect the functional system of the stomach (time interval of functional activity 07.00-09.00), drugs are prescribed that affect appetite, gastric secretion, gastric motility, iron preparations; to affect the functional system of the spleen-pancreas (time interval of functional activity 09.00-11.00), drugs are prescribed that optimize the activity of the pancreas (drugs that stimulate or inhibit pancreatic secretion, replacement analogues of pancreatic enzymes, antidiabetic drugs) and spleen (drugs, affecting blood formation, blood coagulation); cardiotropic (antihypertensive, antianginal, antiarrhythmic), vascular, psychotropic drugs, thyroid hormone preparations are prescribed to affect the functional system of the heart (the time interval of functional activity is 11.00-13.00); to affect the functional system of the small intestine (time interval of functional activity 13.00-15.00), vitamin and microelement preparations, salt laxatives, castor oil, anthelmintic are prescribed; to affect the functional system of the bladder and kidneys (time interval of functional activity 15.00-19.00), diuretics, uterotropic drugs, drugs that affect the prostate gland are prescribed; cardiotropic (antihypertensive, anti-anginal, antiarrhythmic), vascular, psychotropic drugs (especially sedative, hypnotics) are prescribed to affect the pericardial functional system (the time interval of functional activity is 19.00-21.00); to influence the functional system “three heaters” (time interval of functional activity 21.00-23.00), drugs are prescribed that affect the tone of the autonomic nervous system, libido, potency, immunomodulators.

Methods of administration of drugs are similar to traditional (intravenously, intramuscularly, orally).

BRFT is carried out in such a way that the most affected functional system is exposed to specific tropic drugs in a therapeutic dose (from minimal to shock), the remaining functional systems are subtherapeutic (“signal”) doses of tropic drugs (these doses can be 4-10 and more times smaller than the minimum therapeutic).

In order to prevent desynchronosis, BRFT is carried out exclusively with “signal” doses of drugs.

To illustrate the effectiveness of the proposed method, we chose arterial hypertension (AH) and chronic obstructive bronchitis (COPD), since nosology data are one of the most pressing problems of modern medicine.

Currently in the world 30% of the population (1580 million people) have high blood pressure (BP). According to the results of the Framingham study, out of every thousand people who have an increase in blood pressure, 10 develop heart failure (HF), which is approximately 30 million people [16].

In Russia, 2 million 682 thousand people, 39.2% of men and 41.1% of women, have elevated blood pressure. Moreover, 37.1 and 58.0% are aware of their disease, respectively, only 21.6 and 45.7% are treated, and only 5.7 and 17.5% are effectively treated. For comparison, 27% of hypertensive patients are effectively treated in the USA, in France - 24%, in Canada - 22%, in Italy - 9%, in Egypt - 8%, in the UK - 6%, in China - 3% and in Poland - 2% [11-13]. Most authors consider hypertension as one of the key factors in the occurrence of ischemic and hemorrhagic strokes, coronary heart disease (CHD), and the development of heart and kidney failure. It should be noted that over the past two decades, Russia has reached one of the first places in Europe in mortality from coronary heart disease and brain strokes. Moreover, more often hypertension and more often die men of working age - up to 55 years [16]. In our country, among men aged 45-74, coronary heart disease and stroke account for 87.5% of deaths from cardiovascular diseases (40.8% in the structure of total mortality), for women of the same age, these rates are 85% (45.4%), respectively [4 ].

AH is based on the failure of normal neurogenic and / or humoral regulation of vascular tone with the gradual formation of organic changes in the heart and vascular bed, which undoubtedly contributes to the atherosclerotic process [6]. Atherosclerosis, which affects vital organs, is based on hypercholesterolemia, or rather, specific changes in the blood lipid spectrum, characterized by a high level of atherogenic lipids (low-density lipoprotein cholesterol - LDL, triglycerides, chylomicron remnants) and their transport proteins (apoprotein B, alpha lipoprotein ) and low levels of anti-atherogenic cholesterol high density lipoprotein (HDL) and its transport protein.

Worldwide population studies (NOT, FACET, TONP-1, TAIM, TOMHS, etc.) have shown the importance of effective treatment of hypertension in reducing the risk of cardiovascular complications (MTR) and mortality. It has been proven that a decrease in the level of diastolic blood pressure (DBP) is only 2 mm Hg. Art. leads to a decrease in stroke frequency by 15%, ischemic heart disease - by 6% [11].

Known methods of treating arterial hypertension of antihypertensive therapy are intended to reduce high blood pressure to the "target level": for patients of young and middle age up to 130/85 mm RT. Art., for the elderly - up to 140/90 mm RT. Art. [8].

The main classes of drugs are used (diuretics, beta-blockers, calcium antagonists, ACE inhibitors, angiotensin receptor antagonists, alpha-blockers). Monotherapy provides a decrease in systolic blood pressure (SBP) by an average of 3-7 mm RT. Art. and DBP - 4-8 mm RT. Art. It is often impossible to achieve a decrease in blood pressure to the target level with a single antihypertensive drug. According to the study of NOT, a decrease in blood pressure to normal values with monotherapy can be achieved only in 30% of patients [11, 22].

One of the main principles for treating patients with high blood pressure is the use of a rational combination of antihypertensive drugs (diuretic and beta-blocker, diuretic and ACE inhibitor, diuretic and angiotensin receptor antagonist, calcium antagonist (dihydropyridine series) and beta-blocker, calcium antagonist and ACE inhibitor, calcium antagonist and angiotensin receptor antagonist, alpha blocker and beta blocker). If the "average" dose of the drug is ineffective, preference is given to the appointment of a combination of antihypertensive drugs, rather than increasing the dose of the starting drug to the maximum. Widespread low-dose combinations of antihypertensive drugs containing two drugs in one tablet, and prolonged forms of antihypertensive drugs [8, 19].

Studies of the daily profile of blood pressure (SPAD) revealed a pronounced variability in blood pressure values. The use of both invasive and non-invasive monitoring of blood pressure allowed us to identify patterns of fluctuations in blood pressure during the day. The Framingham epidemiological study showed that the time for the maximum risk of sudden death falls in the morning (from 7.00 to 9.00 h), the minimum risk for the period from 9.00 to 13.00 h. The risk of sudden death in the morning is on average 70% higher than the rest the period of the day [23]. It was also revealed that the peak of the development of cerebral strokes, both ischemic and hemorrhagic, occurs in the morning (between 8.00 and 12.00 in the morning). The incidence of myocardial infarction in all examined groups (young, elderly, women and men, with a previous history of IHD and without a history of IHD) also has a peak in the morning. In the period from 6.00 to 12.00 h, a sharp increase in blood pressure, an increase in vascular tone, which coincide with neurohumoral changes, are observed. This time is also the only period during the day when there is an increase in platelet aggregation, hypercoagulation and a decrease in fibrinolytic activity. In patients with stable angina pectoris, up to 40% of episodes of pain and painless myocardial ischemia occur from 6.00 to 12.00 h and account for 46% of the total time of ischemia per day [21].

The clinical picture of arterial hypertension in most cases is determined by a number of functional disorders having a reflex and, therefore, reversible character. BRFT involves in the implementation of the therapeutic effect phylogenetically determined levels of organization of organ-forming systems (the “main organs” —the hypothalamus and the central nervous system structures associated with it, including the vasomotor center of the medulla oblongata — the “main organs”), primarily the vascular component, which allows you to change in the desired direction, the vascular regimen, and therefore affect the level of blood pressure at the appropriate time of day.

Clinical example 1. Patient K., 58 years old, was under outpatient observation with a diagnosis of Hypertension II tbsp. Atherosclerosis of the aorta. Hyperlipidemia 2b-type. Peptic ulcer of the duodenum without exacerbation.

Condition before BRFT (against the background of traditional pharmacotherapy).

Complaints about:

- increase in blood pressure to a maximum of 220/120 mm RT. Art., accompanied by a headache in the occipital region,

- a feeling of "unmotivated anxiety" in the evening,

- poor sleep at night (falls asleep badly, wakes up early), drowsiness during the day,

- a feeling of "heaviness" in the right hypochondrium after eating fatty foods,

- episodic aching pains in the epigastrium at night.

From the anamnesis: 15 years ago for the first time noted an increase in blood pressure to 180/100 mm RT. Art. with emotional stress, accompanied by a headache in the occipital region. Not examined, not treated. About 2-3 years ago, episodes of increased blood pressure during physical and emotional stress increased to a maximum of 220/120 mm RT. Art. Over the past 3 months, an almost daily increase in blood pressure to 170-180 / 100-110 mm Hg was noted. Art., a feeling of “unmotivated anxiety” in the evening, poor sleep at night (falls asleep badly, wakes up early), drowsiness during the day. Examination of the blood revealed an increase in creatinine to 1.5 mg / dl, total cholesterol up to 260 mg / dl, triglycerides up to 200 mg / dl, with ECHO-KG - signs of aortic atherosclerosis, initial left ventricular hypertrophy; the condition is regarded as hypertension of the II stage, it is recommended to take metoprolol 25 mg in the morning, 25 mg in the evening, furosemide 40 mg in the morning. Against the background of regular intake of prescribed drugs (traditional pharmacotherapy) and blood pressure control 3 times a day, an increase in blood pressure remained up to 170-185 / 100-110 mm Hg. Art. 3-6 times a week.

In addition, a history of 20 years ago was diagnosed with duodenal ulcer; the last exacerbation - 5 months ago, treatment was carried out: mechanically, chemically, thermally sparing diet (Pevzner table No. 1), famotidine 40 mg at night, omeprazole 20 mg in the morning and 20 mg at night, denol 1 tablet 3 times a day 30 minutes before meals, Trichopolum 250 mg 1 tablet 3 times a day, oxacillin 0.5 g 4 times a day before meals - for 21 days. At the time of treatment, aching epigastric pain occasionally occurs at night (up to 2-3 times a week).

On examination: HELL 170/90 mm RT. Art. Rhythmic heart sounds, heart rate 88 / min. The abdomen with deep palpation is sensitive in the epigastrium, right hypochondrium.

When conducting a clinical and laboratory examination in the blood, an increase in the level of G-GT to 87 units / l (N 3-49), urea nitrogen to 25 mg / dl (N 10-20), uric acid to 7.5 mg / dl was detected ( N 2.5-7.0). In the lipid spectrum, there was an increase in triglycerides to 216 mg / dl (N 50-150), total cholesterol - up to 270 mg / dl (N 150-250), VLDL - up to 44 mg / dl (N 10-30); the atherogenic coefficient was 4.5 (N 1.2-4.2); type of hyperlipidemia 26. During the ultrasound of the abdominal organs, signs of fatty liver, gallbladder dysfunction were revealed.

BRFT was carried out under the control of indicators of 24-hour blood pressure monitoring (BPM) at time intervals of the daily functional activity of the main functional systems (average SBP - SBP, average DBP - SDAD, average daily blood pressure - SBP).

Initially, before the appointment of BRFT (against the background of taking metoprolol 25 mg in the morning and 25 mg in the evening, furosemide 40 mg in the morning), the total SDPA was 145 mm Hg. Art., SDAD total - 95 mm RT. Art., total GARDEN - 110 mm RT. Art. The level of blood pressure was:

- 7.00-9.00 - 115 / 85-175 / 115 mmHg. Art.,

- 9.00-11.00 - 125 / 90-185 / 95 mmHg. Art.,

- 11.00-13.00 - 165 / 95-180 / 105 mmHg. Art.,

- 13.00-15.00 - 150 / 100-180 / 120 mmHg. Art.,

- 15.00-19.00 - 145 / 95-160 / 95 mmHg. Art.,

- 19.00-21.00 - 140 / 95-180 / 90 mmHg. Art.,

- 23.00-3.00 - 90 / 60-140 / 95 mmHg. Art.

BRFT was carried out according to the following scheme: to affect the functional system of the stomach (7.00-9.00), papaverine 1 tablet (40 mg) was prescribed at 7.00-9.00; on the functional system of the spleen-pancreas (9.00-11.00) - 1/4 tablet aspirin (125 mg), panzinorm 1 tablet at 9.00-11.00; on the functional system of the heart (11.00-13.00) - no-shpa 1/2 tablets at 11.00, trental 1/4 tablets (25 mg) at 11.15, metoprolol 1/2 tablets (25 mg) at 11.30, valerian 1 dragee at 11.30; functional system of the small intestine (13.00-15.00) - multivitamins of 1 tablet in 13.00; urinary system (bladder 15.00-17.00, kidneys 17.00-19.00) - furosemide 1/2 tablet (20 mg) at 16.00; the functional system of the pericardium (19.00-21.00) - 1/2 tablet at 19.00, trental 1/4 tablet (25 mg) at 19.15, metoprolol 1/4 tablet (12.5 mg) at 19.30, valerian 1 dragee at 20.00; biliary system (gall bladder 23.00-01.00, liver 01.00-03.00) - allochol 1 tablet at 23.00, Zokor 1 tablet (10 mg).

On the 7th day of the BRFT, the patient noted improvement in well-being, a decrease in blood pressure with independent monitoring of blood pressure 3 times a day to 150-135 / 90-75 mm RT. Art.

On the 14th day of the BRFT with the control of BPM, there was an improvement in a number of indicators: total SBPT was 135 mm Hg. Art., SDAD total -85 mm RT. Art., GARDEN total -100 mm RT. Art. The level of blood pressure was:

- 7.00-9.00 - 120 / 75-160 / 100 mmHg. Art.,

- 9.00-11.00 - 130 / 95-175 / 110 mmHg. Art.,

- 11.00-13.00 - 125 / 85-170 / 130 mmHg. Art.,

- 13.00-15.00 - 105 / 70-135 / 90 mmHg. Art.,

- 15.00-19.00 - 100 / 70-180 / 100 mmHg. Art.,

- 19.00-21.00 - 120 / 70-160 / 75 mmHg. Art.,

- 23.00-3.00 - 110 / 60-150 / 85 mm Hg. Art.

On the 14th day of BRFT, the daily doses of metoprolol and furosemide were reduced (the dose of metoprolol to 25 mg, furosemide to 10 mg), the rest of the drugs were given in the previous daily dose.

On the 21st day of the integrated BRFT, the patient noted a significant improvement in overall well-being: night sleep normalized, the feeling of "anxiety" ceased to bother, the pain in the epigastrium stopped, the sensations of "heaviness" in the right hypochondrium, and "bloating" disappeared.

On the 28th day of BRFT in the blood, urea nitrogen, uric acid levels are within normal values; a decrease in triglycerides to 205 mg / dl, total cholesterol - to 245 mg / dl, VLDL - to 39.2 mg / dl, an increase in HDL - from 46 to 56 mg / dl; the atherogenic coefficient was 3.89.

On the 28th day of the BRFT during the ABM SSAD, the total was 125 mm RT. Art., SDAD total - 80 mm RT. Art., total GARDEN - 95 mm RT. Art. The level of blood pressure was:

- 7.00-9.00 - 145 / 100-160 / 100 mmHg. Art.,

- 9.00-11.00 - 120 / 80-140 / 95 mmHg. Art.,

- 11.00-13.00 - 130 / 90-140 / 90 mmHg. Art.,

- 13.00-15.00 - 135 / 85-150 / 95 mmHg. Art.,

- 15.00-19.00 - 105 / 65-140 / 80 mmHg. Art.,

- 19.00-21.00 - 115 / 75-135 / 85 mmHg. Art.,

- 23.00-3.00 - 85 / 50-120 / 80 mmHg. Art.

The data of BPMD in dynamics (initially on traditional antihypertensive therapy, against the background of BRFT) are presented in table 1.

Table 1 Drugs and time of admission, indicators of BPM (mmHg) To BRFT Against the background of the BRFT Originally 1st day of BRFT 14th day of the BRFT 28th day of the BRFT Papaverine ------- 1 tablet (40 mg) at 7.00 1 tablet (40 mg) at 7.00 1/2 tablet (40 mg) at 7.00 Aspirin ------- 1/4 tablet (125 mg) at 9.00 1/4 tablet (125 mg) at 9.00 1/4 tablet (125 mg) at 9.00 Panzinorm ------- 1 tablet at 9.00 1 tablet at 9.00 1 tablet at 9.00 No-shpa ------- 1/2 tablet at 11.00 and 1/2 tablet at 19.00 1/2 tablet at 11.00 and 1/2 tablet at 19.00 1/2 tablet at 11.00 and 1/2 tablet at 19.00 Trental ------- 1/4 tablet (25 mg) at 11.15 and 1/4 tablet (25 mg) at 19.15 1/4 tablet (25 mg) at 11.15 and 1/4 tablet (25 mg) at 19.15 1/4 tablet (25 mg) at 11.15 and 1/4 tablet (25 mg) at 19.15

Drugs and time of admission, indicators of BPM (mmHg) To BRFT Against the background of the BRFT Originally 1st day of BRFT 14th day of the BRFT 28th day of the BRFT Metoprolol 1/2 tablet (25 mg) in the morning and 1/2 tablet (25 mg) in the evening 1/2 tablet (25 mg) at 11.30 and 1/4 tablet (12.5 mg) at 19.30 1/4 tablets (12.5 mg) at 11.30 and 1/4 tablets (12.5 mg) at 19.30 1/4 tablet (12.5 mg) at 11.30 and 1/8 tablet (6.25 mg) at 19.30 Valerian -------- 1 tablet at 11.30 and 1 tablet at 20.00 1 tablet at 11.30 and 1 tablet at 20.00 1 tablet at 11.30 and 1 tablet at 20.00 Multivitamins -------- 1 tablet at 13.00 1 tablet at 13.00 1 tablet at 13.00 Furosemide 1 tablet (40 mg) in the morning 1/2 tablet (20 mg) at 16.00 1/4 tablet (10 mg) at 16.00 1/4 tablets (10 mg) at 16.00 every other day Allochol -------- 1 tablet at 23.00 1 tablet at 23.00 1 tablet at 23.00 Zokor -------- 1 tablet (10 mg) at 23.00 1 tablet (10 mg) at 23.00 1/4 tablet (5 mg) at 23.00 SSAD total 145 (90-185) 135 (100-180) 125 (85-160) Total for rent 95 (60-120) 85 (60-135) 70 (50-100) GARDEN total 110 100 95 SSAD in the afternoon 155 (115-185) 140 (100-180) 125 (105-160) FOR SALE 100 (80-120) 90 (70-130) 80 (60-100) GARDEN in the afternoon 115 105 95 NAD at night 125 (90-150) 125 (105-150) 125 (85-160)

Drugs and time of admission, indicators of BPM (mmHg) To BRFT Against the background of the BRFT Originally 1st day of BRFT 14th day of the BRFT 28th day of the BRFT DELIVERY at night 85 (60-95) 80 (60-95) 75 (50-100) GARDEN at night 100 95 90 HELL 7.00-9.00 115 / 85-175 / 115 120 / 75-160 / 100 145 / 100-160 / 100 HELL 9.00-11.00 125 / 90-185 / 90 130 / 95-175 / 110 120 / 80-140 / 95 HELL 11.00-13.00 165 / 95-180 / 105 125 / 85-170 / 130 130 / 90-140 / 90 HELL 13.00-15.00 150 / 100-180 / 120 105 / 70-135 / 90 135 / 85-150 / 95 HELL 15.00-19.00 145 / 95-160 / 95 100 / 70-180 / 100 105 / 65-140 / 80 HELL 19.00-21.00 140 / 95-180 / 90 120 / 70-160 / 75 115 / 75-135 / 85 HELL 23.00-3.00 90 / 60-140 / 95 110 / 60-150 / 85 85 / 50-120 / 80

The most common cause of chronic obstructive pulmonary disease (COPD) is COPD (about 90% of cases) [10]. Every year there is an increase in the number of patients with COPD among both men and women. In the structure of the incidence of COPD, they took 12th place in 1990, and in 2020 they are expected to go to 5th place [18]. In Russia, the prevalence of COPD is 16 per 100,000 of the population, COPD reduces the life expectancy of patients by an average of 8 years [14]. COPD cause significant economic damage associated with disability of the most active part of the population. Mortality due to COPD is approximately 6% in men and 4% in women [17], while COPD is the cause of death in 80% of cases and the cause of disability in more than 50% of cases among diseases of the bronchopulmonary system [15]. According to forecasts, after about 20 years, mortality from COPD will reach 3rd place among all diseases [17].

The main risk factor for COPD (80-90% of cases) is smoking. An increase in mortality from COPD is predicted, especially in developed countries, and especially among smokers [14, 17].

Clinical example 2. Patient S., 55 years old, was under observation with a diagnosis of Chronic obstructive mucopurulent bronchitis with the development of cylindrical bronchiectasis in the lower sections of both lungs of moderate severity in the acute phase. Emphysema. Respiratory failure art. II Chronic pulmonary heart in the formation phase. Prolapse of the membranous wall of the trachea and main bronchi of the 1st stage

Complaints before the appointment of BRFT: cough with separation of mucopurulent viscous sputum mainly at night (2.00-7.00), occasionally accompanied by a feeling of "difficult exhalation"; shortness of breath when walking fast.

From the anamnesis: since childhood - frequent SARS. He smoked since the age of 21, at the insistence of doctors he quit 5 years ago. For 10 years, a cough has been disturbing with the separation of mucopurulent sputum mainly at night (2.00-7.00), which occurs against the background of acute respiratory viral infections. For 7 years, shortness of breath while walking fast has been disturbing. A year ago, he noted an increase in ARVI episodes (up to 4 times a year), an increase in cough, accompanied by an increase in body temperature to 38.0 ° C. In a stationary examination, the condition is regarded as chronic obstructive mucopurulent bronchitis of moderate severity in the acute phase; Berodual therapy was carried out 4 breaths 4 times a day through a metered-dose inhaler (DI), bromhexine 2 tablets 4 times a day, Halixol 30 mg, 1 tablet 3 times a day; claforan 1 g 2 times a day iv for 14 days; Trichopol 0.25 1 tablet 3 times a day; verapamil 80 mg 1 tablet 3 times a day. Against this background, noted improvement in health, normalized body temperature. Dry cough persisted, especially in the morning. Despite taking Berodual 4 times 4 times a day through CI, Bromhexine 2 tablets 4 times a day, Halixol 30 mg 1 tablet 3 times a day, Verapamil 80 mg 1 tablet 3 times a day, I felt worse 3 months ago : cough with separation of mucopurulent viscous sputum mainly at night-morning time (2.00-7.00), a feeling of "difficult exhalation" with intense coughing, more frequent episodes of shortness of breath when walking. Due to an increase in body temperature to 38.3-38.5 ° C, he took claforane 2 g / day iv, Trichopol 0.25, 1 tablet 3 times a day for 4 days.

On examination: moderate severity. Body temperature 38.5 ° C. Cyanosis of the lips. Nails are not changed. No swelling. In the lungs, breathing is weakened, more to the left in the lower parts, in the interscapular space, buzzing, wheezing rales were heard, intensified on forced expiration. BH = 22 in 1 min. Heart sounds are rhythmic. Heart rate = 90 beats in 1 min. HELL = 140/80 mm RT. Art. He refused treatment in the hospital. Examined before the appointment of BRFT:

Clinical blood test: HB 14.42 g%, col. pok 0.91, erythro. 4.729 million, lake. 12660, p 2, s 81, e 1, l 9, m 7, ESR 20 mm / h.

Sputum examination: viscous consistency, mucopurulent character, leukocytes - 10-20-40 in the field of view, densely in the cluster, flat epithelium - a little, cylindrical epithelium - a lot; macrophages - a lot; CD, atypical cells not found.

X-ray of the chest: lungs are swollen in the upper sections, the walls of the bronchi are tightened, the pulmonary pattern is somewhat enhanced due to the interstitial component, single cylindrical bronchiectasis in the lower sections of both lungs.

ECG: sinus rhythm, correct. Heart rate 90 / min. High P waves in lead II. Deep S waves in leads V5-6.

ECHO-KG: sizes of the right chambers of the heart within normal limits, revealed hyperkinesis of the free wall of the right ventricle.

Peak expiratory flow rate (PSV) in the morning: 350 l / min.

External Respiratory Function (VFD): forced expiratory volume in 1 s (FEV1) 67%; FEV1 / FZHEL (forced vital lung capacity) 68%. After the test with berotek: FEV1 -72%.

Fibrobronchoscopy (FBS): signs of prolapse of the membranous wall of the trachea and main bronchi of the 1st century, moderate hyperemia and swelling of the bronchial mucosa, in the lumen of the bronchi - a moderate amount of mucopurulent viscous secretion diffusely distributed throughout the bronchial tree.

Sowing bronchial contents: Streptococcus pneumoniae 10 * 8.

BRFT was carried out under the control of laboratory parameters, PSV, data of the HPF (data are presented in table 2).

table 2 Drugs and time taken, controlled parameters To BRFT Against the background of the BRFT Originally 1st day of BRFT 14th day of the BRFT 28th day of the BRFT No-shpa -------- 1/2 tablet in 5.00 -5 days --------- -------- Trental -------- 1/4 tablets (25 mg) in 5.15 -5 days --------- -------- Claforan 1 g 2 times a day iv 1 g at 5.30 iv 5 days --------- --------- Trichopolum 250 mg 1 tablet 3 times a day 1 tablet in 5.30-10 days ---------- --------- Berodual 4 breaths 4 times a day through CI 4 breaths at 5.30 through CI 2 breaths at 5.30 through CI 1 breath at 5.30 through CI Bromhexine 2 tablets 4 times a day 2 tablets at 5.45 1 tablet in 5.45 1/2 tablet in 5.45

Drugs and time of admission, indicators of BPM (mmHg) To BRFT Against the background of the BRFT Originally 1st day of BRFT 14th day of the BRFT 28th day of the BRFT Halixol 30 mg 1 tablet 3 times a day 1 tablet in 5.45 1/2 tablet at 5.45 1/4 tablets at 5.45 Papaverine --------- 1 tablet (40 mg) at 7.00 1 tablet (40 mg) at 7.00 1 tablet (40 mg) at 7.00 Aspirin --------- 1/4 tablet (125 mg) at 9.00 1/4 tablet (125 mg) at 9.00 1/4 tablet (125 mg) at 9.00 Panzinorm ---------- 1 tablet at 9.00 1 tablet at 9.00 1 tablet at 9.00 Verapamil 80 mg 1 tablet 3 times a day 1 tablet at 11.00, 1 tablet at 19.00 1/2 tablet at 11.00, 1/2 tablet at 19.00 1/4 tablets at 11.00, 1/2 tablets at 19.00 Valerian ---------- 1 tablet at 11.00 and 1 tablet at 20.00 1 tablet at 11.00 and 1 tablet at 20.00 1 tablet at 11.00 and 1 tablet at 20.00 Multivitamins ---------- 1 tablet at 13.00 1 tablet at 13.00 1 tablet at 13.00 Furosemide --------- 1/4 tablets (10 mg) at 16.00 1/4 tablets (10 mg) at 16.00 1/4 tablets (10 mg) at 16.00 every other day Allochol --------- 1 tablet at 23.00 1 tablet at 23.00 1 tablet at 23.00 PSV in the morning (ml) 350 450 530 FEV1 (%) 67 78 85 FEV1 / FVC (%) 68 80 86 White blood cells 12660 7100 5500

Drugs and time of admission, indicators of BPM (mmHg) To BRFT Against the background of the BRFT Originally 1st day of BRFT 14th day of the BRFT 28th day of the BRFT ESR (mm / hour) twenty 14 7 Bpm 22 19 17 HELL (mmHg) 140/80 130/80 125/80 Heart rate / min 90 78 69

Against the background of BRFT in the conditions of a day hospital, positive dynamics was noted.

On the 3rd day, body temperature returned to normal, the intensity of coughing decreased, sputum discharge improved.

On the 7th day, PSV increased to 400 ml / min.

On the 14th day of the black hole 19 / min. Auscultatory single wheezing in the lower parts of the lungs on a forced expiration. In the blood - white blood cells 7100, ESR 14 mm / hour. In sputum - white blood cells 8-10 in the field of view. PSV 450 ml / min. HPF: FEV1 -78%; FEV1 / FVC 80%. HELL 130/80 mm RT. Art. Heart rate 78 / min.

On the 28th day of the BRFT: cough, shortness of breath have passed. BH 17 / min. There are no wheezing in the lungs. Blood test: white blood cells 5500, ESR 7 mm / h. FVD: OFV1 -85-%; FEV1 / FVC 86%. HELL 125/80 mm RT. Art. Heart rate 69 / min. FBS: in the lumen of the visible bronchi, a moderate amount of mucous secretion, inflammatory phenomena are mild. Sowing of bronchial contents is negative. ECHO-KG: there is no hyperkinesis of the free wall of the right ventricle. ECG: positive dynamics.

When carrying out BRFT, it was possible to reduce the daily dose of basic drugs: see table 2.

BRFT showed higher efficiency compared to traditional pharmacotherapy and the absence of side effects and allows you to "significantly" reduce daily doses of basic drugs (metoprolol, furosemide, antibiotics, berodual, bromhexine, chalixol, verapamil) in a short time of curation in various pathological conditions, which allows you to effectively apply it not only in therapy, but also in other areas of practical medicine (pediatrics, obstetrics and gynecology, etc.)

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Claims (1)

A biorhythmic pharmacotherapy method, characterized in that one or more necessary drugs are selected, selected from the series: at 23.00 from the number of choleretic drugs; at 01.00-3.00 - hepatotropic drugs; at 03.00-5.00 - antitussive drugs, bronchodilators, mucolytics, adrenal hormones; at 05.00-7.00 - agents that normalize the bacterial flora of the large intestine, antidiarrheal, laxatives; 07.00-9.00 - funds affecting appetite, gastric secretion, gastric motility, iron preparations; at 09.00-11.00 - drugs that stimulate or inhibit the secretion of the pancreas, replacement analogues of pancreatic enzymes, antidiabetic drugs, drugs that affect blood formation, blood coagulation; at 11.00-13.00 - antihypertensive, antianginal, antiarrhythmic, vascular, psychotropic drugs, thyroid hormone preparations; at 13.00-15.00 - vitamin, microelement preparations, salt laxatives, castor oil, anthelmintic; at 15.00-19.00 - diuretics, urerotropic drugs, drugs that affect the prostate gland; at 19.00-21.00 - antihypertensive, antianginal, antiarrhythmic, vascular, psychotropic drugs, sedatives, hypnotics; at 21.00-23.00 - drugs that affect the tone of the autonomic nervous system, libido, potency, immunomodulators.

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