RU2329042C2 - Method of treatment of patients suffering from acute and chronic cerebrovascular diseases of atherosclerotic genesis - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: within 8 days from treatment beginning 1% emoxypin solution dosed 20 ml and 20% pyracetam solution are drop-by-drop introduced simultaneously intravenously daily, dissolved in 200 ml of physiological saline, once a day in the morning, combined with sermyon of single dosage 4 mg intramuscularly in the afternoon. From 9th day 1% emoxypin solution is injected intramuscularly daily dosed 5 ml once a day within 7 days, and capsulated eikonol is dosed 2 g 5 times a day within 20 days. Course of treatment continues 28 days.

EFFECT: method provides optimum scheme of treatment for the given group of patients and decrease in by-effects of medical agents.

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Description

The present invention relates to medicine, namely to neurology, and can be used to treat patients with acute and chronic forms of vascular diseases of the brain of atherosclerotic origin.

The essence of the method is that within 8 days from the start of treatment, 20 ml of a 1% solution of emoxipin and 10 ml of a 20% solution of piracetam are administered intravenously every day, diluted in 200 ml of physiological solution, 1 time per day in the morning and 4 mg of sermion once intramuscularly during the day; from day 9, a 1% solution of emoxipin is prescribed in a dose of 5 ml intramuscularly daily 1 time per day for 7 days and eikonol in capsules in a dosage of 2 g 3 times a day: during breakfast, lunch and dinner for 20 days.

A known method (1) of the treatment of cerebral ischemic stroke, selected as a prototype. It has inherent disadvantages: invasiveness caused by the use of intravenous helium-neon laser therapy and acupuncture acupuncture reflexology, uncomfortable procedures that complicate the clinical course of the disease and can in some cases cause complications.

The invention solves the problem of expanding the arsenal of the therapeutic approach, improving the clinical course of the disease, reducing side effects and complications, as well as improving the neurological status of the patient.

This problem is solved by the fact that within 8 days from the start of treatment, 20 ml of a 1% solution of emoxipin and 10 ml of a 20% solution of piracetam are administered intravenously every day, diluted in 200 ml of physiological solution, 1 time per day in the morning and 4 mg of sermion once intramuscularly during the day; from day 9, a 1% solution of emoxipin is prescribed in a dose of 5 ml intramuscularly daily 1 time per day for 7 days and eikonol in capsules in a dosage of 2 g 3 times a day: during breakfast, lunch and dinner for 20 days.

The method is performed in the following sequence.

Patients with acute vascular diseases of the brain of an atherosclerotic nature (ischemic stroke) are prescribed 20 ml of 1% solution of emoxipine and 10 ml of a 20% solution of piracetam intravenously drop by drop every day, diluted in 200 ml of physiological solution, 1 time per 8 days from the start of treatment. day in the morning and 4 mg sermion once intramuscularly in the afternoon.

This allows from the first hours of the disease to carry out complex therapy, which includes the following areas: vasodilation, disaggregation, lowering blood viscosity, antioxidant and nootropic effects. At the same time, the arsenal of the therapeutic approach to the treatment of ischemic stroke has been significantly expanded.

Subsequently, from day 9, a 1% solution of emoxipin 5 ml is administered intramuscularly daily 1 time per day for 7 days and eikonol in capsules in a dosage of 2 g 3 times a day: during breakfast, lunch and dinner for 20 days.

The patient management scheme at this stage can improve the clinical course of the disease, as well as dramatically reduce the number of side effects and complications.

The method is illustrated by clinical examples.

Example 1

Patient S., 64 years old, higher education, native language Russian, left-handed.

Diagnosis: ischemic stroke in the pool of the right middle cerebral artery against the background of cerebral atherosclerosis and arterial hypertension with moderate left-sided hemiparesis of the central type. Progressive vascular leukoencephalopathy. Obesity is exogenously constitutional.

The patient was prescribed at the same time 20 ml of 1% solution of emoxipin and 10 ml of 20% solution of piracetam intravenously daily, diluted in 200 ml of physiological saline, 1 time per day in the morning for 8 days from the start of treatment, during the same 8 days, sermion is prescribed for 4 mg once intramuscularly during the day; from 9 days a 1% solution of emoxipin is prescribed in a dose of 5 ml intramuscularly daily 1 time per day for 7 days; in addition, from 9 days from the start of treatment, eikonol is prescribed in capsules in a dosage of 2 g 4 times a day: during breakfast, lunch, lunch, afternoon snack and dinner for 20 days.

The patient tolerated the treatment well. Dyspeptic phenomena are not observed. The total duration of treatment is 24 days. Upon admission, the patient's neurological status was evaluated at 17 points, and after treatment - at 13 points. Such a shift was achieved due to improved speech, increased strength in the left hand and regression of paresis of the facial and sublingual nerves.

Example 2

Patient S-va, 67 years old, secondary education, native language Russian, right-handed person.

Diagnosis: ischemic stroke in the basin of the right middle cerebral artery with moderate left-sided hemiparesis of the central type. Progressive vascular leukoencephalopathy. Hypercoagulation Syndrome.

The patient was prescribed at the same time 20 ml of 1% solution of emoxipin and 10 ml of 20% solution of piracetam intravenously daily, diluted in 200 ml of physiological saline, 1 time per day in the morning for 8 days from the start of treatment, during the same 8 days, sermion is prescribed for 4 mg once intramuscularly during the day; from 9 days a 1% solution of emoxipin is prescribed in a dose of 5 ml intramuscularly daily 1 time per day for 7 days; in addition, from the 9th day from the start of treatment, eikonol is prescribed in capsules in a dosage of 2 g 4 times a day: during breakfast, lunch, lunch, afternoon snack and dinner for 20 days; add an additional meal - 250 ml of kefir 2 hours before bedtime for 20 days.

Table 1 shows the positive results of the treatment of patient C-howl, 67 years old.

Table 1. Nn Indicator Before Treatment After treatment D (in %%) one Prothrombin (in %%) 97 82 15,5 2 Hematocrit (in %%) 42.7 44.8 4.9 3 Platelets (× 10 g / L) 193 240 24.4 four %% Platelet Aggregation 93 fifty 46.2 5 TEG: in sec. 6 R 6 7.3 21.7 7 R + K 8 9 12.5 8 Ma (mm) 80 74 7.5 9 APTT (sec) 28 28.1 0.4 10 Fibrinogen (g / l) four 3.8 5 eleven PST 0.552 0.489 11,4 12 Ethanol Test - 13 FAK (%%) 38 42 10.5 d - the degree of change in %% of the initial level

The table below shows the positive effect of eikonol on platelet and coagulation hemostasis.

Example 3

Patient Sh-na, 57 years old, secondary education, mother tongue Ukrainian, right-handed person.

Diagnosis: ischemic stroke in the pool of the right middle cerebral artery against the background of cerebral atherosclerosis and arterial hypertension. Violation of lipid metabolism as hypercholesterolemia.

The patient was prescribed at the same time 20 ml of 1% solution of emoxipin and 10 ml of 20% solution of piracetam intravenously daily, diluted in 200 ml of physiological saline, 1 time per day in the morning for 8 days from the start of treatment, during the same 8 days, sermion is prescribed for 4 mg once intramuscularly during the day; from 9 days a 1% solution of emoxipin is prescribed in a dose of 5 ml intramuscularly daily 1 time per day for 7 days; in addition, from the 9th day from the start of treatment, eikonol is prescribed in capsules in a dosage of 2 g 4 times a day: during breakfast, lunch, lunch, afternoon snack and dinner for 20 days; simultaneously with eikonol for 4 weeks a low-calorie diet is prescribed based on: proteins - 80 g / day, fats - 60 g / day, cholesterol - up to 250 mg / day, carbohydrates - 300 g / day, table salt - 3 g / day, energy value - 2000 - kcal / day.

Table 2 shows the lipid spectrum of the blood after 34 days from the start of treatment with patient Sh-no, 57 years old.

Table 2. Indicator Before treatment After treatment D (in %%) O-CS (mmol / l) 6.98 5.92 15,2 HDL cholesterol (mmol / l) 1.29 1.92 48.8 LDL cholesterol (mmol / l) 4.12 3.13 24.0 Atherogenic index 5.41 3.08 43.1 TG (mmol / L) 3.47 1.92 44.7 d - the degree of change in %% of the initial level

From the table below you can see the normalizing effect of eikonol on the blood lipid spectrum: a decrease in the level of O-cholesterol, LDL cholesterol, TG, atherogenic index, an increase in HDL cholesterol.

Example 4

Sick Peninsula, 67 years old, higher education, native language Russian, right-handed person.

Diagnosis: atherosclerotic dyscirculatory encephalopathy of the II stage. Residual effects of ischemic stroke in the pool of the left middle cerebral artery from IV. 1990 g with severe right-sided hemiparesis of the central type. Hypertension II Art. IHD: atherosclerotic and post-infarction cardiosclerosis with rhythm and conduction disturbances. Chronic gastritis, colitis, cholecystitis. Atherosclerosis of the retinal vessels of both eyes.

The patient was prescribed at the same time 20 ml of 1% solution of emoxipin and 10 ml of 20% solution of piracetam intravenously daily, diluted in 200 ml of physiological saline, 1 time per day in the morning for 8 days from the start of treatment, during the same 8 days, sermion is prescribed for 4 mg once intramuscularly during the day; from 9 days a 1% solution of emoxipin is prescribed in a dose of 5 ml intramuscularly daily 1 time per day for 7 days; additionally, from the 9th day from the start of treatment, eikonol is prescribed in capsules in a dosage of 2 g 4 times a day: during breakfast, lunch, lunch, afternoon snack and dinner for 20 days and a festival of 1 dragee meal.

The results of the treatment of the patient P-howl, 67 years old, are shown in table 3

Table 3. Indicator Before treatment After treatment D (in%) 1. Prothrombin (in%) 97 82 15,5 2. Hematocrit (in %%) 42.7 44.8 4.9 3. Platelets (× 10 g / l) 193 240 24.4 3. %% platelet aggregation 93 fifty 46.2 4. TEG: in sec. R 6 7.3 21.7 R + K 8 9 12.5 Ma (mm) 80 74 7.5 5. APTT (sec) 28 28.1 0.4 6. Fibrinogen (g / l) four 3.8 5 7. PST 0.552 0.489 11,4 8. Ethanol Test - - - 9. FAK (%%) 38 42 10.5 D - the degree of change in %% of the initial level

The proposed method allows to improve, table 4, the clinical course of the disease (ischemic stroke), as well as reduce, table 5, side effects of the drugs and achieve a greater regression of neurological symptoms.

Table 4.
Dynamics of neurological symptoms in the acute period of ischemic stroke in patients of different clinical groups Nevrol. Symptoms (in points) n = 19 Emoxipin d (%%) n = 30 Akonol d (%%) n = 42 2 drugs d (%%) M ± m M + m M + m 1. Cerebral symptoms 64.5 68.8 78,4 Before treatment 3.1 ± 0.2 3.2 ± 0.1 3.1 ± 0.3 After treatment 1.0 ± 0.15 1.0 ± 0.2 0.67 ± 0.21 p = 0.04 p = 0.008 2. Focal symptoms 51,2 40,2 56.3 Before treatment 9.5 ± 0.4 8.2 ± 0.18 9.6 ± 0.5 After treatment 4.6 ± 0.5 4.97 ± 0.15 4.2 ± 0.5 p = 0.04 3. Aggregate symptoms 55,2 49.6 61.9 Before treatment 12.5 + 0.6 11.3 + 0.8 12.6 + 0.5 After treatment 5.6 ± 0.6 5.7 + 0.3 4.8 + 0.5 P = 0.0001 p = 0,0003 p = 0.0001 4. The Positive Effect of Treatment 12 (63.2%) 18 (60%) 34 (80.1%) D - the degree of change in %% of the initial level

Table 5.
The effectiveness of treatment in comparison with the prototype Groups Nevrol. Symptoms (in points) Complete regression nevrol. Symptoms d (in %%) ADE I p = 67 ** 31 67.7 before treatment 6.5 ± 0.5 (46.3%) After treatment 2.1 ± 0.5
p = 0.0001 ADE II p = 55 ** 7 41.7 before treatment 10.8 + 0.6 (12.7%) After treatment 6.3 + 0.6 p = 0.0001 ADE III p = 26 ** 24.6 before treatment 13.0 + 0.8 After treatment 9.8 ± 0.3 p = 0,0003 ADE P = 148 ** 38 43.9 before treatment 9.8 + 0.4 (25.7%) After treatment 5.5 ± 0.5 p = 0.0001 D - the degree of change in %% of the initial level
- * - direct reliable correlation of medium strength \
- ** - direct significant strong correlation

Literature

1. RF patent No. 2188008, Class A61K 31/202

2. N.V. Lebedeva, E.V. Khrapova, T. N. Fedorova // Journal of Neurology and Psychiatry. S.S. Korsakova. - 1991. - No. 7. - p. 79-82.

3. V.N. Bobyrev, I.Sh. Veselovsky, L.E. Bobyreva // Journal of Neurology and Psychiatry. S.S. Korsakova. - 1989. - No. 9. - pp. 60-63.

4. V.I. Shmyrev, T.Yu. Khokhlova // Transactions of the First international scientific forum "Cardiology-99". - M., January 28-29, 1999 .-- p. 323.

Claims (1)

A method of treating patients with acute or chronic vascular diseases of the brain of an atherosclerotic nature, characterized in that within 8 days from the start of treatment, 20 ml of a 1% solution of emoxipine and 10 ml of a 20% solution of piracetam are administered intravenously daily, diluted in 200 ml saline, 1 time per day in the morning and 4 mg sermion once intramuscularly in the afternoon; from day 9, a 1% solution of emoxipin is prescribed in a dose of 5 ml intramuscularly daily 1 time per day for 7 days and eikonol in capsules in a dosage of 2 g 5 times a day for 20 days, the course of treatment lasts 28 days.