RU2465884C1 - Method of complex treatment of patients with chronic gout at resort stage - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to balneology. Method includes complex treatment of patients. First, patient's individual sensitivity to radon procedures is estimated. For this purpose arterial pressure and heart rate are measured before bath. After that, patient takes a bath with mineral water of thermal radon springs with natural water temperature of about 38°C, rests for 30 minutes. Arterial pressure and heart rate are re-measured. If heart rate does not change, or changes by 10 beats/minute, and systolic and/or diastolic arterial pressure changes by ±10 mm Hg, I type of reaction is determined in patient. If heart rate changes by ± 20 beats/minute, and systolic and/or diastolic arterial pressure changes by ±15 mm Hg, II type of reaction is determined in patient. If heart rate changes by ± 30 beats/minute, and systolic and/or diastolic arterial pressure changes by ±20 mm Hg, III type of reaction is determined in patient. In case of I type reaction, bath with radon water is taken according to the following scheme: first procedure - 5 minutes, second procedure - 8 minutes, third procedure - 10 minutes, the following procedures - 15 minutes. In case of type II reaction bath with radon water is taken according to the following scheme: first procedure - 5 minutes, second procedure - 8 minutes, third procedure - 10 minutes, all following procedures - 15 minutes. In case of type III reaction bath with radon water is taken according to the following scheme: first procedure - 3 minutes, second procedure - 5 minutes, third procedure - 8 minutes, all following procedures - 10 minutes, bath with radon water general or local with submergence of legs into water, or four-chambered. Baths are taken for two days every day, then follows a day break. Treatment is performed at the background of No 6 diet. In the first half of the day, two hours after breakfast patient drinks 200 ml of radon water in sips at a measured pace. After that, mud applications on the area of feet and lower third of shins are performed. Detensor-therapy is carried out. In the second half of the day, two hours after dinner patient drinks 200 ml of radon water in swallows at a measured pace. After that, patient takes a bath with radon water. After bath procedure in accordance with programme of resonance-acoustic fluctuations (PRAF) is performed. On the days when baths are not taken, in the first half of the day intestinal lavage is performed. In the second half of the day mini-sauna "Cedar burrel" with products of antler deer-breeding is carried out.

EFFECT: method increases treatment efficiency due to reduction of uric acid, improvement of joint mobility.

3 cl, 2 tbl

Description

The invention relates to medicine and can be used in the practice of doctors involved in balneology or rehabilitation.

Gout is a systemic tofus disease characterized by the deposition of crystals of sodium monourate in various tissues and developing in connection with this inflammation in people with hyperuricemia due to environmental and / or genetic factors (Nasonova V.A., Barskova V.G. Early diagnosis and treatment of gout - a scientifically substantiated requirement to improve the labor and life prognosis of patients. Scientific and Practical Rheumatology, No. 1, 2004, p.5-7). Acute pain syndrome in the big toe was described by Hippocrates. However, until now the relevance of studying this disease has not lost its medicosocial significance (Luk AJ, Simkin PA. Epidemiology of hyperuricemia and gout. Am J Manag Care. 2005 Nov; 11 (15 Suppl): S435-42; quiz S465-8). In particular, epidemiological studies conducted over the past decade indicate an increase in the prevalence of the disease (Arromdee E., Mi-chet CJ, Crowson CS, O'Fallon WM, Gabriel SE. Epidemiology of gout: is the incidence rising? J Rheumatol. 2002 Nov; 29 (11): 2403-6). So, for example, if in the USA in the 60s of the XX century only 0.2% of the population was diagnosed with gout (Pihlak E.G. Podagra. M., Medicine, 1970, p. 11), then at the beginning of the XXI century it was already more than 1% (Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther. 2006; 8 Suppl l: S2. Epub 2006 Apr 12). In addition, recent studies have shown a significant increase in the incidence of gout in postmenopausal women (De Souza AW, Fernandes V, Ferrari AJ. Female gout: clinical and laboratory features. J Rheumatol. 2005 Nov; 32 (11): 2186- 8; Park YB, Park YS, Song J, Lee WK, Suh CH, Lee SK. Clinical manifestations of Korean female gouty patients. Clin Rheumatol. 2000; 19 (2): 142-6), although gout has traditionally been more common in men after 40 years (Corrado A, D'Onofrio F, Santoro N, Melillo N, Cantatore FP. Pathogenesis, clinical findings and management of acute and chronic gout. Minerva Med. 2006 Dec; 97 (6): 495-509).

Currently, three main anti-inflammatory lines are actively used to treat gout: colchicine, non-steroidal anti-inflammatory drugs or glucocorticoids (GC) (V. G. Barskova, I. A. Yakunina. Pharmacotherapy of rheumatic diseases. Anti-inflammatory therapy of acute and chronic gouty arthritis. Consilium- medicum. 2005, No. 2).

The most ancient method of treating gout is diet therapy. Currently, the negative effect of products rich in purine bases (meat, fish, beans, mushrooms, cauliflower, etc.) has been proven (Choi NK. Dietary risk factors for rheumatic diseases. Curr Opin Rheumatol. 2005 Mar; 17 (2): 141 -6), as well as alcohol (Choi NK, Atkinson K, Karlson EW, Willett W, Curhan G. Alcohol intake and risk of incident gout in men: a prospective study. Lancet. 2004 Apr 17; 363 (9417): 1277- 81; V.A. Nasonova, V.G. Barskova / Gout. Handbook of a polyclinic physician. 2002, No. 3, volume 2) on the development of gout.

There is a method of complex treatment of gout by performing ultrasound on the affected joint, after 10 treatments the patient is prescribed Tashkent mineral water (in the form of baths and drinks), therapeutic exercises, massage of the affected joints (prototype SU 929070, 05.23.1982).

The present invention was the development of a method for the comprehensive treatment of patients with gout at the spa stage.

The proposed method ensures the achievement of the following technical result: improving the treatment of patients with gout at the spa stage due to:

- lower uric acid levels,

- improved mobility in the joints,

- improving the quality of life of patients.

The method is as follows.

Initially, the individual sensitivity of the patient to radon procedures is evaluated. Why, on an empty stomach, before taking the first bath, blood pressure and pulse rate are measured, then the patient takes a bath with mineral water of thermal radon sources with a natural water temperature of about 38 ° C (radon water), rests for 30 minutes, after which the patient’s blood pressure is measured again pressure and heart rate, and if:

- the pulse did not change or changed by ± 10 beats / min, and the systolic and / or diastolic blood pressure changed by ± 10 mmHg, the patient’s type I reaction was determined;

- the pulse changed by ± 20 beats / min, and the systolic and / or diastolic blood pressure changed by ± 15 mmHg, the type II reaction is determined in the patient;

- the pulse changed by ± 30 beats / min, and the systolic and / or diastolic blood pressure changed by ± 20 mmHg, the type III reaction is determined in the patient.

Based on the revealed type of reaction, the mode of taking radon baths is determined:

- in the presence of type I reactions, a bath with radon water is taken according to the scheme: the first procedure is 5 minutes, the second is 8 minutes, the third is 10 minutes, then all procedures are 15 minutes, a total of 10-15 baths;

- if there is a reaction type II, the bath with radon water is taken according to the scheme: the first procedure is 5 minutes, the second is 8 minutes, the third is 10 minutes, then all procedures are 12 minutes, a total of 10-15 baths;

- if there is a reaction type III, the bath with radon water is taken according to the scheme: the first procedure is 3 minutes, the second is 5 minutes, the third is 8 minutes, then all procedures are 10 minutes, a total of 10-15 baths.

Then carry out complex treatment for 11-14 days:

- a bath of radon water (general or local with immersion in the feet or four-chamber water) is taken for two days in a row, then the day of a break,

- treatment is carried out against a background of diet No. 6,

- the first half of the day:

- two hours after breakfast, at a measured pace, the patient drinks 200 ml of radon water,

- mud applications on the feet and lower third of the legs, and mud treatment is performed only on those days when they take baths with radon water,

- detensor therapy, and it is carried out only on those days when they take baths with radon water,

- afternoon:

- two hours after dinner, in sips at a measured pace, the patient drinks 200 ml of radon water,

- takes a bath with radon water, after which - the procedure for the program of resonant-acoustic vibrations (PRAC).

- on days without baths, intestinal lavage is performed in the first half of the day, and a Cedar Barrel mini-sauna with antler reindeer products in the afternoon.

The course of treatment is 9-14 days.

Due to the fact that the characteristic of the regulatory mechanisms of the recovery reaction subtly reflects the individual peculiarity (individual sensitivity to radon procedures) of the patient in connection with the upcoming treatment, we have developed a method for preliminary assessment of the patient's reaction type, depending on which a certain regimen of reception of radon procedures is prescribed.

The use of radon water in the proposed method is due to the fact that it affects the purine metabolism, the violation of which leads to the development of gout. A decrease in uric acid in the blood of a patient with gout is noted 10 minutes after taking a bath.

It was revealed that in 86% of the examined patients with gout after a course of radon therapy (baths and drinking radon water, in the regimen we developed), there is a decrease in uric acid, which is accompanied by clinical improvement (improved mobility in the affected joint). This effect is due to the fact that radon and its decay products penetrating into the blood have a reflex (through the central nervous system) effect on the metabolism. Moreover, the joint use in one course of radon baths and drinking radon water, and the water of thermal radon sources with a natural water temperature of about 38 ° C, mutually reinforces the results achieved.

The specific used mineral radon water has an undoubted effect on the achieved result. Optimal, from the point of view of penetration into the body of radon and its decay products, is water with a natural temperature of about 38 ° C. It is known that when heated, radon escapes from water. At the same time, it is from warm water that a greater amount of radon enters the body than from cool water. In this connection, we used unheated radon water during the procedures, with a natural water temperature of about 38 ° C.

Water with such a characteristic can be obtained, in particular, in the resort of Belokurikha, in the sanatorium "Altai Castle". Water in the treatment rooms of the sanatorium comes from well No. 4E of the Belokurikhinsky field. The water temperature in the well + 42 ° C at an air temperature of + 15 ° C. The concentration of radon is 5.5-6.0 nKu / dm ³ . It is known that the concentration of radon undergoes drastic changes during its transportation from the source to the treatment room. So, for example, passing through pipelines, radon losses can be 65% or more. In this connection, in order to maintain the concentration of radon, and therefore, to achieve the maximum effectiveness of the procedures, it is advisable to take radon therapy procedures at a minimum distance from the well from which the radon water is taken. At such a distance is the sanatorium "Altai Castle".

In addition, we revealed an increase in efficiency when the gut procedure “Intestinal lavage” was included in the course of treatment of patients. The technique of lavage is patented (RU 2178696, 01/27/2002) and consists in the fact that a patient is given an empty stomach to drink a certain mixture of 200-400 ml every 5-10 minutes. As the intestines fill, diarrhea develops. Intestinal lavage is carried out until the appearance of liquid secretions from the rectum, not containing inclusions of chyme. The total volume of the mixture per procedure is an average of 3-6 liters. The mixture has the following composition: sodium phosphate, sodium chloride, sodium acetic acid, potassium chloride, calcium chloride, magnesium sulfate, citric acid, distilled water, vitamins A, E, D, C, B ₁ , B ₂ , B ₃ , B ₆ , B ₁₂ , B _c , K ₁ , H, PP, trace elements: potassium iodide, iron fumarate, copper oxide, zinc oxide, manganese sulfate, chromium chloride, sodium molybdate, sodium selenate, nickel sulfate, tin chloride, sodium metasilicate, metavanad sodium, drugs based on normal microflora waste products s intestine eubiotiki and pectin in the amount of a single daily dose, non-mineral flavorings and food colorings. The physiological nature of the mixture, the presence of probiotics and pectin in it, ensure the normalization of mineral and vitamin metabolism between the enteral and internal environments of the body, microbiocenosis, which in turn increases the effectiveness of gout treatment.

Another significant component of the proposed comprehensive treatment is PRAC - resonant-acoustic vibration programs (PRAC) - a method of bioresonance effects on organs and systems whose functions have pronounced deviations from the physiological norm. Resonance-acoustic oscillations (PRAC) programs provide directed remote (non-contact) and non-drug restorative effects on the patient's body, depending on the diseases he has.

The resonant-acoustic vibrations (PRAC) programs are selected by forming music audio sequences for music therapy, ensure the restoration of a person’s biopotential and the introduction of the body into self-regulation mode with the subsequent restoration of disturbed functions of organs and systems. The PRAC methodology was approved by the Ministry of Health and Social Development of the Russian Federation (Resolution of the Commission on New Medical Equipment of the Ministry of Health of the Russian Federation of October 9, 2002, protocol No. 3; registration certificate No. 229/03031002 / 4633-02 of December 26, 2002).

The proposed method also uses detensor therapy. Studies have shown that this particular method of influencing the spine, which provides muscle relaxation and sparing traction of the spine, allows to achieve, in combination with other methods of exposure, the most optimal therapeutic effects (tables 1, 2).

So, a study of two groups of patients with gout showed the following (table). The first group (n = 24) took a course (11 days) of radon baths in combination with drinking mineral water, the second group (n = 30) took a course (11 days) of radon baths in combination with drinking radon water (twice a day in two hours after ingestion with sips at a measured pace, for 1 meal - 200 ml of mineral water), using water of thermal radon sources with a natural water temperature of about 38 ° C (drink: twice a day two hours after eating with sips at a measured pace , for 1 dose - 200 ml of radon water).

Table 1 First group Second group Before treatment After treatment p Before treatment After treatment p Uric Acid, μmol / L 553.3 ± 126.2 514.1 ± 130.1 525.9 ± 128.6 472.4 ± 105.9 0.01 Urea, mmol / L 6.1 ± 0.7 5.8 ± 0.4 7.4 ± 1.8 6.8 ± 3.4 0.005

It is noteworthy that only in the second group did the changes in the indicators have a reliable character.

The effectiveness of the proposed methodology for the complex treatment of patients with gout was studied in the following groups of patients with gouty arthritis of the ankle joint: group 1 - ultrasonic treatment of the affected joint, taking Tashkent mineral water (in the form of baths and drinking), therapeutic exercises, massage of the affected joints; Group 2 - a complex of therapeutic measures according to the claimed method.

table 2 The first group (n = 12) The second group (n = 14) Before treatment After treatment p Before treatment After treatment p Uric Acid, μmol / L 553.3 ± 126.2 514.1 ± 130.1 545.9 ± 128.6 472.4 ± 105.9 0.01 Urea, mmol / L 6.1 ± 0.7 5.8 ± 0.4 7.4 ± 1.8 6.8 ± 3.4 0.005 Changes in the amplitude of movement of the ankle joint: extensia flexion 19.3 ± 1.28 22.1 ± 0.15 18.9 ± 1.22 27.1 ± 0.28 0.05 amplitude 34.1 ± 1.47 40.8 ± 1.22 0.005 34.1 ± 1.56 44.3 ± 1.37 0.001 53.3 ± 2.15 66.4 ± 1.56 0.005 53.0 ± 2.54 71.4 ± 2.17 0.01 Quality of life according to the SF 36 questionnaire: Physical component of health 30.1206 39.7677 34.3729 50.34751 Mental component of health 65.7823 70.3453 59.32201 74.68344

The data obtained allow us to conclude that the proposed method is effectively used in the treatment of gout at the spa stage.

Claims (3)

1. A method for the complex treatment of patients with chronic gout at the spa stage, including taking baths, characterized in that first, the individual sensitivity of the patient to radon procedures is evaluated, for which on an empty stomach, blood pressure and pulse rate are measured before the bath, then the patient takes a bath with mineral water thermal radon sources with a natural water temperature of about 38 ° C - radon water, rests for 30 minutes, after which the patient's blood pressure and pulse rate are re-measured and if: the pulse did not change or changed by ± 10 beats / min, and the systolic and / or diastolic blood pressure changed by ± 10 mmHg, the patient’s type I reaction was determined, the pulse changed by ± 20 beats / min, and the systolic and / or diastolic blood pressure changed by ± 15 mmHg, the type II reaction was determined in the patient, the pulse changed by ± 30 beats / min, and systolic and / or diastolic blood pressure changed by ± 20 mmHg, determined by patient type III reaction; on the basis of the detected type of reaction, the mode of taking radon baths is determined: if there is a type I reaction, the bath with radon water is taken according to the scheme: the first procedure is 5 minutes, the second - 8 minutes, the third - 10 minutes, then all procedures for 15 minutes; in the presence of type II reaction, a bath with radon water is taken according to the scheme: the first procedure is 5 minutes, the second - 8 minutes, the third - 10 minutes, then all procedures for 12 minutes; in the presence of type III reaction, a bath of radon water is taken according to the scheme: the first procedure is 3 minutes, the second 5 minutes, the third 8 minutes, then all procedures for 10 minutes; carry out complex treatment, including a bath with radon water total, or local with immersion in the feet, or four-chamber, which are taken - two days in a row, then the day of a break, the treatment is carried out against a background of diet No. 6; first half of the day: after 2 hours after breakfast, the patient drinks 200 ml of radon water with sips at a measured pace, mud applications on the feet and lower third of the legs, and mud therapy is performed only on those days when they take baths with radon water, detensor therapy, moreover it is carried out only on those days when they take baths with radon water; second half of the day: after 2 hours after lunch, the patient drinks 200 ml of radon water at a measured pace, takes a bath of radon water, after which - the procedure for the program of resonant-acoustic vibrations (PRAC); on non-bathing days, intestinal lavage is performed in the first half of the day, and a Cedar Barrel mini-sauna with antler reindeer products in the afternoon. 2. A method for the complex treatment of patients with chronic gout at the spa stage according to claim 1, characterized in that the radon water baths are shared, or local, with feet immersed in water, or four-chamber. 3. The method of complex treatment of patients with chronic gout at the spa stage according to claim 1, characterized in that the course of treatment is 9-14 days.