RU2414253C1 - Method for prevention of renal insufficiency in complex correction of obesity patient state - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely to restorative medicine and rehabilitation, and can be used for prevention of renal insufficiency in complex correction of an obesity patient state. That is ensured by reducing dietary treatment (RDT) under Cal-Calif intoxication index (II) with underlying music therapy, psychocorrection, dynamic motor conditions. At the 1st stage, 1-2 days hypocaloric vegetable-cereal diet of caloric content 1800-2200 kcal/day is prescribed. Then, at the 2nd stage, if observing the II increasing more than 3.9 standard units, the vegetable-cereal diet is kept for 15-19 days in the patient and combined with daily depletion. If the II is decreasing to 3.9 standards units and lower, the patient is moved either to a starvation diet, or to a diet of daily calorage limited by 1000-1500 kcal. After the 2nd stage completed, daily caloric content of food is gradually increased to 2200 kcal for 15 days. ^ EFFECT: method provides more effective RDT and allows controlling endotoxicosis degree and functional kidney load that allows reducing a percentage of renal complications representing transient renal insufficiency. ^ 3 cl, 2 tbl, 2 ex

Description

The present invention relates to medicine, namely to restorative medicine and rehabilitation.

Endotoxemia and renal failure are known to significantly aggravate the course of any acute or chronic disease. In this regard, in the treatment of diseases by doctors, attempts are made to reduce the severity of endotoxemia by various methods and thereby reduce the load on the organs of excretion and, in particular, the kidneys. Reducing the severity of endotoxemia of various etiologies is a preventive measure to prevent the development of renal failure.

A known method of combating endotoxemia and the prevention of renal failure by cleansing the blood by passing it through hemosorbents (A.G. Rumyantsev, V.A. Agranenko, 1998). These methods are used in the development of crash syndrome, the ingestion of hemolytic poisons in the body, etc. When using these methods, large vessels must be catheterized in order to draw blood, while the passage of shaped elements through the sorbent is accompanied by their damage. In this regard, the procedures are limited to two to three sessions. In addition, the cost of hemosorbents is extremely high.

A known method of reducing the severity of endotoxemia by ingestion of substances with sorption ability (enterosorbents) (Yu.M. Levin, 2003). As non-selective enterosorbents, depending on the goal and individual characteristics of the patient, use: polyphepan in a daily dose of 0.5-1 g / kg of patient weight; SUMS-1 in a daily dose of 1 g / kg of patient weight. However, the effectiveness of such procedures is low, and with severe endotoxemia does not prevent the development of renal failure.

A known method for the treatment of chronic diseases, adopted for the closest analogue, the so-called "fasting and dietary therapy" (RDT) (A.N. Kokosov, 2007). The method is used for a variety of pathologies, but quite often the technique is used to correct weight. However, when using this technique, the development of transient renal failure (PPN) is a fairly frequent complication. The pathogenesis of this complication remains unclear, but it has been established that endotoxemia plays a leading role in its implementation. In this regard, the search for methodological approaches that contribute to the prevention of this complication is justified.

The objectives of the invention are to increase the effectiveness of RDT and its differentiated use in the treatment of endotoxemia in overweight and obese patients to prevent the development of complications from the kidneys in the form of transient renal failure.

This goal is achieved by the fact that against the background of music therapy, psychocorrection, an active motor regimen, at the 1st stage for 1-2 days a hypocaloric vegetable-cereal diet with a calorie content of 1800-2200 kcal / day is prescribed, then at the 2nd stage for 15 -19 days under the control of the Cal-Caliph Intoxication Index (AI) with an increase in AI of more than 3.9 conventional units the patient is left on a plant-cereal diet in combination with daily bowel cleansing, and with a decrease in AI below 3.9 conventional units they are transferred either to a hungry diet, or with a daily calorie restriction of up to 1000-1500 kcal, and after the completion of the 2nd stage for 15 days, the daily calorie content of food is gradually increased to 2200 kcal. Due to the differentiated approach, it is possible to regulate the degree of endotoxemia and, accordingly, the functional load on the kidneys. As a result of this approach, it is possible to significantly reduce the percentage of complications in the form of transient renal failure. Known methods do not provide for the simultaneous integrated use of all methods of preventing renal failure under the control of an intoxication index (II).

The method is as follows. After clarifying the essence of using the method of unloading and dietary therapy, psychological preparation and performing laboratory tests, patients are prescribed a hypocaloric diet with a calorie of 1800-2200 kcal / day for 1-2 days. In addition, patients are prescribed a motor regimen, including 4-5 km long walks 2 times a day. From the very beginning of the course, all patients are given music therapy in the treatment course, including listening to the live works of Bach, Chopin, Tchaikovsky, Scriabin and others. In parallel with these activities, patients underwent daily psychocorrection, which included a review of motivation for behavior in life and society, the formation of beliefs in the need to take care of one’s health and the health of loved ones, the formation of a food culture and the replacement in the mind of a “food cult” with a “cult of health”. Elements of psychocorrection were presented to patients daily throughout the course of treatment. In the same plan, patients were taught the basic elements of auto-training, which they performed daily.

Therapeutic massage, which was prescribed from the second day of the hospital stay, included a daily general toning massage of the whole body or the use of special massage tables (such as "Nougat Best").

Improving gymnastics was carried out in the mornings daily and included exercises on the main muscle groups for 15 minutes. Water procedures included taking a shower 2 times a day or a contrast shower (usually in the morning). The specified complex provides maximum comfort during treatment. As a criterion for the severity of endotoxemia, we selected the Cal-Caliph intoxication index (II), which is determined by a blood smear according to the formula: AI, conventional units = (4 * myel. + 3 * youth. + 2 * pal. + 1 * seg.) * (Square + 1) / (mon. + Lymph.) * * (Eos. + 1), where myel. - myelocytes, youth - young, fell. - stab, seg. - segmented, pl. - plasma cells, lymph. - lymphocytes, mon. - monocytes, eos. - eosinophils.

With an intoxication index value of more than 3.9 conventional units (the minimum value of the interval of the series, lying within one sigma), patients are prescribed mainly a plant and cereal diet with a calorie content of 1800-2200 kcal / day for 15-19 days. The multiplicity of food intake is from 4 to 6 times. The other part is for patients whose intoxication index did not exceed the value of 3.9 conventional units. in the absence of contraindications and if desired by the patient, a hypocaloric diet with a calorie of 1000-1500 kcal / day or a complete abstinence from food was prescribed. In this case, bowel cleansing is performed using cleansing enemas or hydrocolonotherapy. Hydrocolonotherapy was carried out (in the absence of contraindications) on average after 2-3 days 4-5 times for the entire period of the treatment course. In both cases, access to water is not limited.

The duration of treatment was 15-19 days. The "exit" from the solid propellant after completion of the 2nd stage is carried out within 15 days with a gradual increase in total calorific value to 2200 kcal.

The rationale for the proposed method for the prevention of PPN is the following prerequisites. According to the proposed method, over 15 thousand patients have been rehabilitated for 24 years, starting from 1985 to the present. An analysis of clinical results showed that when conducting therapeutic fasting with complete food deprivation, transient renal failure (PPN) develops in 21.4% of cases. Clinically, it manifested itself in varying degrees of severity, but its appearance in any case should be regarded as an unfavorable factor in rehabilitation measures. In this regard, we proposed a differentiated approach to the appointment of a particular method of unloading and dietary therapy, which allowed to significantly reduce the incidence of PPN during RTT. As a laboratory criterion that allows for a differentiated approach, we took the index of intoxication of AI according to Cal-Caliph.

To prove the viability of the proposed method was examined 732 patients with a varying severity of obesity at the age of 20 to 64 years. The average age is 41 ± 8.8 years. Men - 116, women - 616. The control group consisted of 220 healthy individuals aged 22 to 55 years. The Ketle index was calculated for all subjects - the ratio of body weight, expressed in kilograms, to height, expressed in meters, squared. To determine the degree of endotoxemia, a blood indicator was used - the Cal-Caliph intoxication index.

As a result of a comprehensive program using RDT, compelling evidence was obtained to reduce the degree of endotoxemia and its clinical manifestations. So, for example, in patients with obesity, the most informative signs and the percentage of their detectability were used to characterize the general condition of patients before treatment: memory impairment in 94%, general weakness in 85%, shortness of breath in 76%, headache in 66%, violation sleep in 65%, impaired bowel function in 58% and 40% of patients noted a violation of appetite (table 1). After treatment, there is a significant decrease in the percentage of detected pathological signs.

Table 1 The percentage of detectable clinical signs of endotoxemia syndrome in overweight and obese individuals before and after RTT (n = 186) Signs The occurrence of the sign,% Before treatment After treatment Memory impairment 94 63 General weakness 85 44 Dyspnea 76 32 Headache 66 thirty Intestinal dysfunction 58 23 Sleep disturbance 40 25 Increased appetite 78 32

However, despite the pronounced clinical detoxification effect, it was found that overweight and obesity are accompanied by symptoms of transient renal failure (table 2). In this regard, we proposed a differentiated approach to the application of various RDT techniques. In particular, with high rates of intoxication index (3.9-7.6 conventional units), these patients were not prescribed hunger, but only a reduced diet (with limited calorie content) with or without cleansing enemas. In the case of moderate indicators of intoxication index (less than 3.9 conventional units), patients were prescribed starvation for 14-19 days or a hypocaloric diet with a total calorie content of 1000-1500 kcal / day in combination with cleansing enemas and hydrocolonotherapy. Subsequently, patients for 15 days were transferred to a diet with a total calorie content of 1800-2200 kcal / day. Thus, the patient “exited” from RDT.

table 2 The incidence of PPN and the degree of endotoxemia before and after the use of unloading and dietary therapy (Msr ±) Applied Technique Intoxication index indicator, conv. The percentage of complications,% BUT B Healthy (n = 220) 1.50 ± 0.10 1.68 ± 0.12 1.36 1. Traditional technique (n = 64) 4.17 ± 0.54 2.48 ± 0.20 *** 21,4 2. Diff. approach (n = 91) 5.8 ± 0.11 1.60 ± 0.21 *** 4.6 *** Note: the reliability is calculated in relation to the results of traditional treatment; *** - p <0.001; A and B are indicators of intoxication index before and after treatment, respectively.

As can be seen from table 2, the differentiated approach, in contrast to the traditional one, significantly (4.7 times) and significantly reduced the incidence of clinical signs of renal failure. Currently, adhering to this technique, it has been possible to significantly reduce the risk and frequency of development of renal failure and thereby improve the quality and safety of the applied method.

Example 1. Patient B., 44 years old, was admitted to the hospital on 04.10.1997 with a diagnosis of primary obesity of the III degree, hypertension of the II degree, osteochondrosis of the lumbosacral spine with radicular syndrome. On examination, HELL = 170/120 mm Hg, body weight - 117.6 kg, Quetelet ratio> 40.0; intoxication index 5.8 srvc Has been suffering from hypertension for 8 years. Blood pressure is constantly increased, but its level is not stable. Under the influence of a sparing regimen (rest, normalization of sleep, rational organization of labor, etc.), as well as the constant intake of various medications (hypothiazide, dibazole, ACE inhibitors, etc.), the blood pressure returned to normal for some time, but after 2 weeks it was stable again increased. In the last year hypertensive crises have become more frequent.

Acute pains at the lumbar level often and unexpectedly occur (lumbago), accompanied by upset legs, decreased tendon reflexes and vegetative-trophic disorders, lumbar hip extensor rigidity, pain in the right leg, aggravated by walking.

Given that in addition to these diseases, the patient suffers from primary obesity of the III degree, in a hospital, the patient is assigned a hypocaloric diet with a calorie content of 1800 kcal / day. After 2 days, the intoxication index was 6.2 srvc. It was decided to leave the patient on a diet with a total calorie content of 1800 kcal / day. The patient suffered a partial starvation satisfactorily. Simultaneously with the hypocaloric diet, the patient received therapeutic massage daily, walks in the fresh air, dosed walking, therapeutic exercises, water procedures, cleansing enemas, mineral water without restriction, psychocorrection. Blood pressure was constantly monitored and changed as follows:

10/04/97 - 170/120 mm Hg; 05.10 - 160/120 mm Hg; 06.10 - 140/100 mm Hg; 07.10 - 130/90 mm Hg; 08.10 - 120/90 mm Hg; 10.10 - 120/80 mm Hg; 11.10 - 24.10 - 120/90 mm Hg The patient was canceled drug antihypertensive therapy. Accordingly, body weight indicators, kg: 117.6; 116.4; 113.4; 113.0; 111.6; 110.4; 109.6; 109.6; 108.2; 108.0; 107.2; 107.0 kg

The rate of AI after the course of treatment is 1.32 standard units Laboratory criteria confirmed a significant decrease in the severity of endotoxemia. There were no manifestations of functional insufficiency on the part of the kidneys.

After 20 days, the patient was transferred to rehabilitation in a clinic. Violations of the kidney function is not marked. Over the next 15 days he was on a hypocaloric diet (2100-2200 kcal). At the same time, the patient constantly maintained a positive psychological attitude to the diet and his lifestyle.

After 6 months, the patient does not show complaints.

Example 2. Patient K., 56 years old, Kötle coefficient 26, was admitted with a diagnosis of overweight, hypertension of the III degree.

Signs of endotoxemia are confirmed by laboratory criteria: II - 5.20 conventional units

The patient was prescribed a hypocaloric diet with a total calorie of 1900 kcal / day, as well as therapeutic massage, water procedures, music therapy, psychocorrection, dosed walking. After 3 days, the index of intoxication index was 3.5 srvc. The patient was assigned hunger with unlimited access to water. During the course of the course, the kidneys functioned normally. The full course of RTD was 19 days.

Before discharge, indicators of endotoxemia significantly decreased:

AI - 1.40 conventional units After discharge from the hospital, he adhered to a diet with a total calorific value of 1900-2000 kcal. After 2 months, the weight returned to normal, blood pressure stabilized at 120/80 mm Hg. No evidence of impaired renal function. Monitoring the condition for 2 years showed that the patient's well-being did not worsen. Adheres to recommendations for a balanced diet and active lifestyle.

The given clinical examples confirm the effectiveness of the differential use of RDT in patients with obesity in terms of reducing the frequency of possible complications (from 21.4 to 4.6%) on the part of the kidneys. Given the broad indications for the use of RDT in patients with a wide variety of pathologies, the described technique can be used either independently or as an additional method of treating endotoxemia in chronic non-infectious diseases.

Literary sources

1. Levin Yu.M. Fundamentals of general clinical lymphology and endoecology. Issue H. - Moscow, 2003. - S.149-150.

2. Rumyantsev A.G., Agranenko V.A. Clinical transfusiology. M .: GEOTAR MEDICINE, 1998.

3. Kokosov A.N. Unloading and diet therapy. A guide for doctors. St. Petersburg: SpetsLit, 2007 .-- 320 p.

Claims (2)

1. A method for the prevention of renal failure with complex correction of the condition of patients with obesity, including the identification of clinical indicators, fasting and dietary therapy, characterized in that against the background of music therapy, psychocorrection, active motor mode, at the first stage, for 1-2 days, a hypocaloric prescription is prescribed plant-cereal diet with a calorie content of 1800-2200 kcal / day, then at the 2nd stage for 15-19 days under the control of the Cal-Caliph intoxication index (AI) with an increase in AI of more than 3.9 conventional units the patient is left on a plant-cereal diet in combination with daily bowel cleansing, and with a decrease in AI below 3.9 conventional units they are transferred either to a hungry diet, or with a daily calorie restriction of up to 1000-1500 kcal, and after the completion of the 2nd stage for 15 days, the daily calorie content of food is gradually increased to 2200 kcal. 2. The method according to claim 1, characterized in that throughout the entire course of prophylaxis the patient is prescribed therapeutic massage, water procedures, bowel cleansing using cleansing enemas or colon hydrotherapy, morning exercises.