RU2570544C1 - Method for integrated health-resort treatment of chronic venous insufficiency accompanying varicose veins in lower extremities - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patient does therapeutic exercises with Nordic walking elements. An ozone therapy represents treating lower extremities in a plastic chamber for 20-30 minutes with ozone-oxygen gas mixture with the ozone concentration of 4-8 to 15-20 mcg/l; the therapeutic course is 6-10 procedures. Balneological treatment involves taking baths with Esculus 3D homeopathic preparation either daily, or every second day, for 10-15 minutes, at water temperature 37°C; the therapeutic course is 10-12 baths. The baths are prepared by adding 1 litre of boiled water containing pre-dissolved 60-70 granules of Esculus 3D to 250 litres of water. Besides, the preparation is administrated orally and externally as Esculus 3D homeopathic ointment applied on various veins twice a day. The patient also takes mineral water, which is warm sodium-hydrocarbonate-chloride water from Psekupskoye deposit, well No. 104-R, in an amount of 200 ml 30-40 minutes before a meal, 3 times a day.

EFFECT: reducing clinical manifestations and delaying progression of the disease, preventing complications and reliably prolonging length of remission and improving patient's quality of life.

2 ex, 1 tbl

Description

The invention relates to medicine, namely to the treatment of patients with chronic venous insufficiency (CVI) with varicose veins of the lower extremities in a spa setting.

It is known that the main cause of CVI is the reverse blood flow (reflux) in the main veins, which initiates venous hypertension and a cascade of pathological changes at the tissue, cellular and molecular levels.

By CVI of the lower extremities (NK), doctors understand the insufficiency of the venous outflow associated with the pathology of the venous wall and valvular apparatus of the veins, the presence of intra- and extra-vascular obstruction for blood flow, and, as a result, venous stasis, which goes beyond the physiological norm of the individual.

The main reasons for the formation of CVI in NK are currently considered as varicose veins, post-thrombotic diseases, leg vessel injuries, congenital arteriovenous anastomoses, etc. Phlebitis, thrombophlebitis, erysipelas of the legs, lymphadenitis, etc. contribute to the progression of CVI. , that this is a disease of the whole organism, since it significantly violates the system of homeostasis, microcirculation, macro- and microdynamics, mineral metabolism, redox processes, farm -commutative and hormonal activity of the whole organism.

Chronic disturbance of the venous outflow leads to changes in the venous wall and mucosal hypertrophy due to the accumulation of glycosaminaglycans (chondroitin sulfate L and C), muscle fiber hypertrophy, and thickening of collagen fibers (A.P. Dovganuk, 2003).

The course of CVI NK is determined by the severity of morphological changes. In practice, there are three stages of the disease: compensation, subcompensation and decompensation.

The Association of Phlebologists of Russia and the All-Russian Society of Surgeons developed and approved 02.10.2013, "Russian clinical guidelines for the diagnosis and treatment of chronic venous diseases." They recommend classifying CVI as according to the International CEAP system (where C is the clinical manifestations, E is the etymology, A is the anatomical localization, P is the pathogenesis), and according to ICD-10 (International Classification of Diseases).

When issuing medical documentation, including health resort cards and treatment standards, doctors are required by law to specify a diagnosis code according to ICD-10. In our spa practice, if it is necessary to clarify the diagnosis, we use the table recommended by our colleagues from the above “Recommendations ...”.

The development of a method for the comprehensive treatment of CVI in varicose veins of the lower extremities is based on two fundamental principles:

- complex effect on a pathogenic target;

- correspondence of the strength of therapeutic factors to the availability of reserves of the functional system of a particular patient.

The treatment technique is based on theoretical developments, practical recommendations of leading scientists and specialists in the field of spa, traditional and bioinformation medicine and on many years of experience of the doctors of our sanatorium.

It is based on:

Zilov V.P., Sudakov K.V., Epstein O.I. “Elements of information biology and medicine. Chapter 3 “Information effects of ultra-low doses of substances”. Chapter 4 “Information homeostasis. The Information Essence of Traditional Medicine. ”

Zenin S.V. "The structure of water and the mechanisms of action of homeopathic medicines." Traditional Medicine Magazine, No. 2, 2004

Clerk B.C. "Skin as an immune organ: the effect of therapeutic physical factors." The journal "Questions of balneology, physiotherapy and exercise therapy", 2007

Zamarenov N.A. and others. "Homeophytotherapy in homeopathy."

Fedosov V.M., Zamarenov N.A. "Homeopathic baths - an unconventional method of hydrotherapy in the complex treatment of patients."

Badtieva V.A., Trukhacheva M.V., Kulchitskaya D.B. "Non-drug methods of treatment of chronic venous insufficiency: current state of the problem." The journal “Questions of balneology, physiotherapy and exercise therapy”, No. 2, 2010

Known patents for inventions and utility models RU (No. 2042182, 2201148, 2159604, 2089241, 100402, etc.).

The closest in technical essence to our method are the methods of balneotherapy in a spa environment: “A method for the treatment of CVI NK in patients with osteoarthritis” (patent RU 2089241) and “Composition for the treatment of CVI containing an aqueous extract of red grape leaves, and anti-inflammatory agent” ( patent RU 2367464), which we adopted as prototypes.

SUMMARY OF THE INVENTION

Based on modern research in the field of biomedical sciences, the experience of leading balneologists, and most importantly, on many years of experience in treating and nursing patients in our sanatorium, a method for the comprehensive treatment of CVI in varicose veins of the lower extremities has been developed.

The most important tasks of the method:

- improvement of phlebohemodynamics;

- normalization of the function of the venous wall;

- correction of microcirculation disorders, hemorheology and lymph drainage;

- reduction of clinical manifestations (edema, feeling of heaviness in the legs);

- preservation of working capacity;

- elimination of risk factors (correction of lifestyle, nutrition, rational employment, etc.);

- improving the quality of life of patients.

The essential features of a method for the treatment of CVI are that exercise therapy with elements of Finnish walking; ozone therapy by treating the lower extremities in a plastic chamber for 20-30 minutes with a gas ozone-oxygen mixture with an ozone concentration of 4-8 to 15-20 μg / l, a course of 6-10 procedures; balneological procedures, which are baths with the homeopathic preparation “Esculus" 3D, daily or every other day, lasting 10-15 minutes, at a water temperature of 37 ° C, a course of 10-12 baths, while the baths are prepared by pouring 1 liter of boiled water into 250 liters of water water, in which 60-70 esculus grains of 3D are dissolved; in addition, the drug is administered orally, as well as externally in the form of a homeopathic ointment “Esculus” 3D, applying to the area of varicose veins twice a day; and as mineral water use warm bicarbonate-sodium chloride water of the Psekupsky field of well No. 104-P, 200.0 ml 30-40 minutes before meals, 3 times a day.

Horse Chestnut

The biological effect of horse chestnut: constricting venous vessels, reducing the permeability and fragility of capillaries, pronounced decongestant, anti-inflammatory and analgesic effects.

In the scientific and medical literature there is an abundance of experimental and clinical research data on horse chestnut as a whole and chemically pure biologically active substances isolated from it. The flowers contain flavonic glycosides (rutin, quercetin), triterpene saponins (escin, choline), purine derivatives (uric acid, adenosine).

The bark contains coumarin glycoside esculin (3%), oxycoumarin glycosides (fraxin).

Horse chestnut fruits contain glycosides, esculin, fraxin, escin, tannins, fatty oil, flavonoid glycosides (quercetrin, isocvercitrin, quercetin and kempferol), starch and other substances.

The pharmacological effect of galenic preparations of horse chestnut is associated with the presence in it of the most biologically active chemical compound - escin (triterpene glycoside). Escin is one of the few glycosides obtained in crystalline form.

Experimental studies have established that escin has a pronounced venotropic property. The maximum venotonic effect of glycoside corresponds to the activity of serotonin and dihydroergotamine. Escin has a pronounced anti-inflammatory and decongestant effect on models of local inflammatory edema of various origins.

When studying the mechanism of the anti-inflammatory and anti-edematous action of escin, it was found that glycoside reduces the lymph flow and at the same time increases the dry matter content of the lymph, reduces the permeability of the plasma-lymphatic barrier. The presence of capillary-strengthening properties in escin confirms the assumption of its predominant effect on the first phase of inflammation, when there is a violation of vascular permeability.

According to Sklyarevsky and Gubanov (1968), horse chestnut preparations reduce blood coagulation, strengthen the walls of veins and capillaries, and prevent the formation of blood clots in blood vessels. In the treatment of thrombophlebitis with horse chestnut preparations, thrombotic masses soften and gradually disappear.

For the production of homeopathic medicines, mainly the leaves and fruits of horse chestnut are used.

In the proposed method of treatment, a homeopathic preparation “Esculus” 3D is used, made from fruits of horse chestnut.

The use of this medicine in the form of bathtubs is more effective, since the information of the homeopathic medicine enters through the receptors of the skin. It should be noted here that the skin of each person receives “their” signals and filters them. An individual's skin-receptor apparatus receives as much information as he needs.

In the case of exposure to allopathic doses, the skin is not able to interrupt strong signals and even more so to regulate and filter them.

When using homeopathic baths through the skin, it is easier to convey and more accurately restore the lost physiological rhythm, function and energy vibration.

In water, dissolving a homeopathic medicinal product, clusters with a certain frequency response are evenly distributed. At the same time, the body reads this information well in the form of a homeopathic effect.

Homeopathic hydrotherapy is based only on fresh baths. You can use not only general baths, but also local ones (foot, sessile, etc.).

Homeopathic technique

Homeopathic baths. This is a general external exposure method - homeopathic hydrotherapy. In the morning, patients receive homeopathic baths. Before the bath, the patient takes a hygienic shower. 250 liters of water are poured into the bath. Separately, the nurse dissolves 60-70 grains of the homeopathic medicine “Esculus” 3D in a 1 liter jar of boiled water at room temperature and pours the solution into the bath, distributing evenly. Baths are taken daily or every other day, lasting 10-15 minutes, at a water temperature of 37 ° C, a course of 10-12 baths.

All patients are simultaneously prescribed the homeopathic preparation “Esculus" 3D as follows: the patient daily, independently dissolves 3 grains in 100 ml of boiled water at room temperature, stirring the water in a glass with a non-metallic spoon. It takes 1 sip 30 minutes before taking mineral water, 3 times a day, before each reception, stirring the solution in a glass with a non-metallic spoon. The solution is prepared daily in the morning.

In addition, all these patients are locally topically prescribed the Esculus 3D homeopathic ointment, which is applied in smooth movements on the skin from bottom to top from the feet to the knee joints, over the varicose veins, 2 times a day: in the morning upon waking and in the evening before bedtime.

Drinking Mineral Water Treatment

From the first day, all patients are prescribed intake of low-salinity hydrocarbonate-chloride-sodium mineral water (1.9 g / l) from the Psekupsky field from well No. 104-P, 200.0 ml 30-40 minutes before meals, 3 times a day warm. The diuretic effect of this mineral water is used to reduce swelling on the legs (Medical report of the Federal State Institution of the Pyatigorsk Research Institute of Balneology on the possibility of using medicinal water from well No. 104-P. Psekupskoye field, Goryachiy Klyuch, Krasnodar Territory).

Before breakfast, all patients with diseases of the veins of the lower extremities receive a dosed physical activity in the form of alternating (every other day) classes in the group of exercise therapy and Finnish walking.

The basis of physiotherapy exercises in CVI should be the exclusion of static exercises in a standing position. It is advisable to do most exercises in a supine position with legs raised up or sitting, not requiring much stress. A feature of the exercise therapy in CVI is the individuality of the selection of a set of exercises, depending on the severity of clinical manifestations and concomitant diseases.

Finnish walking is an effective and affordable type of physical activity that uses a certain walking technique and special sticks to evenly distribute the load on the muscles of the whole body. Finnish walking as one of the types of therapeutic exercises has a beneficial effect on the prevention of relapse and progression of CVI. The synergistic movement of the arms and legs leads to the active work of the muscular-venous pump of the lower leg and thigh. The contraction of the muscles of the latter leads to the outflow of blood from the venous sinuses into the deep veins (the so-called peripheral muscle “heart” works). Compression of the plantar venous network of the foot, which occurs during Finnish walking, leads to the fact that blood flows into both deep and superficial veins. The movements of the chest and diaphragm are enhanced when moving with the support of the hands on sticks, involving the muscles of the upper shoulder girdle, which differs from normal walking. Rhythmic respiratory movements create a “suction” effect due to negative pressure in the proximal section of the inferior vena cava. The more active and rhythmic the movement, the more effective the pumping action of the muscles. Without excessive accumulation of venous blood in the feet, edema does not develop in the ankles and lower legs.

After lunch, patients receive local ozone therapy by treating the lower extremities in a plastic chamber for 20-30 minutes with a gas ozone-oxygen mixture with an ozone concentration of 4-8 to 15-20 μg / L, No. 6-10.

Features of dietary nutrition for CVI are to limit sodium chloride to 3.0 g per day. Considering that the key factor in the comprehensive treatment of CVI in our sanatorium is the use of homeopathic medicines, strong tea, natural coffee, and alcohol must be excluded from the diet. It is advisable not to eat chocolate, spicy dishes and sauces, reduce sugar intake. In general, when taking homeopathic medicines, it is advisable to avoid all "excesses" in food.

All patients receiving the above set of procedures are provided with medical supervision, laboratory and instrumental monitoring of the condition is carried out (general blood test, IPT and blood coagulation time, foot rheovasography).

EXAMPLES OF SPECIFIC IMPLEMENTATION

Example 1

Patient P., 38 years old, was treated at a sanatorium for 18 days. She complained of vascular "stars" on the outer surface of the legs, heaviness in the legs by the end of the working day, periodic swelling of the lower third of the legs and feet.

From the anamnesis of the disease it is known that vascular "stars" on the legs appeared after the birth of the second child 5-6 years ago, and swelling and heaviness in the legs - during the last year. It should be noted that the patient was always full, working as a cashier while sitting. There is no family history of varicose veins. I did not seek medical help. I did not receive treatment.

An objective examination: the condition is satisfactory. Proper physique, increased nutrition. In the lungs, vesicular breathing, no wheezing. The tones are rhythmic, clear. Pulse - 68 in 1 min, rhythmic, satisfactory filling and tension. HELL - 120/80 mm RT. Art. The abdomen is soft, painless. The liver and spleen are not palpable. On the skin of the outer surface of the thighs and lower legs - multiple telangiectasias. There is a slight pastiness of the feet. In the study of a clinical blood test, no pathology was detected. PTI - 98%, coagulation time - 03 min 10 sec. An angiography of the legs revealed: in all segments, the main type of blood circulation. The volume of arterial blood flow is significantly reduced on the left in the lower leg and foot and in the right lower leg, and moderately in the right foot. Vascular elasticity is reduced in the foot on the right. Venous outflow is difficult in the legs and left foot.

Based on complaints, medical history, clinical manifestations and objective examination data, the diagnosis was established: Varicose veins of the lower extremities. Chronic venous insufficiency of the lower extremities 0-I degree.

The patient in the sanatorium was assigned: a blood test (general analysis, IPT, coagulation time) and leg reovasography - twice, at the beginning and end of the stay, and treatment.

In the sanatorium, while taking mineral water of source No. 104-P, 200.0 ml 30-40 minutes before meals, 3 times a day, warm, and diet food, complex treatment was prescribed (treatment course - 18 days): treatment gymnastics No. 6, in alternation with Finnish walking No. 6.

In the first half of the day, the patient received baths with the homeopathic medicine “Esculus” 3D, for 10-15 minutes, at a water temperature of 37 ° C, daily or every other day, No. 10.

In the afternoon, the patient took local ozone therapy on her legs, No. 8, every other day.

In addition, the patient received the homeopathic medicine “Esculus” 3D in various dosage forms (in granules and in ointments).

The portability of the procedures was good. By the fifth day of the stay in the sanatorium, the feeling of heaviness in the legs disappeared, by the 10th day of the stay the pasty legs almost disappeared even in the evening. According to leg angiography, positive dynamics was noted: the volume of arterial blood flow improved on the left in the lower leg by 16%, in the lower leg on the right - by 17%, in the left foot by 49%, in the right foot - by 40%.

The elasticity of the vessels in the foot on the right normalized. Venous outflow improved slightly in the legs and feet.

PTI - 81%, blood coagulation time - 04 minutes 10 seconds.

Example 2

Patient B., 58 years old, was treated for 18 days with a clinical diagnosis: Varicose veins of the lower extremities. Chronic venous insufficiency of the lower extremities of the II degree.

I entered the sanatorium “Foothills of the Caucasus” with complaints of varicose veins on the inner surface of the legs, heaviness and swelling of the legs in the evening, periodic leg cramps at night. It is observed and treated only on an outpatient basis. She received Detralex courses, externally used Lyoton, Troxevasin gels. The last 3 years, upon reaching retirement age, the condition has stabilized (leg swelling does not increase).

An objective examination: the condition is satisfactory. Proper physique, normal nutrition. In the lungs, vesicular breathing, no wheezing. The tones are rhythmic, clear. Pulse - 66 in 1 min, rhythmic, satisfactory filling and tension. HELL - 120/80 mm RT. Art. The abdomen is soft, painless. The liver and spleen are not palpable. On the inner surface of the legs, more to the right, varicose veins are visible. On the hips - multiple telangiectasias. Skin color over varicose veins is normal. Swelling of the lower third of the legs and feet. More on the right. In the study of a clinical blood test, no pathology was detected. PTI - 88%, coagulation time - 02 min 50 sec.

An angiography of the legs revealed: in all segments, the main type of blood circulation. The volume of arterial blood flow is significantly reduced in the legs and feet. Vascular elasticity is reduced in the legs and feet. Venous outflow is significantly hindered in the legs, and moderate venous outflow is noted in the feet.

The volume of examination and treatment was carried out according to the algorithm of example No. 1, with an increase in the number of procedures: baths - up to 12, local ozone therapy - up to 10, exercise therapy and Finnish walking - 8. Mineral water, homeopathic treatment in the form of an internal preparation of the drug “Esculus” 3D in solution and external use of homeopathic ointment "Esculus" 3D - daily. The patient well tolerated the prescribed treatment. By day 10, swelling and heaviness in the legs decreased, and by day 15, convulsions disappeared. By the end of treatment, in a control laboratory study, the level of the prothrombin index decreased to 80%, the blood coagulation time increased by 01 minute 05 seconds. Leg vasography data is especially indicative: significant (1.7 times) improvement in arterial blood flow in the legs, moderate (1.4 times) in the feet.

Vascular elasticity increased. Venous outflow improved in the legs and feet.

PTI - 81%, blood coagulation time - 03 minutes 55 seconds.

The proposed method treated 68 people. The portability of the procedures was good. All observed patients showed positive dynamics of clinical, laboratory and instrumental data. None of the patients had an exacerbation during the course of treatment. Upon discharge, all patients were advised to observe simple but very important rules of behavior: do not take hot baths and a sauna, do not wear tight belts, stockings and socks with tight elastic bands, do not wear shoes with heels above 4 cm, do not sit cross-legged. All patients rest lying with their legs raised and rested against the wall. As often as possible, step on the spot, make rotational movements of the feet. After a shower or bath, rinse your feet with cold water. It is recommended that you walk, swim, ride a bike, and ski in the winter. For prophylactic and therapeutic purposes, wearing compression hosiery is recommended.

Significant in the recommendations is the continuation of homeopathic therapy in the form of an internal intake of an Esculus 3D aqueous solution for another 2-3 months, and an external use of Esculus 3D ointment with two-week courses No. 3, with 10-day breaks.

According to the results of a survey conducted 6 months after the spa treatment, 2/3 of the patients showed stabilization of clinical manifestations and rheological parameters. There was no deterioration of well-being during this period, no medical treatment was carried out. Half of the treated patients requested repeated courses of treatment in the conditions of our sanatorium.

Thus, the proposed method for the complex treatment of CVI NK gives the opportunity to reduce the clinical manifestations of CVI NK, slow the progression of the disease, prevent complications, significantly increase the duration of remission and thereby improve the quality of life of people.

Claims (1)

A method for the complex treatment of chronic venous insufficiency in case of varicose veins of the lower extremities in spa conditions, characterized in that exercise therapy with elements of Finnish walking is performed; ozone therapy by treating the lower extremities in a plastic chamber for 20-30 minutes with a gas ozone-oxygen mixture with an ozone concentration of 4-8 to 15-20 μg / l, a course of 6-10 procedures; balneological procedures, which are baths with the homeopathic preparation “Esculus" 3D, daily or every other day, lasting 10-15 minutes, at a water temperature of 37 ° C, a course of 10-12 baths, while the baths are prepared by pouring 1 liter of boiled water into 250 liters of water water, in which 60-70 esculus grains of 3D are dissolved; in addition, the drug is administered orally, as well as externally in the form of a homeopathic ointment “Esculus” 3D, applying to the area of varicose veins twice a day; and as mineral water use warm bicarbonate-sodium chloride water of the Psekupsky field of well No. 104-P, 200.0 ml 30-40 minutes before meals, 3 times a day.