RU2509563C2 - Method for modifying procedure of intestine preparation for medical intervention using medical preparation fortrans (macrogol 4000 on basis of macromolecular compound polyethylene glycol) - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to methods for patient's preparation for diagnostic and therapeutic medical interventions requiring a clean intestine. To prepare the intestine for the medical interventions with using Fortrans (Macrogol), a required quantity of sachets per one intake is calculated according to the table, particularly if a body weight is less than 50 kg and the age is under 50 years old - 1 sachet, the age is between 51 to 70 years old - 1-2 sachets, over 71 years old - 1 sachet, a body weight of 51-70 kg and the age under 50 years old - 1-2 sachets, the age of 51-70 years old - 2-3 sachets, over 71 years old - 2 sachets; a body weight more than 71 kg and the age under 50 years old - 2 sachets, 51-70 years old - 3 sachets, over 71 years old - 2 sachets. Besides, the presence of constipations requires +1 sachet; 1 sachet of Fortrans is dissolved in 1 litre of water.

EFFECT: using the method enables extending the indications, taking into account and coping the contraindications, reducing and eliminating the side effects, preparing in the more sparing regimen with underlying minimal emotional load.

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Description

The invention relates to medicine in those sections where a "clean intestine" is required before surgery on the abdominal cavity, pelvis and other surgical interventions, before an ultrasound examination of the abdominal cavity, before an x-ray of the intestine, lumbosacral spine, in \ in urography , before endoscopic examination of the intestine and surgical intervention (colonoscopy, sigmoidoscopy, polypectomy), before examining the organs of the retroperitoneal space (computer tomography, magnetic resonance imaging) Description of existing techniques:

- A routine technique has arisen together with appropriate medical interventions: - The alternative stood out in medical practice more than 10 years ago (in personal medical practice it has been used since 1999): - General rules for the preparation of "clean intestines": 2-3 days slag-free diet; - total intestinal cleansing per os with volumetric osmotic laxatives based on macromolecular compounds of polyethylene glycol - with constipation - cleansing enemas and laxatives 3-4 days, the last cathartic in the morning before surgery, cleansing enema in the morning on the day of surgery; - carried out within 1 day in any case - in the absence of constipation, these measures within 1-2 days

Comparison of existing techniques for parameters affecting quality:

Routine (variations of a non-slag diet, laxatives, cleansing enemas) ← → Alternative with fortrans (macrogol 4000) duration (from 1 to 4 days) ↓ ↑ not duration (up to 1 day) not physiological (slag-free diet 1-4 days, cleansing enemas) ↓ ↑ as close to physiological drinking routine ↑ ↓ receiving per os fluid volume 1.5-2 times the daily norm for 1 \ 8 daily time the need for medical staff to participate in additional medical interventions ↓ ↑ minimal specially equipped training site ↓ ↑ not required negative ethical aspect ↓ ↑ minimum difficulties of preparation are overcome by variations of combinations of hunger, a slag-free diet, cleansing enemas, laxatives ↑ ↓ lack of certainty of contraindications, side effects, special instructions training quality predictably less than 50% ↓ ↑ 90% predictable quality of training

The purpose of the invention: the introduction into normal medical practice of an alternative gentle methodology by its modification by individual calculation of parameters in terms of its non-physiological

- taking large doses of a medicinal product with a corresponding large amount of fluid.

The length of the colon is from 1.10 to 2.15 m (A.L. Grebenev, L.P. Myagkova, 1997) A certain amount of water and salts passes through the colon of a healthy person per day

The mechanisms of water absorption in the colon are similar to those that occur in the remaining parts of the digestive tube - this is a passive process regulated by the osmotic and hydrostatic components.

H ₂ O ml 1500 100 1400 Cammol 210 4 206 Kmmol 9 9 0 Cl mole 105 2 103 HCO3 mmol 75 - -

The ratio of intake, excretion, absorption of water and electrolytes has distinctive indicators of intake, excretion and absorption of potassium, leading to rapid hypopotassemia (Hawker R.S., Ternberg L.A, 1983)

The occurrence of diarrhea depends on the rate at which the contents of the small intestine enter the colon, which should not exceed 6 ml / min. (Hawker R.S., Ternberg L.A., 1983), which prevents the occurrence of diarrhea.

In the action of a bulk osmotic laxative based on polyethylene glycol in the form of Fortran, its properties are used, which cause a targeted opposite effect.

Fortran has long been widely used for alternative methods (macrogol 4000).

In 2006, many years of experience “at the patient’s bedside” (N.I. Pirogov, 1841) of the St. Petersburg Medical Academy of St. Petersburg preparing 546 patients for diagnostic colonoscopy and endoscopic polypectomy were published (according to the publication, it can be judged that standard annotation dosages were used).

Published data on the drug goiter (PEG 4000, Adler, 2001), the development of a domestic drug based on polyethylene glycol was reported at one of the Russian Gastronedel RGA. Data on the use of the drug goiter - PEG 4000 is reported that about 10% of patients do not complete the preparation due to the need to take a large amount of fluid.

The principle of the use of drugs based on polyethylene glycol as osmotic volumetric laxatives for total bowel cleansing: the dose of the drug is standardized for connection with one liter of water, 4 standard macrogol packets of 4000 are recommended, and therefore at least 4 liters of water for preparation for one medical intervention.

The modification of the technique is aimed at the individual use of fortrans in each case of preparation for medical intervention. This is done as follows: when a patient is referred for diagnostic or therapeutic medical intervention, his age, weight, type of medical intervention, the nature of physiological administration, concomitant diseases and the corresponding laboratory test data, in particular blood electrolytes, are taken into account to prevent the consequences of latent or overt hypokalemia, often accompanying old age and concomitant pathology, after which the necessary number of packages of fortrans is calculated according to the table its:

Age \ Weight <50kg 51-70kg 71 kg < Number of Fortrans packages at one time Up to 50 years one 1-2 2 51-70 years old 1-2 2-3 3 71 and more years one 2 2 Constipation (<2 times a week) +1 +1 +1

Personal data of a special category in clinical examples has been processed and presented to the extent available under paragraphs 3), 4) of Part 2 of Article 10 of the Law of the Russian Federation No. 152-FZ of June 27, 2006 “On Personal Data”

Clinical example No. 1.

Patient N, 40 years old, weight 51 kg, was targeted for planned surgical intervention in one of the surgical departments of the State Clinical Hospital of the Republic of Mari El in June 2000 (the medical history was lost, the result of postoperative histology of the Clinical Hospital 8-147 from June 2000) . Preparation for medical intervention was carried out qualitatively on an outpatient basis with Fortran according to a modified method: in the amount of 2 packets of 74 g per 2 liters of water from 15 hours a day on the eve of surgery. During the preparation period, not expressed and not prolonged side effects were observed, described when taking fortrans, associated with the uncertainty of the pharmaceutical annotation for the drug. The age, the nature of the medical intervention, the consideration of concomitant pathology did not require a preliminary determination of the level of blood electrolytes, but dictated the use of the maximum number of packets -2 by a modified method. In the early postoperative period, clinical signs of hypokalemia were observed, which also confirms the effectiveness of the modification of the technique, as with a more thorough approach and taking into account individualization factors, without increasing costs, it was possible to apply the preparation with a minimum number of Fortrans-1 packets (74 g).

Clinical example No. 2.

Patient N, 75 years old, 49 kg (outpatient card of MLPUZ City Clinic No. 1 in Yoshkar-Ola) with concomitant arterial hypertension, coronary heart disease, chronic pyelonephritis, autoimmune thyroiditis, presumably hidden age-related and associated with pathology hypokalemia, in connection with pain of the lower back is aimed at radiography of the lumbosacral spine in the outpatient practice of the MLPUZ Polyclinic No. 1 of Ioshkar-Ola.

The author of the modification of the method was assigned home preparation by calculating the dose of fortrans according to individualization factors 1 packet (74 g) per 1 liter of water from 5 p.m. before the medical intervention. Medical monitoring was carried out for the pulse and blood pressure, transient changes in the monitoring parameters did not require interruption in the preparation and administration of additional drugs. A high-quality result of the preparation was achieved, medical intervention was carried out. After that, in addition to the constantly taken sick drugs, a 10-day course of the potassium preparation was prescribed to Aspark 0.5 * 3 times a day.

Claims (1)

A method of preparing the intestines for medical interventions with fortrans (macrogol 4000), characterized in that the required number of fortrans packets per dose is calculated according to the table, namely, with a body weight of less than 50 kg and up to 50 years of age - 1 - packet, aged 51 to 70 years - 1-2 packets, 71 and more years - 1 packet, body weight 51-70 kg and under the age of 50 years - 1-2 packets, aged 51-70 years - 2-3 packets, age 71 and more years - 2 packages; body weight over 71 kg and up to 50 years old - 2 packets, 51-70 years old - 3 packets, 71 and more years - 2 packets; in addition, in the presence of constipation, +1 packet, while 1 packet of fortrans is dissolved in 1 liter of water.