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Шамхи Имен, Грищенко О.В., Бобрицкая В.В. Принципы метаболической терапии пролапса гениталий у женщин после родов
28.05.2014, 17:56

Резюме
Шамхі Імен, Грищенко О.В., Бобрицька В.В. Принципи метаболічної терапії пролапсу геніталій у жінок після пологів.
Під спостереженням знаходилися 140 пацієнток після пологів крупним плодом – 110 основна і 30 контрольна групи. Всім проводилася ехографічна оцінка стану тазового дна після пологів. Дослідження маркерів сполучнотканинної дисплазії – фракції глікозаміногліканів в крові, хондроітінсульфат, лужна фосфатаза - істотних відмінностей не виявлено. П'ятдесят пацієнток з основної групи виконували гімнастику Кегеле, 60 гімнастику Кегеле у поєднанні з метаболічною терапією: тіотріазолін в суппозиторіях з аскорутином реr os. Пацієнтки контрольної групи не проводили ніяких реабілітаційних заходів. Кращі результати по відновленню тазового дна у пацієнток, що проводили гімнастику з метаболічною терапією. Методика рекомендується всім жінкам після пологів.
 Ключові слова: пролапс тазових органів, післяпологовий період, глікозаміноглікани, гімнастика, метаболічна терапія.
Резюме
Шамхи Имен, Грищенко О.В., Бобрицкая В.В. Принципы метаболической терапии пролапса гениталий у женщин после родов.
Под наблюдением находились 140 пациенток после родов крупным плодом - 110 основная и 30 контрольная группы. Всем проводилась эхографическая оценка состояния тазового дна после родов. Исследование маркеров соединительнотканной дисплазии - фракции гликозаминогликанов в крови, хондроитинсульфат, щелочная фосфатаза - существенных отличий не выявлено. Пятьдесят пациенток из основной группы выполняли гимнастику Кегеле, 60 гимнастику Кегеле в сочетании с метаболической терапией: тіотріазолін в суппозиторіях из аскорутином реr os. Пациентки контрольной группы не проводили никаких реабилитационных мероприятий. Лучшие результаты по возобновлению тазового дна у пациенток, которые проводили гимнастику с метаболической терапией. Методика рекомендуется всем женщинам после родов.
Ключевые слова: опущение тазовых органов, послеродовый период, гликозаминогликаны, гимнастика, метаболическая терапия.
Summary
Chamkhi Imen, Grishchenko O.V., Bobritskaya V.V. Metabolic therapy principles of genital prolapse in women after delivery.
Under a supervision there were 140 patients after delivery by a large fetus 110 basic and 30 control groups. All was conduct the echografic estimation of the state of pelvic bottom after births. research of markers of unittissue dysplasy is fractions of glycoseaminoglicanes in blood - substantial distinctions it is not discovered. Fifty patients from a basic group executed the gymnastics of Kegele, 60 gymnastics of Kegele in combination with metabolic therapy: thiotriazoline suppositories with ascoruthine per os. The patients of control group conducted no rehabilitation measures. The best results on renewal of pelvic bottom for patients, conducting a gymnastics with methabolic therapy. A method is recommended all of women after births.
Key words: prolapsus of pelvic organs, down-lying, glycoseaminoglicanes, gymnastics, metabolic therapy.
Рецензент: д.мед.н., проф. В.В. Лазуренко

УДК618.52: 036.82 – 085

Харьковская медицинская академия последипломного образования

61176, г. Харьков, ул.Корчагинцев, 58

Kharkov medical academy of Postgraduate Education

61176, Kharkov, 58 str.Korchahyntsev

imen.chamkhi@yahoo.fr

One of the current problems of modern gynecology is the problem of genital prolapse in women of reproductive age, the morbidity of which does not have reducing trend. In the structure of gynecological surgical diseases genital prolapse amounts to 28-40% and ranks the fourth place after benign tumors and endometriosis. Operative therapy of women with genital prolapse in reproductive age results in the necessity of labour by consecutive delivery with the help of caesarian section that dramatically increases maternal and perinatal risks. At the same time the absence of prolapse correction causes the deterioration in woman’s condition significantly complicating her physical state which certainly affects performing her social functions [1]. Detection and correct assessment of factors leading to the development of this pathological state, in our opinion, may become a starting point in working out of individual correction program of genital prolapse in women of the given age group considering the necessity of retention of reproductive function.

One of the leading classic theories of genital prolapse development is regular abrupt increase of abdominal pressure that is primarily associated with hard physical work and weight lifting which results in extrusion of uterus. Thus, some investigators determine one of risk factors of genital prolapse development which is low level of education predisposing hard physical work. A number of studies showed that the risk group includes women suffering from overweight and obesity and women with the body weight index of 26 kg/m2 with greater degree of possibility will need surgical treatment of prolapse than women with less body weight index.     

However, not only a problem of ovenweight is|appear| determining for development of genital prolapse|. An important role is taken the full value of tissue|histic| structures of pelvic bottom, including tissue-connecting components|reductant|, and also full value of microcirculation [1]|. There is a necessity  to conduct careful research|work-up| of problem of prolapsus of muliebrias, attended with the stagnant phenomena|phenomen| and violation functions of the urinoexcretory system, connecting between itself anatomically, etiologic, clinically.

     A problem acquires|buy| the special actuality in a down-lying for patients with births|luing-in| by a large|major| fetus.

      For local therapy of functional|function| inferiority of pelvic bottom application of preparations of metabolic action|act| is possible|possibly|. Can serve as preparation of choice tiotriasoline| is antioxidantive| preparation, possessing regenerative, antiflammatory|, by a antioxidantive|| action|act|. There is a medicinal form|shape| of tiotriasoline| in suppositoria| for vaginal| application [2].

       To|by| dignities of metabolic therapy of tiotriasoline| | behave:

– possibility|potentialitie| of its use|utillizing| is both in sharp|bitingly| cases|accident| and at the chronic forms|shape| of diseases|pathema|;

– simultaneous positive|staid| affecting a few|a little| organs|viscus| and systems, including musclular system, that is accompanied not only the improvement of the functional|function| state|fortune| of organ|viscus|-target but also organism on the whole|all in all|. Universality of such action|act| is explained|unravele| community of metabolic processes|Carbro| in different|diverse| fabrics|CLO| of human organism;

– wide spectrum of metabolic effects, directed|ducted| on protecting|protection| from a sharp|bitingly| and chronic ischemia, also traumatic genesis (including|inclusion| of reserve antihypoxic mechanisms, decline|lowering| of maintenance of lactat|lactacidemi| is in a cage|cell|, renewal|reduction-oxidation| of electric|electrical| potential of cellular|cell-self| membranes), oxidative stress (blocking|lock| of free radicals, stimulation of synthesis of intracellular| antioxidants)

-  potentioning| of action|act| of other pharmacological facilities due to the improvement of local reology|;

– low|subzero| frequency of side effects.

      In addition, in  metabolism of connecting tissue strengthening element ascorbic acid acts part, and also in combination with rutine (vitamin|Vitaminum| PP). It is known that ascorutine| enters|login| in the complement of vasoactive| preparations, strengthening a vascular wall|paries|, functional|function| inferiority of which also is|appear| the display of dysplasia of connecting tissue (DCT). Therefore parenterally application of ascorutine| is rotined at the states|fortune|, accompanied DCT.

The use|utillizing| of metabolic therapy in the complex of restoration|reproduction| measures|step| for the muscles of pelvic bottom after births|luing-in| can have a positive|staid| clinical effect, what defined aims and tasks|tsk| of this research|work-up|.

A research purpose  is  an improvement of method  of conservative therapy of functional inferiority of muscles of pelvic bottom after births by a correction by the complex of the special exercises for training of muscles of pelvic bottom in combination with local metabolic therapy.

Materials and methods Under a supervision were 110 patients of basic group and 30 by control. For all of patients births happened by a large fetus by mass of 4000-4900г. The degree of violation of anatomy of muscles of pelvic bottom was estimated by an ultrasonic method, estimated correlation of position of neck of uterus in relation to a bosom [3]. The scale of estimation is developed in marks from 1 to 4 (4 most degree of prolapsus) (table 1).

The features of metabolism of matrice of connecting fabric|CLO| were determined on the concentration of glycosaminoglicanes (GAG), free glucuronic acid|protophobe| (GA) in the whey of blood on the karbazole| reaction of Dishe. Determination|definition| of hondroithinesulfate was conducted in the whey of blood on a reaction with a rivanol on the method of Lapsa Y.Y. and Sluckogo L.I. (1969). The study of concentration is in-process conducted general|common| and free N-acetylglicosamine|, in the whey of| blood of pregnant on the method of Shtern M.R. (1982)

A basic|main| group parted on two sub-groups – 50 persons conducted a gymnastics for the muscles of pelvic bottom (exercises|ex.| of Kegele), a group from 60 persons executed|implement| the that complex of exercises|ex.| in combination with local metabolic therapy of supposithorias| with tiotriasoline| is a 1 candle in days 20 days, and ascorutine| per| os| 250 mgs 3 times per days. Therapy was begun in 4 weeks after births|luing-in|. Estimation|appraisal| of results of complex correction|compencation| of the state|fortune| of pelvic bottom was conducted through 8 and 12 weeks after births|luing-in|.

Results and discussion. The got|receive| results of ultrasonic|ultrasound| estimation|appraisal| of pelvic bottom allowed to define the full value of the state|fortune| of mascular structures and genital prolaps || after births|luing-in|. On the basis of ultrasonic|ultrasound| estimation|appraisal| of the state|fortune| of pelvic bottom we are develop the scale|scaleplate| of estimation|appraisal| in marks|number| from 1 to 4 (4 most degree of prolapsus) (table 1). In accordance with the scale|scaleplate| of genital prolaps| the analysis of maintenance of connecting-tissue methabolites| matrice is conducted, for the estimation|appraisal| of displays of DST and degrees of violations of pelvic bottom after births|luing-in|. Among the patients of basic group with the low estimation of full value of pelvic bottom (3-4 marks) the results of relative decline of maintenance of glycosaminoglicanes are got in blood, that testifies to the presence of displays of DCT (table 2). Most expressed patients had this index with 4 degrees on the ball scale of estimation.

Table 1

Results of ball estimation|appraisal| before rehabilitation measures|step|

Scale of estimation

Clinical groups

Basic, n=110

Control

n=30

 n=50

 N=60

n

P±Sp %

N

P±Sp %

n

P±Sp %

0

4

3,91±0,41*

6

5,36±0,59*

1

0,37±1,43*

1

17

15,45±2,15

19

18,91±0,97

13

12,33±0,05

2

17

16,73±1,16

20

18,82±1,27

14

14,07±0,11

3

7

6,91±0,90

8

6,91±1,90*

1

1,03±0,28*

4

5

4,29±0,90*

7

6,62±1,33*

1

1,03±0,28*

Note|endnote|: * it is a difference with the indexes|metric| of control group statistically|collation| for certain (p<0,05|)

 

 Research of maintenance was conducted all of women in blood of glycosaminoglicanes (table 2), as an index of presence of connecting-tissue dysplasy, and also methabolites of connecting fabric (table3).

Table 2.

A table  of contents of glycosaminoglicanes is in blood of patients of groups of supervision

Clinical groups

 

Glikosaminoglikansulfates (unites)

 

general

 

I faction

 

II faction

 

III faction

 

Basic|main|

(I sub-group), n=50

 

10,33±0,06*

6,52±0,07

2,24±0,05*

1,57±0,07

Basic|main|

(II sub-group), n=60

 

11,05±0,08

6,34±0,04*

2,93±0,06*

1,78±0,07*

Control, n=30

 

10,61±0,06*

6,44±0,07*

2,69±0,03*

1,48±0,06*

Note|endnote|: * it is a difference with the indexes|metric| of control group statistically|collation| for certain (p<0,05|)

      Table of contents in blood of glycoprotein, hondroithinesulfate|, alkaline phosfatase| for the patients of basic|main| group (sub-group 50 persons and sub-group 60 persons) and control group did not differ substantially. It was not got|receive| substantial distinctions in accordance with weight of fruit, parity. An insignificant|trace-level| increase was observed|exist| among patients with the traumas|maim| of delivery ways are breaks of vagina, to the crotch – that can be bound to increasing| in blood of products of tissue|histic| disintegration, and that straight does not depend on initial status of proper DCT.

Table 3

Table of contents in blood of glycoprotein, hondroithinesulfate|,

alkaline phosfatase| for the patients of groups of supervision

 

Clinical groups

 

Glycoprotein (un)

 

Hondroithinsulfate (gramme/L)

 

Alkaline phosphatase (E/L)

 

Basic|main|

(I sub-group), n=50

 

0,70±0,06

0,19±0,06*

476,22±0,05

Basic|main|

(II sub-group), n=60

 

0,64±0,05*

0,15±0,07

415,53±0,05*

Control, n=30

 

0,54±0,06*

0,09±0,07*

320,80±0,05*

 

Note|endnote|: * it is a difference with the indexes|metric| of control group statistically|collation| for certain (p<0,05|)

Estimation|appraisal| of results of complex correction|compencation| through 8 and 12 weeks clinical effects of the conducted measures|step| rotined after births|luing-in|.

Patients of basic|main| group, which physical|physics| therapy was conducted only by the complex of exercises|ex.| (a sub-group is 50 persons), rotined worst results, what sub-group (60 persons) of applying a complex exercises|ex.| with local therapy vaginal suppositorias| with tiotriasoline|, taking into account the metabolic effect of this medicinal matter.

Table 4

Results of ball estimation|appraisal| of efficiency of rehabilitation measures|step|

Scale of estimation

 

Clinical groups

Basic, n=110

Control

n=30

Engaged in a gymnastics (50 brows.)

Complex of gymnastics with metabolic therapy (60 brows.)

n

P±Sp %

n

P±Sp %

n

P±Sp %

0

32

30,91±4,41

44

36,36±4,59

2

6,67±4,55*

1

14

15,45±3,45

13

10,91±2,97

13

43,33±9,05

2

3

2,73±1,55*

2

1,82±1,27*

14

46,67±9,11

3

1

0,91±0,90*

1

0,91±0,90*

1

3,33±3,28*

4

0

-

0

-

0

-

Note|endnote|: * it is a difference with the indexes|metric| of control group statistically|collation| for certain (p<0,05|)

As a result of control examination in 12 weeks after births|luing-in| for the patients of the first|first-run| sub-group (gymnastics for the muscles of pelvic bottom) renewal|reduction-oxidation| on the scale|scaleplate| of estimation|appraisal| happened for 27 (54,0%) patients, in a sub-group, getting|receive| complex therapy for 41(68,3%) women after births|. For the patients of control group renewal|reduction-oxidation| of pelvic bottom in 12 weeks after births|luing-in| happened at 5 (16,6%).

These researches|work-up| allow|permit| make the conclusions| about clinical efficiency of the offered complex method of renewall of pelvic| bottom after births|luing-in|.

Conclusions  Effective is a complex correction of the state of pelvic bottom after births, including physical exercises for strengthening of muscles of pelvic bottom and application of supposithorias with tiotriasoline natively with ascorutine 250 mgs 3 times per days of per os. For patients with the presence of signs of DCT the effect of therapy below, however also there is a positive dynamics as a result of the conducted treatment.     

This complex of therapy can be recommended to|by| application for all of women|forewoman| in a down-lying after births.

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