ОПЫТ ПРИМЕНЕНИЯ МЕКСИКОРА В СХЕМЕ ТЕРАПИИ БОЛЬНЫХ ОСТЕОХОНДРОЗОМ
ORCID: 0000-0001-6692-4968, кандидат медицинских наук, доцент,
Национальный Исследовательский Мордовский Государственный Университет им. Н.П. Огарева, медицинский институт, г. Саранск, Республика Мордовия, Россия
ОПЫТ ПРИМЕНЕНИЯ МЕКСИКОРА В СХЕМЕ ТЕРАПИИ БОЛЬНЫХ ОСТЕОХОНДРОЗОМ
Нестероидные противовоспалительные препараты (НПВП) широко применяются в медицине и относятся к числу наиболее эффективных симптоматических лекарственных средств. Остеохондроз позвоночника занимает одно из ведущих мест среди причин обращаемости к врачу, и наиболее часто для купирования болевого синдрома назначаются препараты из группы НПВП. Гастротоксические и кардиотоксические эффекты вызывают практически все препараты из этой группы. В статье представлены результаты исследования, цель которого – обосновать целесообразность использования комбинации омепразола и мексикора для коррекции негативных эффектов НПВП, возникающих при длительном лечении болевого синдрома у пациентов с остеохондрозом. Под наблюдением находилось 105 пациентов с достоверным диагнозом остеохондроз позвоночника. Установлено, что применение мексикора с омепразолом у пациентов, длительно принимавших НПВП по поводу остеохондроза, не снижает эффективность лечения основного заболевания, а способствует улучшению самочувствия, уменьшению жалоб со стороны желудочно-кишечного тракта (ЖКТ), приводит к положительной динамике при эзофагогастродуоденоскопическом (ЭФГДС) исследовании, уменьшению систолического и диастолического артериального давления.
Ключевые слова: остеохондроз, мексикор, омепразол, нестероидные противовоспалительные препараты.
ORCID: 0000-0001-6692-4968, MD, Associate Professor,
Mordovia N. P. Ogarev National Research State University, Institute of Medicine, Saransk, Republic of Mordovia, Russia
EXPERIENCE OF USING MEXICOR IN MEDICAL TREATMENT OF PATIENTS WITH OSTEOCHONDROSIS
Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in medicine and are among the most effective symptomatic drugs. Osteochondrosis is one of the leading causes of visiting the doctor, and most often preparations of NSAID group are prescribed for pain relief. Almost all preparations of this group cause gastro toxic and cardio toxic effects. The article presents the results of a study the purpose of which is to prove expediency of using a combination of omeprazole and mexicor to correct the negative effects of NSAIDs, appearing as a result of a long-term treatment for chronic pain in patients with osteochondrosis. Under supervision there were 105 patients with a documented diagnosis of osteochondrosis. It was found that the use of mexicor with omeprazole in patients with osteochondrosis treated with NSAIDs for a long time, does not reduce the effectiveness of the underlying disease treatment and contributes to health improvement, reduction of complaints about the gastrointestinal tract (GI) disorders, leads to positive changes at esophagogastroduodenoscopy procedure (E.G.D.), a decrease in systolic and diastolic blood pressure.
Keywords: osteochondrosis, mexicor, omeprazole, nonsteroidal anti-inflammatory drugs.
NSAIDs have become an integral part of modern person’s life and a factor of the environment surrounding him [4, P. 3452]. This trend has become particularly noticeable in the last decade due to general «aging» of the human population and, as a consequence, an increase in the number of elderly people suffering from chronic pain syndrome.
The pathology of the gastrointestinal tract that occurs after ingestion of NSAIDs, in fact, has gone beyond the complications of a particular type of drug therapy [3, P. 2227]. Nearly all NSAIDs (with different frequencies), regardless of their chemical structure, a dosage form and a method of administering the medication, cause gastro toxic effects. This issue, increasing the number of hospitalizations and deaths, is extremely important not only from merely medical, but also social and economic positions, [1, P. 3].
The study included patients with osteochondrosis of various localizations (cervical, thoracic, lumbar) and severe pain having been treated with non-steroidal anti-inflammatory drugs (NSAIDs) for 1 year or longer, at least for 4 months each year. All respondents were hospitalized in a neurology department of State Budgetary Public Health Institution «Mordovian Republican Clinical Hospital» in the Republic of Mordovia in 2015-2016. 105 patients with health deterioration were divided into 3 groups and examined. The patients of the first group (n = 35) received NSAIDs in combination with nootropic and vascular medications, the second group of patients (n = 35) were additionally given omeprazole — a dose of 20 mg a day, the third group of patients (n = 35) were additionally given omeprazole — a dose of 20 mg a day orally and mexicor – a dose of 300 mg a day intravenously. Duration of a course treatment was 14 days. The disease duration of the patients in the first group was 10,3 ± 1 years, the average age was 55 ± 0,8 years old; the second group — 9.7 ± 1 years, the average age — 57 ± 1 years old; the third group — 10.8 ± 1 years, the average age — 58 ± 1 years old.
We took into account the complaints related to the underlying disease: pain, pelvic disorders, numbness, motion limitations, extremities weakness, dyspeptic symptoms (heartburn, acid regurgitation, nausea, chest pain associated with food intake, a salty sour taste in the mouth; stool disorders (constipation / diarrhea); unpleasant / painful sensations in the stomach after eating, (tympanitic resonance/ abdominal distention), disorders of the cardiovascular system (CVS) (high blood pressure, edema, chest pain caused by exercise). The dynamics of systolic and diastolic blood pressure (SBP and DBP), heart rate (HR) were also taken into account. Each of the complaints, depending on its intensity, was evaluated from 0 to 4 points by the patients.
The patients in the examined groups definitely did not differ on the initial analyzed parameters. The disease duration of the patients from the first group was 10,3 ± 1 years old, body mass index (BMI) was on average 29 ± 0,4 kg / m2.
A course treatment for this group of the patients (the average age was 55 ± 0,8 years old) was accompanied by a significant decrease in the number of points connected with complaints related to the underlying disease (from 7,4 ± 0,3 to 4 ± 0,1). The original sum of points, which characterize the gastrointestinal tract (GIT) lesions, was 5,7 ± 0,7; during the treatment there was an insignificant decline to 5,1 ± 0,4. All patients in this group at esophagogastroduodenoscopy procedure (E.G.D.) had signs of atrophic and / or erosive lesions of the mucous membrane of the stomach, which were also present after a course of osteochondrosis treatment.
Subjective manifestations of the circulatory system (CS) disorders changed insignificantly, reaching before and after the treatment respectively: 17,4 ± 1,2 and 15,3 ± 0,9. The level of SBP and DBP, as well as HR, before and after the treatment was not significantly different.
The second group included 35 patients with the disease duration of 9.7 ± 1 years and the average BMI of 28 ± 0,7 kg / m2. In the second group of the patients (the average age was 57 ± 1 years old) the intensity of complaints caused by neurological disorders, expressed in scores, decreased from 9,5 ± 0,4 to 4,9 ± 0,8 (p <0,001). The initial amount of complaints, reflecting gastroenteropathy manifestations in patients of the second group, was 7,8 ± 0,7; including omeprazole in the treatment made it possible to reduce the intensity of subjective symptoms of the disease up to 5,1 ± 0,8 (p <0,001). At E.G.D. procedure damage of the gastric mucosa in the form of atrophy, swelling, hyperemia was detected in all patients and 42% were diagnosed with erosions. The scoring of cardiovascular complaints was not significantly changed. SBP decreased from 147 ± 3 to 136 ± 1 mm Hg (P <0,001), DBP decreased during the treatment from 98 ± 2 to 90 ± 1 mm Hg (P <0,01), HR remained unchanged.
The third group consisted of 35 patients with the disease duration of 10.8 ± 1 years and the average BMI was 26 ± 0,8 kg / m2. In the third group of the patients (the average age was 58 ± 1 years old) the intensity of complaints caused by neurological disorders, expressed in scores, decreased from 9,8 ± 0,5 to 3,7 ± 0,4 (p <0,001). The initial amount of complaints, reflecting gastroenteropathy manifestations in the patients of the third group was 6,5 ± 0,6; including omeprazole and mexicor in the treatment scheme reduced the intensity of subjective symptoms of the disease up to 4,1 ± 0,7 (p <0,01). At E.G.D. procedure damage of the gastric mucosa in the form of atrophy, swelling, hyperemia was detected in all patients and 38% were diagnosed with erosions. The use of omeprazole in combination with mexicor was accompanied by a significant decrease in the number of patients with erosive lesions of the gastric mucosa to 7%. Complaints about the cardiovascular system disorders decreased from 18,3 ± 0,4 to 13,2 ± 0,6 (p <0,001). SBP during the treatment decreased from 150 ± 2 to 136 ± 2 mm Hg (P <0,001), DBP – from 99 ± 2 to 87 ± 1 mm Hg (P <0,001), HR — from 77 ± 1 to 72 ± 1 per 1 min (p <0,05).
For dynamics objectification of the results obtained, as well as for the comparative evaluation between the groups, an analysis of data expressed as a percentage of initial values was carried out.
A significant decrease in the number of patients with complaints about the nervous system disorders was registered in the first group, the levels of SBP, DBP and HR decreased as well. In the second group of the patients the number of complaints about all organ systems disorders decreased significantly. Here a greater reduction in complaints about the nervous system, digestive system and circulatory system disorders was registered, compared with the first group. The levels of SBP and DBP significantly decreased compared with the initial ones and did not differ from the dynamics of SBP and DBP in the first group.
In the third group a relative number of complaints about all organ systems disorders significantly decreased compared with their initial amount. A greater reduction of complaints about the digestive system and circulatory system disorders was registered compared with the first group. As for the complaints about the circulatory system disorders, by the 14th day of the treatment they were significantly fewer than in the second group. The relative level of SBP, DBP and HR was decreased significantly from the initial one and became significantly lower than the level of SBP, DBP and HR in the first group. In addition to this, SBP and HR in the patients of the third group decreased more significantly than in the patients of the second group.
Thus, the course treatment of the patients in all groups was accompanied by a reduction in the number of complaints and positive clinical dynamics of the underlying disease. Inclusion of omeprazole in the treatment scheme of patients with osteochondrosis does not reduce the effectiveness of NSAIDs, is accompanied by health improvement, reduction of complaints about the digestive tract disorders, a decrease in systolic and diastolic blood pressure [2, P. 58]. At E.G.D. procedure a significant decrease in the number of patients with erosive lesions of the gastric mucosa was registered. However, all patients still have signs of mucosal lesions in the form of hyperaemia and swelling.
Using mexicor in combination with omeprazole in patients who have a long-term therapy with non-steroidal anti-inflammatory drugs for osteochondrosis of different localizations makes it possible to correct the negative effects of NSAIDs on the digestive and cardiovascular systems.
Список литературы / References
- Семелева Е. В. Коррекция негативных эффектов НПВП-терапии у больных остеохондрозом: автореферат диссертации на соискание ученой степени кандидата медицинских наук / Е. В. Семелева. – Мордовский государственный университет им. Н.П. Огарева. Саранск, 2012. – 18 с.
- Семелева Е. В. Коррекция негативных эффектов НПВП-терапии у больных остеохондрозом: дис. … канд. мед. наук : 14.03.06 : защищена 27.12.12 : утв. 15.07.13 / Е. В. Семелева. – Саранск: ГОУВПО «Мордовский государственный университет», 2012. – 122 с.
- Schjerning Olsen A.M. Effect of duration of therapy NSAIDs on the risk of death and recurrent heart attacks in patients who underwent previous myocardial infarction. National cohort study / Olsen A. M. Schjerning, J. Lindhardsen, F. Folke, M. Charlot, C. Selmer, M. Lamberts, Olesen J. Bjerring, P. R. Hansen, C. Torp-Pedersen, G. H. Gislason // Circulation. – 2011. — Vol. 123. – P. 2226-2235.
- Schmidt M. Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study /M. Schmidt, C. F. Christiansen, F. Mehnert, K. J. Rothman , H. T. Sorensen // BMJ. — 2011. — Vol. 343. — P. 3450-3457.
Список литературы на английском языке / References in English
- Semeleva E. V. Korrekcija negativnyx jeffektov NPVP-terapii u bolnyh osteohondrozom [Correction of adverse effects of NSAID therapy in patients with osteochondrosis]: abstract of candidate for M.D. degree dis. / E. V. Semeleva. –Mordovian State University named after N.P. Ogarev, Saransk, 2012. – 18 p. (In Russian)
- Semeleva E. V. Korrekcija negativnyx jeffektov NPVP-terapii u bolnyh osteohondrozom [Correction of adverse effects of NSAID therapy in patients with osteochondrosis]: dis. … of PhD in Medicine: 14.03.06: defense of the thesis 27.12.12: approved. 15.07.13 / E. V. Semeleva. – Saransk: Mordovian State University, 2012. – P. 122. (In Russian)
- Schjerning Olsen A.M. Effect of duration of therapy NSAIDs on the risk of death and recurrent heart attacks in patients who underwent previous myocardial infarction. National cohort study / Olsen A.M. Schjerning, J. Lindhardsen, F. Folke, M. Charlot, C. Selmer, M. Lamberts, Olesen J. Bjerring, P.R. Hansen, C. Torp-Pedersen, G.H. Gislason // Circulation. – 2011. — Vol. – 123. – P. 2226-2235.
- Schmidt M. Non-steroidal anti-inflammatory drug use and risk of atrial fibrillation or flutter: population based case-control study /M. Schmidt, C.F. Christiansen, F. Mehnert, K.J. Rothman , H.T. Sorensen // BMJ. — 2011. — Vol. 343. — P. 3450-3457.