APPLICATION
OF HBO IN COMPLEX TREATING OF CHRONICLE PHOSPHORIC INTOXICATION.
Informational letter.
The process of obtaining of phosphorus and phosphoric
compounds is accompanied with the pollution of environment with toxic compounds:
phosphorus; phosphine; phosphoric oxides; etc. Prolonged influence of these
compounds can cause industrial disease of stuff (G. Belogurskaya, 1978).
Pathogenesis of phosphoric intoxication (PI) isn't
studied sufficiently yet. Phosphorus is known to be a resorbtive subject; it
would violate the oxidation-reduction processes, if involved in tissue;
sequentially the blood is contaminated with intermediate products of oxidation.
Accompanying that process hypoxia accelerates the pathology.
Phosphorus can cause dystrophic and necrobiotic
processes in liver; inflation of its stroma; improvement of tissue's hypoxia. It
is obviously that treating of hypoxia would be included in complex treating of
PI.
An effective method of treating any kind of hypoxia is
HBO - that is controlled improvement of tension of oxygen in body (B. Petrovsky;
S. Efruni, 1976). Besides that improved oxygental pressure can also suppress the
bactericidal activity and accelerate the regeneration (L.Shimkevitch, 1976). HBO
is proposed for treating of liver (S. Biletsky, 1975; V. Rybachkov, 1977).
Thus HBO can be recommended in complex therapy of
chronicle PI - it can reduce the tissue hypoxia; improve regeneration (in liver,
in particular); stimulate metabolism. This is a principally new approach for
treating the industrial diseases of such kind.
Clinical and biochemical displays of PI.
The displays of PI pathology have no specific
properties. A specific group of violations of digestive organs (liver and
intestine); nerves and endocrine systems with further violation of
cardiovascular, locomotor systems; respiratory tracts; kidneys.
Toxic hepatitis participates in PI as a principle
element. Sometimes it can become an active form, accompanied with pain;
hepatomegalia; etc. Biochemical investigations represent here violations of
protein synthesis in liver; pigmentary, fatty and carbohydratal metabolism. The
intermediate products appear (lactate and piruvate). The activity of ALT;
aldolase; alkaline phosphatase; suppression of serous cholinesterase. The
activity of organospecific and excretory liver enzymes improves (arginase,
gammaglutamiltranspeptidase, lactatdehydrogenese).
Pathology of digestive system is displayed as
violations of secretoral and motoral functions of stomach and its mucosal
resulting in gastritis. Colitis is developed in intestine.
The violations of cardiovascular system are the same as
in case of neirocirculatoral dystonia and diffusive dystrophy of myocard.
Sometimes the violations of atrioventricular conductivity. All these are the
properties of the development of dystrophy of myocard, as the
result of either direct influence of phosphorum on
cardiac muscle, or the result of transgressions in nerves system.
One of the principle displays of PI is the violation of
nerves system: that usually is astenovegetative syndrome; sometimes (2 - 3
degrees of process) - toxic encephalopathy.
The thyroid gland and adrenal gland are damaged in
endocrynal system.
The usual violations of respiratory tracts are chronic
transgressions of mucosal of nose and larynx. The PI can also damage the kidney
(lessening of concentrational and filtrational systems; etc.).
The locomotor system responds usually in ostealgia and muscular weakness
of extremities. In hard cases the osteosclerosis of tubular bones.
Lessening of hemoglobin and erythrocytes; anysocytose
and poykilocytose, absolute neiropenia and relative lymphpenia can appear in the
peripheral blood.
According to all of this 3 degrees of chronicle PI are
determined (G. Beloscurskaya,1980).
Pathogenesis indications of clinical application of
HBO.
The influence of phosphoric compounds on body is
accompanied with hard violations of oxidation- reduction processes; activity of
polyenzimal systems of mitochondrion; disorder of oxidizing phosphorilation,
that is caused by changes of trans parency of membranes of mitochondrion.
Sequentially interstitial hypoxia is and important element of PI.
Sequentially suppression of hypoxia would be a
principle element of healing from PI.
The toxic violation of liver is a prominent in
pathology of PI. Thus a combination of medicamental therapy of liver together
with HBO can be applicable.
The practice had convincingly approved the
applicability of HBO in prophylaxis and treating of PI. Thus, the figures of
respiratory control and conjunction of oxidizing phosphorilation were improving;
HBO-prophylaxis lessened the development of hard functional violations of liver
mitochondrion; stabilized the transparency of membranes of liver and hepatocydes
and the activity of polyenzymal systems.
Curing application of HBO experimentally resulted in
bettering of indexes of red and white blood; fat and carbohydrate metabolism;
lessened the concentration of intermediate products of oxidation. Normalization
of the activity of ALT; aldolase was observed as well as of arginase,
gammaglutamiltranspeptidase, lactatdehydrogenese - this was the approval of
normalization of state of liver.
Thus, experiments as well as clinical results
unanimously approved the applicability of HBO in treating of PI.
Method of application of HBO.
An investigation of patient would be held before the
first procedure to determine the state of PI. The special investigations of
contraindications are also held, if necessary; the results would be represented
in a special map. Later the dynamics of disease would also be represented in
this map - this can be of use in indicating of the repetitive course. The
patient would be acquainted with the rules of behavior during the procedure. The
patient would be dressed in cotton; all kinds of oil and fat would be removed
from the skin. In the process of HBO a permanent communication with the patient
would be terminated.
The regime would be selected according the
recommendations of B. Petrovsky and S. Efruni (1976). We can recommend the following regimes of HBO applied to the
sicks with PI of different degrees.
The principle is that less intoxication would be
treated with more prolonged procedures with higher saturation for prophylaxis of
the development of the disease; besides for less sick people the applied regime
can be less tender, but more active. More sick patients usually have more
violated nerves system; for them the regime would be more tender.
The regimes of compression and decompression would also
be selected from principle: less violations for hardest sicks.
The proposed regimes of HBO.
|
degree
of PI |
speed of
compression kg/min./sm.2 |
pressure in saturation ATI |
exposition of saturation
min |
amount of procedures in
course |
|
practically
healthy people |
0,1 |
1 - 2 |
40 -
60 |
10 -
12 |
|
"probably"
sicks |
0,1 |
0.8 -
1,0 |
40 -
60 |
10 -12 |
|
slight
sicks |
0,1 |
0,6 -
1,0 |
30 -
40 |
8 - 10 |
|
middle
sicks |
0,05 |
0,4 -
0,8 |
30 -
40 |
8 - 10 |
The compression for "probable" and slight
sicks is done at 0,1kg/sm.2/min. till 1,5ATA; then - 0,2kg/sm.2/min. till the
saturation.
If the patient feels headache; disorder, the regime
would be shifted to more tender one.
In 6 - 8 months the repetitive course is recommended,
independently of any other kind of therapy in that period. Practically the
repetitive course is usually more effective. That can be the result of the first
one and the stabilization of functions of body.
Contraindications and complications of HBO application.
The conditional contraindications are:
- epilepsy;
- caverns in lung and other internal organs;
- otorhinolaryngologic diseases;
- claustrophobia;
- improved individual sensitivity to oxygen.
The danger in the process of persuing the HBO:
- development of acute oxygental intoxication;
- strong pain in otorhinolaryngological organs;
- any kind of sudden worthening of state of patient.
The hardest complication after HBO can be the oxygental
intoxication. It begins with dizziness; vomity; numbness of extremities; later -
paleness; convulsions; violations of respiration; unconsciousness and final
lethality. Sequentially after appearance of the primary displays of the
intoxication the procedure would be immediately interrupted. The decompression
usually automatically returns the patient to the normal state. Usually the
intoxication can be observed at the very first procedures; sometimes - later (in
case the combination of hard intoxication with little concentration of
erythrocytes and hemoglobin.
Assessment of HBO in treating of chronic PI.
The assessment would be based on: clinical criteria;
biochemical investigations; investigation of circulation in liver, cerebrum and
state of central nerves system in process of treating. If these investigations
are too complicated for clinic, a number of more simple and observable figures
can be proposed. These are: lessening of muscle's weakness; lessening of the
headaches; normalization of sleep and appetite; finishing of dyspnea, pain in
heart, reduction of improved pulse.
The objective criteria of the efficiency of HBO are:
Normalization of arterial pressure and pulse; cardiogram; lessening of the size
of liver; pathology of nevrologic investigation.
The enzymal function of liver is controlled by:
reduction of activity of alaninaminotransferasa and organospecific enzymes;
excretory liver enzyme; activity and concentration of lactatdehydrohynasa.
The change of intermediate metabolism: reduction in
serum of blood of citric and lactic acids.
The dynamics of vascularity of the cerebrum the
reoencephalography can be recommended as well as liver circulation by means of
reohepatography; electroencephalography for controlling the central nerves
system.