N.A. Semashko Nizhny Novgorod Regional Clinical Hospital USING ELECTRIC PULSE THERAPY IN THE EARLY POSTOPERATIVE PERIOD AFTER SURGERY FOR TUBO- PERITONEAL INFERTILITY I.E. Holmogorova 2010

Relevance  One of the current issues of restorative medicine and gynecology is the development of new effective non-drug therapies for tuboperitoneal infertility - most common, well-researched, but most treatment-resistant type of infertility in women.

Relevance  Biofeedback SCENAR-therapy is scientifically interesting and prospective treatment modality in early postsurgical period after tuboplasty, which combines the principles of physio- and reflexotherapy.

Research objective  Develop and provide scientific background for SCENAR-therapy in multiple rehabilitation treatment of patients after tuboplasty

Research aims 1. Compare clinical effectiveness of multiple rehabilitation treatment complemented with SCENAR-therapy and drug therapy in early post- surgical period after tuboplasty. 2. Study the effect of various SCENAR-therapy methods on pelvic hemodynamics, indices of lipid peroxidation and antioxidant system in early post-surgical period after tuboplasty. 3. Identify how different SCENAR-therapy methods influence the autonomic and psychological state of patients in early post-surgical period after tuboplasty. 4. Evaluate the effectiveness of different SCENAR- therapy methods in preserving patency of uterine tubes and restoring the generative function.

Research materials  130 patients after laparoscopic tuboplasty participated in the complex clinical and laboratory research and rehabilitation treatment.  All the patients were of similar age (average age years), with similar duration of the disease (on average years), concomitant pathologies and clinical and functional data.  Study groups included only women without any pathological changes in the endocrine profile.

Research materials All the examined women were divided into 3 groups:  I group (control group) (30 patients) – in early post-surgical period after laporascopic tuboplasty patients received only drug therapy.  II group (50 patients) – in early post-surgical period, since 1 day, patients received drug therapy and pulse electrotherapy with the SCENAR-1-NT device following the combined method that includes external abdominosacral method (10-15 minute stimulation); local vaginal method (15 minute stimulation); stimulation of acupuncture points GI 11, E36, RP 6, 2 minutes each in the subjectively dosed mode with 90Hz frequency. Total stimulation time was minutes, 10 daily sessions during the treatment course.  III group (50 patients) - patients that in early post-surgical period, since 1 day, received drug therapy and pulse electrotherapy with the SCENAR-1-NT device following the external method and stimulation of acupuncture points, stimulation settings and stimulation zones are same as in the II group.

Research methods  general clinical research methods  bacterioscopic and bacteriological examination of vagina and cervical channel  examination of the bloodflow in the uterine and ovarian arteries using the Doppler sonography  analysis of general antioxidant activity of the blood plasma and intensity of free radical oxidation processes  cardiointervalography  questionnaire survey to evaluate patient’s autonomic status (by A.M. Vein)  analysis of patient’s psychological state using the questionnaire survey to calculate the index of general psychological wellness (by G. Dupuis, 1984, D.A. Rivitsky, 1996)

 2-3 months after the rehabilitation treatment all the patients had hysterosalpingography with water solutions of contrasts following the common method  The restoration of reproductive function was stated when the woman got spontaneously pregnant during the year  The male factor in women’s infertility was excluded basing on spermogram analysis and andrologist consultation

Methods of statistical analysis  Statistical data were analysed in the program Statistica 6.0, using the Kolmogorov-Smirnov criterion.  Significance of sample differences was evaluated using the t-tailed Student's test, the Mann–Whitney U test, the Wilcoxon W test – to compare two linked samples.  Groups were compared by the qualitative binary criterion using the Fisher's test for unrelated groups.  In all the cases differences with the significance level р<0.05 were regarded as significant.

Regression of Clinical Symptoms

Positive dynamics in several changed indices of clinical blood analysis:  Significant decrease of leucocytes, band and segmented neutrophils, erythrocyte sedimentation rate (ESR).  The changes in the amount of leucocytes, band and segmented neutrophils in the peripheral blood is more evident in Group II and III and significantly differed from the results in the Group I, except the ESR, which equally decreased in all the groups.

Dynamics of the bloodflow in the uterine and ovarian arteries after the treatment Dynamics of resistance index in the uterine arteries (N= ) Dynamics of resistance index in the ovarian arteries (N= )

Dynamics of lipid peroxidation and antioxidant protection indices Imax index dynamics (mV/sec) (in N not > 2.0 mV/sec) I/S index dynamics (rel.un.) (N= rel.un.)

Dynamics of patient’s autonomic status (in points) Dynamics of patient’s autonomic status (in points) (by A.M. Vein)

Dynamics of cardiointervalography indices after treatment Tension index dynamics (conv. units) (Autonomic balance ) АМо index dynamics (%) (Autonomic balance 31-49)

Dynamics of cardiointervalography indices after treatment Mo index dynamics (sec.) (Autonomic balance ) ΔX index dynamics (sec.) (Autonomic balance )

Dynamics of patient’s psychological state

Medical and Economic Significance

The effect of SCENAR-therapy on the patient’s reproductive function Comparative analysis of treatment results for maintenance of fallopian tube patency Comparative analysis of treatment results for spontaneous pregnancy

Findings 1. SCENAR-therapy in multiple rehabilitation treatment of patients in early post-surgical period after tuboplasty helps the patients to overcome the post-surgical period easier, decreases the intensity of pain syndrome, reduce the in-hospital period. Combined method is by 32% more effective than the external one. 2. SCENAR-therapy in multiple rehabilitation treatment of patients in early post-surgical period after tuboplasty contributes to improvement of regional hemodynamics, which is greater when following the combined method, that is proved by the 22% increase of resistance index in the uterine arteries and 23% increase of the resistance index in the ovarian arteries.

Findings 3. SCENAR-therapy in treating patients after tuboplasty neutralizes negative changes in the state of lipid peroxidation system and antioxidative system, greatly decreases lipid peroxidation and increases antioxidative activity. At this the correction of lipid peroxidation and antioxidative system indices is significantly more often observed when following the combined method. 4. SCENAR-therapy in early postsurgical period after tuboplasty decreases the stress of body regulatory mechanisms, decreases the influence of sympathetic and increases the tone of parasympathetic systems, which is indicative of increased stability of autonomic regulation. SCENAR provides evident psychocorrective effect, manifested as decrease of anxiety level, depression, increase of self-control, general health and emotional well-being. 5. SCENAR-therapy in multiple drug therapy in early postsurgical period improves treatment effectiveness as a prophylaxis of reocclusion of uterine tubes and increase of the generative function by 43%.

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