RU2008904C1 - Method of pleurodes at spontaneous pneumothorax - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: 250-350 ml of 4% sodium bicarbonate solution are injected into pleural cavity. The process takes place before and after evacuation of air from pleural cavity is carried out, exposition being 20-30 min. EFFECT: prevents painful syndrome, decreases treatment time.

Description

 The invention relates to medicine, namely to pulmonology.

 There is a method of pleurodesis by performing thoracotomy and applying to the serous integument of the parietal and visceral pleura chemical agents by hand (talc, chlortetracycline hydrochloride, etc.).

 There is a method of pleurodesis by applying chemical agents (collagen, talc, etc.) through a tube and under the control of an operating thoracoscope by spraying a substance under pressure.

 However, these methods are extremely painful, time-consuming, and in the case of a serious condition of the patient, it is difficult to do.

 As a prototype, a pleurodesis method was adopted, including emptying the pleural cavity from the air and a single injection of a solution of chlortetracycline hydrochloride into the pleural cavity (0.2 kg per 10 kg of the patient’s body weight in a solution of 150 mg of 50 ml lidocaine) after preliminary administration into the pleural cavity into as an anesthetizing agent, a solution of 150 mg of lidocaine in a volume of 150 ml with an exposure of the drug to the pleural cavity for treatment for 2 to 3 hours

 The disadvantages of the method are the following points: despite the preliminary intrapleural administration of an anesthetic drug, the use of a solution of chlortetracycline hydrochloride as a chemical agent for pleurodesis causes a pronounced pain syndrome, which, reducing the effectiveness of pleurodesis, leads in most cases to the formation of a lumped reactive hydrothorax and necessitates repeated the use of analgesic and narcotic drugs for several days ok after performing the manipulation and lengthens the length of stay of the patient in the hospital.

 The aim of the invention is to prevent the occurrence of pain and reduce treatment time.

 This goal is achieved by the fact that in a method comprising emptying the pleural cavity from air and a single injection of a drug into the pleural cavity in an amount of 250-350 ml with exposure for 20-30 minutes, 4% is introduced into the pleural cavity as a drug sodium bicarbonate solution.

 The method is based on the use of a known substance of sodium bicarbonate as a chemical agent for pleurodesis, used in medicine as an alkalizing agent when introduced into the bloodstream (for the treatment of acidosis) (or into the lumen of the stomach) to neutralize the acidic gastric contents.

 There are no reports of intrapleural administration of this substance and its effect on humans and animals with the above administration method.

 The mechanism of action that differs from the prototype is that a 4% sodium bicarbonate solution, having a slightly alkaline effect (pH 8.1) when introduced into the pleural cavity, causes intensive fibrin prolapse and gluing of serous leaves, practically without causing edema of the pleura and others tissues, which is clinically expressed in the painlessness of the procedure.

 A similar mechanism of action of the chemical agent and its clinical effect are unknown.

 The method is as follows: by pleural puncture with a syringe, the pleural cavity is emptied from the air. Once injected into the pleural cavity 4% solution of sodium bicarbonate in an amount of 250 - 350 ml, depending on the patient's body weight. A 4% solution of sodium bicarbonate is in the pleural cavity for 20-30 minutes, and then it is removed by repeated pleural puncture or through drainage.

 The optimal conditions for the implementation of the method were determined experimentally and confirmed by 61 clinical observations. The experiments were performed on 79 animals (rats).

 Studies have shown that only with the introduction of a 4% solution of sodium bicarbonate, the most active intrapleural fibrinogenesis is achieved, there is a lack of pleural edema and complete adhesion of the pleural sheets without any changes in animal behavior. All animals of these groups, unlike others, remained alive. The introduction of higher concentrations of solutions into the pleural cavity caused significant changes in the behavior of animals (increased motor activity with subsequent physical inactivity and death of animals) or incomplete adhesion of pleural sheets, due to the appearance of reactive serous effusion in the pleural cavity. The introduction of sodium bicarbonate solutions less concentrated than optimal did not cause complete adhesion of serous pleural sheets in all animals in these groups, i.e. complete pleurosis was not achieved.

 PRI me R 1. Patient S. Ponomarev, 49 years old, medical history N 4263, was taken to hospital 10.03.90, with a diagnosis of Relapsing nonspecific spontaneous pneumothorax on the right, respiratory failure of 1 - 2 degrees. A year ago, due to spontaneous pneumothorax, he was hospitalized in another hospital, where the pleural cavity was drained on the right, followed by aspiration for 2 days, was discharged after 4 days. This disease arose sharply on 10.03.90, when after physical exertion he noted the appearance of sharp pain in the right half of the chest, a feeling of lack of air and increasing shortness of breath. I went to the clinic, where an X-ray examination revealed the presence of air in the right pleural cavity with compression of the right lung to half its volume. Ambulance brigade delivered to the Research Institute of the joint venture named after Sklifosovsky N.V.

 Drainage of the right pleural cavity with constant aspiration for the next 2 days was ineffective, and therefore pleurodesis was performed by the proposed method. After evacuation of air from the pleural cavity, a 4% solution of sodium bicarbonate in the amount of 300 ml was introduced into it once. During and after intrapleural administration of the drug, the patient did not experience pain, injections of narcotic and non-narcotic drugs were not made. The adhesion of pleural sheets occurred within the next three hours after pleurodesis, as evidenced by the cessation of air from the pleural cavity. The patient's condition improved: shortness of breath disappeared, the respiratory rate in 1 min was 18. The next day, radiological monitoring showed no signs of pneumothorax. On the 8th day after the application of pleurodesis, the patient was discharged from the hospital in satisfactory condition.

 PRI me R 2. Patient Yatskov I.A. 25 years old, medical history N 2410, was taken to the clinic by the ambulance team on 8.02.89, with a diagnosis of Right-sided total spontaneous pneumothorax, respiratory failure of 2 degrees. He fell ill 5 hours before admission, when pain suddenly appeared in the right half of the chest, a feeling of lack of air, shortness of breath up to 24 in 1 min. Upon admission to the Research Institute of the Joint Venture named after N.V. Sklifosovsky X-ray revealed total pneumothorax on the right with a significant displacement of the mediastinum on the left. Conventional treatment regimens, including continuous pleural air aspiration within 30 hours, had no effect, air continued to flow from the pleural cavity in large quantities. In this regard, pleurodesis was performed by the proposed method. In this case, 350 ml of a 4% aqueous sodium bicarbonate solution was intrapleurally administered. The pain syndrome, which would require the introduction during the procedure and in the next 5 hours after it, pain medication also did not occur. In the next 5 days, the patient's condition was satisfactory. Clinically and radiologically, signs of pneumothorax were absent, which allowed 7 days later, i.e., 15.02.89 g to discharge the patient from the hospital.

 The experimental results are confirmed by clinical experience using the prototype method and the proposed method in 61 patients with non-specific spontaneous pneumothorax (see table 1). When comparing groups of patients identical in gender, age, and severity of the pathological process according to the results of using the proposed method and prototype, it turned out that the application of the proposed method eliminated the need for non-narcotic and narcotic analgesic therapy, making it unnecessary to conduct preliminary intrapleural anesthesia before the chemical agent was introduced into the pleural cavity , was not accompanied by the occurrence of atelectatic pneumonia and the formation of a pummeled reactive gy dothorax. Using the proposed method 4 times reduced the number of recurrences of pneumothorax and significantly reduced the average hospital bed day of the patient in the hospital.

 The use of a 4% solution of sodium bicarbonate prevents the onset of pain due to its slightly alkaline action, which does not cause pleural edema, and contributes to the intensive prolapse of the fibrion into the pleural cavity and the gluing of its serous sheets due to aseptic inflammation in it.

 The introduction of a 4% solution of sodium bicarbonate in the pleural cavity leads to the fact that being absorbed through the visceral pleura, it causes alkalization (liquefaction) of the alveolar and bronchial mucus, while improving the drainage function of the bronchial tree. It is well known that sodium bicarbonate in the body breaks down into non-toxic metabolites (water and carbon dioxide).

 A 4% sodium bicarbonate solution used in pleurodesis in a volume of 250 - 350 ml does not have any effect on the acid-base balance of the blood, since over 1000 ml of such a solution is necessary intravenously or intra-arterially to overcome the natural buffer capacity of the blood. (56) R.W. Light. Diseases of the pleura. M., 1986, p. 134 - 139, 285 - 286.

Claims (1)

 METHOD OF PLEURODESIS IN SPONTANEOUS PNEUMOTORAX, including evacuation of air from the pleural cavity and a single injection into the pleural cavity of a drug solution in a volume of 250 to 350 ml with an exposure of 20 to 30 minutes, characterized in that, in order to prevent the occurrence of pain and reduce treatment time, A 4% sodium bicarbonate solution is introduced into the pleural cavity.