RU2244517C2 - Method for treating pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine, phthisiology.

SUBSTANCE: one should create pulmonary atelectasis from inside due to applying bronchial valve in tuberculosis-affected lung in case of bronchoscopy depending upon localization of tubercular process. The method enables to avoid course anatomical alterations and functional disorders, avoid the development of reactive exudative pleuritis and rigid pneumothorax.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to medicine, namely to phthisiology, and can be used for the treatment of patients with pulmonary tuberculosis, including in its chronic and complicated forms.

Existing treatments for pulmonary tuberculosis are imperfect. This is due to the fact that modern chemotherapy and phthisiosurgery are not effective enough.

A known method of treating pulmonary tuberculosis through the use of chemotherapy. However, its capabilities are insufficient due to the drug-resistant forms of tuberculosis that are increasingly being formed recently (Ursov I.G., Borovinsky A.I. The modern concept of accelerated cure of patients with destructive pulmonary tuberculosis. Novosibirsk, 1993, S.205).

Closest to the claimed prototype is a method of treating pulmonary tuberculosis, which consists in creating therapeutic collapse from the outside by introducing air into the pleural cavity (K. Kharcheva Collapse therapy in the complex treatment of pulmonary tuberculosis patients. 1972, Moscow, p. 182).

However, the known method is limited to developing gross anatomical changes and functional disorders, frequently occurring complications, lack of selectivity, and when pleural cavity is obliterated, it requires prior surgical intervention, or even becomes inapplicable. However, this method requires regular insufflations (every 7-10 days) for a long time (from 3-4 months to 1 year or more), as a result of which rigid pneumothorax is often formed.

The author proposes a new method for the treatment of pulmonary tuberculosis by using a valve that creates the effect of collapse therapy. A positive result of the claimed invention is to increase the effectiveness of treatment by achieving a state of hypoventilation and atelectasis in the lung affected by tuberculosis, creating the conditions for its cure.

A positive result is achieved by creating atelectasis of the lung from the inside by applying a valve in the bronchus affected by pulmonary tuberculosis, with bronchoscopy, depending on the location of the tuberculosis process.

The method is as follows. A bronchoscopy is performed under anesthesia. Anesthesia is carried out according to generally accepted rules, namely, after standard premedication with anticholinergic and antihistamines (atropine 0.1% 1.0; diphenhydramine 1.0% 1.0 intravenously), short-acting barbiturates are anesthetized (sodium thiopental from 0.5 to 1 , 0 or hexinal from 0.5 to 1.0) intravenously. Next, basic anesthesia with a solution of ketamine at a dose of 1-3 mg per kilogram of weight intravenously is carried out. Artificial ventilation of the lungs is carried out throughout the entire bronchoscopy through the tube of the bronchoscope with a respirator, for example “Bioart-1”, in high-frequency ventilation mode with a frequency of 120-200 per minute. After bronchoscopy is completed, with the restoration of independent breathing and general muscle tone, the patient is transferred to the intensive care unit.

Carrying out bronchoscopy.

After the onset of muscle relaxation, the trachea is intubated with a tube of a rigid Friedel bronchoscope with a diameter of 11-12 mm. After examining the bronchial tree and removing sputum, a valve fixed with biopsy forceps is brought to the mouth of the draining bronchus (corresponding to the localization of the tuberculous process in the lung) and set into the lumen of the bronchus until it sticks (to the stop). This completes the valve installation procedure. After restoration of spontaneous breathing, the patient’s bronchoscope tube is removed.

Valve device.

The valve is made of rubber mixture IRP 14-01 and is a hollow cylinder. On the one hand, the internal opening of the valve has an even round shape, on the other hand it is made in the form of a falling flap valve, which is locked by excessive external pressure (the difference between internal and external pressure). On two-thirds of the outer surface of the valve made thin lamellar radial petals for fixing it at the place of use (figure 1). The place of fixation of the valve in the bronchus depends on the location of the tuberculous process in the lung (figure 2). The valve allows air and sputum to escape from the lung when exhaling and coughing, while there is no return flow when inhaling, thereby creating a state of hypoventilation and atelectasis in the lung (Fig. 3).

Clinical observation.

A 36-year-old patient M. was admitted to the department on January 23, 2002: he was diagnosed with fibro-cavernous tuberculosis of the upper lobe of the left lung in the phase of infiltration and seeding, complicated by hemoptysis VK ⁺ .

Suffers from pulmonary tuberculosis for 10 years. During this time, annually and for a long time, he underwent courses of antibacterial antituberculous therapy inpatient and outpatient settings. The treatment gave a short remission, then again there was an exacerbation of the tuberculosis process, usually accompanied by pulmonary hemorrhage or hemoptysis.

The patient's condition upon receipt of moderate severity. Complaints of coughing up blood, weakness, fever up to 38.0 ° C.

General blood test: Нb 102 g / l, ESR 49 mm / hour, Er. 3.4 × 10 ¹² , L - 10.7 × 10 ⁹ , E - 7, P - 1, C - 54, L - 21, M - 6.

On January 24, 2002, bronchial blocking with a valve made of rubber mixture ИРП 14-01 was performed according to the described method. Moved well. Hemoptysis stopped immediately.

For clarity, we present the radiological dynamics.

X-ray upon admission: on the left, the upper lobe and S6 are slightly reduced in volume due to pneumofibrosis. Different-sized abdominal masses with pericavital infiltration are determined. One of them is larger, approximately 5 cm in diameter with a horizontal level of contents at the bottom. Polymorphic foci. The left root is moderately pulled up. Foci of bronchogenic dropout in both lungs. The shadow of the mediastinum is located in the middle.

Radiograph after bronchoscopy: on the left in the upper parts of the lung - a larger cavity has decreased in volume, pericavital infiltration persists. Upper lobe in hypoventilation.

Radiograph after 3 months: the upper lobe in the atelectasis is on the left, the cavity formations have decreased in volume, some of them are scarring, pericavital infiltration has decreased, the number of polymorphic lesions has decreased. There is a thickening of the pleura in the upper sections. The number of screenings on both sides has decreased significantly. The left root is pulled up. The shadow of the mediastinum is shifted to the left.

Radiograph after 5 months: the upper lobe in the atelectasis is on the left, pleuro-pneumocirrotic changes are noted in it. Compared with the previous x-ray examination, cicatricial changes in the lung tissue are determined at the site of the abdominal masses. On both sides there are single dense foci.

X-ray 3 months after valve removal: on the left is the upper lobe in pleuro-pneumocirrhosis. In the lungs, there are isolated dense foci on both sides.

General analysis of blood at discharge: Нb 115 g / l, ESR - 10 mm / hour, Er. - 3.4 × 10 ¹² , L - 4.7 × 10 ⁹ , E - 7, P-1, C - 54, L - 21, M - 6.

As a result of the treatment, the patient's condition improved. Body temperature returned to normal, weakness did not bother, bacillus excretion stopped.

06/18/2002 Patient M. was discharged in satisfactory condition for outpatient treatment and observation by a TB doctor.

The inventive method was applied in 6 patients with progressive drug-resistant pulmonary tuberculosis. In all patients, stabilization of the process and positive dynamics were achieved.

The inventive method allows for the selective treatment of pulmonary tuberculosis, including in its chronic and complicated forms, regardless of the adhesive process, does not require frequent repeated insufflation of air, avoids many complications, such as reactive exudative pleurisy, rigid pneumothorax, the formation of gross anatomical and functional disorders, eliminate the risk of iatrogenic pneumothorax, avoid surgical treatment. In addition, the low-invasiveness of the method allows to expand the indications for its use in debilitated patients and in patients with contraindications to other types of treatment.

The inventive method allows to achieve a state of hypoventilation and atelectasis in a lung affected by tuberculosis by applying a valve.

Claims (1)

A method of treating pulmonary tuberculosis, which consists in creating a therapeutic collapse, characterized in that atelectasis of the lung is created from the inside by applying a valve in the bronchus of a pulmonary tuberculosis infected bronchoscopy depending on the location of the tuberculosis process.

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