RU2262938C1 - Method for treating patients for pulmonary tuberculosis accompanied with purulent endobronchitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying physiologic saline with ozone concentration of 5-10 mcg/l that is introduced in rectal way in the amount of 40 ml at a rate of 30 drops/min with pause 1-2 times per week within 2 months on the background of antibacterial treatment.

EFFECT: enhanced effectiveness in closing disintegration cavities and stopping bacterioexcretion.

Description

The invention relates to medicine, namely to phthisiology.

A known method of treating patients with pulmonary tuberculosis by intravenous administration for 2-7 months dissolved in 200-400 ml of isotonic sodium chloride solution (physiological solution) of ozone at a concentration of 1-4 μg / ml (Belyanin I.I. Issues of epidemiology, diagnosis and treatment tuberculosis. M., 1996, p. 86). There is a method for treating diseases of the bronchopulmonary system by intravenous administration of 200 ml of ozonized physiological solution (OGF) with a gas concentration of 2-4 μg / l 2-3 times a week for up to 4 weeks (Struchkov P.V., Zubkova A.V. , Zolkina I.V., Kulikov A.G. Ozone and Methods of Efferent Therapy in Medicine (Nizhny Novgorod, 2000, pp. 60-61).

However, intravenous administration of dissolved ozone is often aggravated by its irritating effect on the walls of blood vessels, and therefore the possibility of prolonged use of the method necessary in the treatment of chronic inflammatory processes, such as tuberculosis with concomitant purulent endobronchitis, is limited.

In clinical practice, a method is known for treating inflammatory bowel diseases by rectal insufflation of 50-500 ml of an ozone-oxygen gas mixture with an ozone concentration of 5-60 μg / ml (Basic principles and tactics of ozone therapy. A manual for doctors. M., 2000, p.5). In this case, the local effect of ozone on the intestinal mucosa is used mainly: anti-inflammatory, hemostatic effects, increased microcirculation, stimulation of reparative processes. It is not possible to control the amount of ozone absorbed in the intestine; its constant concentration in the blood plasma is not created.

In phthisiatric practice, there is a method for treating pulmonary tuberculosis by rectal drip of solutions of isoniazid and PASK in an amount of 30-40 ml (Gavriliev S.S. Chemotherapy of destructive forms of pulmonary tuberculosis using various methods of drug administration: Abstract, Ph.D. . Sciences, M., 1997). This ensures the creation of a uniform constant concentration of drugs in the blood for a long time with the start of their absorption after 10-15 minutes. The main absorption mechanism is penetration into the lower hemorrhoidal veins with direct entry into the pulmonary circulation, bypassing the stomach, intestines and liver.

With rectal drop-by-drop administration of OFR to a depth of 10 cm in the rectal ampoule, complete absorption and complete penetration of the entire administered dose of dissolved ozone into the pulmonary circulation occurs, which can provide a multifactorial effect of ozone on the body: antibacterial, anti-inflammatory, immunomodulatory, detoxification and antioxidant .

The aim of the invention is to increase the efficiency and reduce the time of treatment of patients with destructive pulmonary tuberculosis with concomitant purulent endobronchitis.

A method for the treatment of patients with pulmonary tuberculosis with concomitant purulent endobronchitis is as follows. Against the background of conventional anti-tuberculosis antibacterial therapy, rectal drop-wise infusions of OGF in the amount of 40 ml with an ozone concentration of 5-10 μg / ml 1-2 times a week are performed. The course of treatment is 2 months. To obtain FGF, the ozone-oxygen mixture is bubbled with a bulk velocity of 0.5 l / min with an ozone content of 50 μg / ml through an isotonic sodium chloride solution. The bottle with OFR is mounted on a tripod and is connected through a disposable infusion system to the tip, which is a disposable male catheter. The tip is inserted into the rectum freed from the contents to a depth of 10 cm. By slowly opening the clamp, located below the dropper, the insertion rate is set to 30 drops per minute. Perfusion lasts for 20-30 minutes. After infusion, patients are in bed for one hour.

Before and after the course of treatment, patients undergo immunological, bronchoscopic and x-ray tomography, and if necessary, the course of treatment is repeated. The duration of treatment is determined by the dynamics of involution of a specific process in the lungs (resorption of infiltration, healing of decay cavities) and concomitant endobronchitis and lasts from 2 to 6 months.

Complex treatment with antibacterial drugs with the addition of ozone therapy was used by 23 patients with destructive pulmonary tuberculosis with concomitant purulent endobronchitis from the age of 19 to 52 years. As a result of the combined treatment, the closure of the decay cavities was observed in 82.6% of cases, the cessation of bacterial excretion was observed in 95.6%. In the control group, where treatment was carried out only with antibacterial drugs, the corresponding indices were 40.7 and 74.1% (p <0.005). Destruction healing occurred on average after 5.7 months, cessation of bacterial excretion after 2.3 months, which is 2 months shorter than the data in the control group.

Treatment of concomitant purulent endobronchitis occurred in 95.6% of cases, while in the control group - in 44.4% (p <0.005). The average period of rehabilitation of the bronchial tree was 3.8 months, which is 2.5 months faster than the control group.

A positive clinical result of complex ozone chemotherapy was accompanied by an immunomodulatory effect on cellular and humoral immunity, observed in 82.6% of cases. After 2 months from the start of ozone therapy, a statistically significant increase in the absolute number of lymphocytes and T cells was noted, their functional activity increased, and the level of immunoglobulins A and G was normalized. In the control group, no positive dynamics of immunological parameters was observed at the indicated time.

Example. Extract from the medical history No. 441 Shabolina OA, 32 years old. Russian nationality, permanent address: Republic of Sakha, Yakutsk. st. Khabarova, building 21, apt. 47, disabled, group II disabled person since childhood. Sick since July 2002, with severe clinical symptoms and fever. Clinic No. 2 of the Yakutsk Research Institute of Tuberculosis of the Ministry of Health of the PC (I) was admitted on July 15, 2002 with symptoms of severe intoxication. According to a chest radiograph of July 11, the pulmonary fields on the right are transparent. In the upper lobe of the left lung, lung tissue infiltration with the presence of decay cavities in the projection of segments 1 and 2. The left root is infiltrated. In sputum, MVT was detected by luminescence microscopy from July 18–22 and a significant amount; when sowing sputum from July 17–18, there was an increase in more than 100 colonies of MVT. Diagnosed with: Infiltrative tuberculosis of the upper lobe of the left lung in the decay phase. Office +. Bronchoscopically from August 19, the presence of drainage purulent endobronchitis of the left upper lobar bronchus, bilateral catarrhal endobronchitis of the I-II degree was established. After 4 months of antibiotic therapy, radiological from November 15, there is a slight dynamics towards a decrease in inflammatory infiltration in the upper lobe of the left lung, the decay cavity is preserved. With repeated bronchoscopy on November 16, the same changes were found. On November 19, a course of ozone therapy with a rectal drip method was started. On the control x-ray 2 months after February 20, 2003, pronounced positive dynamics were noted: complete resorption of inflammatory infiltration in the left lung, decay cavities ceased to be detected, limited fibrous changes in the lung tissue in the 2 segment were formed. Bacterial excretion stopped 1 month after the start of ozone therapy. At control bronchoscopy of March 9, cure of endobronchitis was ascertained.

Thus, a comparison of the obtained data with the control revealed the advantage of complex treatment using rectal administration of FGF, which is manifested in an increase in the frequency of cure of endobronchitis, closure of decay cavities, and cessation of bacterial excretion in patients with destructive pulmonary tuberculosis with concomitant purulent endobronchitis with a shorter treatment time. The following advantages of the treatment method are its good tolerance, the absence of complications, the possibility of long-term use associated with the absence of the effect of ozone irritating the intestinal mucosa.

Claims (1)

A method for the treatment of pulmonary tuberculosis with concomitant purulent endobronchitis, including ozone therapy with antibacterial treatment, characterized in that ozone physiological solution with an ozone concentration of 5-10 μg / ml, which is administered rectally in an amount of 40 ml at a rate of 30 drops per minute, is used as ozone therapy. with an interval of 1-2 times a week for 2 months.