RU2289407C2 - Method for achieving rapid relief of cardiovascular insufficiency symptoms in treating pneumonia cases - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves applying drug therapy for improving respiratory and cardiac activity. Antibiotics are administered in single age-specific dose dissolved in 0.5% Novocain solution into one of spinal processes of VII-XI thoracic vertebra. No inflammatory process reduction being observed, the procedure is repeated 1-2 times during 2-3 days, making injection into a spinal process of lower vertebra relative to the vertebra used for making injection in previous time. To fix the result, one more injection is done 1-2 days later after the last procedure.

EFFECT: reduced number of lethal outcomes; accelerated process for helping patients out of critical state.

2 cl, 9 dwg

Description

The present invention relates to medicine, namely to pulmonology, and can be used to treat pneumonia with complications.

In complicated pneumonia, there is cardiovascular and respiratory failure due to foci in the lung tissue, as well as a limitation of chest excursion due to pain when the pleura is involved in the inflammatory process. The need for an immediate withdrawal of the patient from this condition is explained by the fact that increasing respiratory and cardiovascular failure can lead to death.

Antibacterial drugs are currently used to remove the patient from the state of respiratory and cardiovascular insufficiency, as well as to stop the inflammatory process in complicated pneumonia, along with drugs that improve respiratory and cardiovascular insufficiency.

Intramuscular, intravenous administration of antibiotics due to circulatory disorders does not reach the lesion with a sufficient concentration. The drugs currently available, with their traditional introduction, do not always lead to an improvement in the respiratory excursion of the chest.

For the prototype, a method was selected for removing from the state of respiratory and cardiovascular insufficiency, namely, that drugs are administered intravenously, leading to an improvement in respiratory, cardiovascular insufficiency, and the administration of antibiotics in shock doses ("Surgical lung diseases in children." Rokitsky M. R. Medicine. 1988). However, this method has the following disadvantages:

- a sufficiently long removal from the state of respiratory and cardiovascular failure (within a few days)

- with this method of treatment it is impossible to quickly improve the respiratory excursion of the chest, thereby ensuring oxygenation of the body, and it is also impossible to quickly stop the inflammatory process

- longer overall treatment period (several weeks)

- high percentage of deaths (up to 80% according to Yudin LB)

The objective of the invention is:

- reduction in the number of deaths

- reducing the time to remove from the state of respiratory and cardiovascular failure to several minutes, in the prototype - after a few days)

- reduction of the total treatment time.

The task is achieved in that a single age-related dose of the antibiotic is dissolved in a 0.5% solution of novocaine and injected into one of the spinous processes of the VII-XI thoracic vertebra, in the absence of a decrease in the inflammatory process within 2-3 days, the procedure is repeated 1-2 times.

A new technical result is that:

- mortality is reduced from 80% to 2.4% (out of 41 treated patients, 1 death was observed)

- the period of elimination from the state of respiratory and cardiovascular failure is reduced

- reduced overall treatment time.

To substantiate the proposed method, a series of animal experiments was carried out, in which the rate of drug administration to the vessels of the lungs and heart was compared for various injections: intravenous, injection into soft tissues, introduction to the spinous processes of the thoracic and lumbar spine.

The experiment was conducted on 10 rabbits of three-, four-month-old age of the chinchilla breed, which were injected with an oil solution of iodipol. At the same time, the authors expected that its administration would lead to fat embolism in the vessels of the lungs and heart, depending on the route of administration. X-ray examination allowed to determine the accumulation of contrast medium. For rabbits, all rabbits were sedated with a 1% solution of promedol in a dose of 1.0 ml.

Figure 1 shows the x-ray of the rabbit (without number) without the introduction of contrast. Panoramic x-ray of the chest and abdominal cavity.

Figure 2 shows the x-ray of rabbit No. 000 with the introduction of iodlipol. The vessels of the rabbit’s ear are filled with contrast medium and, in a small amount, the cavity of the heart and liver.

Figure 3 shows the x-ray of rabbit No. 001. Filling of the vessels of the lungs with contrast medium, a vessel leaving the vena cava fills the vessels of the right kidney, liver.

Figure 4 shows the x-ray of rabbit No. 002, side view. The contrast vessels continue to fill the vessels of the lungs.

Figure 5 shows the x-ray of rabbit No. 003, side view. The vessels of the heart and lungs, the cavity of the heart in the form of a spherical shape are traced.

Figure 6 shows the x-ray of rabbit No. 004. Contrast is observed in the form of a chain along the inner surface of the heart cavity.

Figure 7 shows the x-ray of rabbit No. 189. The needle located in the spinous process of the thoracic vertebra X is visible. The contrast is around IX-X-XI of the thoracic vertebrae, the vessels of the lungs and the heart are traced.

On Fig, 8a shows the x-ray rabbit No. 289 (front and side projection). The vessels of the lungs and the heart are contoured. Needle with contrast in the X thoracic vertebra. The contrast goes to the small vessels around the vertebral column of the IX-X-XI vertebrae and the intercostal vessels.

Figure 9 shows the x-ray No. 323. Contrast in the soft tissues of the spinal column.

Experience No. 1.

Before the introduction of contrast produced control x-ray of the chest. The pulmonary fields are transparent. The shadow of the mediastinum is visible (Figure 1).

4.0 cm of iodlipol was introduced into the right vein of the rabbit's ear. At the same time, we calculated that the oil solution would cause fat embolism primarily in the organ, which it reaches faster.

In the first minute after the introduction of iodlipol on the x-ray of the chest 000 (Figure 2) and the rabbit’s ear, it is seen that the vessels of the rabbit’s ear are filled with contrast medium. In a small amount, the contrast is in the cavity of the heart, liver. The rabbit's behavior is calm, with no signs of shock or fat embolism.

After 18 minutes on the radiograph 001 (Figure 3), the vessels of the lungs begin to fill with contrast; from the vena cava, the outgoing vessel fills the vessels of the right kidney, liver. The behavior of the rabbit is calm. There are no signs of shock, fat embolism. After 23 minutes (x-ray 002 (Figure 4), side view), the pulmonary vessels continue to be filled with contrast medium. The condition of the rabbit remains the same.

After 35 minutes (x-ray 003 (Figure 5), side view), not only the blood vessels of the heart, but also its cavities begin to be traced in the form of a contour of a spherical shape.

After 1 hour (x-ray 004 (Fig.6)) there is an accumulation of contrast in the form of a chain on the inner surface of the heart cavity. The state of the rabbit in the dynamics: anxiety, convulsive twitching, death.

Conclusion: with intravenous administration of iodlipol, the accumulation of the oil component in the vessels of the heart, lungs, leading to death due to fat embolism, occurs no earlier than 1 hour.

Experience No. 2.

Into the spinous process of the thoracic vertebra X, 2.0 cm of iodlipole was introduced through a thin needle. On the chest x-ray 189 (Fig. 7), immediately after the injection of the solution, a needle is located in the spinous process X of the thoracic vertebra. Contrast material is located around the IX-X-XI vertebrae. Well traced vessels of the lungs, heart. A sharp motor anxiety of the animal due to fat embolism of the vessels of the lungs and heart is observed. After 5 minutes, a fatal outcome occurred.

On the radiograph 289 (Fig. 8, 8a, a direct and lateral projection) of the chest with the capture of the abdominal cavity, the blood vessels of the lungs and the heart are well contoured. Needle in the spinous process of the X thoracic vertebra. The contrast goes to the small vessels around the vertebral column of the IX-X-XI vertebrae and fills the intercostal vessels.

Compared with previous experience, fat embolism in the vessels of the lungs, the heart occurs 12 times faster.

Experience No. 3.

4.0 ml of iodlipol was introduced into the soft tissue around the X thoracic vertebra. Observation of the animal was carried out for 1.5 hours. During the observation period, no reaction indicating a fat embolism was observed. The rabbit was withdrawn from the experiment by an air embolism in the marginal vein of the ear.

On x-ray 323 (Figure 9), a contrast agent is observed in the soft tissues around the spinal column. In the vessels of the lungs, heart, abdominal cavity there is no contrast. This experience confirms that there is no absorption of the oil solution and its distribution through the bloodstream during intramuscular administration.

Thus, based on the experiments, we can conclude that:

1) with the intravenous administration of iodlipol, its slow accumulation (within an hour) in the vessels of the lungs and heart occurs. When it is introduced into the soft tissues, it reaches the vessels of the lungs, there is no heart;

2) with the introduction of iodlipol in the spinous processes of the thoracic spine compared with intravenous administration, the delivery to the vessels of the lungs and heart is accelerated by 12 times;

3) with the introduction of a contrasting oil solution into the spinous processes of the thoracic spine, its accumulation in the vessels of the heart and lungs is accelerated by 12 times compared with intravenous.

Thus, for the first time on the basis of experimental studies, it was shown that the accumulation of the control substance when introduced into the spinous processes of the spine in the vessels of the lungs and heart will accelerate by 12 times compared with its intravenous, intramuscular injection.

It has been clinically established that the method of administering antibiotics in a 0.5% solution of novocaine to the spinous processes of the thoracic spine allows to reduce the percentage of deaths and reduce the treatment time for complicated pneumonia.

The proposed method is as follows.

When a state of cardiovascular and respiratory failure occurs, which in the traditional method of treatment leads to death in 80% of cases, along with antibiotic therapy, the introduction of drugs that improve respiratory and cardiovascular failure, they perform manipulation: the antibiotic is introduced into the spinous processes of the thoracic vertebrae dosage corresponding to age, in a 0.5% solution of novocaine (novocaine in a 0.5% concentration allows for an analgesic effect and to provide a better excursion of the chest).

The position of the patient on his side, with knees bent to the abdomen in order to better contour the spinous process of the thoracic spine. The initial introduction begins with the overlying spinous process, i.e. VII thoracic vertebra. (An introduction to these spinous processes is explained by the fact that venous outflow to the lungs is carried out from them). A needle is usually used for intramuscular administration of drugs, but always with a mandrin to ensure that the lumen of the needle is not clogged with bone tissue. With light rotational movements, the needle is inserted into the spinous process, and a slight failure is felt when passing through the compact layer. When you pull the piston toward yourself, blood appears in the lumen of the syringe. A solution of 0.5% novocaine with antibiotics without effort is slowly introduced into the spinous process.

At the same time, the number of breaths per minute decreases, the excursion of the chest increases.

With local summing up of antibiotics, a quick regression of the inflammatory process in the lung tissue begins.

If the inflammatory process does not decrease within 2-3 days, the administration of antibiotics with novocaine is carried out in the underlying process, i.e. in the spinous process of the VIII thoracic vertebra. (Each subsequent introduction is carried out in the underlying process, since re-introducing the needle into the same place is undesirable).

In addition to the manipulation performed in especially severe cases, in order to consolidate the effect, after 1-2 days the antibiotic is reintroduced into the underlying spinous process.

Example.

Extract from the medical history No. 11243 from DKB.

Pirozhkova Irina Nikolaevna, 12 years old.

The patient was hospitalized in the purulent surgery department from 09/19/2000 to 10/31/2000. Diagnosis: septicopyemic form of acute hematogenous osteomyelitis of multiple localization with damage to the left tibia, left and right foot bones, right clavicle, right femur; bilateral metastatic pneumonia. The disease is 5 days old. On September 14, a rise in body temperature to 39 ° C was observed. There were pains in the left foot. From September 16, the girl stopped walking. There were pains in the left ankle joint, right clavicle. Antibacterial therapy in the RCH did not produce an effect; the child was referred to the DCH.

The condition of the child upon admission is very serious. Severe signs of respiratory, cardiovascular failure. Intoxication. Primary foci in the form of ulcers after attrition in the Achilles tendon on both sides. Hyperemia of the skin in the right clavicle. Swelling of the soft tissue in the left ankle and left lower leg. After preoperative preparation on September 19th, an operation was performed under intravenous anesthesia: decompressive osteoperforation of the left tibia, opening of abscesses of the right clavicle, left and right foot. Due to the severity of the condition, the girl was placed in the intensive care unit. In the analysis of leukocyte blood 3.3 * 10 / l, high ESR 34 mm / h, the shift of the leukocyte formula to the left. In the analysis of urine, cylindroids. On the second day, the condition improved slightly, but there were pains in the right thigh, swelling. On an emergency basis, on September 20, an operation was performed under intravenous anesthesia: opening the subperiosteal abscess of the lower third of the thigh, decompressive osteoperforation. During decompressive osteoperforations in the left tibia, in the right thigh, pus was obtained from the bone marrow canal. Staphylococcus aureus is isolated, which is sensitive to most antibiotics used. Clinically, radiologically, the girl has bilateral pneumonia. For 7 days until September 26, she was in the intensive care unit, where detoxification, desensitizing, antibacterial therapy was carried out, including local summation of antibiotics to the lesion by intracostal administration. Due to the critical condition, characterized by an increase in cardiovascular and respiratory failure, the fact that the girl has pneumonia, in order to locally bring antibiotics to the lung tissue, to improve the respiratory excursion of the chest, a solution of novocaine with ampicillin in the spinous process of the VII thoracic vertebra was started.

The phenomena of respiratory, cardiovascular insufficiency were stopped and the girl was transferred to the purulent surgery department, where treatment continues in the form of detoxification, desensitizing therapy. Due to the fact that the patient's condition improved immediately after the introduction of the antibiotic into the spinous process, it was not necessary to consolidate the result, re-introduction.

For the purpose of immune correction, interferon was administered. 05.10 - the operation of applying secondary sutures to the wound of the lower third of the right thigh was performed.

The girl is discharged in satisfactory condition.

In total, 41 patients were treated with the proposed method. The results showed that the period of elimination from the state of respiratory and cardiovascular failure, the overall duration of treatment, and the percentage of deaths are reduced.

Claims (2)

1. A method of stopping respiratory and cardiovascular failure in the treatment of pneumonia, including antibiotic therapy, the introduction of drugs that improve respiratory and cardiac activity, characterized in that the age-related dose of the antibiotic is dissolved in a 0.5% solution of novocaine and administered once or once in one of of the spinous processes of the VII-XI thoracic vertebra, or in the absence of a decrease in the inflammatory process, the procedure is repeated 1-2 times for 2-3 days, with the introduction of each time being carried out in the spinous process of the underlying chest th vertebra relative to the vertebra, which was carried out in the introduction of the previous procedure. 2. The method according to claim 1, characterized in that in addition, 1-2 days after the last procedure, one more introduction is carried out to consolidate the effect.

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