RU2290201C1 - Method for treating acute purulent-destructive pulmonary diseases - Google Patents

Abstract

FIELD: medicine, resuscitation, thoracic surgery, pulmonology.

SUBSTANCE: the present innovation refers to detoxication methods and could be applied at treating acute purulent-destructive pulmonary diseases. After sanitation of purulent focus it is necessary to introduce perorally Reaferon-EC-Lipint at the dosage of 10000-15000 U/kg. After that, one should sample blood followed by extracorporal treatment of leukocytes with immunophan. Then treated leukocytes should be intravenously injected for a patient by drops. Starting since the next day it is necessary to introduce Reaferon-EC-Lipint again perorally at the dosage of 10000-15000 U/kg once daily. Therapy course should last for 5 d. The innovation enables to increase efficiency in treating acute purulent-destructive pulmonary diseases and, also, prevent septic complications in patients at such a pathology due to correcting immune state in patients by normalizing cellular phagocytic link and decreasing the circulating immune complexes.

EFFECT: higher efficiency of therapy.

3 ex, 1 tbl

Description

The invention relates to medicine, namely to anesthesiology-resuscitation, breast surgery, pulmonology and detoxification methods, can be used in the treatment of acute purulent-destructive lung diseases of various etiologies.

Known methods of treating acute purulent-destructive pulmonary diseases, which are as follows: sanitization of the purulent foci, antibiotic therapy, hormone therapy with glucocorticosteroids, anti-inflammatory, desensitizing, diuretic therapy (Kolesov A.P. et al. Clinic, diagnosis and treatment of lung anaerobic abscesses and // Bulletin of surgery.-1984. - No. 1. - P.17-22; Muromsky Yu.A. et al. Purulent-destructive pulmonary diseases and modern principles of their treatment // Surgery. - 1986. - No. 12. - C .3-13; Grigoryeva E.G. et al. t. Treatment of acute complicated lung abscesses // Bulletin of surgery. - 1987. - No. 8. - 14-17).

The disadvantages of these methods is that they do not take into account the development of cellular T-immunodeficiency in infectious patients and inhibition of the phagocytic activity of neutrophils and macrophages, and do not include immunomodulators in the complex treatment (Alsynbaev MM et al. Use of leukocyte interferon and immunoglobulins as immunomodulators in the complex treatment of patients with purulent-septic surgical infection / Medical immunology. - 2002. - T.4. - No. 2. - P.345).

Closest to the proposed is a Method for the treatment of acute destructive pneumonia in children (Patent No. 2077335, C1, 04/20/1997), which consists in administering reaferon in a daily dose of 50,000 IU / kg in two doses in the form of inhalation and / or endobronchial and after 12 hours. rectally in combination with intravenous administration of unitiol. However, this method is intended for the complex treatment of sick children. Its disadvantage is the short period of action of reaferon solution 4-12 hours

The objective of the invention is to increase the effectiveness of the treatment of acute purulent-destructive pulmonary diseases and the prevention of septic complications in patients with acute purulent-destructive pulmonary diseases.

The task is achieved due to the fact that additionally after sanitizing the purulent lesion, patients are orally administered Reaferon-EU-Lipint at a dose of 10,000-15,000 IU / kg, then blood sampling and extracorporeal treatment of leukocytes with immunofan are followed, followed by intravenous drip of leukocytes and from the next day they are administered orally Reaferon-EU-Lipint at a dose of 10000-15000 IU / kg once a day for 5 days.

The method is as follows. After rehabilitation of a purulent lesion in the lungs, a patient with acute purulent-destructive pulmonary disease in the lungs is administered Reaferon-EU-Lipint at a dose of 10,000-15,000 IU / kg, then an extracorporeal treatment of leukocytes with immunofan is performed. Blood sampling from a patient's vein is carried out in an amount of 400-500 ml. Vials with exfused and heparinized blood are centrifuged for 15 min at a speed of 2000 rpm, after which the plasma is exfused. A leukocyte film is collected in a sterile vial and diluted with 0.9% - 200-250 ml NaCl solution and 199 - 200-250 ml medium, red blood cells are returned to the patient, 75-125 μg immunofan per 1 × 10 ⁹ leukocytes are injected into the vial; the resulting solution is incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution is removed from the vials to a white blood cell film, then the white blood cells are washed 3 times with a sterile NaCl solution of 0.9% - 390-485 ml, washed leukocytes are diluted with 0.9% NaCl - 50-100 ml and intravenously administered to the patient. In a subsequent patient, Reaferon-EC-Lipint is administered orally at a dose of 10000-15000 U / kg once a day for 5 days.

Comparison of the treatment results (see table) of the experimental (with Reaferon-EU-Lipint and extracorporeal treatment of leukocytes with Imunofan) and control (by the known method) groups shows that the use of Reaferon-EU-Lipint with extrocarporal treatment of leukocytes with Imunofan reduces the duration of treatment by 1 , 6-1.7 times, reduce the total number of complications and reduce mortality in patients with acute purulent-destructive lung diseases of various etiologies by 2 times.

Results of treatment of patients with acute destructive pulmonary diseases

Table Group, n Bed day, days Complications,% Mortality,% Control, 30 patients 62.4 ± 1.1 56.7 ± 4.7 13.3 ± 0.87 Researched. 30 patients 37.6 ± 2.48 28.3 ± 3.3 6.7 ± 0.96 p <0.001 <0.001 <0.001

Clinical example 1. Patient A., 49 years old, was admitted to thoracic surgery on 03.20.03. with Diagnosis: Acute abscess of the upper lobe of the right lung. Type II diabetes mellitus, in the stage of subcompensation.

For 2.5 weeks was on outpatient treatment, without effect. The patient was admitted in serious condition with symptoms of respiratory failure, intoxication, cough with sputum up to 50 ml of a purulent character. In the analyzes of Hb - 105 g / l; white blood cells - 9.7 × 10 ⁹ ; ESR - 50 mm / hour; protein - 60 g / l; sugar - 20 mmol / l. Radiographically on the right in the upper lobe of S2-3 is a cavity of 5 × 6 cm with a fluid level with severe perifocal inflammation. The patient underwent clinical and radiological - bronchological examination, bacteriological examination of sputum and sensitivity to antibiotics, the study of the immune status. Conservative complex therapy has begun. Given the patient’s condition, Reaferon-EU-Lipint 10,000 thousand units / kg was orally administered to him after sanitation of a purulent lesion in the lung and an extracorporeal treatment of leukocytes with immunofan was performed. After blood sampling from the patient's vein in an amount of 400 ml, the vials with exfused and heparinized blood were centrifuged for 15 min at a speed of 2000 rpm, after which the plasma was exfused. A leukocyte film was collected in a sterile vial and diluted with 0.9% - 200 ml NaCl solution and 199-200 ml medium, erythrocytes were returned to the patient, 75 mcg immunofan per 1 × 10 ⁹ leukocytes was introduced into the vial; the resulting solution was incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution was removed from the vials to a white blood cell film, then the white blood cells were washed 3 times with a sterile solution of 0.9% - 390 ml NaCl, the washed white blood cells were diluted NaCl 0.9% - 50 ml and was administered intravenously to the patient. In the next 5 days, the patient was orally administered Reaferon-EC-Lipint at a dose of 10,000 units / kg.

After a complex immunotherapy session on day 10, the patient's well-being and general condition improved, sputum stopped (dry cough persisted), the temperature returned to normal, LII returned to normal, ESR decreased, and sugar was within the physiological norm. Radiologically, the cavity is dry with slight perifocal inflammation. In the immune status, normalization of the cell phagocytic link with a decrease in circulating immune complexes. The patient was discharged on the 30th day in a satisfactory condition. Radiological outcome of the cavity in pneumosclerosis.

Clinical example 2. Patient B., 40 years old, was admitted to thoracic surgery on 02/05/03 with a diagnosis of Acute total metapneumonic empyema of the pleura on the left with bronchopleural fistula.

Prior to admission, she was treated in the therapeutic department for 2 weeks for pneumonia, comprehensive therapy was carried out, but the course of pneumonia was complicated by pleural empyema. The patient was sent to a specialized department. Received in serious condition with a body temperature of up to 39 ° C severe intoxication, cough with purulent sputum in an amount of up to 200 ml / day. In the analyzes of Hb - 102 g / l; white blood cells - 10.0 × 10 ⁹ / l; ESR-53 mm / hour; protein-58 g / p. Clinical x-ray, bronchological studies, bacteriological studies of sputum and sensitivity of the selected microflora to antibiotics were performed upon admission. Conservative complex treatment was carried out. On an emergency basis: Thoracocentesis. Bulular drainage of the pleural cavity. A study of the immune status was performed - there was a secondary immunodeficiency with depression of the phagocytic link. Given the patient’s condition, Reaferon-EU-Lipint 13000 thousand units / kg was orally administered after the purulent lesion was sanitized and an extracorporeal treatment of leukocytes with immunofan was performed. After blood sampling from a patient's vein in an amount of 450 ml, the vials with exfused and heparinized blood were centrifuged for 15 min at a speed of 2000 rpm, after which the plasma was exfused. A leukocyte film was collected in a sterile vial and diluted with 0.9% - 225 ml NaCl solution and 199-225 ml medium, red blood cells were returned to the patient, 100 mcg immunofan per 1 × 10 ⁹ leukocytes was introduced into the vial; the resulting solution was incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution was removed from the vials to a white blood cell film, then the white blood cells were washed 3 times with a sterile NaCl solution of 0.9% - 435 ml, the washed white blood cells were diluted NaCl 0.9% -75 ml and the patient was injected intravenously. In the next 5 days, the patient was orally administered Reaferon-EC-Lipint at a dose of 13000 U / kg.

The patient spent 3 sessions of extracorporeal immunocorrection with immunofan for 7 days. Against the background of the therapy, the patient's condition improved: the temperature returned to normal after 2 sessions, the state of health improved, and the general condition. In Hb analyzes, 16 g / l, white blood cells - 6.9 × 10 ⁹ / l; ESR-27 mm / hour. After immunocorrection, a decrease in LII was noted, the ratio of cell subpopulations of lymphocytes and T-lymphocytes, activation of the phagocytic link was normalized. The fistula closed independently, drainage from the pleural cavity was removed on the 15th day. The outcome of empyema in pleural overlays. The patient was discharged on the 38th day from the hospital in satisfactory condition.

Clinical example 3. Patient V., 41 g was admitted to thoracic surgery 10.10.02, with a diagnosis of Gangrene of the right lung. Sick for a week for medical help did not apply. Received in extremely serious condition with severe intoxication syndrome, respiratory failure, temperature up to 39 ° C, cough with purulent sputum up to 500 ml. In the analyzes of Hb - 89 g / l; white blood cells - 15 × 10 ⁹ / l; ESR - 56 mm / hour; protein - 55 g / l. Clinical-radiological, bronchological studies were carried out, sputum was tested for microbial flora, sensitivity to antibiotics, the patient's immune status was studied. A comprehensive conservative therapy has begun, including the rehabilitation of a purulent focus. Then, given the patient’s condition, Reaferon-EU-Lipint 15,000 thousand units / kg was orally administered to her and a session of extracorporeal treatment of leukocytes with immunofan was performed. After blood sampling from the patient's vein in an amount of 500 ml, the bottles with exfused and heparinized blood were centrifuged for 15 min at a speed of 2000 rpm, after which the plasma was exfused. A leukocyte film was collected in a sterile vial and diluted with 0.9% - 250 ml NaCl solution and 199-250 ml medium, red blood cells were returned to the patient, 125 mcg immunofan per 1 × 10 ⁹ leukocytes was introduced into the vial; the resulting solution was incubated for 90 min at 37 ° C, then centrifuged again for 15 min at a speed of 2000 rpm, the solution was removed from the vials to a white blood cell film, then the white blood cells were washed 3 times with a sterile NaCl solution of 0.9% - 485 ml, the washed white blood cells were diluted NaCl 0.9% - 100 ml and the patient was injected intravenously. In the next 5 days, the patient was orally administered Reaferon-EC-Lipint at a dose of 15,000 U / kg.

The patient within 3 days had 3 sessions of extracorporeal immunocorrection with immunofan. After the immunocorrection, the patient's condition improved, the temperature became subfebrile (normalized on the 10th day after the correction), the amount of sputum decreased to 100 ml, it became more mucous (completely stopped on the 25th day after the correction), normalization of LII, and a decrease in ESR were noted. In the immune status, normalization of indicators of the cellular and phagocytic link. The patient was discharged on the 25th day in satisfactory condition, the outcome in pulmonary pneumosclerosis.

The proposed method allows to reduce the duration of treatment by 1.6-1.7 times, reduce the total number of complications and reduce the mortality of patients by 2 times.

Claims (1)

A method for the treatment of acute purulent-destructive pulmonary diseases, including sanitation of a purulent lesion in the lungs, characterized in that, after sanitizing a purulent lesion, patients are orally administered Reaferon-EU-Lipint at a dose of 10,000-15,000 IU / kg, then blood sampling and extracorporeal treatment of leukocytes are performed Imunofan followed by intravenous drip of leukocytes, and from the next day Reaferon-EU-Lipint is administered orally at a dose of 10000-15000 U / kg once a day for 5 days.