RU2306157C2 - Method for treating chronic pneumonia at mucoviscidosis background in children - Google Patents

Abstract

FIELD: medicine, juvenile physiotherapy.

SUBSTANCE: it is necessary to irradiate with red-infrared radiation at first from the right and from the left paravertebrally onto area from the 1^st cervical up to the 5^th sacral vertebrae for about 5-10 min, after that - onto posterior area of a patient's thorax per 3-5 min. Irradiation technique - contact, labile, daily per 10-12 procedures/course. The innovation provides rapid interruption of pulmonary inflammation, reveals pronounced secretolytic effect, high draining effect, decreased quantity of daily intake of mucolytic preparations and enzymes and prolonged terms of remission.

EFFECT: higher efficiency of therapy.

2 ex, 2 tbl

Description

The invention relates to medicine, in particular to pediatric physiotherapy, and relates to methods for treating chronic pneumonia with cystic fibrosis in children.

Cystic fibrosis is a genetically caused disease inherited by an autosomal recessive trait: one of the 20 representatives of the European race is its carrier. Cystic fibrosis is a systemic pathology of exocrine glandular tissue. It is accompanied by sinusitis, adenoids of the nasal cavity, hyperglycemia, pancreatic insufficiency and bronchiectasis. In this case, damage to the respiratory organs proceeds in the form of early signs of damage to the lung tissue with the development of bronchiectasis. Such children often already in the first years of life have chronic pneumonia, which is constantly accompanied by decompensation of respiratory function due to insufficiency of enzymes that thin the sputum, and must constantly receive enzyme preparations both orally and by inhalation.

A known method of treating chronic pneumonia against the background of cystic fibrosis by aerosol therapy of enzymes that thin the sputum (N - acetylcysteine) and chest vibration massage. The patient is inhaled with N - acetylcysteine for 7-10 minutes (depending on age) daily, up to 15 -20 procedures [1]. On the same day, chest vibro massage is performed after inhalation in a draining position [2].

However, this method is not effective enough, because Allows you to only reduce the viscosity of sputum and remove it for a period while the procedure is performed, since the function of exocrine glands is insufficient. After the cessation of treatment, the viscous secretion in the bronchi again accumulates. There is again a need for the appointment of procedures and the appointment of enzyme preparations in a constant mode.

Also known is a method of treating chronic pneumonia with bronchiectasis in adults and children, which consists in the introduction of pancreatin 2-3% according to the transverse procedure on the chest above the focus of bronchiectasis with a current strength of up to 10 mA for 10-15 minutes, a course of 10-15 daily procedures [ 3].

However, this method is also not effective enough, because:

- Inhalation of enzymes must be carried out up to 2-3 times a day, despite the fact that enzymes are administered orally.

- local effects on the outbreak of chronic pneumonia have only a local effect during the vacation procedures.

- the preventive effect of the procedures is short-term (up to 2-3 weeks).

The objective of the invention is to increase the effectiveness of the treatment of chronic pneumonia against the background of cystic fibrosis in children while reducing the aerosol therapy of enzymes, reducing the number of ingestion of enzymes, improving the drainage function of the bronchi, reducing the number of relapses of chronic pneumonia. In addition, treatment can be carried out regardless of the period of the disease.

The problem is achieved by using the influence of a physical factor, which is prescribed in the form of red-infrared radiation, first right and left paravertebrally to the region from 1 cervical to 5 sacral vertebrae for 5-10 minutes, and then to the back surface of the chest for 3- 5 minutes of contact, labile, daily for 10-12 procedures per course.

The method has a segmental-reflex effect on the glands that produce exocrine secrets that contribute to liquefaction of sputum; increases nonspecific resistance of systemic and local immunity, which helps to improve drainage of the bronchi, relief of inflammatory phenomena in the lungs.

The selection criteria of the proposed method was the safety and high efficiency of light therapy that improves microcirculation due to the activation of biological cell membranes. In this case, the energy conversion of quanta of red and infrared radiation ends with the formation of high-frequency currents of nerve cells (namely in neurons), which restores functional impairment. An increase in the metabolism of all types of metabolism enhances vascular and epithelial permeability, which in turn contributes to a secretolytic effect, an improvement in the drainage function of the pulmonary tree, and resorption of swelling at local foci. As a result, general and local resistance increases due to the normalization of the neurohumoral response mechanism [4].

In addition, the use of light therapy is possible at an early age, as these factors are part of the natural light flux. The proposed method of exposure in patients with chronic pneumonia on the background of cystic fibrosis is pathogenetically substantiated, since the effect is on exocrine glands through reflex-segmental effects, normalizing their functional state.

The use of illumination of the segmental-reflex zones paravertebrally in combination with the illumination of the posterior surface of both lungs allowed to obtain a new result:

1. Stimulated neurohumoral mechanism for the production of exosecrets that contribute to the fluidizing effect of sputum (the amount of protein in sputum is 2.3 times lower compared to the prototype).

2. Increases the drainage function of the mucous membrane of the respiratory tract compared with the prototype (mucociliary clearance is 17.8 minutes versus 34.6 minutes in the prototype).

3. The possibility of more rapid relief of the inflammatory process by the 6-7th procedure.

4. Significantly increase the period of the inter-relapse period: up to 7-8 months, which is more than 7 times more compared to the prototype.

5. The decrease in the number of inhalations of mucolytics per day (1 time in 1-2 days, and not 2 times a day compared with the prototype).

EXAMPLE 1. Sergey Karganeev, 9 years old, medical history No. 45.

He entered the department with a diagnosis of cystic fibrosis, pulmonary form; complications: chronic pneumonia in the form of bilateral bronchiectasis, a period of incomplete remission. Concomitant diseases: chronic rhinosinitis, a period of incomplete remission. From the anamnesis it is known that a child from the first months of life suffers from obstructive bronchitis, which up to 3 years required intensive care. At 3 years old, he was diagnosed with cystic fibrosis, for which he regularly receives mucolytics in the form of inhalations of N - acetylcysteine 10% solution 2 times a day (morning and evening), during the exacerbation 3 times, in addition, he regularly receives 50 mg orally 4 once a day. At the same time, 3-4 times a year (in spring, winter and autumn) there is an exacerbation of the pneumatic process, and therefore receives antibiotics for 2 weeks (maxipim, fluimucil, cephalosporins). On admission, marked intoxication is noted in the form of orbital cyanosis, pallor of the skin, general decreased activity, poor appetite; constant coughing of an unproductive character (in the morning the cough is more pronounced, the amount of sputum increases to a tablespoon of a purulent nature of a thick consistency). During auscultation, moist and crepitating wheezing of a constant nature is heard over the projection of the middle lobes of both lungs. Before treatment, studies of mucociliary clearance revealed an increase of up to 28 minutes (at a rate of 14.7 ± 1.1 minutes, P <0.001); the amount of total protein in nasal secretion was 3.7 mg / ml (at a rate of 1.22 ± 0.09 mg / ml P <0.001); the concentration of total protein in sputum is 4.3 mg / ml (with a norm of 1.77 ± 0.15 mg / ml P <0.001). The number of neutrophils in sputum smears exceeded the norm tenfold: 56% with a norm of 2.2 ± 0.6% (P <0.001). Phenomena of obstruction were revealed during a functional study of the spirogram, in which there was a decrease in VC to 68.8% (with a norm of 93.4 ± 1.7%, P <0.001); FEV - 72.3% (with a norm of 90.7 ± 1.4% P <0.001); MVL - 69.7 (with a norm of 89.2 ± 1.4, P <0.001). Treatment was prescribed in accordance with the claimed method, according to which light therapy was carried out from the apparatus by red-infrared radiation: from the right and left paravertebrally from 1 cervical to 5 sacral vertebrae for 5 minutes, after which 3 minutes on the back surface of the chest were contacted, labile, daily for 10 treatments per course. After the 5th procedure, coughing became rare, sputum less viscous, the amount decreased by 2 times, its nature became mucous. When examining the indicators after the end of the course of treatment, significant positive dynamics were revealed: mucociliary clearance was 18 minutes, the concentration of total protein in nasal secretion was 2 mg / ml, and in sputum it was 2.6 mg / ml; the number of neutrophils decreased to 10%; spirogram indicators were determined: VC - 88%, FEV - 85%, MVL - 80%. The follow-up test showed that remission lasted 8 months, with mucolytics inhaled once every 2 days, their ingestion was limited to two doses of 50 mg. With an exacerbation of the process in late autumn, the boy received 1 course of kefzol for 7 days, and then was transferred to the rehabilitation department according to the proposed treatment regimen according to the claimed method. Symptoms were stopped by procedure 8.

EXAMPLE 2. Semenova Marina is 11 years old. Case history No. 89. Was admitted to the department with a diagnosis of cystic fibrosis, pulmonary form; complications: chronic pneumonia in the form of bronchiectasis of the middle lobe of the left lung, a period of incomplete remission. Concomitant diseases: chronic rhinosinitis, complete remission, chronic compensated tonsillitis. From the anamnesis it is known that the girl was born from a normal pregnancy, on time, was breastfed for up to 12 months. At the age of 14 months, she first became ill with a viral infection, which was complicated by obstructive bronchitis, which could not be stopped for a long time. After this episode, bronchitis became constantly ill with bronchitis, which 2 times a year was complicated by pneumonia in the left lung. At 4 years old, he was diagnosed with cystic fibrosis, when he was diagnosed with chronic pneumonia of the middle lobe of the left lung in the form of bronchiectasis. In subsequent years, the girl received treatment annually for exacerbation of chronic pneumonia with antibiotics up to 3-4 courses. In the treatment of the underlying disease, she constantly received mucobene 4 times a day, N-acetylcysteine in the form of inhalation 2 times a day,

On admission, a frequent cough was observed with a purulent sputum, especially in the morning. During auscultation in the middle lobe of the left lung, small bubbling and crepitating wheezing of a constant nature were heard, over which the blunting of percussion sound was determined. Studies of protein in nasal secretions revealed a high concentration: 4.8 mg / ml, in sputum - 6.1 mg / ml, the number of neutrophils in sputum was 43%. Mucociliary clearance was 31 minutes. Spirography data showed a significant decrease in VC (62.4%); FEV (69.8%); MVL (66%), the girl underwent a course of procedures according to the claimed method, according to which red-infrared light therapy was carried out on the right and left paravertebrally from 1 cervical to 5 sacral vertebrae for 10 minutes, after which 5 minutes on the back of the chest , contact, labile, daily only 12 procedures. After the treatment, a significant reduction in cough was noted: it persisted only in the morning, while sputum was sanitized by the 7th procedure, it was less dense. When studying the secrets revealed: the concentration of total protein in nasal mucus decreased to 2 mg / ml; in sputum - up to 2.6 mg / ml; the number of neutrophils in sputum was detected - 10%; mucociliary clearance was 20 minutes. Functional tests showed an improvement in performance: VC - 89%; FEV - 87%; MVL - 83.4%. In the lungs auscultation, there were single small-bubbling and crepitating rales in the middle lobe of the left lung. After the 6th procedure, the girl began to receive inhalations of bronchodilators 1 time per day, and after the course of treatment - 1 time in 3 days. Ingestion was canceled completely. Catamnesis showed that an exacerbation of the pulmonary process took place only after 7 months, which was treated with a 7-day course of Biseptol-480, and then the treatment method was applied according to the proposed method of light therapy. At the end of which the subsequent remission was 6 months. At the same time, the girl received bronchodilator drugs only inside 2 times a day.

Under observation were 52 children aged 8 to 12 years with a diagnosis of the main: pulmonary cystic fibrosis. Complications: chronic pneumonia in the form of bronchiectasis in the period of incomplete remission. Before and after treatment, each patient underwent a study of factors of nonspecific protection of nasal secretion and sputum: protein concentration, mucociliary clearance, the number of neutrophils in sputum (N), as well as spirography data with the most dynamic indicators: vital lung capacity (VC), forced expiratory volume (FEV), maximum ventilation of the lungs (MVL). The results showed that the proposed method has a pronounced drainage and anti-inflammatory effect on the mucous membrane of the respiratory tract throughout (Table 1 and 2). The above indicators of the dynamics of non-specific factors of protection of local immunity and functional tests before and after treatment clearly indicate the pronounced corrective effect of the proposed method, which is expressed in a decrease in the viscosity of the respiratory secretion by reducing the amount of total protein and normalizing mucociliary clearance (table 1), as well as improving indicators functional tests of the spirogram (table 2). For comparison, indicators of nonspecific protection and functional tests of the main and control groups are presented. The main group included 28 children with chronic pneumonia on the background of cystic fibrosis who received treatment by the present method. The control group included 25 children with the same pathology who received treatment according to the prototype. As can be seen from table 1, the concentration of total protein in nasal secretion and sputum under the influence of light therapy is almost normalized against the background of the restoration of secrets in the form of a decrease in the number of neutrophils in sputum. At the same time, lung function indices reach age standards (table 2), which proves the pronounced secretolytic, draining effect of the proposed method.

The effect of the proposed method, consisting in the following:

1. Quick relief of the inflammatory process in the lung.

2. A pronounced secretolytic effect with a significant dilution of sputum.

3. High drainage effect of the bronchial tree.

4. Reducing the amount of daily intake of mucolytics and enzymes inside and inhalation.

5. An increase in the duration of remission of a chronic inflammatory process.

6. Significant improvement in lung function.

Table 1
Non-specific protective factors before and after treatment Indicator Before treatment After treatment Main group Control group Main group Control group Total nasal secretion protein (norm 1.22 ± 0.09 mg / ml) 4.6 ± 1.2 4.8 ± 1.4 2.1 ± 0.4 * 4.3 ± 1.2 Total sputum protein (normal 1.77 ± 0.15 mg / ml) 5.5 ± 0.9 5.2 ± 0.8 2.6 ± 0.7 * 4.4 ± 0.7 Sputum neutrophils (norm 2.2 ± 0.6%) 59.8 ± 1.8 54.6 ± 2.1 19.4 ± 0.9 * 44.3 ± 2.1 Mucociliary clearance (norm 14.7 ± 1.1 minutes) 35.4 ± 2.3 36.0 ± 3.1 20.1 ± 1.2 * 29.9 ± 3.5 Note: * significant change in the indicator at P <0.001

table 2
Functional indicators of the lungs before and after treatment Indicator Before treatment After treatment Main group Control group Main group Control group VC (norm 93.4 ± 1.7%) 66.6 ± 1.3 68.6 ± 1.3 88.7 ± 1.5 * 72.1 ± 2.3 FEV (norm 90.7 ± 1.4%) 70.4 ± 0.6 72.3 ± 1.2 86.7 ± 1.4 * 75.8 ± 2.1 Ministry of Internal Affairs (norm 89.2 ± 1.4%) 67.8 ± 0.9 69.7 ± 1.3 79.8 ± 2.1 * 72.1 ± 1.5 Note: * significant difference at P <0.001

Information sources

1. Obrosov AN, Karachevtseva T.V. Guidelines for physiotherapy and physioprophylaxis of childhood diseases, M .: Medicine, 1987, p.208.

2. Tatochenko V.K. For every day pediatrician - 2002, M., 2002, p. 141.

3. Sosin I.N., Tondiy L.D. Clinical Physiotherapy, Kiev: Health, 1996, p. 70.

4. Zhukovsky V.D. Quantum therapy is 21st century medicine. Materials of the 2nd All-Russian Conference on MIL Therapy, M., 1995, pp. 10-14.

Claims (1)

A method for the treatment of chronic pneumonia against the background of cystic fibrosis in children, which consists in the action of a physical factor, characterized in that the specified effect is prescribed in the form of red-infrared radiation, first right and left paravertebrally to the area from 1 cervical to 5 sacral vertebrae for 5-10 minutes, then on the back surface of the chest for 3-5 minutes, contact, labile, daily, 10-12 procedures per course.