RU2318522C2 - Complex therapy method for treating children for severe mucoviscidosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves introducing ozonized physiologic saline once a day during 30 min in addition to traditionally applied drugs. The ozonized solution has ozone in concentration of 100-150 mcg/l in the amount of 100-150 ml when treating children younger than 3 years. Children being elder then 3 years, ozone concentration is 200-250 mcg/l, its amount is 200-250 ml. The total therapy course is 5 days long. The traditionally applied drugs are not to be used within 30 min before and after ozonized physiologic saline application.

EFFECT: accelerated treatment course; no antibiotics being used; reduced risk of adverse side effects.

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Description

The invention relates to medicine, namely to pediatrics.

The generally accepted treatment option for cystic fibrosis in the exacerbation period is the use of mucolytic drugs, enzymes and kinesitherapy with the mandatory inclusion of intravenous courses of antibiotics in the basic therapy (Kapranov N.I. Cystic fibrosis in children. 2003, 76 p.).

The disadvantage is that traditional treatment involves extremely aggressive and long-term antibiotic therapy in the absence of components that fundamentally affect the main pathogenetic syndromes (tissue hypoxemia and hypoxia).

In pediatrics, methods of using ozone therapy in children with appendicular peritonitis are known (Shamsiev AM, Yusupov Sh.A., Atakulov D.O. et al. Ozone therapy in the prevention and treatment of postoperative abdominal abscesses in children // Det. Surgery, 2001, No. 2 S.10-12) and in the treatment of duodenal ulcers (Shamsiev AM, Yuldashev B.A. The effectiveness of ozone therapy in children in the complex treatment of duodenal ulcers associated with helicobacteriosis // Vestnik doktora obshchestva, 1997, No. 2, p. 7-10).

However, in children suffering from cystic fibrosis, the ozone therapy method has not previously been used.

The technical result of our invention is to increase the effectiveness of complex treatment.

The technical result is achieved by the fact that additionally intravenously, within 30 minutes, 30 minutes after the introduction of basic drugs, patients under the age of 3 years old are given an ozonated solution, the ozone concentration is 100-150 μg / l with the volume of the injected solution 100-150 ml, once a day, for 5 days, for children older than 3 years, 30 minutes after intravenous administration of traditional medicines, an ozonized solution with an ozone concentration of 200-250 μg / l is introduced for 30 minutes with a volume of the injected solution of 200-250 ml once a day to rsom 5 days.

The method is as follows. The preparation of the ozone solution used for intravenous use is carried out by passing (sparging) the oxygen-ozone mixture through physiological saline. For this purpose, we used an apparatus with a low concentration and an ozone destructor AOT-N-01-AR3 TU 9444-001-075-13518-97. Certificate N ROSS RV, ME34, B00214. - for children up to 3 years, 30 minutes after intravenous administration of traditional drugs, an ozonized solution in the amount of 100-150 ml with an ozone concentration of 100-150 μg / l, 1 time per day, 5 days course is administered for 30 minutes.

For children older than 3 years, 30 minutes after intravenous administration of traditional drugs, an ozonized solution with an ozone concentration of 200-250 μg / l is administered for 30 minutes with a volume of injected solution of 200-250 ml, once a day, for 5 days.

Given the active oxidizing ability of ozone, the following rules were observed during intravenous use: medications were not used 30 minutes before the introduction of ozone and 30 minutes after the use of ozonized solutions. Transfusion of ozone was carried out for 30 minutes, because it's half-life.

Monitoring the effectiveness of ozone therapy was carried out according to the clinical parameters: decrease and normalization of temperature; improvement of well-being, positive dynamics of physical data in the lungs; change in the gas composition of the blood; achievement of remission occurred on average 3-4 days earlier than in patients who received standard therapy.

Example No. 1. Patient T., born in 2001, medical history No. 4035, was hospitalized in the CSTO No. 2 2.06.2004 - 06.06.2004

Diagnosis: Cystic fibrosis, mixed form, severe course, period of exacerbation. Chronic deforming bronchitis. Pulmosclerosis. Emphysema. Syndrome of malabsorption and maldigestion. Functional bowel disorders. JEWP. Secondary immunodeficiency. An emerging pulmonary heart. Chronic pseudomonas infection.

The girl is observed and treated in the center of cystic fibrosis of Voronezh for 4 years. The diagnosis of cystic fibrosis was established at the age of 4.5 months, the disease was manifested by respiratory syndrome (bronchitis, pneumonia from birth), retarded physical development, and steatorrhea. The diagnosis was confirmed clinically, x-ray, laboratory (sweat chloride - 70 mmol / l).

From the anamnesis it is known that the girl was born from elderly parents (mother was 36 years old, father - 34 years old). Pregnancy II, which occurred with gestosis of the second half, childbirth I, on time, by cesarean section (I pregnancy - medical abortion, after which the mother was treated for infertility for a long time).

The girl was born weighing 3600 kg, height 53 cm. She was applied to the breast for 4 days, was breastfed for up to 7 days, after which she received artificial feeding. Discharged from the hospital on the 21st day. At the same time, there was a colorless, decorated chair with a greasy sheen, poorly washed from the diapers, plentiful, 4-5 times a day.

At 1 year of age, she was observed by a neurologist about perinatal encephalopathy. At 1 year, the weight was 8 kg (weight deficit was 35%).

Hereditary history: in the mother - chronic bronchitis, anemia; at the father - sinusitis.

The last exacerbation of the pneumonic type - May 2004 - required inpatient care. The girl underwent the following laboratory examination:

General blood test: HB 128 g / l; L. - 5.8 × 10 ⁹ / l; P - 2%; C - 34%; e. - one%; l - 59%; m. - 4%; ESR - 26 mm / h.

Urinalysis - without pathology.

Chest x-ray - pneumonia S 4-5 on the right against the background of obstructive syndrome.

Biochemical blood test: free. bilirubin - 9.5; thymol ave. - 9.3 units; AlAt - 203; AsAt - 89; total protein - 64.3 g / l; SRB - 2; glucose - 3.28 mmol / l; amylase - 2.02 mg / s; urea - 2.3 mmol / l; sialic acids - 2.68 mmol / l; creatinine - 0.035 mmol / l.

ECG: heart rate - 114 per minute, sinus rhythm, vertical EOS. Signs of an overload of the right atrium: broadening of z.R in the II Art. open and V ₁ ; V ₂ .

Smear from the throat and nose on pat. Flora: p. Candidae, bacteria Ps. aeruginosa and St. aureus.

Ultrasound GPDZ: signs of hepatomegaly. Liver: ave. Lobe - 9.8 cm, lion. share - 4.0 cm. The contour is even, the structure is homogeneous, the figure is smoothed. Echogenicity is increased. The spleen 6.8 cm × 2.4 cm is a homogeneous structure, hyperechoic dashed striation. Kidneys without pathology.

Coprogram: mucus - moderately; lake. - 4-5 in the field; epithelium - 1-2; extracellular starch. (++), intracellular. (+); muscle fiber (+); fiber overdone. (+); neutral fat (++); detritus (+); microbes (+).

CBS - pH - 7.31 mm RT. st .; pO ₂ 34.8; pCO ₂ - 44.4; BE - (- 4.4) me / l; AB - 21.7 me / l; total СО ₂ - 23.0 me / l; About ₂ sat. - 60.3%.

The girl received the following therapy: Creon 10 thousand - 6 caps./day, Maxipim, Fortum, Eufillin, Lazolvan, Ambroxol, ACC, multivitamins, Ursofalk, Viferon, Nystatin, Ca gluconate, laser therapy on gr. class No. 7, inhalation through a nebulizer with berodual, intravenous infusion of ozonized saline solution 100.0, with an ozone concentration of 100 μg / l, 5 days course. Ozone solutions were administered in a half-hour time interval from the completion of the introduction of the remaining components of the infusion, for 30 minutes, 1 time per day. Adverse reactions when using ozonated solutions were not observed.

Against the background of the complex therapy using intravenous ozone therapy, the temperature returned to normal on the 2nd day of treatment, and the state of health significantly improved during the same period; on the 3rd day of treatment, the volume of catarrhal phenomena in the lungs decreased, the degree of DN decreased.

After 5 days, i.e. after completing the course of ozone therapy, the gas composition of the blood improved significantly: pH - 7.34 mm Hg; pO ₂ -71.4; pCO ₂ - 35.7; BE - (-5.4) me / l; AB - 19.1 me / l; total СО ₂ - 20.1 me / l; O ₂ sat. - 93.1% (see table) and hemograms: HB 128 g / l; L. - 5.4 × 10 ⁹ / l; P - 2%; C - 56%; e. - one%; l - 37%; m. - 4%; ESR - 12 mm / h.

In the hemogram, ESR decreased to 12 mm / h.

On the 7th day of treatment, taking into account the stable positive dynamics of clinical and laboratory parameters, the girl was discharged home. Thus, in a child with a severe degree of hypoxemia, after 5 days of ozone therapy, CBS indicators significantly improved, therefore, homeostasis stabilized, and the degree of tissue hypoxia decreased.

Example No. 2. Patient M., born in 1994 Extract from the medical history No. 2216. Hospitalization at the Center for Cystic Fibrosis from June 8 to June 16, 2004

The patient was treated with a diagnosis of Cystic fibrosis, mixed form, severe course. Chronic bronchitis, exacerbation of the bronchopulmonary process by pneumonic type, DN2. Secondary hepatitis An emerging pulmonary heart. Lag of physical development.

From the anamnesis it is known that a girl from 1 pregnancy, which proceeded with gestosis of 1 half against the background of anemia, urogenital candidiasis, was born full-term with a mass of 2800, height 50 cm. Neuropsychic development in accordance with age. A poor increase in body weight was noted, and the weight deficit was 30% per year. At an early age, she repeatedly suffered severe pneumonia complicated by pneumothorax. The diagnosis of cystic fibrosis was made at the age of 5 months based on the clinic and sweat chloride parameters of 95 mmol / L. Every 3 months the patient was given courses of preventive therapy using intravenous infusions of antibiotics.

Last exacerbation in June 2004. Complaints of persistent cough with viscous sputum, loss of appetite, undigested copious stools, flatulence. The condition at admission is severe, the state of health sharply suffers. A girl of low nutrition, a weight deficit of 5 kg. High fever, temperature "candles" up to 39 degrees. The skin is pale, sweating is increased. Respiratory rate 54 per minute. Difficult nasal breathing, mucopurulent discharge. The chest cage is barrel-shaped, the deformation of the distal phalanges of the fingers according to the type of "drum sticks". During auscultation, harsh breathing, fine-bubbly moist rales in all pulmonary fields. Heart rate 120 per minute. During auscultation, heart sounds are muffled, a gentle systolic murmur at the aortic projection point and at the apex. The abdomen is slightly increased in size, soft, painless, liver +1 cm. The chair is unstable, with an admixture of fat and a pungent odor. Survey data at admission:

1. General an. blood HB - 110 g / l, Er. - 3.7, L - 11.1; p / a - 7%, s - 54%, e - 2%, l - 33%, m - 2%, ESR - 18 mm / h.

2. B / chemistry of blood - about. 57 g / l, glucose - 4.4 mmol / l, amylase 27,

3. CBS and blood gases: pH 7.44, pO ₂ - 50, pCO ₂ - 44, BE - (-1.7), AB - 23.8, saturated oxygen - 89.

4. Sputum culture - Pseudomonas aeruginosa is isolated.

5. ECG sinus tachycardia, signs of right ventricular overload, p puimonale in the right thoracic leads.

6. The function of external respiration: OFV1-55%, FVC-57%, MOS25-103. Conclusion - a combined form of ventilation failure, with a predominance of obstructive.

7. Ultrasound of the internal organs: an increase in the size of the liver, the pancreas parenchyma is compacted, heterogeneous.

Conducted treatment. Intravenous infusion of amikacin and fortum - 5 days, nebulizer aerosols with lazolvan, saline solution, fluimucil, pancytrate 25,000 10 capsules per day. In order to correct severe hypoxemia and hypoxia, in order to correct metabolism and reduce the activity of inflammation, a 5-day course of intravenous ozone therapy was carried out at an ozone concentration of 250 μg / l, 1 time per day, 5 days, for 30 minutes, half an hour after traditional therapy . When prescribing ozone, there were no adverse reactions, positive dynamics of clinical symptoms and laboratory parameters was noted. The temperature returned to normal during the day. On the 3rd day of treatment, the state of health significantly improved, appetite returned to normal, motor activity increased, and during the same period of treatment, the volume of catarrhal phenomena in the lungs and their prevalence decreased. Values of CBS after 5 days of treatment: pH 7.42, pO ₂ - 110, pCO ₂ - 30, BE - (- 2.5), AB - 20, saturated oxygen - 99.7. General an. blood at discharge: HB 132, E.- 4, L - 6.5; p - 1%, s - 70%, l - 25%. M - 4%, ESR - 3 mm / h. After eight days, the exacerbation period was stopped and the girl was discharged home.

Our proposed method for the treatment of children suffering from cystic fibrosis is technically simple, does not require expensive equipment, and makes it possible to increase the effectiveness of the treatment of extremely severe patients. The positive dynamics of clinical symptoms and indicators of the gas composition of the blood allows a rather high assessment of the possibilities and prospects of an additional non-drug treatment for children with severe, sometimes fatal, pathologies. The method significantly improves the quality of therapy, reduces the treatment time for patients, while not causing acute or chronic side effects.

Indicators of CBS and blood gases of the patient T. 4 l. (deoxygenated blood) Parameter Norm cap. Before treatment After 5 days of ozone therapy pH 7.32-7.45 7.31 7.34 PO ₂ 83-108 34.8 ** 71.4 ** pCO ₂ 38-48 44.4 ** 35.7 ** BE 0 ± 2.3 mmol / L -4.4 -5.4 AB 18-23 mmol / l 21.7 19.1 O ₂ sat (pulse oximeter) 93% 60.3 ** 93.1 ** ** Statistically significant differences

Claims (1)

A method for the complex treatment of severe forms of cystic fibrosis in children, including the introduction of traditional drugs, characterized in that an additional 30 minutes is administered intravenously ozonized physiological saline (OGF) once a day, and for children under 3 years of age use OGF with an ozone concentration 100-150 mcg / L in an amount of 100-150 ml, and for children older than 3 years old - an OPF with an ozone concentration of 200-250 µg / L in an amount of 200-250 ml, the course of treatment for an OPF is 5 days, with traditional do not use drugs for 30 minutes before and after le introduction of OFR.