RU2323739C1 - Method of treatment of pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: antibacterial therapy is conducted in accordance to standard conditions. 1 tablet vobenzim TID 30 minutes before a meal, is included into the complex treatment of pulmonary tuberculosis starting from the first day. Also, the daily transcutaneous electroneurostimulation (TENS) is performed in direct pulmonary plane above the area of pathologic focus and in the central universal zone - along the median line, right and left paravertebral lines, at comfort energetic mode with frequency 77 Hz, total exposure time 30-35 min and 20 sessions of treatment course.

EFFECT: method improves a microcirculation in body organs and tissues, provides the anti-inflammatory and analgesic effect, increases the immune response and resistance to infectious agents, normalizes the balance and enhances the production of endorphins, cortisone, dopamine, provides the spasmolytic and anti-edema action.

2 tbl, 2 ex

Description

The invention relates to medicine, namely to phthisiology, and can be used in the complex treatment of pulmonary tuberculosis.

Pulmonary tuberculosis currently continues to be one of the most acute socio-economic problems, without the solution of which it is impossible to predict the positive development of state strategic programs.

The problem of etiotropic therapy of tuberculosis, and especially pulmonary tuberculosis, has attracted special attention of clinicians over the past two decades due to a sharp increase in the incidence of this severe chronic infection and an increase in the number of destructive forms of pulmonary tuberculosis, accompanied by massive excretion of mycobacterium tuberculosis, usually resistant to the main anti-TB drugs.

The leading method in the treatment of pulmonary tuberculosis is antibiotic therapy with anti-TB drugs, which determines the main direction in the future in the fight against tuberculosis (order of the Ministry of Health of the Russian Federation dated March 21, 2003 No. 109). However, many years of experience in the use of etiotropic therapy for tuberculosis allowed domestic and foreign researchers to note certain limits on the possibilities of chemotherapy in achieving a clinical effect. Modern chemotherapy for pulmonary tuberculosis has expanded and approved the pathogenetic direction in the treatment of patients, since an increase in the body's defenses creates favorable conditions for acting directly on the pathogen.

A disadvantage of the known methods of treatment is the rapid emergence of drug resistance of tuberculosis mycobacteria to these drugs, the appearance of various toxic reactions from the liver, gastrointestinal tract and nervous system, and weakening of the immune status. A particularly significant drawback is the lack of bioavailability of antibacterial anti-TB drugs to the lung tissue due to extensive fibrotic changes. Significant disadvantages include the development of dysbiotic disorders of the gastrointestinal tract, which leads to a further decrease in immunity.

All this makes us look for new ways to treat pulmonary tuberculosis that reduce the above disadvantages. Numerous studies aimed at studying the immunological state of patients with pulmonary tuberculosis in order to increase the body's defenses show that the use of drugs that adjust the body's immune status creates favorable conditions for influencing mycobacterium tuberculosis.

Conducted research of medical, scientific and patent literature identified various methods of treatment of pulmonary tuberculosis.

So, in the work of S.S. Arshinova and B.V. Pinegin, “Immunomodulators in the treatment of patients with active pulmonary tuberculosis” (the journal “The attending physician”, October 2002, No. 10, pp. 36-37), a method for the treatment of pulmonary tuberculosis providing for the inclusion in the complex chemotherapy of patients with polyoxidonium, which stimulates a protective immune response mediated by Th1 cells.

In the work of A.S. Svistunov and B.V. Pinegin, “The use of the immunomodulator lycopide in the complex treatment of pulmonary tuberculosis” (Journal of Problems of Tuberculosis, 2002, No. 3, p.21-25), a method for treating tuberculosis using lycopid is described - a synthetic analogue of the component of the cell wall of all bacteria with pronounced immunomodulating properties.

In the work of G.Yu. Vasilyeva and G.S. Balasanyants: “The experience of using bestim in the complex treatment of infiltrative destructive forms of pulmonary tuberculosis” (Family Doctor magazine, 2003, No. 3, pp. 17-19) describes a method of treatment pulmonary tuberculosis, including in the complex treatment of the bestim immunomodulator, which helps to increase the content of the main immunocompetent cells (CD3 and CD4) and interleukin-2.

In the work of V.V. Erokhin and V.Yu. Mishin: “Leukinferon in the treatment of acute progressive pulmonary tuberculosis” (Journal of Problems of Tuberculosis, 2004, No. 10, pp. 10-15) describes a method of treating tuberculosis using complex therapy of leukinferon, which allows to achieve significant positive dynamics in patients with acute progressive forms of pulmonary tuberculosis, even in the presence of drug resistance.

RF Patent No. RU 2219939 C1, IPC 7 A61P 31/06, protects the "Method for the treatment of pulmonary tuberculosis", which provides for the use of the probiotic bactisporin containing a live bacterial culture of Bacillus subtilis 3H as part of complex therapy.

RF patent No. RU 2217137 C2, IPC 7 A61P 31/06, protects the "Method for limiting complications and adverse reactions in the treatment of pulmonary tuberculosis", which provides for the inclusion in the complex treatment of ferrous sulfate in therapeutic doses.

RF patent No. RU 2242222 C1, IPC 7 A61P 31/06 protects "A method for the treatment of focal and infiltrative pulmonary tuberculosis", which provides for an additional administration of amixin at a dose of 0.125 g for 36 days.

The closest in essence and taken as a prototype is the method of treatment of tuberculosis, provided for by the order of the Ministry of Health of the Russian Federation No. 109 dated 03/21/03, "On the improvement of anti-TB measures in the Russian Federation." Order No. 109 defines standard chemotherapy regimens for tuberculosis patients consisting of two phases with different tasks:

1) the intensive care phase is aimed at eliminating the clinical manifestations of the disease, maximizing the impact on the mycobacterium tuberculosis population in order to stop bacterial excretion and prevent the development of drug resistance, reduce infiltrative and destructive changes in organs;

2) the phase of continued therapy is aimed at suppressing the persisting mycobacterial population. It provides a further reduction in inflammatory changes and involution of the tuberculosis process.

The disadvantages of the method are: the rapid development of drug resistance, pronounced toxic and allergic reactions, and long periods of abacillation and closure of decay cavities.

The purpose of the invention:

increasing the efficiency of treatment of patients with pulmonary tuberculosis by reducing the time for abacillation and closing of the decay cavities, as well as reducing the time for the disappearance of clinical manifestations of the disease and the length of hospital stay.

This goal is achieved by prescribing standard anti-TB treatment regimens with the simultaneous inclusion of 1 tablet 3 times a day 30 minutes before meals, daily, for the entire treatment period, and percutaneous dynamic electroneurostimulation in the direct projection of the lungs over the area from the first days of treatment in the complex treatment of wobenzym pathological focus and in the central universal zone - along the midline, right and left paravertebral lines.

The method is as follows:

after examination and diagnosis, the patient is prescribed antibiotic therapy according to standard chemotherapy regimens. At the same time, from the first day of treatment, the complex treatment of pulmonary tuberculosis includes wobenzym 1 tablet 3 times a day 30 minutes before meals, daily, for the entire treatment period, and TENS (percutaneous electroneurostimulation) in a direct projection of the lungs over the area of the pathological focus (in accordance with radiological data), and the central universal zone - along the median line, right and left paravertebral lines, in a comfortable energy mode with a frequency of 77 Hz, daily, exposure duration 30-35 minutes, treatment course 20 sea nsov.

The skin is a complex organ, closely associated with all body systems. Electrical stimulation affects the exteroreceptors of the skin, certain zones of which correspond to a specific sympathetic or parasympathetic plexus, which has a connection with internal organs. Each internal organ corresponds to a nerve plexus, and to it, in turn, a skin-reflexogenic zone. There is a natural relationship between internal organs and skin metamers.

In diseases of the internal organs, irritation radiates to the corresponding area on the skin and the reflected pain zones of Zakharyin-Ged arise, which coincide with the areas of percutaneous electroneurostimulation. Under the influence of percutaneous electroneurostimulation, the functional state of thoracic structures changes, significant changes in blood composition, phagocytic activity occur, which indicates the active involvement of immune processes in the general reaction of the body to reflex effects. Electropuncture effects lead to pronounced changes in the content of serotonin, catecholamines, acetylcholine and an increase in the production of endogenous opiates, which play an important role in the regulation of immune processes. The change in the number of catecholamines that have a stimulating effect on immunogenesis is part of the general reactions of the body, which are realized by the hypothalamic-pituitary-adrenal system.

Description of exposure zones.

Hardware exposure is carried out in areas of direct projection of the lungs over the area of the pathological focus and the central universal zone - along the midline, right and left paravertebral lines. The exposure is carried out in a constant mode at a comfortable energy level (the patient experiences slight tingling or vibration) at a frequency of 77 Hz, the apparatus is moved with massage movements (rectilinear or spiral) in the direction of the ribs to the spine, that is, from the outside inward and from the bottom up from the beginning, and then on the other hand. The apparatus should be moved over the skin surface at a speed of 1-2 cm per second for 30-35 minutes. During the procedure, the patient is sitting, the effect is on dry clean skin.

Direct rear projection of the lungs:

the upper border is at the level of the body of the 1 thoracic vertebra, the lower is horizontally at the level of the 11 thoracic vertebra, the lateral borders are the middle axillary lines on both sides. The impact in the area of the posterior direct projection of the lungs is indicated for pulmonary tuberculosis, which occurs with cough, shortness of breath, hemoptysis, weakness, decreased appetite, and fever.

Direct anterior projection of the lungs:

the upper border is horizontally at the level of the clavicle, the lower border is the line connecting the front edges of the axillary hollows, the lateral border is the grooves passing between the deltoid and pectoralis major muscle. The impact in the area of the anterior direct projection of the lungs is indicated for pulmonary tuberculosis occurring with cough, shortness of breath, sputum production, hemoptysis, fever, weight loss.

Central universal zone:

posterior median line, right and left paravertebral lines. The impact in the projection of the universal zone is indicated for lung diseases, including tuberculosis, which occurs with shortness of breath, cough, sputum production, weakness, fever.

The ability of wobenzym to increase the concentration of antibiotics in the lesion focus enables us to use it in the pathogenetic therapy of pulmonary tuberculosis and to accelerate the resorption of infiltrative changes. The ability of wobenzym to improve microcirculation and the supply of oxygen and nutrients to tissues is used in destructive processes to accelerate repair. Given the development of a secondary immunodeficiency state with common tuberculous lesions, wobenzym is used to influence the immunological reactivity of the body, increase the functional activity of macrophages and phagocytic activity of cells.

The use of CHENS (percutaneous electroneurostimulation), the action of which is based on the principle of permanent monitoring of the surface impedance of the skin, through reflex and neurochemical reactions triggers the body's own adaptive mechanisms, which allows to increase the effectiveness of treatment for patients with pulmonary tuberculosis, makes it possible to act directly over the affected area and helps to reduce the closing time cavity decay and abacillation. Unlike other methods of physiotherapy, TENS (percutaneous electroneurostimulation) can be used from the first day of treatment of the patient; not contraindicated in hemoptysis; gives a quick response of the body. TENS (percutaneous electroneurostimulation) improves microcirculation in organs and tissues; It has anti-inflammatory and analgesic effects; increases immunity and resistance to infections; normalizes the ratio and enhances the formation of certain types of neurohumoral substances (endorphins, cortisone, dopamine, etc.); It has an antispastic and decongestant effect.

Examples of the implementation of the claimed method:

1. Patient A., 39 years old, was admitted to an inpatient treatment in the pulmonary therapy department of the State Regional Healthcare Institution “Tuberculosis Dispensary” in Rostov-on-Don for infiltrative tuberculosis of the upper lobe of the left lung in the phase of decay and contamination of both lungs, MBT (Mycobacterium tuberculosis) +.

Pulmonary tuberculosis was first detected. Complaints at admission to the department of weakness, cough with sputum, sweating, fever, weight loss, loss of appetite.

Survey data at admission:

R-gram - on the left in S 1.2, against the background of pneumosclerosis, infiltration of lung tissue of a heterogeneous structure with a decay cavity up to 2 cm in diameter, with small areas of destruction around, with polymorphic foci in S 1, 2, 10 on the left and in S 1, 2 on the right, with vascular "paths" to the roots.

Mantoux test with 2 TE PPD-L - 11 mm.

Blood test - HB - 125 g / l, Er - 3.9 × 10 / l, L - 7.5 × 10 / l, E - 0.5, P - 10, C - 65.5, L - 22, M - 2, ESR - 42 mm.

Sputum analysis (by bacterioscopy method) - CMC (acid-resistant mycobacteria) found 2-4 in the field of view.

Sputum culture gave rise to 1 colony of medium-sized mycobacterium tuberculosis (MBT).

The patient received treatment according to the intensive phase 1 of the chemotherapy regimen, while the DENS-DETS-DT device was added to the treatment according to the method described above, for the treatment course of 20 sessions, daily, in the morning and 1 wobenzym 1 tablet 3 times a day for 30 minutes before meals daily for the entire treatment period. Monitoring the results of treatment was carried out throughout the course of combination therapy.

The data of the control examination (after 4 months):

R-grams and T-grams - in S 1.2 of both lungs against the background of medium intensity pneumosclerosis foci with clear contours. In comparison, the R-gram at admission is a significant resorption of infiltration, closure of the decay cavity and densification of foci.

Blood test - HB - 121 g / l, Er - 3.7 × 10 / l, L - 5.2 × 10 / l, E - 1, P - 2, C - 67, L - 27, M - 3, ESR - 3 mm.

Sputum culture (two cultures) - gave a negative result.

Sputum tests (repeatedly by bacterioscopy) - CMC not found.

The patient was discharged for outpatient treatment in satisfactory condition with a diagnosis of Infiltrative tuberculosis of the upper lobe of the left lung in the phase of resorption and compaction, MBT (Mycobacterium tuberculosis) -.

2. Patient B., 32 years old, was admitted to an inpatient treatment in the pulmonary therapy department of the State Regional Healthcare Institution “Tuberculosis Dispensary” in Rostov-on-Don for infiltrative tuberculosis of the upper lobe of the right lung in the decay and seeding phase, MBT ( Mycobacterium tuberculosis) -.

Pulmonary tuberculosis was detected a month ago, when the patient sought medical help in connection with hemoptysis. Upon admission to the department complaints of chest pain, cough with sputum, hemoptysis, weight loss, loss of appetite.

Survey data at admission:

R-grams and T-grams - on the right in S 1,2, against the background of pneumosclerosis, infiltrative foci 2.5 cm in diameter with destruction sites, polymorphic foci around and in S 1-2 on the left.

Mantoux test with 2 TE PPD-L - 16 mm.

Blood test - HB - 163 g / l, Er - 5.3 × 19 / l, L - 8.2 × 10 / l, E - 2, P - 3, C - 72, L - 19, M - 4, ESR - 3 mm.

Sputum analysis (three times by bacterioscopy) - CMC (acid-resistant mycobacteria) not found.

Sputum culture (two cultures) gave a negative result.

The patient received treatment according to intensive phase 1 of the chemotherapy regimen; at the same time, CHENS (percutaneous electroneurostimulation) was added to the treatment with the DiaDENS-DT device according to the method described above, for a treatment course of 20 sessions, daily, in the morning and 1 wobenzym, 1 tablet 3 times a day. Monitoring of treatment results was carried out throughout the course of combination therapy.

The data of the control examination (after 4 months):

R-grams and T-grams - in S 1,2 bilaterally fibrosis, groups of clearly contoured foci. In comparison - resorption of infiltration, closure of destruction, compaction of foci.

Blood test - HB - 143 g / l, Er - 4.6 × 10 / l, L - 4.8 × 10 / l, E - 2, P - 2, C - 62, L - 33, M - 1, ESR - 2 mm.

Sputum analysis (by bacterioscopy method) - CMC (acid-resistant mycobacteria) not found. Sputum culture (two cultures) gave a negative result.

In satisfactory condition, the patient was discharged to outpatient treatment with a diagnosis of infiltrative tuberculosis of the upper lobe of the right lung in the phase of resorption and compaction, MBT (Mycobacterium tuberculosis) -.

Under our supervision were 12 people. Of these, 6 people received anti-TB treatment according to standard chemotherapy regimens (control group). The second group consisted of 6 people (the main group); in this group of patients, CHENS (percutaneous electroneurostimulation) was included in the complex treatment of pulmonary tuberculosis in the direct projection of the lungs over the area of the pathological focus and the central universal zone - along the midline, right and left paravertebral lines, per treatment course of 20 sessions, daily, in the morning, once a day and Wobenzym 1 tablet 3 times a day 30 minutes before meals daily for the entire treatment period. The effectiveness of the treatment was controlled by laboratory and radiological studies. The results of the treatment were evaluated after 2 and 4 months, according to order No. 109.

As a result of the treatment in the main group, an increase in the effectiveness of treatment was revealed: closure of cavities 3 times higher, abacillation 1.5 times, disappearance of clinical symptoms - cough 6 times, weakness 2 times, sputum production 3 times, shortness of breath 3 times , normalization of temperature by 1.2 times, normalization of appetite and weight gain by 2 times. The results are presented in tables 1 and 2.

Table 1 The dynamics of the disappearance of clinical symptoms Clinical symptoms disappear Main group Control group After 1 month 2 months later In 3 months After 4 months Total After 1 month 2 months later In 3 months After 4 months Total Cough disappearance 6 people one hundred% - - - 6 people one hundred% 0 0 0 1 pax 16.6% 1 pax 16.6% Stopping sputum production 6 people one hundred% - - - 6 people one hundred% 0 0 1 pax 16.6% 1 pax 16.6% 2 pax 33.3% The disappearance of shortness of breath 6 people one hundred% - - - 6 people one hundred% 0 1 pax 16.6% 1 pax 16.6% - 2 pax 33.3% The disappearance of weakness 6 people one hundred% - - - 6 people one hundred% 0 0 1 pax 16.6% 2 pax 33.3% 3 pax fifty% The disappearance of catarrhal phenomena 6 people one hundred% - - - 6 people one hundred% 0 0 0 1 pax 16.6% 1 pax 16.6%

As can be seen from the table, in all patients of the main group, during the first month, the clinical symptoms of pulmonary tuberculosis disappeared - cough, shortness of breath, sputum production, weakness, catarrhal symptoms disappeared. In patients of the control group, after a month, these symptoms persisted. T.O. combination therapy made it possible to improve the condition of patients after 1 month from the start of treatment. In the control group and after 4 months, clinical symptoms persisted in most patients.

table 2 The effectiveness of treatment of patients * Indicator Main group Control group After 1 month 2 months later In 3 months After 4 months Total After 1 month 2 months later In 3 months After 4 months Total Decay cavity closure - 2 pax 33.3% - 3 pax fifty% 5 pax 83.3% - 0 - 1 pax 16.6% 1 pax 16.6% Abacillation 2 pax 33.3% 3 pax fifty% 1 pax 16.7% - 6 people one hundred% 0 2 pax 33.3% 1 pax 16.6% 1 pax 16.6% 4 pax 66.6% * - the closure of the decay cavities was evaluated after 2 and 4 months.

As can be seen from the table, in the patients of the control group after 2 months the decay cavities remained, after 4 months the cavities closed only in 16.6% of cases. In the main group, after 2 months in 33.3% of cases, the decay cavities closed, after 4 months the cavities closed in another 50% of cases.

In patients of the control group, after 1 month, bacterial excretion persisted, after 4 months 66.6% of patients were abacilated. In the main group of patients after 1 month, 33.3% of patients were abacilated, after 3 months - 100% of patients.

Patients of the main group were transferred to outpatient treatment after 4 months, while patients of the control group continued treatment in the hospital for up to 8-10 months.

The proposed method for the treatment of patients with pulmonary tuberculosis can improve the treatment of patients with pulmonary tuberculosis by reducing the time required to close the decay and abacillation cavities, accelerate the disappearance of the clinical manifestations of the disease and reduce the length of hospital stay.

Claims (1)

A method of treating patients with pulmonary tuberculosis, providing for antibiotic therapy according to standard modes, characterized in that the complex treatment of pulmonary tuberculosis from the first day includes wobenzim 1 tablet 3 times a day 30 minutes before meals, daily for the entire treatment period and daily DENS- therapy - percutaneous electroneurostimulation in the direct projection of the lungs over the area of the pathological focus and in the central universal zone - along the midline, right and left paravertebral lines, in a comfortable energy Český mode frequency of 77 Hz, the total exposure duration of 30-35 minutes and 20 the course of treatment sessions.