RU2357728C2 - Method of exudative pleurisies treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, particularly phthisiology and thoracic surgery, and can be applied in treatment of patients with pulmonary diseases accompanied by exudative pleurisies. Method involves pneumoperitoneum application at the background of etiotropic therapy. Air volume introduced to abdominal cavity at first take does not exceed 200-300 ml. By the recurrent introduction air volume comprises 500 ml. Procedure is repeated over each 5 days until fluid in pleural cavity is completely resorbed.

EFFECT: prevented commissure formation and accelerated fluid resorption in pleural cavity due to fluid level elevation to functionally 'free' upper pleural cavity compartments without invasive intervention to pleural cavity.

1 ex, 1 dwg

Description

The invention relates to medicine, namely to phthisiology, pulmonology, thoracic surgery.

An analogue of the invention is etiotropic treatment with daily or 1-2 days of fluid extraction from the pleural cavity for 2-3 months (V.A. Sokolov. Pleurisy. Yekaterinburg, 1998, pp. 206-234).

The disadvantages of the prototype of the invention are:

1) the burden for the patient of frequent procedures when extracting fluid;

2) with frequent punctures, there is a loss of body protein;

3) although infrequently, there is a risk of violating the integrity of the visceral pleura with an injection needle, followed by air and infection into the pleural cavity from the lungs;

4) removal of fluid causes a decrease in pressure in the pleural cavity, which, on the one hand, promotes enhanced re-flow of exudate from the lungs to the pleural cavity through the visceral pleura, and on the other hand, a decrease in pressure in the pleural cavity reduces fluid resorption along natural routes;

5) according to the prototype method (V.A. Sokolov. Pleurisy. Page 212), streptomycin or other antibacterial drugs that enhance the formation of pleural adhesions are introduced into the pleural cavity during punctures through the microirrigator. In severe pleurisy, the prototype treatment method is aimed specifically at the formation of pleural adhesions (ibid., P. 211). These adhesions subsequently cause the development of pneumosclerosis due to lymphostasis and impaired lymph flow from the cortical to the root of the lung;

6) delayed resorption of exudate, resulting in adhesions that contribute to the subsequent development of pleurogenic pneumosclerosis, pneumofibrosis or cirrhosis, which in turn lead to hypertension of the pulmonary circulation with a risk of pulmonary heart failure, and angiectasis and bronchiectasis, also occurring in pneumosclerosis fraught with the danger of pulmonary hemorrhage and amyloidosis of the internal parenchymal organs.

The aim of the invention are: reducing the time of resorption of exudate from the pleural cavity, preventing increased formation of pleural adhesions, which have a risk of subsequent pathological processes in the body.

The essence of the invention lies in the use of air for applying pneumoperitoneum against the background of etiotropic treatment. To apply pneumoperitoneum (PP), a pneumothorax apparatus is used. The patient is laid on his back, a roller is placed under the pelvis. The injection site for introducing air into the abdominal cavity is a point 4-6 cm below and to the left of the navel. Anesthetizing the injection site with a 0.5% novocaine solution in an amount of 3.0-4.0 ml, the abdominal wall is punctured, followed by air through a needle connected to a pneumothorax apparatus. The volume of air introduced into the abdominal cavity at the first injection does not exceed 200-300 ml, repeated injections of air in the amount of 500 ml are made every 5 days until the fluid is completely absorbed in the pleural cavity. Each time after the procedure, the patient should lie on his healthy side for 3-5 minutes so that the air mainly moves under the dome of the diaphragm of the patient side.

Distinctive features of the proposed method from the prototype

Due to artificial pneumoperitoneum occurs:

1) collapse of the lung mainly in the lower parts of the affected side and restriction of the movement of the lung, which is a necessary condition for reducing the flow of fluid into the pleural cavity through the visceral pleura;

2) pressure increases in the pleural cavity, which also helps to reduce the flow of fluid into the cavity, and on the other hand, fluid resorption through the parietal pleura is enhanced;

3) the rise of the dome of the diaphragm leads to the movement of part of the fluid in the upper parts of the pleural cavity, which contributes to the involvement of the parietal pleura that is not in contact with the PP with the fluid, where the pores, the so-called “hatches”, of the parietal pleura are not yet covered by the exudate protein, and therefore the number of hatches "for resorption of liquid increases;

4) PP creates rest in the affected lung, in which the pressure difference in the pleural cavity during exhalation and inhalation decreases, therefore, during inhalation, the fluid output into the pleural cavity also decreases;

5) reduced treatment time;

6) with a reduction in the time of fluid resorption, the risk of adhesions is also reduced;

7) finally, the economic benefits are also associated with a reduction in the terms of fluid resorption and the treatment time.

Schematic representation of radiographs with pleurisy and the presence of air in the abdominal cavity: see drawing, a - fluid in the pleural cavity; b - the dome of the diaphragm raised by air; in - air under the dome of the diaphragm.

An example of a clinical implementation of the method

Patient Khaibova R.A. Born in 1988 with a high temperature between 38-39 ° C, with pain in the left half of the chest, shortness of breath on 12.12.2006, was hospitalized in the therapeutic department of the 2nd mountain. hospitals in Makhachkala. After examination, after 2 days with a diagnosis, exudative pleurisy was discharged on the left and sent to the Republican Tuberculosis Dispensary, where the diagnosis was made: focal tuberculosis of the upper lobe of the left lung in the MBT infiltration phase, complicated by exudative pleurisy on the left.

December 20, 2006 on the survey R-gram on the left in I-II m / reb. Large focal shadows, from the 3rd rib to the bottom intense darkening with an oblique upper level - effusion (Photo No. 1). Sinus, the dome of the diaphragm does not differentiate.

Against the background of anti-tuberculosis antibiotic treatment, an artificial pneumoperitoneum was placed on an outpatient basis, an R-gram survey dated 12/20/06 (Photo No. 2), where we observe an aperture-raised dome of the diaphragm that was maintained for 15 months. During this time, the liquid completely resolved without pronounced adhesions. Survey R-gram from 01/30/07 (Photo No. 3).

Radiographs in dynamics are attached.

Utility of invention

1) according to the method of the invention, patients can be treated not only in hospital but also in outpatient settings, which is economically more beneficial;

2) the duration of treatment according to the method of the invention is not longer, on the contrary, even less than according to the prototype;

3) residual changes in the form of pleural adhesions according to the method of the invention is less than according to the prototype.

Claims (1)

A method of treating exudative pleurisy by conducting etiotropic therapy and applying pneumoperitoneum, while the volume of air introduced into the abdominal cavity at the first injection does not exceed 200-300 ml, re-introduction of air in a volume of 500 ml is performed every 5 days until the fluid is completely absorbed into the pleural cavity.

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