RU2449737C1 - Method of treating diffuse endobronchitis in acute and early periods of cervical-spinal trauma - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to endoscopic surgery, anesthesiology and resuscitation. Method includes anesthesia of upper and lower respiratory tract, laying patient in horizontal position without flexion and extension of neck, puncture of trachea. Puncture is performed in sagittal plane at angle 70-85° to the surface of thyroid cartilage at the distance about 0.5 cm on the right and on the left of medial neck line. Installation of flexible fibrobronchoscope in trachea is carried out. Under its control through places of puncture catheters, for instance radio-opaque, are introduced. The latter are brought into orifices of right and left distal bronchi. By means of flexible fibrobronchoscope zone of pathological process is determined. Installation of catheters into orifice of segmental bronchi is selectively finished. After that each of them is marked outside for control of position. Flexible fibrobronchoscope is extracted. Catheters are fixed to skin of anterior neck surface. Introduction of medications through catheters into zone of pathologic process is performed daily.

EFFECT: application of claimed invention makes it possible to reduce terms of performed treatment and further rehabilitation with reduction of operation trauma and increase of efficiency.

3 cl, 1 ex

Description

The invention relates to medicine, namely to endoscopy, anesthesiology and intensive care, and can be used in providing urgent and planned care to patients with diffuse endobronchitis, which developed in acute and early periods of cervical-spinal injury.

Known methods of treating endobronchitis, including diffuse [copyright certificates SU for inventions No. 1153921, 1243700, 1477412, RU patents for the invention No. 2053814]. All of them are characterized by the implementation of therapeutic bronchoscopy, including the treatment of drugs with the zone of the pathological process.

However, a prolonged stay of the bronchoscope in the lumen of the respiratory tract during treatment causes them injury.

There is also known a method of treating inflammatory and purulent diseases of the bronchi, in particular diffuse endobronchitis, and lungs requiring single or multiple administration of antibiotics [Manipulations and operations on the trachea // Tashkent Medical Academy, website: http://drdima03.narod.ru/praktichnavik .htm (accessed: July 1, 2010)]. The patient is laid on his back, on a flat surface. A roller is placed under the shoulders, the head is thrown back. Carry out the processing of the front surface of the neck. Below the lower edge of the thyroid cartilage, the trachea is found and fixed. Make a puncture of the trachea between the rings using a needle. If multiple and prolonged administration of drugs is necessary, then a syringe with dicain is attached to the needle and two to three drops of anesthetic are injected into the lumen of the trachea. Then the syringe is removed. An elastic conductor is inserted into the trachea on a needle. After that, the needle is removed. A polyvinyl chloride catheter is inserted into the trachea by rotational, persistent, but not coarse movements, which is fixed to the skin of the front surface of the neck with an adhesive plaster.

However, this method does not provide visual monitoring of the selective installation of a catheter into the lumen of the bronchus, which, in turn, limits the possibility of local delivery of drugs to the area of the pathological process.

The closest analogue to the claimed invention is a method for the treatment of inflammatory processes of the respiratory tract [website: http://lekmed.ru/info/literatura/abscess-i-gangrena-legkogo-7.html (accessed 07.07.2010)]. It is characterized in that a catheter is inserted for a long time through a puncture of the cervical trachea. Under visual control, carried out using a bronchoscope, the end of the catheter is sent to the draining bronchus. The bronchial tree is sanitized and the cough is stimulated by the drip of various solutions containing mucolytic and antibacterial agents.

However, the closest analogue, like all of the above, is not intended for use in the treatment of patients with injuries of the cervical spine.

The task of the invention is to reduce the duration of treatment and subsequent rehabilitation while reducing morbidity and increasing efficiency.

The essence of the claimed invention is characterized by the fact that they perform anesthesia of the upper and lower respiratory tracts, lay the patient in a horizontal position without flexion and extension of the neck, puncture the trachea in its sagittal plane at an angle of 70-85 ° to the surface of the thyroid cartilage at a distance of about 0.5 cm to the right and left of the midline of the neck, a flexible fibrobronchoscope is inserted into the trachea, catheters are inserted under its control through the puncture sites, the latter are carried out to the mouth of the right and left lower lobe bronchi they determine the area of the pathological process using a flexible fibrobronchoscope, selectively complete the installation of catheters in the segmental bronchi, then mark each of them externally to control the position, remove the flexible fiber bronchoscope, fix the catheters to the skin of the front surface of the neck, and administer medications to the area of the pathological process daily through catheters funds.

A method for treating diffuse endobronchitis in acute and early periods of cervical-spinal injury with the above symptoms is also claimed, in which the treatment process is additionally monitored daily by collecting biological material from the pathological process through catheters and its cytomorphological study.

In addition, there is also claimed a method of treating diffuse endobronchitis in acute and early periods of cervical-spinal injury with the above symptoms, in which catheters use radiopaque.

The technical result of the claimed invention consists in solving the problem posed earlier. The set of signs of the implementation of the treatment method described in this application can reduce the time of its implementation and the subsequent rehabilitation period by accurately determining the location of the pathological process zone and the possibility of ensuring local delivery of drugs to it. This, in turn, is achieved by the method of introducing catheters through two punctures described in this application. The use of a flexible fibrobronchoscope in the claimed method, which allows therapeutic manipulation without flexion and extension of the neck, helps to reduce the risk of secondary damage to the patient’s spinal cord in acute and early periods of cervical-spinal injury, as well as to monitor the introduction of catheters and their approach to the area of the pathological process .

A method of treating diffuse endobronchitis in acute and early periods of cervical-spinal injury is as follows.

Preliminarily 20 minutes prior to the implementation of medical manipulations for the purpose of sedation, 0.5 ml of a 0.1% solution of atropine sulfate, intramuscular baralgin 5 ml and relanium 10 mg are injected subcutaneously.

Anesthesia of the upper and lower respiratory tract. Why local anesthesia of the upper respiratory tract is performed with a 10% solution of lidocaine hydrochloride - 4 ml or 10% spray - 2 doses. Then, during the execution of fibrobronchoscopy, local anesthesia of the lower respiratory tract is performed with a 2% solution of lidocaine hydrochloride - 5 ml.

The patient is placed in a horizontal position without flexion and extension of the neck. Carry out the processing of the front surface of the neck. Produce local anesthesia of the skin and subcutaneous tissue with a 0.25% solution of novocaine. Below the lower edge of the thyroid cartilage, the trachea is found and fixed in order to avoid displacement from the midline of the neck. Using puncture needles, the trachea is punctured in its sagittal plane at an angle of 70-85 ° to the surface of the thyroid cartilage at a distance of about 0.5 cm to the right and left of its midline. According to the Seldinger method, puncture needles are inserted into the trachea with conductors followed by removal of the needles.

A flexible fibrobronchoscope is installed in the trachea, focusing on standard anatomical landmarks: the tongue of the soft palate, epiglottis, and vocal folds. At the same time, the working distal part of the fibrobronchoscope is located in the sub-vocal space of the trachea.

The choice of access for the introduction of a fibrobronchoscope through the mouth or lower nasal passage is determined by the somatic condition of patients, as well as local anatomical features. The most optimal access due to the ease of its implementation and atraumatic is transnasal - through the lower nasal passage.

Then, under the control of a fibrobronchoscope, catheters, for example, radiopaque, are inserted through the guides through the puncture sites. Spend the latter at the mouth of the right and left lower lobar bronchi. Using a flexible fibrobronchoscope, the area of the pathological process is determined. Complete the installation of catheters in the segmental bronchi. After labeling each of them outside to control the situation. A fibrobronchoscope is removed. Catheters are fixed to the skin of the front surface of the neck using ligatures or band-aid. Daily, through catheters, medications are introduced into the pathological process zone, in particular antibacterial drugs, taking into account their daily dosage and sensitivity data.

In addition, daily monitoring of the treatment process is carried out by collecting biological material from the pathological process zone through catheters and its cytomorphological study. To do this, through the installed catheters, a washing liquid is introduced in portions of 20 ml each - a sterile isotonic solution of sodium chloride with a pH of 7.2–7.4 and a temperature of 38–40 ° C. Then, this washing liquid is aspirated into a sterile graduated container, which is subsequently sent for cytological examination.

With positive indicators of dynamic clinical and laboratory control, catheters are removed.

Example.

Patient E., 29 years old, was admitted to the neurosurgery clinic after 9 hours from the moment of injury due to diving in shallow water with the diagnosis: “Closed complicated injury of the cervical spine. Compression-comminuted fracture of the C6 vertebral body with contusion and compression of the spinal cord at this level. Tetraplegia. Pelvic organ dysfunction. ”

From the anamnesis: there were no episodes of loss of consciousness and aspiration with fresh water, blood and gastric contents.

Clinically determined diaphragmatic respiration, ascetic-vesicular respiration and the absence of wheezing.

In an emergency, the patient underwent surgery: resection of the C6 vertebra, anterior decompression of the spinal cord, anterior corporodesis with a mesh endofixer, fixation with a metal plate.

3 hours after the completion of the surgery, extubation was performed.

The next day, with stable hemodynamic parameters, the medical manipulation claimed in this application was performed. Every day, through catheters, antibacterial drugs were introduced into the pathological process zone, taking into account their daily dosage and sensitivity data, and biological material was taken from the pathological process zone for cytomorphological studies. On the 14th day after the manipulation, with positive indicators of dynamic clinical and laboratory control, catheters were removed from the left and right lower lobar bronchi. 3 days after this patient was transferred for aftercare in the specialized department.

Claims (3)

1. A method of treating diffuse endobronchitis in the acute and early periods of cervical-spinal injury, characterized in that they perform anesthesia of the upper and lower respiratory tract, lay the patient in a horizontal position without flexion and extension of the neck, puncture the trachea in its sagittal plane at an angle of 70 85 ° to the surface of the thyroid cartilage at a distance of about 0.5 cm to the right and left of the midline of the neck, a flexible fibrobronchoscope is inserted into the trachea, and catheters are inserted under its control through puncture sites, drive the latter to the mouth of the right and left lower lobar bronchi, determine the area of the pathological process using a flexible fibrobronchoscope, selectively install the catheters at the mouth of the segmental bronchi, then mark each of them from the outside to control the position, remove the flexible fibrobronchoscope, fix the catheters to the skin of the front surface of the neck, daily, through catheters, the introduction of drugs into the pathological process zone is carried out. 2. A method of treating diffuse endobronchitis in acute and early periods of cervical-spinal injury according to claim 1, characterized in that they further monitor the treatment process by taking biological material from the pathological process zone through catheters and its cytomorphological study. 3. A method of treating diffuse endobronchitis in acute and early periods of cervical-spinal injury according to claim 1, characterized in that the catheters use radiopaque.