RU2464017C2 - Method of treating chronic obstructive pulmonary disease accompanied by bronchiectasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely pulmonology, and concerns treating chronic obstructive pulmonary disease accompanied by bronchiectasia. That is ensured by the endotracheal introduction of berodual 2 ml, 0.25% novocaine 5 ml, 1% diphenylhydramine 1 ml, and 1% dioxidine 15 ml; the procedure is performed for 15-20 min; the therapeutic course makes 10-15 daily instillations.

EFFECT: endotracheal introduction of such complex of the therapeutic preparations provides the effective treatment with no side effects, particularly antibiotic-induced bronchial spasm.

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Description

Proposed as an invention, the method relates to medicine, in particular to pulmonology, and in particular to methods of treating respiratory diseases.

The existing analogue is a method of treating bronchiectasis (Respiratory medicine, 2007, Shoikhet Y., Lepikhin N.M., Lepikhina D.N.) involves fibroscopic debridement with the introduction of antibiotics into the bronchi.

Its disadvantage is the need for an unsafe and quite burdensome procedure for bronchoscopy daily. Antibiotics recommended by the authors for administration to the bronchi sensitize the body and respiratory tract and provoke bronchospasm.

Another analogue (Weinsberger S. Bronchiectasis. Internal diseases according to Tinsley R. Harrison 2002. Volume 2. P.1748) proposes to administer antibiotics for the treatment of bacterial infections in patients with bronchiectasis, depending on the sensitivity of microflora, intramuscularly or aminoglycosides by inhalation.

The disadvantage of this method of treatment is the need for the administration of antibiotics intramuscularly, which, in full dosage, do not reach the lumen of bronchiectatically altered bronchi, cause suppression of immunity, and sensitize the body. Inhalations of aminoglycosides often cause or provoke bronchospasm, especially in people with an initial allergic background.

Closest to our method (prototype) is the method of treatment of bronchiectasis, proposed by A. Kokosov. (COPD, "Binom", 1998. P.421), which proposes regular postural drainage with intrabronchial administration of solutions containing antimicrobial agents and mucolytics, periodic therapeutic bronchoscopy, phytoncide inhalation. This method is taken by us as a prototype.

The disadvantages of the prototype are the need for the introduction of antibiotics that irritate the bronchi and cause bronchospasm. In addition, the author has not proposed a specific scheme (algorithm) for the administration of drugs and their dosage. Inhalations of phytoncides do not reach the lesion site enough and can cause bronchospasm, do not have an effective antibacterial effect.

The purpose of the invention.

The aim of the invention is to increase the effectiveness of treatment of patients with bronchiectasis by developing an adequate method of treatment based on endotracheal installations.

SUMMARY OF THE INVENTION

The essence of the proposed method consists in endotracheal installations of dioxidine using a laryngeal syringe. At the same time, an anesthesia of the larynx is performed using a laryngeal syringe in the area of the glottis with lidocaine 0.5 ml of solution with novocaine 0.25% solution of 5 ml and berodual 2 ml, diphenhydramine 1% 1.0 ml. Then, after 3-5 minutes, an endotracheal installation of 15 ml of a 1% solution of dioxidine in portions of 2.0 ml per installation is carried out selectively in the affected bronchus.

Bronchiectasis is a purulent inflammation of the bronchi, which can be congenital and acquired. The basis of inflammation is infection. Oral and intramuscular administration of antibiotics does not give a sufficient effect due to poor access of drugs to the bronchi. The most effective way to eliminate the infection in the bronchi is to directly introduce them into the lesion (affected bronchi) in combination with mixed-action bronchodilators (anticholinergic and beta2-agonist).

Dioxidin is an antimicrobial agent that has a wide spectrum of antimicrobial activity. It is effective for infections caused by Pseudomonas aeruginosa, vulgar protea, dezentery stick, Klebsiella, Salmonella, pathogenic anaerobes, acts on bacterial strains resistant to other chemotherapy drugs, including antibiotics. In addition, dioxidine does not have a sensitizing, allergenic effect on the respiratory system.

Atrovent has a pronounced bronchodilator effect and prevents the development of bronchospasm. It also causes a decrease in the secretion of the glands of the mucous membrane of the bronchi and nose.

Berotek, exciting beta2-adrenergic receptors, activating adenylate cyclase, causes the accumulation of cyclic AMP, thereby expanding the bronchi. The combination of atrovent and berotek potentiates their bronchodilatory effect.

The proposed method of treatment was carried out in 16 patients: chronic obstructive pulmonary disease (COPD) with bronchiectasis, bronchodilator and expectorant.

When treating patients with the proposed method immediately after endotracheal administration of the drug mixture, sputum discharge improved, breathing was facilitated. The amount of sputum decreased sharply after 5-7 endotracheal procedures.

Indicators of bronchial patency (BP) in the observation group, i.e. patients who underwent treatment according to the proposed method, after 10 days of treatment (see table) significantly improved in 5 of 16 (31.2%) people (15% or more of the original), in 6 patients (37.5% ) indicators increased from 5 to 14% and only 5 people (31.2%), despite the improvement of clinical indicators, the increase in FEV _{1 was} not significant. Shortness of breath, cough, sputum disappeared in the control group 4-6 days earlier, bed / day decreased by 3-4 days, the economic effect was 500-800 rubles per treatment course.

The control group included 13 patients with COPD with bronchiectasis who received traditional intramuscular antibiotic therapy.

Of 13 patients in the control group, only one (7.7%) significantly improved after 10 days, indicators increased from 5 to 14% in 3 (23.1%) patients, indicators did not change in 9 (69, 2%) patients. In the control group, the improvement in BP was significantly less (in 30.8% of cases versus 68.7%, p> 0.05).

An example of a specific implementation of the method.

1. Patient M., 22 years old. Diagnosis: chronic obstructive pulmonary disease of the 1st century with bronchiectasis on the left. Previous antibiotic treatment did not give an effect, continues to excrete mucopurulent sputum in the amount of 100-120 ml per day, cough and shortness of breath are disturbed when walking.

After daily installations of diphenhydramine 1% 1.0 ml, berodual 2 ml (iprotropium bromide 42 μg, phenoterol 100 μg), novocaine 5 ml (0.25% solution) and dioxidine 1% solution 15 ml for 10 days, the cough completely disappeared. sputum decreased to a few spitting mornings. Indicators of bronchial patency increased: FEV ₁ by 12%, FVC by 12%, MOS ₅₀ by 21%. After 3 years of follow-up, the patient's condition is good, there is no cough, shortness of breath does not bother.

2. Patient A., 62 years old. Diagnosis: chronic obstructive pulmonary disease, II tbsp. with bronchiectasis on the right, pneumosclerosis. For the last 6-7 years, he received treatment in various hospitals using traditional methods without any effect. After endotracheal installations of dioxidine 1% 15 ml, berodual 2 ml, novocaine 0.25% 5 ml, the amount of sputum decreased by ½ of the original, the color changed to a lighter, the severity of shortness of breath decreased. 10 days after the course of treatment, VC increased by 370 ml ³ (13% of the initial), FVC - by 320 ml ³ (17% of the initial), FEV ₁ - by 40 ml ³ (by 3%). After 1.5 months, VC increased by another 150 ml ³ (19%), FVC increased by 600 ml ³ (32%), FEV ₁ by 380 ml ³ (27%).

Distinctive features of the proposed method of treatment for the prototype is the endotracheal administration of the antiseptic drug dioxidin in combination with bronchodilators directly into the site of the affected bronchus. These significant distinguishing features of the method can enhance both the antibacterial effect and the bronchodilating effect.

A positive effect of the invention are: simplicity and accessibility of the procedure. Our treatment method does not require expensive equipment, is less burdensome for the contractor and patient, economically justified (the cost of treatment is reduced by 500-800 rubles per patient), reduces the number of beds / days, and reduces financial costs. The proposed method gives a tangible therapeutic effect after 10 procedures. The treatment has no side effects, is absolutely safe and easily tolerated by the patient. The effectiveness of therapy was evaluated by analyzing the clinical symptoms, the function of external respiration, blood and sputum tests, both immediately after the procedure and at the end of the course of treatment.

Table Comparative analysis of the growth of FEV ₁ against the background of endotracheal installation of drugs and traditional treatment Method of treatment increase in phase conjugation ₁ in% more than 15% 5-14% no gain endotracheal installations n = 16 31.2 ± 11.9 37.5 31.2 ± 11.9 traditional treatment n = 13 7.7 ± 7.8 23.1 69.2 ± 13.3

Claims (1)

A method for the treatment of chronic obstructive pulmonary disease with bronchiectasis, including the introduction of antimicrobial agents, characterized in that they carry out endotracheal administration of berodual - 2 ml, novocaine 0.25% - 5 ml, diphenhydramine 1% - 1 ml and dioxidine 1% - 15 ml, procedure performed within 15-20 minutes, the course of treatment is 10-15 daily instillations.