RU2491077C1 - Method of treating patients suffering pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely phthisiology, and concerns treating the patients suffering pulmonary tuberculosis. For this purpose anti-tuberculosis treatment according to the standard regimens is prescribed. Two months after the beginning of the therapeutic course, the same is added with subcutaneous injections at the level of an angle of scapula; what is injected is a mixture of equal portions of venous autoblood and 0.25% novocaine, once a day, in the fasted state, according to the schedule: on the 1^st day - 1.0 ml, on the 4^th day - 2.0 ml, on the 8^th day - 3.0 ml, on the 11^th day - 4.0 ml, on the 15^th, 18^th and 22^nd days - 5.0 ml; If observing a unilateral lesion, the injections are administered on the side of the lesion; while a bilateral lesion requires the injections to be administered one by one on both sides.

EFFECT: method provides infiltrate dispersion, cavity closures and abacillation ensured by an anti-inflammatory and immunomodulatory effect of the autohemotherapy, as well as body reparation activation.

2 ex, 1 tbl

Description

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

Pulmonary tuberculosis currently continues to be one of the most acute socio-economic problems.

The problem of anti-tuberculosis therapy in the last two decades has attracted particular attention of clinicians due to the high 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, which are usually resistant to the main anti-tuberculosis drugs.

The leading method in the treatment of pulmonary tuberculosis is the treatment with anti-TB drugs, which determines the main direction of the prospects for the fight against tuberculosis and is regulated by the order of the Ministry of Health of the Russian Federation No. 109 dated 03/21/03 "On improving TB control in the Russian Federation." However, many years of experience with the use of anti-tuberculosis therapy indicates an insufficient clinical and radiological effect. The disadvantage of standard anti-TB treatment regimens 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 the weakening of the immune status.

All this makes us look for various new ways to treat pulmonary tuberculosis, which reduce the above disadvantages.

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

In the work of G.Yu. Vasilieva 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 patients with pulmonary tuberculosis, including Bestim 0.1 mg intramuscularly in the complex treatment of the immunomodulator, daily, for the course of treatment 5 injections.

M.V. Sinitsin (abstract of a dissertation for the degree of candidate of medical sciences “The use of thiopoietins in the complex treatment of patients with pulmonary tuberculosis”, Moscow, 2007, p.22) describes a method of treating patients with pulmonary tuberculosis with anti-tuberculosis drugs with an additional prescription of glutoxim in the course of treatment. The course of treatment with glutoxim begins in the first weeks of the intensive phase of chemotherapy and ends before the first follow-up examination, i.e. 2 months after the start of chemotherapy. The daily dose of glutoxim is 60 mg.

In the work of S.S. Arshinova and B.V. Pinegin "Immunomodulators in the treatment of patients with active pulmonary tuberculosis" (The Physician, October 2002, No. 10, pp. 36-37) describes a method for the treatment of pulmonary tuberculosis, including the inclusion of 6 mg polyoxidonium intramuscularly 2 times in the course of anti-tuberculosis therapy per week, 10 injections per course of treatment.

RF patent No. 2253460 (BIPM No. 16, 2005) protected the "Method for the treatment of pulmonary tuberculosis", which provides for the inclusion of zinc sulfate in the treatment regimen, which potentiates the effect of anti-TB drugs. Zinc sulfate is prescribed in a daily dose of 2.3-3.5 mg / kg for oral administration 2-3 times, the course of treatment is 21-28 days.

RF patent No. 2222222 (BIMP No. 35, 2004) protected the "Method for the treatment of focal and infiltrative pulmonary tuberculosis", which provides for the additional introduction of amixin into the course of anti-tuberculosis treatment. Amiksin is prescribed in a dose of 0.125 mg for 36 days: the first two days - 2 tablets, then 1 tablet after 48 hours.

RF patent No. 2340372 (BIMP No. 34, 2008) protected the "Method for the treatment of pulmonary tuberculosis" providing for an additional prescription of the herbal preparation "Populin".

RF Patent No. 2357745 (BIMP No. 16, 2009) protected the “Method for the treatment of pulmonary tuberculosis”, which provides for the addition of the traditional antibiotic therapy and probiotic bactisporin, the appointment of oxymethyluracil in a dose of 0.5 g twice a day for 10 days.

RF patent No. 2380113 (BIMP No. 3, 2010) protected the "Method for the treatment of pulmonary tuberculosis patients" providing for the additional use of the drug Viferon, rectal suppositories 1,000,000 ME (human recombinant interferon alpha-2), one suppository twice a day, from 12 -chasovym interval during 10 ^ti days - daily, from 11 ^th to 60 ^th day - a day.

The disadvantages of the above methods for the treatment of pulmonary tuberculosis are their lack of effectiveness in relation to the closure of decay cavities, resorption of infiltration and abacillation.

RF patent No. 2329782 (BIMP No. 21, 2008) protected the "Method for the treatment of patients with pulmonary tuberculosis" providing for the additional appointment of percutaneous electroneurostimulation in the direct projection of the lungs, the central universal zone and areas of systemic amplification - points 4GI, 5TR, 6MS, 14VG, one once a day, daily in a comfortable energy mode, at a frequency of 77 Hz, with a total duration of exposure of 30-35 minutes, for a treatment course of 20 sessions.

The disadvantage of this method of treatment is the presence of contraindications in some patients with individual intolerance to electric current, the presence of a pacemaker, epilepsy.

RF patent No. 2302251 (BIMP No. 19, 2007) protects the "Method for the treatment of pulmonary tuberculosis" providing for the additional use of a complex of homeopathic medicines - apis mellifica 6, quina officinalis 6, helidonium mayus 6, stannum 6, sanguine cana-densis 6, Kalium bichromicum 6, carbo vegetabilis 6 5 grains 3 times a day for 3-4 months, regardless of food intake.

The disadvantage of this method of treatment is the limitation of the contingent of patients who agree to the use of homeopathic medicines.

The closest in essence and taken as a prototype is the method of treatment of patients with pulmonary tuberculosis, provided for by the order of the Ministry of Health of the Russian Federation No. 109 dated 03/21/03, "On improving TB control in the Russian Federation." The method provides anti-tuberculosis therapy according to standard modes.

The disadvantage of the prototype is its lack of effectiveness in relation to the closure of decay cavities, resorption of infiltration and abacillation.

The objective of the invention is to increase the effectiveness of treatment of patients with pulmonary tuberculosis.

The technical result is to increase the effectiveness of treatment, namely the closure of decay cavities, resorption of infiltration and abacillation.

The technical result is achieved by prescribing a patient anti-tuberculosis therapy according to standard modes; two months after the start of the course of treatment, the patient is additionally prescribed subcutaneous, at the level of the scapular angle, injections of equal volumes of venous autologous blood and 0.25% novocaine solution, once a day, on an empty stomach, according to the scheme:

1st day - 1.0 ml of autologous blood and 1.0 ml of 0.25% novocaine solution, 4th day - 2.0 ml of autologous blood and 2.0 ml of 0.25% novocaine solution, day 8 - 3.0 ml of autologous blood and 3.0 ml of 0.25% novocaine solution, day 11 - 4.0 ml of autologous blood and 4.0 ml of 0.25% novocaine solution,

15th, 18th and 22nd days - 5.0 ml of autologous blood and 5.0 ml of 0.25% novocaine solution. Subcutaneous injections of a mixture of autologous blood and a 0.25% solution of novocaine are performed with a unilateral lesion at the level of the angle of the scapula on the affected side, with bilateral lesions alternately on both sides. In the 2nd, 3rd, 5th, 6th, 7th, 9th, 10th, 12th, 13th, 14th, 16th, 17th, 19th The 20th, 20th, 21st and all subsequent days of the course of therapy, treatment is carried out according to standard modes.

The introduction of a subcutaneous venous autologous blood of a patient in combination with novocaine causes an anti-inflammatory and immunomodulating effect, activates phagocytic activity, enhances non-specific immunity, has a stimulating effect on hematopoiesis and hemostatic system, promotes activation of reparative processes in the body (Tsypkin I.L. Gemonovokain and its use in treatment of patients with severe pain syndrome. -Kiev, 2005. P.44-74). Blood protein products released during the breakdown of blood are irritants of various systems of the diseased organism (Autohemotherapy. Electronic resource - access mode: http://biocentr.org/autogemoterapiva.htme). Subcutaneous administration of a mixture of autoblood and 0.25% novocaine enhances the effect on the immunological reactivity of the body, increases the functional activity of macrophages and the phagocytic activity of cells, and also stimulates the repair processes during lung tissue decomposition. This allows you to significantly increase the effectiveness of treatment of patients with pulmonary tuberculosis - closing the decay cavities, resorption of infiltration and abacillation.

The practical feasibility of the claimed method is illustrated by examples from clinical practice:

Example 1: patient L., 23 years old, medical history No. 785/16, was admitted for inpatient treatment at the State Institution "Tuberculosis Clinical Dispensary" of the Rostov Region for infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay and seeding, MBT +. The patient's condition upon admission is moderate, the skin is pale, the nutrition is low, tuberculous intoxication phenomena are expressed. Auscultatory in the lungs, vesicular breathing is heard, on the right in the upper sections there are single dry rales. Respiratory rate (BH) - 20 in 1 minute, blood pressure (BP) - 125/70 mm. Hg, pulse rate (PP) - 72 in 1 minute.

Survey data at admission:

X-ray and tomograms - in the upper lobe of the right lung, heterogeneous infiltration of the lung tissue of the focal structure with a decay cavity up to 2.5 cm in diameter, with polymorphic foci around and in S6 on the right, a wide broncho-vascular "path" to the root of the lung.

Blood test: hemoglobin - 134 g / l, red blood cells - 3.6 × 10 ¹² / l, white blood cells - 9.1 × 10 ⁹ / l, eosinophils - 2%, stab neutrophils - 9%, segmented neutrophils - 65%, lymphocytes - 20%, monocytes - 4%, ESR-26 mm / hour.

Sputum smear analysis by direct bacterioscopy - acid-resistant mycobacteria (CMC) found: 6-8 in the field of view.

Sputum culture gave rise to 10 colonies of Mycobacterium tuberculosis (MBT).

Mantoux test with 2 tuberculin units (TE) - 16 mm.

On the basis of the examination data, patient L. was diagnosed with infiltrative tuberculosis of the upper lobe of the right lung in the phase of decay and contamination, MBT +.

The patient was prescribed treatment according to the claimed method. The treatment was carried out according to the intensive phase of standard anti-tuberculosis therapy - streptomycin 1 g, isoniazid 0.6 g, rifampicin 0.6 g, pyrazinamide 1.5 g, multivitamins, vitamin B6. Two months after the start of the course of treatment, subcutaneous injections were additionally performed at the level of the right scapular angle, a mixture of equal volumes of venous autologous blood and 0.25% novocaine solution, once a day, on an empty stomach, according to the scheme: 1st day - 1.0 ml, 4th day - 2.0 ml each, 8th day - 3.0 ml each, 11th day - 4.0 ml each, 15th, 18th and 22nd days - 5 each , 0 ml. In the 2nd, 3rd, 5th, 6th, 7th, 9th, 10th, 12th, 13th, 14th, 16th, 17th, 19th The 20th, 20th, 21st and all subsequent days of the course of therapy, treatment was carried out according to standard modes.

After 4 months, the patient underwent a control examination.

Survey data:

X-ray and tomograms. - pneumosclerosis in the upper lobe of the right lung, foci of moderate intensity, infiltrative changes resolved, the decay cavity is not determined.

Blood test: hemoglobin - 138 g / l, red blood cells - 4.1 × 10 ¹² / l, white blood cells - 5.6 × 10%, eosinophils - 2%, stab neutrophils - 5%, segmented neutrophils - 65%, lymphocytes - 26 %, monocytes - 4%, ESR - 7 mm / hour.

Two sputum smear analyzes by bacterioscopy - no CMC found.

Two sputum cultures - there is no growth in the culture of the Office.

Mantoux test with 2 TE - 10 mm.

As a result of treatment according to the claimed method, a positive trend was achieved. The patient's condition improved, the infiltration resolved, the decay cavity was closed, abacillation was achieved, catarrhal phenomena were not heard in the lungs. After 4 months in satisfactory condition, the patient was discharged for outpatient treatment.

Example 2: patient N., 38 years old, medical history No. 698/51. entered hospital treatment in the State Institution “Tuberculosis Clinical Dispensary” of the Rostov Region for infiltrative tuberculosis of the lower lobe of the right lung in the phase of decay and contamination of both lungs, MBT +. The patient's condition at admission is not satisfactory. Complaints of coughing, weakness, fever, lowered nutrition, manifestations of tuberculous intoxication. Auscultatory in the lungs, against the background of vesicular breathing, a few dry rales are heard on the right in the lower sections. BH - 19 in 1 minute, BP - 135/80 mm. mercury column, state of emergency - 76 in 1 minute.

Survey data at admission:

X-ray and tomograms - in S 8 of the right lung, heterogeneous infiltration of the lung tissue of the focal structure, without clear contours, with small destruction, in S 6, 9, 10 on the right and in S 1-2 on the left polymorphic fouling without clear contours, drainage character, vascular "Path" to the root.

Blood test: hemoglobin - 118 g / l, red blood cells - 3.3 × 10 ¹² / l, white blood cells - 11.2 × 10 ⁹ / l, eosinophils - 5%, stab neutrophils - 9%, segmented neutrophils - 64%, lymphocytes - 17%, monocytes - 2%, ESR - 28 mm / hour.

Sputum smear analysis by direct bacterioscopy - CMC found 5-15 in the field of view.

Sputum culture gave rise to 20 colonies of the Office.

Mantoux test with 2 TE - 19 mm.

Based on the examination data, patient N. was diagnosed with infiltrative tuberculosis of the lower lobe of the right lung in the phase of decay and contamination of both lungs, MBT +.

The patient was prescribed treatment according to the claimed method. The therapy was carried out according to the intensive phase of the standard anti-TB therapy - streptomycin 1 g, isoniazid 0.6 g, rifampicin 0.6 g, ethambutol 1.6 g, multivitamins, vitamin B6. Two months later, from the beginning of the course of treatment, subcutaneous injections were performed at the level of the scapular angle, equal volumes of venous autologous blood and 0.25% novocaine solution, once a day, on an empty stomach, according to the scheme: 1st day - 1.0 ml, 4th day - 2.0 ml each, 8th day - 3.0 ml each, 11th day - 4.0 ml each, 15th, 18th and 22nd days - 5.0 each ml, alternately on both sides. In the 2nd, 3rd, 5th, 6th, 7th, 9th, 10th, 12th, 13th, 14th, 16th, 17th, 19th The 20th, 20th, 21st and all subsequent days of the course of therapy, treatment was carried out according to standard modes.

After 4 months, the patient underwent a control examination.

Survey data:

X-ray and tomograms - in S8 of the right lung pneumosclerosis, scattered medium size and large foci of medium intensity, destruction are not determined, in S6,9,10 on the right and in S 1-2 on the left single small medium density clearly contoured foci are determined.

Blood test: hemoglobin - 132 g / l, red blood cells - 4.0 × 10 ¹² / l, white blood cells - 6.1 × 10 ⁹ / l, eosinophils - 1%, stab neutrophils - 4%, segmented neutrophils - 67%, lymphocytes - 25%, monocytes - 3%, ESR - 8 mm / hour.

Two sputum smear analyzes by bacterioscopy - no CMC found.

Two sputum cultures - there is no growth in the culture of the Office.

Mantoux test with 2 TE - 12 mm.

As a result of treatment according to the claimed method, a positive trend was achieved. The patient's condition improved, the infiltration resolved, the destruction was closed, abacillation was achieved, catarrhal phenomena were not heard in the lungs. After 4 months in satisfactory condition, the patient was discharged for outpatient treatment.

Under our supervision, there were 29 patients with unilateral and bilateral pulmonary tuberculosis, which were divided into two groups that differ in the methods of therapy. The formed groups were homogeneous by sex, age, prevalence of tuberculous changes in the lungs, the presence of decay and bacterial excretion. Patients of the main group, in the amount of 11 people, received treatment according to the claimed method, sick comparison groups, in the amount of 18 people, received anti-TB treatment according to standard anti-TB treatment regimens, that is, according to the prototype. The treatment results were evaluated after 4 months, according to the indicators of closure of decay cavities, resorption of infiltration, and abacillation. A comparative analysis of the treatment results of these two groups of patients is presented in the table.

The effectiveness of the treatment of two groups of patients with pulmonary tuberculosis Indicators The main group of 11 people. Comparison group 18 people Resorption of infiltration 8 people = 72.7% 7 people = 38.9% Decay cavity closure 8 people = 72.7% 9 people = 50.0% Abacillation 9 people = 81.8% 7 people = 38.9%

As can be seen from the data given in the table, in patients of the main group who took treatment according to the claimed method, the treatment efficiency is higher than in patients of the comparison group who received treatment according to standard anti-tuberculosis treatment regimens, according to the indices of resorption of infiltration - by 1.9 times closing decay cavities - 1.5 times, abacillation - 2.1 times.

Thus, in comparison with the prototype, the proposed method for the treatment of patients with pulmonary tuberculosis can significantly increase the effectiveness of the treatment in terms of resorption of infiltration, closure of decay cavities and abacillation.

Claims (1)

A method of treating patients with pulmonary tuberculosis, providing for anti-tuberculosis therapy according to standard regimes, characterized in that two months after the start of the treatment an additional once a day, on an empty stomach, is prescribed subcutaneous, at the level of the scapular angle, injections of a mixture of equal volumes of venous autologous blood and 0, 25% solution of novocaine according to the scheme: 1st day - 1.0 ml each, 4th day - 2.0 ml each, 8th day - 3.0 ml each, 11th day - 4 each, 0 ml, 15th, 18th and 22nd days - 5.0 ml each, which in case of a unilateral lesion is performed on the lesion side, with two ronnem - alternately on both sides.