RU2565107C1 - Method of treating patients suffering from community-acquired pneumonia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: prescribing a complex of medicinal products is combined with exposing the patient's blood intravenously to a continuous laser light generated by the Matrix-VLOK apparatus. The medicinal products involve antibacterial and mucolytic preparations; a detoxification therapy is also conducted. If observing a moderate clinical course of community-acquired pneumonia in a combination with lactoferrin measured at 2,420 ng/ml and 34% spontaneous and 55% stimulated nitro blue tetrazolium test results, 7 procedures of the 5-minute intravenous laser exposure of the patient's blood are required. A laser light wavelength is 0.405 mcm; an output power at an end face of a disposable intravenous light guide is 1.0 mW.

EFFECT: method enables increasing the clinical effectiveness in community-acquired pneumonia by normalising functional-metabolic neutrophil activity indices, reducing the inflammatory process activity and drug-induced load on the patient.

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Description

The invention relates to medicine, namely to the section "pulmonology", and can be used in the treatment of patients with pneumonia.

Community-acquired pneumonia (CAP) remains one of the leading causes of morbidity, hospitalization and mortality, being a constant very complex public health problem in both industrialized and developing countries.

The problem of pneumonia is constantly the subject of study in research laboratories, in practical health care both in the Russian Federation and abroad, and the obtained research results are periodically widely discussed at congresses and workshops, which indicates the continuing relevance and social significance of this problem.

It should be noted that in the annual dynamics of the incidence of VP there is no clearly expressed seasonality. However, the incidence is slightly lower in the summer months, but the proportion of deaths remains virtually unchanged.

In Russia, the average duration of one case is 25.6 days, and labor losses in this case reach about 25.5 thousand days per 100 thousand of the population annually. At the same time, annual economic damage is approximately 15 billion rubles.

Despite the huge efforts to improve drug therapy and a large arsenal of drugs with antibacterial, anti-inflammatory and other focuses, the problem of treating community-acquired pneumonia is far from being resolved. The percentage of patients with drug allergies is high; bacterial strains resistant to most antibiotics are seeded. More and more often, pneumonia takes a protracted nature, which currently dictates the need to search for new effective, including non-drug methods of treating pneumonia. Among non-drug methods in recent decades, laser therapy has become widely used.

One of the most common methods of therapeutic effect of low-intensity laser radiation (LIL) on the human body is intravenous laser blood irradiation (VLOK), which is currently successfully used in various fields of medicine. The use of VLOK can significantly reduce treatment time, increase remission time, and stabilize the course of diseases.

A known method of treating patients with pneumonia (A.Ya. Osin, A.I. Itskovich, B.I. Geltser. Laser therapy in pulmonology. - Vladivostok: Dalnauka. - 1999. - S. 177-179), including the use of cutaneous and intravenous laser irradiation of blood, depending on the severity of pneumonia.

The disadvantage of this method is the use of various methods of laser therapy, which requires additional technical support; underestimation of the effect of laser irradiation on some pathogenetic links, including the functional and metabolic activity of neutrophils in patients with community-acquired pneumonia.

There is a method of treating patients with pneumonia (application for invention 2007126899/14 dated 07/13/2007. Authors: Burduli NM, Pilieva NG), which consists in conducting intravenous laser irradiation of blood (VLOK) differentially depending on the detected hemodynamic type of microcirculation and the level of activity of the protein C system.

The disadvantage of this method is the lack of consideration of the possibility of using intravenous laser irradiation of blood with a wavelength of 0.405 μm, which combines the advantages of LLLT of red and ultraviolet (UV) spectra. The effect of laser radiation on the functional and metabolic activity of leukocytes, which is one of the key tools for initiating and determining the direction of the course of inflammation, is also not taken into account.

The closest in combination of essential features to the claimed invention is a method for the treatment of patients with pneumonia, which we took as a prototype (Geynits A.V. et al. Intravenous laser blood irradiation. M., 2012. P. 205), in which simultaneously with the complex use of medicinal drugs carry out intravenous laser blood irradiation, as a result of which cellular respiration is activated and the phagocytic activity of neutrophils increases.

The prototype and the claimed invention has the following essential features: the simultaneous integrated use of drugs and laser therapy.

The disadvantage of this method of treatment is laser therapy without taking into account the severity of the course of VP, indicators of the functional and metabolic activity of leukocytes, the inability to use the KL-VLOK-405 radiating head, which combines the properties of LLLT in the red and ultraviolet regions.

The purpose of the invention is the creation of a method for the treatment of patients with community-acquired pneumonia.

This goal is achieved by the fact that patients of the main group, along with the use of antibacterial and mucolytic drugs, as well as detoxification therapy, are prescribed intravenous laser blood irradiation, taking into account the severity of community-acquired pneumonia, the level of indicators of the functional and metabolic activity of neutrophils, namely lactoferrin, nitrosine tetrazolium test (HCT test). In case of moderate severity of community-acquired pneumonia with a lactoferrin level of 2420 ng / ml, indicators of the nitrosine tetrazolium test: spontaneous 34% and stimulated 55%, 7 daily intravenous laser blood irradiation procedures are performed for 5 minutes, a wavelength of 0.405 μm, and output power at the end of a single-use intravenous fiber 1.0 mW, in continuous radiation mode using the Matrix-VLOK apparatus, which combines the advantages of the LLLT of red and UV spectra.

The solution of this goal ensures the normalization of the functional and metabolic activity of neutrophils, a decrease in the activity of the inflammatory process, a decrease in the severity and duration of the clinical manifestations of the disease, a decrease in the drug load on the patient, and an increase in the effectiveness of complex therapy.

In relation to the prototype, the claimed invention has the following distinctive features: the use of antibacterial and mucolytic drugs, as well as detoxification therapy for patients with community-acquired pneumonia, are combined with intravenous laser irradiation of blood, taking into account the severity of VP, the level of indicators of the functional and metabolic activity of neutrophils, namely lactoferrin , nitrosine tetrazolium test (HCT test). In case of moderate severity of community-acquired pneumonia with a lactoferrin level of 2420 ng / ml, indicators of the nitrosine tetrazolium test: spontaneous 34% and stimulated 55%, 7 daily intravenous laser blood irradiation procedures are performed for 5 minutes, a wavelength of 0.405 μm, and output power at the end of a single-use intravenous fiber 1.0 mW, in continuous radiation mode using the Matrix-VLOK apparatus, which combines the advantages of the LLLT of red and UV spectra.

Example 1

Patient G., 21 years old, was treated in the first therapeutic department of KBSMP from 06/08/2013 to 06/18/2013 with a diagnosis of community-acquired left-sided focal pneumonia with localization in the lower lobe, moderate course. DAY.

He was admitted with complaints of cough with mucous sputum, difficulty breathing, fever up to 39.5 ° C, decreased appetite, weakness.

Considers himself sick for 5 days, when body temperature increased, a cough appeared. He connects his condition with the fact that he got wet in the rain. I did not receive treatment. He independently applied to the sub-station KBSMP, was hospitalized.

Objectively: a state of moderate severity, the skin is of a normal color, there is no edema, peripheral lymph nodes are not enlarged. NPV 20-22 in 1 minute. Auscultation over the lungs weakened vesicular breathing, to the left of the angle of the scapula down, moist medium bubbling rales are heard. The area of the heart and large vessels is not visually changed, heart sounds of sufficient sonority, the rhythm is correct. HELL 120/60 mm. Hg. Art., pulse 85 beats per minute. The tongue is of low humidity, clean, the stomach is of the correct form, painless on palpation. The liver is at the edge of the costal arch, the spleen is not palpable.

In the general analysis of blood: er. 4.3 × 10 ¹² / L; Hb 140 g / L; color indicator 0.9; lake. 1.8 × 10 ⁹ / l; PO Box 13%, PO Box 50%, lymph. 30% mon 5%, e. 2%, ESR 22 mm / h.

In the biochemical analysis of blood: bilirubin - 18.5 μmol / L, total protein - 70 g / L, ALT - 0.17 μmol / L, ACT - 0.17 μmol / L, sugar 5.0 mmol / L, urea 4 , 0 mmol / L, creatinine 56 μmol / L. In the general analysis of urine - without pathology.

On a panoramic radiograph of the chest organs on the left against the background of an enhanced pulmonary pattern, infiltrative shadows, roots are not structural, the heart is without features. The diaphragm is clear, the sinuses are free. Conclusion: Left-sided focal pneumonia.

ECG: heart rate 109-92 per minute. Sinus tachycardia ECG signs of tension of the right atrium.

Phagocytic activity of neutrophils:

HCT test: spontaneous-34% (N <10%), stimulated-55% (N> 40%) Lactoferrin 2420 ng / ml (N 800-1400 ng / ml).

Against the background of drug therapy (antibacterial drugs, mucolytic drugs, detoxification measures), the patient was given a course of IVLO lasting 7 sessions. The laser wavelength used is 0.405 μm, and the power is 1.0 mW. The duration of the procedure is 5 minutes.

By the sixth day of treatment, overall health improved significantly, the temperature returned to normal, it became easier to breathe, and a rare dry cough.

After the treatment, positive dynamics of the phagocytic activity of neutrophils was also observed. HCT test: spontaneous - 7%, stimulated - 45%.

Lactoferrin 1440 ng / ml

On the x-ray on the 8th day of treatment - focal shadows resolved.

Thus, during the treatment process, the normalizing effect of intravenous laser therapy on the phagocytic activity of neutrophils, a positive effect on the clinical signs of the disease, and the acceleration of recovery time were noted.

Example 2

Patient Ch., 46 years old, was treated in the first therapeutic department of KBSMP from 02/08/2014 to 02/21/2014 with a diagnosis of community-acquired right-sided focal pneumonia with localization in the lower lobe. NII.

Received complaints of cough with yellow sputum, shortness of breath mixed in the slightest exertion, pain in the right half of the chest, intensifying with a deep breath, fever up to 38 ° C, sweating, weakness.

He considers himself ill for about 3-4 days, when, after hypothermia, malaise appeared, a dry cough, body temperature increased to 39 ° C. I did not apply for medical help, was treated with folk remedies. The condition did not improve, shortness of breath with small activity, chest pain on the right joined. Called the ambulance team delivered KBSMP, hospitalized in 1 t / o.

Upon admission, the patient's condition is moderate. The skin is of normal color, there is no swelling, peripheral lymph nodes are not enlarged. NPV 22-24 in 1 min. Vesicular breathing is weakened over the lungs, weakened in the lower parts of the right, crepitation is also there. The area of the heart and large vessels is not visually changed, heart sounds are muffled, the rhythm is correct. HELL 125/80 mm. Hg. Art., pulse 90 beats per minute, satisfactory properties. The tongue is of low humidity, coated with a white coating, the abdomen is of the correct form, both halves participate equally in the act of breathing, painless on palpation. The liver is at the edge of the costal arch, the spleen is not palpable.

In the general analysis of blood: er. 4.3 × 10 ¹² / L; Hb 137 g / L; color indicator 0.9; lake. 4.2 x 10 ⁹ %; PO Box 9%, PO Box 50%, lymph. 29% mon 10%, e. 0%, ESR 50 mm / h.

In the biochemical analysis of blood: bilirubin - 12 μmol / l, total protein - 70 g / l, ALT - 0.17 μmol / l, ACT - 0.17 μmol / l, thymol sample -1 unit, sugar - 4.5 mmol / l, urea - 4.5 mmol / l, creatinine - 54 μmol / l. In the general analysis of urine - without pathology.

On an x-ray of the chest organs is determined on the right in the lower pulmonary field, above the diaphragm is a non-uniform, medium intensity dimming. Sines and aperture differentiate. The heart and aorta are normal. Conclusion: Right-sided pneumonia.

ECG: heart rate of 100 per minute, sinus tachycardia. Single ventricular extrasystole. ECG - signs of tension of the right atrium.

Phagocytic activity of neutrophils:

HCT test: spontaneous - 34% (N <10%), stimulated-55% (N> 40%) Lactoferrin 2420 ng / ml (N 800-1400 ng / ml).

A patient under the background of drug therapy (antibacterial drugs, mucolytic agents, detoxification measures) underwent a course of VLOK lasting 7 sessions. The laser wavelength used is 0.405 μm, and the power is 1.0 mW. The duration of the procedure is 5 minutes.

The patient on the 5th day of therapy noted a decrease in shortness of breath, an improvement in sputum discharge was already light in color, chest pain decreased significantly, body temperature returned to normal, sweating went away, and became more active.

After the treatment, there was a positive dynamics of the phagocytic activity of neutrophils. HCT test: spontaneous - 10%, stimulated - 45%.

Lactoferrin 1380 ng / ml

On the x-ray of the chest organs on the 9th day: focal-infiltrative changes were not detected.

As can be seen from the above observation, complex treatment using intravenous laser therapy had a beneficial effect on the general condition of the patient, the rate of recovery of this patient was faster than in the observed patients receiving only drug therapy. The inclusion of laser therapy in complex therapy was accompanied by an improvement in the phagocytic activity of neutrophils.

Clinical and laboratory studies of the proposed method for the treatment of patients with community-acquired pneumonia, compared with the known method (prototype), showed the effectiveness of the proposed method of treatment, the ability to correct changes that occur with this pathology, improve the results of drug therapy, reduce treatment time.

Claims (1)

A method of treating patients with community-acquired pneumonia, including the simultaneous combined use of drugs and intravenous laser blood irradiation in a continuous mode using the Matrix-VLOK apparatus, characterized in that antibacterial and mucolytic drugs are used as drugs, as well as detoxification therapy, for moderate community-acquired pneumonia with a lactoferrin level of 2420 ng / ml, indicators of nitrosine tetrazolium test: spontaneous 34% and stimulus At 55%, 7 daily intravenous laser blood irradiation procedures are performed for 5 minutes, a wavelength of 0.405 microns, and an output power of 1.0 mW at the end of a single-use intravenous fiber.