RU2704569C1 - Treatment method of exudative pleurisy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery and oncology. Pleural cavity is drained into 8 intercostal space along the posterior axillary line with silicone tube 5 mm in diameter to remove exudate. Day after the drainage of the pleural cavity, X-ray control is performed. If on an X-ray image the pleural cavity is dry, the lung is straightened, then the silicone tube with diameter of 5 mm is removed and a polyurethane catheter with diameter of 2 mm is placed in its place in the pleural cavity, its inner end is that part of the catheter placed in the pleural cavity, which has eight through holes with diameter of 1 mm. Then, Tramal is injected intramuscularly, Naropin 50 ml and physiologic saline 50 ml are introduced along the catheter and the outer end of the catheter is squeezed. Patient lies in different positions for 30 minutes. Clamp is removed, Betadin 10 % 30.0 ml and Naropin 60 ml are introduced, and the outer end of the catheter is clamped for 8 hours, during which time the patient lies and changes body position every two hours. Further, a clamp is removed and active aspiration is performed for 12 hours, and the catheter is removed.

EFFECT: method provides effective anesthesia, reduced length of treatment, reduced recurrence.

1 cl, 1 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery and oncology, and can be used to treat exudative pleurisy.

Prolonged drainage of the pleural cavity with exudative pleurisy increases the risk of infection, which contributes to the development of pleural empyema.

In order to eliminate exudate, talc, tetracycline, and betadine solutions with efficacy from 60% to 90% are introduced into the pleural cavity through an established drainage (A.A. Shulutko et al. Endoscopic thoracic surgery. A guide for doctors. M., Medicine, 2006, R Agarvaletal. Efficacy and safety of iodopovidone pleurodesis: a systematic review and meta-analysis. Indian JMedRes. 2012., V. 135., N. 3, p. 297-304).

The disadvantage of this method of treatment is severe pain, fever, risk of pulmonary complications, the duration of treatment.

There is a known patent (Plaksin S.A., Furshatova L.I.) wherein in order to stop the exudation and obliteration of the pleural cavity through the drainage tube installed during thoracoscopy or during drainage of the pleural cavity, they are administered 50 ml of a 1% lidocaine solution into the pleural cavity, after which the tube is closed for 20 minutes. After that, 40-80 ml of a previously prepared mixture consisting of 1% iodopyron solution and 40% glucose solution in a 1: 4 ratio is injected into the drainage tube using a syringe. The drainage is closed for 2 hours. At this time, the patient repeatedly changes the position of the body so that the drugs get into all departments of hemitrax. Then the drainage is opened and active aspiration is continued. Drainage is removed from the pleural cavity with a decrease in the volume of exudation to 100 ml of effusion or less per day.

The disadvantages of this method of treatment are: insufficient analgesia, since there is no premedication (anesthesia before surgical procedures), anesthetic (lidocaine) is administered once; the use of a standard one, without through holes of the drainage tube, of the same diameter, which does not allow to irrigate the pleural cavity effectively with drugs, thereby reducing their effectiveness.

The objective of the invention is the introduction of drugs into the pleural cavity to eliminate resistant exudative pleurisy, premedication prior to their introduction, the installation of a small diameter polyurethane catheter with through holes in the pleural cavity for better irrigation of drugs, two-time administration of anesthetic, which will contribute to a better analgesic effect, reducing the time treatment, reduce the recurrence of the disease.

The technical result is achieved by the fact that with exudative pleurisy, the pleural cavity is drained in the 8 intercostal space along the posterior axillary line with a 5 mm diameter silicone tube to remove exudate, then an x-ray is performed one day after the pleural cavity is drained if the pleural cavity is dry, the lung is straightened, then the silicone tube with a diameter of 5 mm is removed and a polyurethane catheter with a diameter of 2 mm, the inner end (part of the catheter, placed in the pleural cavity) which has eight through holes with a diameter of 1 mm, then tramal (premedication) is intramuscularly injected, 50 ml (100 mg) of Naropin are injected into the catheter, 50 ml of physiological saline and the external end of the catheter are pressed, then the patient lies in in different positions, then the clamp is removed, Betadine 10% 30.0 ml and Naropin 60 ml (120 mg) are introduced via the catheter and the external end of the catheter is squeezed for 8 hours, during this time the patient lies and changes his body position every two hours, then remove clamp and within 12 hours you olnyayut active aspiration, the catheter is removed at the end.

The invention is illustrated in figure 1

Figure 1 illustrates the chest, drainage with a polyurethane catheter for the introduction of drugs into the pleural cavity:

1 - 8 intercostal space,

2 - back axillary line,

3 - polyurethane catheter,

4 - the inner end of the polyurethane catheter,

5 - through hole on the inner end of the polyurethane catheter

6 - the outer end of the polyurethane catheter

The method is as follows.

With exudative pleurisy, the pleural cavity is drained in the 8 intercostal space 1 along the posterior axillary line 2 with a 5 mm diameter silicone tube to remove exudate, then one day after the pleural cavity is drained, an x-ray is performed, if the pleural cavity is dry, the lung is straightened, then the silicone tube with a diameter 5 mm is removed and a polyurethane catheter 3 with a diameter of 2 mm is installed in its place in the pleural cavity, the inner end 4 (part of the catheter located in the pleural cavity) which he has eight through holes with a diameter of 1 mm 5, then tramal (premedication) is injected intramuscularly, 50 ml (100 mg) of Naropin are administered via catheter 3 and 50 ml of physiological saline and the external end of the catheter is pressed, then the patient is in different positions for 30 minutes then the clamp is removed, 3 Betadine 10% 30.0 ml and Naropin 60 ml (120 mg) are introduced via the catheter and the external end of the 6 catheter is squeezed for 8 hours, during this time the patient lies and changes his position every two hours, then the clamp is removed and within 12 hours they perform active aspiration, at the eye Chania catheter 3 is removed.

Clinical example. Patient J., 54 years old, was hospitalized in the surgical thoracic department of the Regional Oncology Clinical Center of Ulyanovsk for surgical treatment with a diagnosis of cancer of the upper lobe of the right lung. Operation: Thoracotomy on the right, upper lobectomy with lymphadenectomy.

On the 6th day, the postoperative period was complicated by exudative pleurisy. The pleural cavity was drained in the 8th intercostal space along the posterior axillary line with a silicone tube with a diameter of 5 mm, 400 ml of exudate was removed, then one day after the pleural cavity was drained, an x-ray was performed and the pleural cavity was dry and light on the radiograph. The silicone tube with a diameter of 5 mm was removed and a polyurethane catheter with a diameter of 2 mm was installed in its place in the pleural cavity, the inner end (the part of the catheter located in the pleural cavity) has eight through holes with a diameter of 1 mm, then the tram (premedication) was intramuscularly inserted (catheter) 50 ml (100 mg) of Naropin were injected, 50 ml of physiological saline and the catheter were squeezed out, then the patient lay in different positions for 30 minutes, then the clamp was removed, 10% 30.0 ml of Betadine and 60 ml of Naropin (120 mg) were inserted through the catheter. and external onets catheter is pinched at 8 hours and during this time the patient is lying down and changed every two hours body position further removed clamp and within 12 hours was performed active aspiration, performed X-ray control, radiographs dry pleural cavity, lung expandable catheter removed. The pain syndrome was 2 points on the Visual Analogue Scale. Further, the postoperative period was uneventful, wound healing by primary intention. The patient in satisfactory condition was discharged home under the supervision of an oncologist, surgeon in the clinic at the place of residence. The patient was examined after a year, there is no relapse of the disease.

Thus, this clinical example proves the advantage of the proposed method for the treatment of exudative pleurisy.

Claims (1)

A method of treating exudative pleurisy, including drainage of the pleural cavity in the 8th intercostal space along the posterior axillary line with a 5 mm diameter silicone tube to remove exudate, characterized in that an x-ray is performed one day after the drainage of the pleural cavity, if the pleural cavity is dry, the lung is straightened, then a silicone tube with a diameter of 5 mm is removed and a polyurethane catheter with a diameter of 2 mm is placed in its place in the pleural cavity, its inner end is that part of the catheter, located a woman in the pleural cavity, which has eight through holes with a diameter of 1 mm, then intramuscularly administer tramal, 50 ml of Naropin and physiological saline are introduced via a catheter and 50 ml of saline and the external end of the catheter is squeezed, then the patient lies in different positions for 30 minutes, then remove the clamp , Betadine 10% 30.0 ml and Naropin 60 ml are introduced via the catheter and the external end of the catheter is squeezed for 8 hours, during this time the patient lies and changes his body position every two hours, then remove the clamp and perform active aspiration for 12 hours,the catheter is removed on completion.

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