RU2797991C1 - Method of complex treatment of patients with destructive forms of pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine, phthisiology and physiotherapy.

SUBSTANCE: invention can be used for the complex treatment of patients with destructive forms of pulmonary tuberculosis. Cutaneous irradiation is performed with an infrared laser at a wavelength of 890 nm of three fields of the corresponding projections of the pathological process in the lungs according to the results of X-ray examination and two fields of projections of the wings of the ilium, left and right. The following parameters of laser radiation in the pulsed contact mode are used: pulse power of 50 W, irradiation area with a matrix emitter of 40 cm², irradiation time of 2 minutes for each field, total procedure time of 10 minutes, 10–15 daily procedures with a gradual increase in the frequency of laser exposure: 3 procedures — with a frequency of 100–150 Hz, 3 procedures — with a frequency of 500–800 Hz, 9 procedures — with a frequency of 1,500 Hz.

EFFECT: method improves the efficiency of complex treatment, reduces the side effects of medicinal products, prevents the progression, exacerbation and recurrence of tuberculosis of the respiratory organs, reduces the length of stay of patients in hospital and return to work, reduces the number of people with chronic tuberculosis and people in need of rehabilitation for account of the set of techniques of the claimed invention.

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Description

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

In phthisiology, laser radiation with different wavelengths has long been used. A laser will be applied to lung tissue affected by tuberculosis and immunocompetent organs [1, 2, 7, 8].

Studies of the use of laser radiation in phthisiology under the influence of an infrared laser with a wavelength of 890 nm on the iliac bones have not been carried out, which does not allow us to compare our data with the literature.

There is a known method of stimulating the release of stem cells from the bone marrow into the peripheral bloodstream (Patent RU 2305573), in which laser radiation is applied to the sternum, sacroiliac region, iliac bones, sacrum, and vertebral region in practically healthy people [12].

The use of various physiotherapeutic factors in tuberculosis with the collapse of lung tissue (UVI, magnetotherapy, galvanization, inductothermy, etc.) is widely known, the most well-established method is the use of a laser. Currently, there are several methods that are most commonly used and more universal.

In the complex treatment of tuberculosis, ultraviolet radiation, red and infrared laser radiation are currently used [4, 5, 10, 11].

It is known the use of low-frequency infrared laser radiation (LILI) on the projection of the pathological focus of internal organs and on the projection of immunocompetent organs - the NLBI technique (supervenous laser blood irradiation). The device for NLBI includes a source of laser radiation, an optical fiber as a conductor, and a terminal device that forms a spot for transcutaneous transvenous irradiation. NLOC is technically the most simple. Its possibility is due to the high penetrating power of red light. The most effective option, pulsed LILI of the red spectrum (635 nm), PM (power density) - 4-5 W/cm2, pulse duration 100-150 ns, frequency 80 Hz. There is a technique with infrared radiation (IR) when using a matrix emitting head. Pulsed IR LILI (890-904 nm), PM - 8-10 W / cm2, pulse duration 100-150 ns, frequency 80 Hz, as well as a technique with the most widely used medical laser - a helium-neon laser (GNL) . This laser radiation source generates light waves with a wavelength of λ=632.8 nm. LILI in the red part of the spectrum has both nonspecific and specific effects in tuberculosis [1, 4, 5, 8].

The presented analogs of external methods of laser therapy are well studied and widely used, but the methods of their application do not sufficiently satisfy the goal set to obtain the most effective result in treatment.

After many years of observation and use of laser therapy, data have been obtained that not all patients tolerate laser radiation well. Individual characteristics and the appearance of side effects led to the search for the most gentle, but at the same time effective method of exposure.

Closest to the claimed method is a method of cutaneous irradiation of three fields of the projection of the pathological process in the lungs, and then the spleen with low-intensity laser radiation with a wavelength of 850-950 nm in the infrared range [9].

The disadvantage of this method is the irradiation of the projection field of the spleen, as an immunocompetent organ, which reduces the most effective treatment outcome.

The disadvantage of this treatment is the occurrence of side effects in a number of patients during or after the end of the course of physiotherapy (pain in the heart area, hypoglycemic state) [9]. When applying the method of influencing the iliac wings of the pelvic bones, no side effects were detected or they were minimized. It has been proven that patients tolerate this method of exposure better.

The technical result of the invention is to increase the effectiveness of the complex treatment of patients with tuberculosis with lung tissue destruction, increase cellular and humoral immunity, reduce the side effects of drugs by reducing the duration of treatment, since there is no need to use pathogenetic drug therapy, which is widely used during the entire intensive phase of the main a course of chemotherapy, the ability to avoid the progression, exacerbation and recurrence of tuberculosis of the respiratory system, the possibility of using it in the treatment of all forms of tuberculosis with destruction of lung tissue, as well as hyperchronic forms of tuberculosis: cavernous and fibrous-cavernous tuberculosis; reducing the length of stay of patients on inpatient treatment and returning to their work activities.

The specified technical result is achieved in a method for treating patients with destructive forms of pulmonary tuberculosis, including skin irradiation with an infrared laser with a wavelength of 890 nm of three fields of the corresponding projections of the pathological process in the lungs according to the results of an x-ray examination and the projection field of an immunocompetent organ against the background of drug therapy with anti-tuberculosis drugs, in which one the session is carried out by sequential laser irradiation of three fields of the corresponding projections of the pathological process in the lungs and two fields of projections of the wings of the iliac bones, left and right, using the following parameters of laser radiation in contact in a pulsed mode: pulse power 50 W, irradiation area with a matrix emitter 40 cm ² , irradiation time each field 2 minutes, total procedure time 10 minutes, 10-15 daily procedures with a gradual increase in the frequency of laser exposure: 3 procedures - with a frequency of 100-150 Hz, 3 procedures - with a frequency of 500-800 Hz, 9 procedures - with a frequency of 1500 Hz .

A gradual increase in the radiation dose during the course of treatment from procedure to procedure is achieved with a change in the pulse frequency: 3 procedures with a frequency of 100-150 Hz, 3 procedures with a frequency of 500-800 Hz, 9 procedures with a frequency of 1500 Hz. The ranges were selected empirically.

An additional effect on the wings of the iliac bones, where the red bone marrow is located, containing hematopoietic precursor cells, including immunocompetent cells, affects all cellular representations of the immune system, not only cellular immunity, but also humoral.

The study was carried out using the Azor-2K-02 laser therapeutic device, a similar result will be achieved using other devices similar in parameters. The laser therapeutic device "Azor - 2K - 02" consists of a power supply unit, a control unit and a matrix of an infrared pulse emitter. The device is intended for the treatment of acute inflammatory and chronic diseases in almost all areas of medicine. Parameters of the laser device: number of channels 2, procedure time 0-60 min., radiation wavelength, 0.63 - 1.5 μm., operating mode: pulsed, continuous, autoresonant, pulse repetition rate 0 - 10000 Hz. Dimensions 200x150x70 mm. Weight 1.0 kg. Operating temperature 10 - 30°C. Laser hazard class II. Electrical safety class II BF. Mains supply voltage 220 V, 50 Hz, 25 VA. The device is also equipped with: a laser power meter, power adjustment, radiation dose calculation, sound alarm, emergency shutdown, the possibility of independent operation of channels.

The method is carried out, for example, as follows.

Irradiation is carried out by contact, using a laser therapeutic apparatus "Azor - 2K - 02". The patient assumes a fixed position lying on his back or on his side. 5 fields are sequentially irradiated: 2 fields - wings of the ilium (right, left); 3 fields - projection zone of specific destruction.

Irradiation time per field is 2 minutes. The total procedure time is 10 minutes. The first three procedures are performed with a frequency of 100-150 Hz, with 4-6 procedures with a frequency of 500-800 Hz, 7-15 procedures with a frequency of 1500 Hz.

The course is 10-15 daily procedures, depending on the extent of the lesion.

The method is confirmed by the following clinical examples.

Example 1 (Fig. 1, 2). Patient Ch., 46 years old, was treated in a day hospital with a diagnosis of infiltrative tuberculosis of the upper lobe of the right lung in the decay phase (Fig. 1), MBT (-). Sensitivity to the main drugs is preserved. Lung pathology was detected in December 2019. Treatment was started according to the first regimen (1RHT) of 4 anti-drug drugs: isoniazid, rifampicin, pyrazinamide and ethambutol against the background of antioxidants, vitamins, lidase and desensitizing drugs. Tolerability of anti-tuberculosis drugs is satisfactory.

After a month of anti-tuberculosis therapy, a course of 14 daily procedures was prescribed according to the method of the proposed method.

For two weeks (excluding weekends), 5 zones were sequentially irradiated: three zones of the inflammation focus itself in the upper lobe of the right lung, then two zones (right and left ilium), each for 2 minutes. Total time 10 minutes. From 1-3 procedures were performed with a frequency of 100-150 Hz, 4 procedure 500 Hz., 5-600 Hz., 6.7-800 Hz., 8-900 Hz, 9-1000 Hz., 10-1100 Hz. , 11-1200 Hz., 12-14 procedures no more than 1500 Hz.

As a result of the treatment, the elimination of symptoms of intoxication and the normalization of laboratory parameters were achieved by the end of 1 month of treatment, respiratory complaints - by 2 months of treatment.

Clinical blood test dated 09/21/19. Hemoglobin 141 g/l, erythr. 4.47*10*12/l, Lake 7.1*10*9/l n63.7% e3.3% l25.3% m7.1%, 60.6% ESR 9 mm/h. Biochemical analysis of blood ALT 11.9 U/l, ACT 15.5 U/l, about. bilirubin 9.0 mmol/l. Urinalysis dated September 21, 2019, density 1020, negative glucose, negative protein, negative leukocytes. An. sputum b / sk from 20-21.09.19, KUM (-).

After the procedures, the patient noted an improvement in general well-being, there was a positive x-ray picture (figure 2), the patient was discharged from the hospital with complete closure of the decay cavity.

Example 2 (Fig. 3, 4). Patient B., aged 54, diagnosed with disseminated tuberculosis in the phase of infiltration and decay (Fig. 3), MBT (+). Respiratory failure 2 degrees. After 2 months of therapy with anti-tuberculosis drugs, due to persistent destructive changes in the lung tissue, the patient was prescribed a course of 15 daily procedures, which he tolerated satisfactorily.

For 15 days (excluding weekends), 5 zones were sequentially irradiated: three zones of the inflammation focus itself in the upper lobes of the right and left lungs, then two zones (right and left ilium), each for 2 minutes. Total time 10 minutes. From 1-3 procedures were performed with a frequency of 100-150 Hz, 1-4 procedures 500 Hz., 5-700 Hz., 6.7-900 Hz., 8-1000 Hz, 9-1000 Hz., 10-1200 Hz., 11-1300 Hz., 12-15 procedures 1500 Hz. Clinical blood test dated 06/29/21 Hemoglobin 140 g/l, erythr. 3.88*10*12/l, Lake 4.9*10*9/l s43.0% e1.9% l44.1% m10.5% 60.5%, ESR 35 mm/h. Biochemical blood test from 29.06.21 glucose 5.5 µmol/l, creatinine 65 mmol/l, ALT 347.5 U/l, AST 695.0 U/l, total bilirubin 34.8 µmol/l, cholesterol 8.29 mmol/l. Urinalysis dated 06/29/21 density 1020, glucose - neg. protein neg, leukocytes-. B / sputum scopy from 28-29.06.21 - KUM (-). Sputum cultures from 10/25/21 negative.

As a result of the treatment, the elimination of symptoms of intoxication and respiratory complaints, the normalization of laboratory parameters, the cessation of bacterial excretion by the method of sowing by the end of 1 month of therapy were achieved. During the treatment he gained 3 kg in weight. Radiologically, after 2 months of treatment, a decrease in the size of infiltrates with decay and foci was determined. X-ray control (Fig. 4) after 4 months of treatment noted the closure of the decay cavities. The patient was discharged to continue outpatient treatment.

Example 3. Patient 3., 58 years old. He had pulmonary tuberculosis in the MLS in 2006, the treatment is effective, he was transferred to the ZGDU. On prophylactic FLG of the chest from 01/15/22, there was a negative trend in the form of an increase in infiltration against the background of previously determined dense foci. MSCT of the chest was performed on January 15, 22 - in the upper lobes of both lungs and in C6 on both sides, local areas of infiltration are determined, with fibrous overlays and dense foci, on the right in C1 in the infiltrate there is a thick-walled air cavity. The recurrence was confirmed in LOPTD 27.01.22-Infiltrative tuberculosis of the upper lobe of the left lung in the phase of decay and seeding, MBT (+). Relapse.

MBT culture was isolated by the method of inoculation on liquid media dated 01/22/21. He was on treatment from 01/24/21 to 03/24/22 (67 days). Treatment according to ZRHT 4 PTP. As a result of treatment, it was staunchly abacilliated b/sk and inoculated from the 2nd month of treatment. Closure of the decay cavity by X-ray dated 04/14/22, according to TM from 03/03/22, the decay cavity is not determined. MSCT of the chest was performed on 05/17/22 - positive dynamics along the path of resorption of focal infiltrative changes.

Examination: Clinical blood test dated 24.08.22: Hemoglobin 144 g/l, erythrol. 4.57*10*12/l, Lake 8.6*10*9/l n53.3% e4.8% l30.1% m10.6% 61.2%, ESR 20 mm/h. Biochemical blood test dated 24.08.22 glucose 5.1 µmol/l, creatinine 92 mmol/l, ALT 132.8 U/l, ACT 88.0 U/l, total bilirubin 12.0 µmol/l. B / sputum scopia from 24-25.08.22 - KUM (neg). Sputum cultures 10/22/21 - positive, 12/28/21 - negative, 02/02/22 - negative, 05/20/22 - negative.

During inpatient treatment from the first days, etiotropic therapy was supplemented by a course of laser irradiation. The patient was performed 15 procedures by the claimed method. For two weeks (excluding weekends), 5 zones were sequentially irradiated: three zones of the inflammation focus on both sides in the upper lobes of the right lung and the left lung, then two zones (right and left ilium), each zone was irradiated for 2 minutes. Total time 10 minutes. From 1-3 procedures were performed with a frequency of 100-150 Hz, from 4 procedures 500 Hz., 5-600 Hz., 6.7-800 Hz., 8-900 Hz, 9-1000 Hz., 10-1100 Hz ., 11-1200 Hz., 12-15 procedures 1500 Hz. During the laser irradiation, the patient did not notice a deterioration in general well-being,

The claimed method treated 52 patients with destructive pulmonary tuberculosis. Tolerability of laser therapy in 100% of cases was good. Allergic manifestations to the impact factor were not identified. A positive clinical, radiological and laboratory effect was noted in 100% of cases. This result was confirmed clinically, radiologically and laboratory.

Thus, the results of the studies have shown that the proposed method of complex therapy using infrared laser radiation according to the method described above in patients with destructive pulmonary tuberculosis can be used in parallel with the intensive treatment phase (main course), and in some cases (relapses) even from the first days of treatment.

The claimed method increases the effectiveness of the complex treatment of tuberculosis patients with lung tissue destruction, increases cellular and humoral immunity, reduces the side effects of drugs by reducing the intensive phase of treatment (in patients treated with laser therapy according to our method, the treatment time was reduced by 1, 5-2 times), since there is no need to use long-term pathogenetic drug therapy, which is widely used during the entire intensive phase of the main course of chemotherapy. Simultaneously with high efficiency, the proposed method provides economic benefits: due to a decrease in the duration of intensive care, the length of stay in hospital is reduced, insurance payments for disability certificates are reduced, the patient returns to work in a shorter time, the number of people with chronic tuberculosis is reduced and people in need of rehabilitation measures. The developed method prevents the progression, exacerbation and recurrence of respiratory tuberculosis, can be used in the treatment of all forms of tuberculosis with lung tissue destruction, as well as hyperchronic forms of tuberculosis: cavernous and fibrous-cavernous tuberculosis.

Information sources:

1. Dobin V.L. The use of laser therapy in the complex treatment of patients with respiratory tuberculosis / V.L. Dobin., A.P. Savkin., V.D. Churaev // Russian Medical and Biological Bulletin named after Acad. I.P. Pavlova. - 2001. - No. 1-2. - With. 20-22.

2. Bogolyubov, M.V. General physiotherapy / M.V. Bogolyubov, G.N. Ponomarenko. - M.: Medicine, 2003. - 480 p.

3. Vinokurova, M.K. Individualized laser therapy in the complex treatment of patients with destructive pulmonary tuberculosis: Abstract of the thesis. dis. ... doctor of medical sciences: 14.00.26 / M.K. Vinokurov. - M., 2005. - 44 p.

4. Sutyagina, D.A. The effectiveness of the complex treatment of infiltrative pulmonary tuberculosis using low-intensity laser radiation: assessment of immediate and long-term results: abstract of dissertation ... candidate of medical sciences: 14.01.16 / Sutyagina D.A. - Moscow, 2015. - 26 p.

5. Moskvin S.V., Kochetkov A.V. Effective methods of laser therapy. - M.-Tver: Triada Publishing House, 2016. - 80 p.

6. Vasiliev I.G. Physical factors in the treatment of destructive pulmonary tuberculosis with bacterial excretion: abstract of the thesis. dis. ... cand. honey. Sciences: 14.00.26/ Yangolenko D.V. - Moscow., 2002. - 23 p.

7. Levkina M.V. Laser therapy in the complex treatment of infiltrative pulmonary tuberculosis (experimental clinical study): author. dis. ... cand. honey. Sciences: 14.00.26/ Levkina M.V. Moscow., 2007. - 25 p.

8. Pilnik G.V. Opportunities to improve the effectiveness of the treatment of patients with destructive pulmonary tuberculosis using a complex of physiotherapeutic methods: abstract of dissertation ... candidate of medical sciences: 14.01.16 / Pilnik G.V. - Novosibirsk, 2017. - 22 p.

9. Patent RU 2375088 Method for the treatment of newly diagnosed infiltrative destructive pulmonary tuberculosis L.A. Skvortsova and others.

10. Patent RU2141859 Method for the treatment of destructive forms of pulmonary tuberculosis by endocavitary irradiation with ultraviolet radiation and a device for its implementation V.V. Apollonov and others.

11. Patent RU No. 2234349 multiwave laser device of bactericidal and therapeutic action for the treatment of infectious diseases Sirotkin A.A. and etc.

12. Patent RU 2305573 Method for stimulating the release of stem cells from the bone marrow into the peripheral bloodstream Golovneva E.S. and etc.

Claims (1)

A method for the complex treatment of patients with destructive forms of pulmonary tuberculosis, including skin irradiation with an infrared laser at a wavelength of 890 nm of the fields of three projections of the pathological process in the lungs according to the results of an X-ray examination and the projection field of an immunocompetent organ against the background of drug therapy with anti-tuberculosis drugs, characterized in that in one session a sequential laser irradiation of three fields of the corresponding projections of the pathological process in the lungs and two fields of projections of the wings of the ilium, left and right, using the following parameters of laser radiation in the pulsed contact mode: pulse power 50 W, irradiation area with a matrix emitter 40 cm ² , irradiation time of each field 2 minutes, the total procedure time is 10 minutes, 10-15 daily procedures with an increase in the frequency of laser exposure: 3 procedures - with a frequency of 100-150 Hz, 3 procedures - with a frequency of 500-800 Hz, 9 procedures - with a frequency of 1500 Hz.

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