SU1388808A1 - Method of determining myocardial defficiency in chronic bronchopulmonary patients - Google Patents

Abstract

This invention relates to medicine, as it relates to pulmonology, intended to determine mucociliary insufficiency in patients with chronic bronchopulmonary diseases. The purpose of the invention is to improve the accuracy of the method. For this, hemoglobin is additionally isolated from autologous blood, inhaled as an indicator into the respiratory tract, and then the indicator is removed for the presence of hem-containing substances in successively collected portions of sputum. The brem, during which hemo-containing islands are detected in the examined sputum, increases with marked sputum stagnation and impaired bronchial patency.

Description

00

sc

00

sc

The invention relates to medicine, in particular, to pulmonology, and can be used to determine the mucosal disease, in patients with chronic bronchopulmonary diseases.

The aim of the invention is to improve the accuracy of the method by inhalation as an indicator of hemoglobin isolated from autologous blood, with subsequent recording of the time of excretion of the indicator for the presence of hemostermic substances in successively collected portions of sputum.

The method is carried out as follows.

5-10 ml of venous blood is taken from the examined patient. The volume of blood for the study is calculated from the hemoglobin content so that the total amount of hemoglobin for the study is about 1 g. The blood is centrifuged to isolate red blood cells. The isolated red blood cells are hemolyzed by the triple volume of distilled water, then centrifuged to separate the hemoglobin solution. The hemoglobin solution is diluted with saline to a volume of 20 ml and then inhaled with the help of an ultrasonic inhaler into the bronchi of the patient under examination.

After inhalation, to clean the oral cavity and pharynx, the patient is offered to rinse the mouth and sip 300 ml of water.

10 minutes after inhalation, the patient is collected sputum in a clean, clean dish every 6 hours, V. the presence of hem-containing substances is determined by each batch using a qualitative reaction.

Example 1. Patient T., 28 years old. Diagnosis: bronchial asthma, infectious-allergic form 1 ,, moderate, chronic obstructive bronchitis. Hemoglobin content in the blood is 155 g / l.

A patient takes 6.5 ml of venous blood per 0.5 ml of heparin solution with an activity of 10,000 units. in 1 ml. To red blood cells, blood is centrifuged with an acceleration of 220p. Then, the isolated erythrocytes are hemolyzed with 15 ml of distilled water, after which the lysate is centrifuged to isolate the hemoglobin solution with acceleration5

0

five

AMOU The resulting hemoglobin solution is brought to a volume of 20 ml with physiological saline and then inhaled into the patient's respiratory tract for the time required for the total volume in the bronchi. 10 minutes after inhalation, the patient is collected sputum in a clean, dry dish every 6 hours. The presence of hem-containing substances is determined in each portion of sputum using an amidopyrine reaction until it is no longer determined: an excess of 1 ml of sputum is added. reagent - a mixture of equal parts of 5% amidopyrine, 3% hydrogen peroxide and 30% acetic acid. The appearance of pronounced blue-violet staining confirms the presence of hem-containing substances in the sputum.

The results of the study:

1portion of sputum (1-6 h) - the reaction is positive ++++

2 portions of sputum (6-12 hours). - reaction is very positive ++++

Sputum 3 portions (12-18 h) - reaction positive + + +

4ports of sputum (18-24 hours) - the reaction is positive +++

5 sputum portions (24-30 h) - the reaction is positive +++

6 portions of sputum (30-36 h) - the reaction is positive +++

7 portions of sputum (36-42 h) - the reaction is slightly positive ++

8 sputum portions (42-48 h) - the reaction is slightly positive ++

9th sputum ratio (h) - the reaction is negative -.

Thus, the removal time of the indicator T is 48 hours, which indicates the presence of mucociliary insufficiency. In this case, the patient should be prescribed a treatment aimed at improving the transport of sputum from the bronchi (expectorant drugs, drainage).

Example 2. Patient A., 52 years old. Diagnosis: bronchial asthma, infectious-allergic form 1, moderate grade, chronic bronchitis.

The hemoglobin content in the blood is 160 g / l. The survey was conducted 5 in the same way as in example 1.

The results of the study:

1 portion of sputum (1-6. H) - the reaction is very positive ++++

0

five

0

five

2ports of sputum (6-12 hours) - the reaction is negative; 3ports of sputum (12-18 hours) - the reaction is negative. Thus, the excretion time of the indicator T was 6 hours, i.e. the patient does not have mucociliary insufficiency. And in this case, the patient is shown therapy aimed at reducing the manifestations of inflammation and discomfort (steroid hormones, theophylline drugs, sympathomimetics).

Example 3. Sick K., 60 years old, diagnosed signs of inflammatory inflammation: chronic obstructive bronchitis. The hemoglobin content in the blood is 120 g / l. For the study, take 8 ml of venous blood per 0.5 ml of a standard heparin solution. The survey was conducted in the same way as in example 1.

The time of T-indicator withdrawal is 30 hours, which indicates the absence of mucociliary insufficiency in the patient.

Example 4. Patient N., 45 years old. Diagnosis: bronchial asthma, infectious-allergic form 1, moderate, chronic obstructive jQ bronchitis. The patient suffers from bronchial asthma for a long time with frequent exacerbations, taking hormones. At the time of the survey, the main complaints of coughing are difficult to withdraw - w; her sputum. Rheological research-. Sputum did not show high viscoelastic properties. Prescribed mucolytic therapy (bromhexine)

35

process and a large amount of purulent sputum in the respiratory tract. A study of the respiratory function (AF) revealed a sharp decrease in all parameters, which is a sign of a generalized violation of bronchial patency. A pharmacological test with a berotok-bronchodilator that relieves bronchospasm showed a slight improvement in spirometry, which indicates obstruction of the bronchial lumen sputum. During examination of the patient by the proposed method, time T was 96 h, which indicates a pronounced stagnation of sputum in the bronchi, causing a sharp violation of bronchial patency. The patient was prescribed expectorant therapy with a lasolvane, which had no effect, the patient's condition continued to remain heavy, which determined the need for therapeutic bronchoscopy and sputum evacuation by suction through a bronchoscope.

no effect. When you study

the bronchial divisional function of the removal of the indicator T was 36 hours, which indicates the presence of mucociliary insufficiency. Since the study of the rheological properties of sputum. low viscoelastic properties were revealed, and the excretory function of the bronchi was moderately reduced, the patient was shown not sputum therapy, but therapy stimulating the function of the ciliated epithelium: B, -aronists, theophylline and drugs that reduce the formation of mucus: S-carboximetyl -1, is distein, which was prescribed with a good clinical effect. Example 5. Patient M., Diagnosis: bronchial asthma, infectious-allergic form, chronic purulent obstructive bronchitis, obo

str. Upon clinical examination, the patient is assessed as severe. The patient complains of the difficulty of wet discharge, an increase in its quantity, the festering nature of sputum. During auscultation, a large number of low-pitched dry and moist rales are heard, which change their localization during coughing, which is a sign of accumulation of sputum in the respiratory tract. To clarify the patient’s diagnosis, a bronchoscopy was performed on which

0

five

Q

five

0

with

0

five

process and a large amount of purulent sputum in the respiratory tract. A study of the respiratory function (AF) revealed a sharp decrease in all parameters, which is a sign of a generalized violation of bronchial patency. A pharmacological test with a berotok-bronchodilator that relieves bronchospasm showed a slight improvement in spirometry, which indicates obstruction of the bronchial lumen sputum. During examination of the patient by the proposed method, time T was 96 h, which indicates a pronounced stagnation of sputum in the bronchi, causing a sharp violation of bronchial patency. The patient was prescribed expectorant therapy with a lasolvane, which had no effect, the patient's condition continued to remain heavy, which determined the need for therapeutic bronchoscopy and sputum evacuation by suction through a bronchoscope.

Example 6. Sick S., Diagnosis: bronchial asthma, infectious-allergic form 1, exacerbation, chronic bronchitis. In a clinical examination of a patient, his condition is assessed as satisfactory. The patient notes the discharge of unsightly sputum, and does not notice difficulties with its separation. During auscultation, a small amount of dry scattered wheezes are heard. A study of the function of external respiration revealed insignificant changes in the indices, the pharmacological procedure with the berotok revealed an increase in all the indices to the proper values, which testifies to the absence of obturadii of the lumen of the respiratory tract by sputum. The examination by the proposed method determined that the time T was not extended to 24 hours, which correlated with a satisfactory condition of the patient, as well as indicators of respiratory function.

In a study of more than 100 patients, it was established that the time during which the sputum in the test was determined, the presence of heme-containing substances was determined, significantly increased with marked sputum stagnation and bronchial obstruction 1 due to clogged bronchus and mucociliary development. insufficiency of IB in different groups of patients this index | had the following values kxt0):

Chronic

obstructive

bronchitis

Chronic

purulent

bronchitis

Chronic

purulent obstructive

bronchitis

58., 5 ± 4.7 h, 05

73, 5 ± 9.6 h, 05

25

The proposed method of examination makes it possible to assess the severity of revealed violations causing a violation of bronchial patency due to bronchial obstruction, sputum and the development of mucociliary insufficiency, to clarify the diagnosis of the disease in its exacerbation. The method is simple to perform, does not cause adverse reactions and complications, can be carried out repeatedly in the same patient, and also performed on an outpatient basis.

thirty

Claims (1)

122.4 ± 4.9 h, 01. The formula of the invention Q 0 five Thus, it can be seen from the above data that in the control group of patients without disturbance of bronchial patency and mucociliary insufficiency due to congestion, the time during which the presence of hem-containing substances in the test sputum does not exceed 30h (X + 26). All examined patients with a clearance time of more than 30 hours showed clinical signs of mucociliary insufficiency and impaired bronchial patency due to stagnation of visceral sputum in the bronchi, The proposed method of examination makes it possible to assess the severity of revealed violations causing a violation of bronchial patency due to bronchial obstruction, sputum and the development of mucociliary insufficiency, to clarify the diagnosis of the disease in its exacerbation. The method is simple to perform, does not cause adverse reactions and complications, can be carried out repeatedly in the same patient, and also performed on an outpatient basis. The p values are given in comparison with the Control. The control group was a group of 15 patients with chronic non-obstructive treatment without out-of-aggravation. In these patients, a small amount of non-viscous sputum was recovered to 30-50 ml per day. When a spirometric study of the violation - bronchial patency was not revealed. The time of hem-containing substances excretion with sputum in these patients was (X ± G): 15.616.9 h. The method for determining mucociliary insufficiency in patients with chronic bronchopulmonary diseases by clinical examination, which is due to the fact that in order to improve accuracy, hemoglobin is additionally extracted from autologous blood, inhaled as an indicator into the respiratory tract, and the clearance time of the indicator for the presence of hemoglobin-containing substances is recorded mucociliary insufficiency is determined in successively collected portions of sputum and with a hatch time value of 30 hours or more.