RU2163126C1 - Method of treatment of patient with acute lung abscess complicated by pyopneumothorax - Google Patents

Abstract

FIELD: medicine, pulmonology, surgery. SUBSTANCE: method involves additional every day intraarterial infusion of ozonized physiological solution of 0.9% sodium chloride into pulmonary artery on the site of damaged lung in the dose 450 ml once for 10-14 days of acute period of disease. For this purpose pulmonary artery is catheterized by Seldinger's procedure through subclavian vein on the site of suppurative process localization. EFFECT: improved microcirculation in lungs, decreased bronchial exudation, improved results of treatment of patients. 2 cl, 1 ex

Description

 The invention relates to medicine, namely to methods for treating acute lung abscess.

 There is a method of treating acute lung abscess by endoscopic debridement of the tracheobronchial tree and abscess cavity, in addition with drainage of the purulent pleural cavity according to Byulau, followed by washing it through drainage with solutions of antiseptics and antibiotics [1].

 However, this traditional method of anti-inflammatory treatment of the lungs and pleura is not effective enough, accompanied by a mortality rate of 11.2%, chronic inflammation in the pulmonary structures and a long duration of the patient’s stay in the surgical hospital.

 The purpose of the invention is to reduce mortality in patients, chronic inflammation in the lungs and pleura, reducing the duration of treatment and the patient's stay in a surgical hospital.

 This goal is achieved by the fact that in the implementation of the traditional method of treating acute purulent pleuropneumonia, complicated by an abscess of the lung and pyopneumothorax, by endoscopic debridement of the tracheobronchial tree and abscess cavity, drainage of the lesion according to Bulau, followed by chemotherapy, the patient is additionally given a daily single infusion of ozonated pulmonary artery into the pulmonary artery a solution of sodium chloride in a dose of 450.0 ml with a concentration of 500 μg / l for 10-14 days of the remaining period of the disease. Pulmonary artery catheterization for intra-arterial administration of an ozonated 0.9% NaCl solution is performed according to the Seldinger technique, through the subclavian vein on the side of the purulent process localization.

 The proposed method for the treatment of a patient with acute lung abscess and pyopneumothorax is as follows.

 The traditional, well-known method of treating patients with acute purulent destructive pneumonia complicated by lung abscess and pyopneumothorax is supplemented by daily administration of 450.0 ml of ozonized physiological saline solution of sodium chloride with an ozone concentration of 500 mg / l into the pulmonary artery of the affected lung. Catheterization of the pulmonary artery is performed on the side of localization of the purulent process in the lung and is carried out according to the Seldinger technique (subclavian vein - superior vena cava - right atrium - right ventricle - common pulmonary trunk - pulmonary artery of the affected lung) under the control of the X-ray machine. The silicone catheter is fixed to the skin with a piercing ligature. A control panoramic x-ray of the chest is performed to diagnose the localization of the distal catheter. At the end of arterial canal catheterization, a 50 ml long solution of heparin is introduced into a fixed and fixed silicone catheter at a dose of 2 ml (5 thousand units) in 5 ml of saline to prevent inflammation of the vascular bed and prevent thrombosis of the catheter cavity. In the following days, the heparin solution is administered to the patient daily in the same dose, after each infusion of the ozonated solution for the same purpose. The proximal catheter is constantly tightly closed with a screw plug, while maintaining the tightness of the vascular bed. The duration of ozonized daily infusions into the arterial bed of patients with acute lung abscess and pyopneumothorax of ozonized physiological saline solution lasts for 10-14 days of the acute period of the disease.

 Example.

 Patient L. 44 years old, diagnosis: right-sided purulent abscessed pneumonia and abscess of the right lower lobe, empyema of the pleura on the right. Under Local Anesthesia Sol. Novocaini 0.25%, the patient underwent thoracocentesis on the right, and the pleural cavity was drained according to Bülau. Prescribed medication: cefazolin 1.0x2 times a day intramuscularly, calcium chloride 10% - 10.0 iv, once a day, potassium chlorine - 5% - 30.0 iv once a day, vitamins : B1, B6 and B12, expectorant medicine for 1 tbsp. spoon 3 times, physiotherapy exercises, physiotherapy. In addition, infusion therapy was included in the treatment complex, during which the ozonized physiological saline solution of 0.9% at a dose of 450.0 with an ozone concentration of 500 μg / l was administered once daily into the right pulmonary artery, after each infusion into the catheter cavity a solution of heparin was introduced in a dose of 2 ml (5 thousand units) in 5 ml of saline. 5 days after intensive therapy, including intra-arterial administration of ozonized physiological saline solution - 0.9%, the patient's condition with pronounced positive dynamics. Dyspnea disappeared in the patient, body temperature decreased to subfebrile digits, poor purulent discharge of a turbid character was noted in the drainage from the pleural cavity, the pulse stabilized - 84 beats per 1 min, blood pressure - 120/80 mm RT. Art. In general, the patient received 10 infusions of ozonized physiological saline solution of 0.9% in the amount of 450.0 once, daily to the right pulmonary artery for a course of additional treatment. There were no pathological adverse reactions in patients with intraarterial administration of an ozonized solution of 0.9% sodium chloride. In general, the patient's condition progressively improved and by the end of the first week of treatment his condition was regarded as satisfactory. When examining the protein composition of the blood in a patient, the content of total protein in the blood serum was 65 g / l with normalization of liver tests: ASAT, ALAT, bilirubin. Positive dynamics and restoration of indicators of the patient's immunogram were noted. Subsequently, on the control x-ray of the patient’s chest organs and during discharge moderate pleural overlays are preserved, in the lower lobe there is a slight deformation, convergence and strengthening of the pulmonary pattern, on the left the x-ray structure of the lung is without features. After 28 days of treatment, the patient was discharged from the hospital and transferred to an outpatient stage rehabilitation with a pulmonologist.

 The proposed method for the treatment of acute lung abscess complicated by pyopneumothorax is quite simple and effective, improves the results of treatment of patients, including a significant reduction in their mortality to 2% of the total number, chronic inflammation in the lungs and pleura to 6%, reducing the duration of intensive treatment of patients in a surgical hospital to 28 rooms.

Sources of information
1. Bogatov A.I., Mustafin D.G. Complicated staphylococcal pneumonia in adults. M., 1984, p. 99 and 100.

Claims (2)

 1. A method of treating a patient with acute lung abscess complicated by pyopneumothorax by endoscopic debridement of the bronchial tree and purulent abscess cavity, with drainage of the pleural cavity according to Bulau and subsequent intensive drug therapy, characterized in that the patient is additionally given a daily intraarterial infusion of ozonized physiological saline solution 0 , 9% in the pulmonary artery on the side of the affected lung, once in a dose of 450 ml, for 10-14 days of the acute period of the disease.  2. The method according to claim 1, characterized in that the pulmonary artery catheterization is carried out according to the Seldinger technique through the subclavian vein on the side of the purulent process localization.