RU2351324C2 - Medication for pre-operation preparation of patient with chronic obstructive lung disease (cold) and method of pre-operation preparation of patient with cold - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: claimed group of inventions relates to field of medicine, namely to anesthesiology-reanimation. Claimed is application of furosemide for pre-operation preparation of patients with chronic obstructive lung diseases caused by smoking and appropriate treatment method. Invention is distinguished not only by bronchdilatation under influence of furocemide but also moistening of bronchi epithelium when respiratory ways are dried by ALV apparatus. Method of pre-operation preparation of patient with COLD lies in carrying out ultra-sound inhalation with furocemide solution.

EFFECT: method reduces number of complications from respiratory and other systems in smoking patients in intra- and post-operation periods.

2 cl, 3 tbl, 3 ex

Description

The proposed group of inventions relates to medicine, namely to anesthesiology-resuscitation, and can be used for preoperative preparation of patients with chronic obstructive pulmonary diseases caused by smoking.

It is well known that lung diseases are currently very common, and smoking, among other risk factors, is in the first place for the occurrence of chronic bronchitis, and after 20 years, people with COPD develop COPD (Diseases of the smoker's lungs. Disease prevention and health promotion, No. 4, 1999. A.G. Chuchalin). This significantly increases the operational and anesthetic risk during surgical interventions, therefore, preoperative preparation in patients with respiratory failure caused by smoking, is an urgent problem.

There is a method of preoperative preparation of a patient with COPD, including the use of medications (Practical Guide to Anesthesiology. Edited by Professor V.V. Likhvantsev. Moscow. 1998, p. 286).

The known method consists in the fact that for the preoperative preparation of such patients, oral, intravenous and inhaled administration of bronchodilators (β ₂ -agonists, anticholinergics, methylxanthines), glucocorticosteroids, mucolytics, M-anticholinergics, theophyllines are used. In addition, physiotherapy exercises are prescribed.

Sympathomimetics or β ₂ agonists cause bronchodilation due to the effect on adenylate cyclase. An increase in cAMP leads to relaxation of the smooth muscles of the bronchi. The time for drug withdrawal before surgery is decided individually. Reception of selective β ₂ agonists (alupent), as a rule, continues before surgery.

Phosphodiesterase or methylxanthine inhibitors (aminophylline) increase the content of cAMP and have a bronchodilating effect. These drugs are indicated for patients with COPD and bronchial asthma. Treatment is continued until the day of surgery. The usual dose is 300-1500 mg / day. Eufillin is usually prescribed to smokers 7 days before surgery. Moreover, smokers require an increased dose of theophyllines (Cigarette smoking and clinically significant drug interaction. Schein Jeffrey R. Ann. Pharmacother. 1995. 29, No. 11. C.1139-1148.).

Corticosteroids are prescribed for patients with COPD, insensitive to the action of β-agonists and phosphodiesterase inhibitors. When they are prescribed, they count on inhibition of swelling of the bronchial epithelium and a decrease in their secretion, stabilization of the plasma membrane of cells and a decrease in histamine secretion. Carefully selected therapy is continued until surgery.

Parasympatholytics (atropine) have a direct bronchodilating effect due to the inhibitory effect on guanylate cyclase (decrease in cGMP content). Assign in the form of inhalation, continue therapy until surgery.

Mucolytics reduce and make the bronchial secretion less viscous. The drug is prescribed in the form of inhalation, therapy continues until the day of surgery.

However, the known method has the following disadvantages.

When inhaled using β ₂ agonists, side effects occur that can provoke the development of arrhythmias, tachycardia and tachyarrhythmias. The patient has a dry mouth, headache, dizziness, tremor, nervousness. The drug is used with caution in case of thyrotoxicosis, coronary heart disease, arterial hypertension. When inhaled glucocorticosteroids are used, such side effects as dysphonia, oropharyngeal candidiasis, cough, as well as suppression of the adrenal cortex, petechiae, osteoporosis, cataracts, glaucoma, metabolic disorders occur. Inhalation of theophyllines causes tachycardia, extrasystole, ventricular tachycardia, nausea, vomiting, dyspepsia, headache, anxiety, and insomnia. With the inhalation use of M-anticholinergics, the patient has a dry mouth, increased intraocular pressure, extrasystole. Prescribing theophylline to smokers at an increased dose increases the toxicity of the drug.

The use of drugs in patients with COPD caused by smoking differs from the use of non-smokers with chronic obstructive pulmonary disease in that smokers require an increase in the dose of drugs, thereby increasing the number of side effects of drugs (Cigarette smoking and clinically significant drug interaction. Schein Jeffrey R. Ann Pharmocother. 1995.29, No. 11 p. 1139-1148).

In addition, sodium retention is typical of chronic pulmonary insufficiency and, naturally, water retention in the body (Acid base and electrolyte balance by gosta rooth. M. D. Professor of perinatal. Medicine perinatal. Research unit university of Uppsala, Sweden. Studentlitteratur. 1975).

The objective of the proposed group of inventions is to reduce the number of complications from the respiratory and other systems in smoking patients in the intra- and postoperative period.

The problem is solved in that as a means for preoperative preparation of a patient with chronic obstructive pulmonary disease, a 1% solution of furosemide is used.

The problem is solved in that in the known method of preoperative preparation of a patient with COPD by administering medications 30 minutes before the start of surgery, ultrasonic inhalation is carried out with a 1% solution of furosemide in a dose of 2 ml.

The proposed group of inventions meets the criteria of the invention of "novelty" and "inventive step", as the patent information research on patent and scientific literature did not identify sources that discredit the novelty of the proposed solutions, as well as technical solutions with similar essential features.

It is known that furosemide is used in the complex treatment of chronic bronchitis. Furosemide inhibits Na ⁺ -K ^- 2Cl ^- cotransport, which contributes to direct bronchodilation (that is, not through the nervous system). Furosemide has a direct relaxing effect on the smooth muscles of the airways, stabilizes mast cell membranes, has a vasodilating and anti-inflammatory effect, reduces the formation of anionic superoxide in the cells of the bronchial epithelium (Zverev YF, Bryukhanov VM, NGMA, 2000. Pharmacological and clinical use of the extrarenal action of diuretics). However, the authors did not identify sources of information that would indicate the use of furosemide as a means to prepare the patient for surgery.

The dose of the drug, the concentration of the solution, the time of administration of the drug are selected empirically. In addition, the selected doses correspond to subdiuretic doses at which a bronchodilating effect develops (Zverev Y. F., Brukhanov V. M., NGMA, 2000. Pharmacological and clinical use of the extrarenal action of diuretics).

The present invention allows, when used, to obtain the following positive effect - an improvement in external respiration function indicators (table No. 1).

In the city clinical hospital No. 30, 14 smoking patients of a surgical and urological profile were examined. A group of patients aged 60-70 years was selected, all smoking men with IR (smoking person index) = 300 (IR = 365 · number of cigarettes / day · 12 ^-1 ), smoking experience over 20 years. Of these, 43% had significant obstructive bronchial obstruction (FVC ₁ - forced vital capacity in 1 second or FEV - forced expiratory volume in 1 second, expiratory capacity, IT - Tiffno index - reduced more than 15% to normal). Investigations of the function of external respiration (FVD) were carried out using a Spiroshift-3000 spirometer using the flow-volume method. The study of indicators of the function of external respiration (HFD) was performed in patients before inhalation with furosemide (1% - 2 ml furosemide solution using an ultrasonic inhaler "Eton") and 30 minutes after inhalation immediately before surgery. The standardized indicators of spirometry of bronchial obstructive syndrome were assessed: vital lung capacity (VC), FVC ₁ , FEV for 1 second (FEV ₁ or FVC ₁ ), expiratory power on the bronchi.

Summarized data are given in the table.

Table Spirogram indicators Average values before inhalation with furosemide M ± m Average values 30 minutes after inhalation with furosemide M ± m R FZHEL (l) 2.55 ± 0.32 2.92 ± 0.29 0.2 FVC for 1 s (l) (FEV ₁ ) 2.0 ± 0.28 2.88 ± 0.26 P <0.05 Expiratory power (l / s) 4.39 ± 0.8 4.85 ± 0.65 0.5 Expiratory power on large bronchi (l / s) 4.08 ± 0.75 4.46 ± 0.65 0.5 The exhalation power of the middle bronchi (l / s) 3.2 ± 0.67 3.48 ± 0.3 0.5 Exhalation power on small bronchi (l / s) 1.67 ± 0.43 1.83 ± 0.22 0.5 Tiffno Index (%) 76.4 ± 5.85 85.75 ± 7.02 0.2

To assess bronchial patency, a forced expiratory spirogram was used, since in this case the laminar air flow turns into a turbulent one, increasing the dependence of the flow velocity on the diameter, which allows better identification of obstruction.

When using bronchodilators, the sample is considered positive with an increase in FEV ₁ , FVC, expiratory power by 15% of the initial value.

The limits of the norm are within ± 15% of the due value.

As can be seen from the table, in 65% of the examined, the increase in indicators after inhalation with furosemide was more than 15%, which is an objective indicator of improving bronchial patency.

Thus, the use of the proposed method of preoperative preparation in smokers with COPD reduces the risk of microatelectasis and violation of the ventilation / blood flow ratio, requiring the mobilization of the alveoli (recruitment), that is, a temporary increase in pressure and / or volume in the airways in order to open the alveoli collapsed due to edema and, therefore, reduce the risk of hypoxia. The method allows to improve bronchial patency (the difference in FVC parameters for 1 second during treatment with furosemide was statistically significant - P <0.05), which also helps to reduce the risk of intra- and postoperative complications from the respiratory system. Since in the proposed method for the preoperative preparation of the patient only furosemide is used, side effects associated with the administration of β ₂ agonists, theophyllines, glucocorticosteroids, M-anticholinergic drugs, etc. are excluded. Since furosemide is a loop diuretic, acting on the tubule epithelium with inhibition of Na ⁺ -K ^- 2Cl ^- , it also acts on the bronchial epithelium, moisturizing them, which is important when drying with a ventilator. At the same time, diuretics inhibit the oxidative explosion, which reduces the inflammatory reaction (N.V. Kuchkina, S.N. Orlov, A.G. Chuchalin. The role of ion transporting systems in the activation of the "oxygen explosion" of human neutrophils: the influence of the osmoticity of the medium. Biol. Membranes. 1994, pp. 174-179). (S.N. Orlov, I.A. Baranov, A.G. Chuchalin. Intracellular signaling and lung pathology systems. Ion transport in the epithelial cells of the respiratory tract. Pulmonology. 1997, pp. 77-83). Side effects were not observed (hypokalemia, hypomagnesemia, hypokalimic metabolic alkolosis). In addition, furosemide improves renal blood flow without increasing the need for nephrons in oxygen (N.Yu. Zhidomorov, S.Yu. Shrygal. The effect of furosemide on intrarenal hemodynamics. Methodological fluometry. 1999, pp. 161-166.), And in smokers is impaired kidney function.

The proposed method is as follows.

In a patient with COPD, 30 minutes before surgery, ultrasonic inhalation of 2 ml (20 mg) of a 1% solution of furosemide is performed.

Examples of specific performance are given in the form of extracts from the medical history.

Example 1

Kalyagin PI, 67 years old, No. Case History 7377. Smoker index = 608.

Diagnosis: Stone in / third of the left ureter.

The planned operation is uroterolithotomy on the left using endotracheal total intravenous anesthesia (TBVA).

30 minutes before the operation, inhalation with a 1% solution of furosemide in a dose of 2 ml was performed.

Spirometry

Spirogram indicators Before inhalation with furosemide 30 minutes after inhalation with furosemide Vital lung capacity (L) 1.59 (58% of due) 2.61 (96% of due) Forced lung capacity (L) 0.62 (23%) 2.0 (73%) Tiffno Index (%) 28.9 76.6 Forced expiratory volume in 1 second (l) 0.46 (21%) 2.0 (92%) Expiratory power (l / s) 0.63 (9%) 2.69 (40%) Exhalation power on large bronchi 0.59 (10%) 2.12 (35%) Exhalation power on the middle bronchi 0.44 (15%) 2.56 (87%) Exhalation power on the small bronchi 0.27 (29%) 2.29 (244%)

Conclusion: Significant changes in obstructive bronchial obstruction in all types of bronchi before inhalation with furosemide. Improvement in bronchial patency after inhalation with furosemide by more than 15%.

No intra- or postoperative complications were noted.

Example 2

Bukin V.E., 65 years old, No. History of the disease 983. IR = 304. 02/01/06

Diagnosis: Chronic calculous cholecystitis.

The planned operation is cholecystectomy using endotracheal total anesthesia.

30 minutes before the operation, inhalation with a 1% solution of furosemide in a dose of 2 ml was performed.

Spirometry

Spirogram indicators Before inhalation with furosemide 30 minutes after inhalation with furosemide Vital lung capacity (L) 3.03 (83% of due) 2.92 (80% of due) Forced lung capacity (L) 2.47 (68%) 2.82 (78%) Tiffno Index (%) 65.7 82.5 Forced expiratory volume in 1 second (l) 1.99 (69%) 2.41 (83%) Expiratory power (l / s) 2.56 (33%) 3.29 (43%) Exhalation power on large bronchi 2.47 (35%) 3.17 (43%) Exhalation power on the middle bronchi 2.35 (63%) 2.74 (74%) Exhalation power on the small bronchi 1.19 (92%) 1.6 (123%)

Conclusion: Moderate obstruction of bronchial obstruction by obstructive type in the middle bronchi and significant in large before inhalation with furosemide. Improvement in bronchial patency by more than 15% after inhalation with furosemide. No intra- or postoperative complications were noted.

Example 3

Baturin V.P., 68 years old, No. of a Case History 3149. IR = 304. 06/07/06.

Diagnosis: Adenoma of the prostate.

The planned operation is an adenomectomy using endotracheal total intravenous anesthesia.

30 minutes before the operation, inhalation with a 1% solution of furosemide in a dose of 2 ml was performed.

Spirometry

Spirogram indicators Before inhalation with furosemide 30 minutes after inhalation with furosemide Vital lung capacity (L) 2.29 (73% of due) 3.38 (108% of due) Forced lung capacity (L) 1.57 (50%) 1.55 (50%) Tiffno Index (%) 50.7 33,4 Forced expiratory volume in 1 second (l) 1.16 (47%) 2.57 (89%) Expiratory power (l / s) 2.48 (34%) 2.99 (42%) Exhalation power on large bronchi 1.59 (24%) 1.71 (26%) Exhalation power on the middle bronchi 0.88 (27%) 0.88 (27%) Exhalation power on the small bronchi 0.66 (62%) 0.63 (59%)

Conclusion: Significant violations of bronchial patency in all types of bronchi before inhalation with furosemide. Improvement in bronchial patency by more than 15% after inhalation with furosemide. No intra- or postoperative complications were noted.

Claims (2)

1. The use of furosemide as a means for preoperative preparation of a patient with chronic obstructive pulmonary disease. 2. A method for preoperative preparation of a patient with COPD by administering medications, characterized in that ultrasonic inhalation with a 1% solution of furosemide at a dose of 2 ml is performed 30 minutes before the start of surgery.