RU2363505C1 - Device for reception of tracheobroncial content at pathology of bronchopulmonary system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine area. The device includes the top both bottom plates and a handle. The bottom plate represents a filter for the top plate and has extremity bent at an angle of 15° having possibility of bracing of a root of tongue at installation of the bottom plate opposite to aperture of larynx. The handle is spring actuated with possibility of extension of the top plate by pressing a handle and return of the top plate to a starting position at releasing of the handle. The top plate represents a surface for collecting of a tracheobronchial secretion.

EFFECT: provision of physiologic collection of a tracheobronchial secretion in the pure state.

5 dwg, 1 tbl

Description

The invention relates to medicine, namely to pulmonology, and is intended to study the nature of the secretion of the tracheobronchial tree for various pathologies of the respiratory system.

In modern conditions, the diagnosis of diseases of the respiratory system is based on data from a comprehensive examination of patients. The “gold standard” for assessing inflammation in the wall of the bronchi is the invasive method of fibrobronchoscopy. Bronchoalveolar lavage can be successfully used to clarify the diagnosis and with limited pathological processes in the lungs (Gerasin V.A., Zhuravlev A.V., Palamarchuk G.F. et al. Subsegmental bronchoalveolar lavage in the diagnosis of inflammatory and disseminating processes in the lungs // // Therapeutic archive - 1985 - No. 3 - C99-102). Bronchoscopy with a sampling of material for examination using bronchial swabs, bronchoalveolar lavage, brashbiopsy, endobronchial and transbronchial biopsy is not recommended in patients with exacerbation of the disease, with severe functional disorders, as they can provoke an exacerbation of the disease and cannot be repeated many times (Avdeev C.N ., Anaev E.Kh., Chuchalin A.G. Application of the method of induced sputum to assess the intensity of inflammation of the respiratory tract // Pulmonology - 1987 - No. 2. - C81-87).

In wide pulmonological practice, bronchoscopy is not always used due to the complexity and invasiveness of the technique, therefore, the study of sputum is a more accessible and optimal method for assessing the inflammatory process in the respiratory tract (Dikes MN, Blay FP Induced sputum in increasingly used to characterize the cellular and ochemical composition of the airways // Eur. Resp. J. - 1994 - V.7. - No. 3 - P.743-760). Sputum examination is considered one of the most important diagnostic methods used in the clinic of pulmonary diseases. Unfortunately, sputum is not always possible to get spontaneously. In such cases, an alternative to these methods can be the method of induced sputum, that is, obtaining sputum after inhalation of a 3-5% hypertonic NaCl solution. (Pin I., Gibson P.G., Kolendowiz R. et al. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax 1992; 47: 25-29).

The disadvantages of the procedure of "salt induction" of sputum include the inability to repeat the procedure after a short period of time, especially in severe patients, children; salty taste in the mouth; hypersecretion of saliva, a large admixture of saliva to the material obtained, the appearance of bronchospasm and suffocation in response to inhalation of a hypertonic solution of sodium chloride.

In addition, the proposed methods for collecting tracheobronchial contents are characterized by invasiveness, difficulties in obtaining material, processing, and the presence of side effects. This gave rise to the need to improve the methodology for collecting tracheobronchial contents and offer a more effective device. As an analogue (prototype), we have studied a method for studying the respiratory system. Copyright certificate No. 1225523 dated 12/22/1985 Khabarovsk Order of the Red Banner of Labor State Medical Institute, author V. Dobrykh, who proposed this device for receiving tracheobronchial contents. The device casing was L-shaped and was equipped with an elastic gasket with a plate with a removable screen installed in the working part of the casing. The tracheobronchial secretion was taken by introducing the device into the oral cavity and obtaining the secret when coughing.

In such cases, an alternative to these methods can be the induced sputum method, i.e., obtaining sputum after inhalation of a 3-5% hypertonic NaCl solution (Pin I., Gibson PG, Kolendowiz R. et al. Use of induced sputum cell counts to investigate airway inflammation in asthma. Thorax 1992; 47: 25-29).

The disadvantages of the procedure of "salt induction" of sputum include the inability to repeat the procedure after a short period of time, especially in severe patients, children; salty taste in the mouth; hypersecretion of saliva, a large admixture of saliva to the material obtained, the appearance of bronchospasm and suffocation in response to inhalation of a hypertonic solution of sodium chloride.

In addition, the proposed methods for collecting tracheobronchial contents are characterized by invasiveness, difficulties in obtaining material, processing, and the presence of side effects.

The objective of the invention is to create a design devoid of the above disadvantages.

The technical result is to obtain a device that allows physiologically extracting in its pure form tracheobronchial contents from the lower parts of the tracheobronchial tree, in a sufficient volume, convenient to use.

The technical result is achieved using a device called us "pharyngeal trap", figure 1, which is introduced into the oral cavity in stages.

It consists of three medical spatulas that make up the device of figure 1:

1 - top plate;

2 - spring-loaded handle;

3 - bottom plate;

4 - latch of the root of the tongue (protective screen).

The extraction of tracheobronchial secretion is carried out in 5 stages.

Stage number 1.

Entering the device into the oral cavity.

The lower plate (3) is installed opposite the entrance to the larynx and is a protective shield for the upper plate, has an end bent at an angle of 15 ° (4), which fixes the root of the tongue, see Fig. 2.

Before entering the device, it is necessary to obtain the informed consent of the patient and, if so, to teach him the technique of secretion secretion (the ability to produce strong cough shocks).

Stage number 2.

The handle is spring-loaded, see Fig. 3 (2), with the possibility of extending the upper plate (1) 4 cm forward towards the throat, by pressing the handle.

The device is ready to accept material.

Stage number 3.

A signal is given to the patient. The patient produces several (3-4) strong coughing tremors. Tracheobronchial secretion occurs on the surface of the upper plate, see figure 4 (1).

Stage number 4.

Returning the upper plate, see Fig. 5 (1) to its original position by releasing the spring-loaded handle (2), the upper plate returns to its original position and becomes closed by the lower plate (4) (protective shield) from saliva from the oral cavity.

Stage number 5.

Removing the device from the oral cavity is done by raising the tongue root retainer (4) and removing the device. Drops of the substrate are transferred onto a glass slide from the top plate.

The benefits of a pharyngeal trap

1) made of medical spatulas;

2) does not require physical effort;

3) ease of sterilization;

4) suitable for repeated use;

5) easy to use, does not require special training;

6) due to the presence of a fixator of the root of the tongue, there is a good visibility of obtaining the material.

Using the aforementioned method, we examined 42 patients with community-acquired pneumonia in males aged 18 to 24 years during the period of resolving infiltration. The results of the contents of the tracheobronchial tree were analyzed during sputum collection using a standard laboratory method (without a trap) and using a “pharyngeal trap”. The resulting materials are presented in the table.

Comparison of the results of cytological examination of sputum obtained by various methods.

Table Methods Standard Using the pharyngeal trap The cell composition,% Sputum Tracheobronchial secret Squamous epithelium 27.3 ± 4.6 * 1.2 ± 0.9 Macrophages 10.7 ± 1.5 25.2 ± 2.0 * Neutrophils 52.6 ± 6.3 40.1 ± 4.3 Ciliated epithelium 11.1 ± 4.1 23.1 ± 3.9 * Eosinophils 0 ± 0 11.2 ± 4.6 * Note: * - indicators with p <0.05 are indicated

Analysis of the cell composition obtained using the “pharyngeal trap” indicates the prevalence of macrophages, ciliated epithelium, eosinophils in it, in contrast to the standard study of sputum, which contains mainly squamous cells. Significant differences in the content of neutrophils at the same level of cytosis were not noted (p> 0.05). Method advantage:

1) the simplicity of the procedure, does not require sedation in the study;

2) non-invasiveness, physiology, the absence of trauma to the bronchial epithelium instrument;

3) obtaining material even in the absence of substrate in 95% of cases;

4) the possibility of repeating the procedure after a short period of time;

5) the absence of an admixture of saliva to the resulting material;

6) ease for the patient and the doctor;

7) profitability.

Claims (1)

A device for obtaining tracheobronchial secretion, including the upper and lower plates and the handle, characterized in that the lower plate is a protective screen for the upper plate and has an end bent at an angle of 15 °, with the ability to fix the tongue root when installing the lower plate opposite the entrance to the larynx, the handle is spring-loaded with the ability to extend the upper plate when you press the handle and return the upper plate to its original position in the absence of the handle, and the upper plate is surface for collecting tracheobronchial secretion.

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