RU2391105C1 - Method of treating pneumonia - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, namely to pulmonology, and can be used in treatment of pneumonia. For this purpose antibacterial, anti-inflammatory, symptomatic therapy and physiotreatment are carried out. As antibiotic selected is ceftriaxone which is introduced by indirect lymphotropic therapy. In case when superior or medial lobe of lung is affected, needle is stuck on the border of mammary gland region and lateral chest region on anterior axillary line of the side of affected lung. In case when inferior lobes of lung are affected - on the border of subscapular and scapular region on scapular line on the side of affected lung. Needle is stuck subcutaneously to the depth 1.0 cm and lidase solution in dose 32 UNITS is injected. 2-3 minutes later, without removing the needle, solution of 0.5 g ceftriaxone is introduced with the following massage of the region along the course of lymphatic channel. Introduction is performed once a day. ^ EFFECT: invention allows to reduce dose of introduced antibiotic, increasing at the same time treatment efficiency due to creation in patient's lymphatic system, in direct vicinity from inflammation focus, of optimal medication concentration. ^ 2 ex

Description

The present invention relates to medicine, namely to pulmonology.

Antibacterial treatment, which is the main link in the complex therapy of this pathology, is prescribed immediately after diagnosis and is always empirical, based on the likely etiology of the disease, the severity of the pathological process in the lung tissue (Sinopalnikov A.I. Community-acquired infections of the respiratory tract. / A. I. Sinopalnikov, R. S. Kozlov. - M .: "Premier MT", 2007. - 352 p.).

With a mild disease, oral antibiotics are administered. The closest is the parenteral administration of antibiotics (intravenous or intramuscular) in the treatment of severe pneumonia (Chuchalin A.G., Sinopalnikov A.I., Strachunsky L.S. Community-acquired pneumonia in adults: practical recommendations for diagnosis, treatment and prevention. - M. : LLC "Publishing house" M-Vesti ", 2006. - 76 p.).

The main antibacterial drugs parenterally used for pneumonia (cefotaxime, ceftriaxone, cefepime, cefuroxime, cefoperazone / sulbactam, amoxicillin / clavulanate, spiramycin, etc.) are usually administered intramuscularly or intravenously 2-4 times a day. With mild pneumonia, the duration of antibiotic therapy is usually 7-10 days, with severe pneumonia, a 10-day course of antibiotic therapy is recommended.

The main disadvantage of these antibacterial drugs used intramuscularly to treat pneumonia in recommended doses is the development of irritation at the injection site, local pain, painful seals or infiltrates at the injection site, and when administered intravenously, the development of phlebitis, paraphlebitis and thrombophlebitis.

Closest to the proposed are the following treatment methods: subxiphoid administration of antibiotics for pneumonia (Provotorov V.M. et al., 1996), indirect lymphostimulation in the treatment of pneumonia (Lyubarsky M.S. et al., 2002).

The technical result of the proposed method is to reduce the amount and dose of the administered antibiotic, increase the effectiveness of treatment by creating an optimal concentration of the drug in the patient’s lymphatic system, reduce the risk of complications, and reduce the length of hospital stay.

What is new in achieving the technical result is that indirect lymphotropic therapy is carried out, and in case of damage to the upper or middle lobe of the lung, a needle is injected at the border of the chest area and the lateral area of the chest along the anterior axillary line on the side of the affected lung.

Also new is the fact that when the lower lobes of the lung are damaged, a needle is injected at the border of the subscapular and scapular region along the scapular line on the side of the affected lung, and the needle is injected subcutaneously to a depth of 1.0 cm.

Another novelty is that a lidase solution in the amount of 32 PIECES is injected through the needle, then after 2-3 minutes a solution of 0.5 g of ceftriaxone is slowly injected, followed by massage of the area along the lymphatic channel, and the administration is carried out once a day.

The transdermal introduction into specially defined areas of the cellular space closest to the lesion of the lung tissue creates a depot of the antibacterial drug. Through the lymphatic vessels that drain this cellular space, the drug enters the lymphatic system, from where it enters the inflammatory focus with a retrograde lymphatic current and creates a higher concentration in the focus of inflammation than with the intramuscular or intravenous route of administration.

In addition, the penetration of an antibiotic into the lymphatic system provides a direct effect of the antibiotic on pathogens in the lymphatic channel. Preliminary subcutaneous administration of lidase contributes to an increase in the concentration of the antibiotic administered in the same area in the central lymph by 2.5 times and exceeds the concentration of the antibiotic administered without prior use of lidase.

The introduction of a drug substance to a depth of 1.0 cm allows the drug to get into the lymphatic channel, since it is at such a depth that the network of lymphatic vessels is located.

Experimental and clinical studies have established that a low molecular weight antibiotic, introduced mainly into the lymphatic system, reaches high concentrations in various organs and tissues. An antibiotic from the lymph enters the bloodstream. Due to the fact that the speed of lymph movement through the vessels is low, the antibiotic enters the blood from the lymphatic system periodically, in small portions, which creates a certain concentration of the drug in the lymphatic system and maintains it for longer in the blood.

In the study of tissues after the lymphotropic administration of ceftriaxone under clinical conditions, a concentration was found that was 2.5 times higher than that with intramuscular administration. All this increases the effectiveness of the treatment of pneumonia and reduces the amount and dose of the administered antibiotic. The proposed method of administering an antibiotic can reduce the length of hospital stay due to a faster resolution of infiltration, which occurs 2-3 days earlier than in known methods of treatment.

Comparative analysis with the prototype shows that the proposed method differs from the known one in that they carry out indirect lymphotropic therapy, while in case of damage to the upper or middle lobe of the lung, a needle is injected at the border of the chest area and the side of the chest along the front axillary line on the side of the affected lung, and in case of damage to the lower lobes of the lung, on the border of the subscapular and scapular region along the scapular line on the side of the affected lung, the needle is injected subcutaneously to a depth of 1.0 cm t lidazy solution in an amount of 32 units, then after 2-3 minutes of ceftriaxone solution was added slowly, followed by massage area along the lymphatic channel, wherein the administration is once per day, which corresponds to the criterion "novelty".

The new set of essential features allows to reduce the number and doses of the administered antibiotic, increase the effectiveness of treatment due to the rapid suppression of pathogenic microflora in the lung tissue and the early onset of tissue repair and regeneration processes, improve the quality of the patient's stay in the hospital by eliminating the painful intravenous and intramuscular antibiotics, reduce length of stay in the hospital. All this meets the criterion of "industrial applicability".

The method is as follows.

In case of pneumonia with damage to segments of the upper, middle or lower lobe of the lung, indirect lymphotropic therapy is performed. For this, after processing the surgical field with an alcohol solution, a 32 U unit of lidase solution is injected subcutaneously to a depth of 1.0 cm along the front of the breast and the side of the chest, along the front axillary line on the side of the affected lung, to a depth of 1.0 cm. Then, without removing the needle, after 2-3 minutes 0.5 g of ceftriaxone diluted in 1.5 ml of a 2% lidocaine solution is slowly introduced. After the injection, an alcohol ball is applied for 1-2 minutes. The area of the breast on the injection side is massaged along the lymphatic channel.

An antibiotic is administered once a day throughout the course of antibiotic therapy. Indirect lymphotropic therapy is carried out against the background of conventional treatment: anti-inflammatory therapy (solution of 50% analginum 2.0 ± 1.01% solution of diphenhydramine intramuscularly and acetylsalicylic acid 0.5 g 2 times a day; symptomatic therapy (bromhexine 8 mg 3 times a day, acetylcysteine 1 tablet 3 times a day, mucaltin 1 tablet 3 times a day); physiotherapy (UHF therapy No. 7, inhalation with an alkaline oil solution No. 7, paraffin baths No. 5).

The proposed method of treatment was applied in 53 patients. In all cases, ceftriaxone was used, since a high sensitivity of microorganisms was determined to it.

According to the localization of the pathological process in the lung tissue, the patients were divided as follows: pneumonia in the middle lobe of the right lung in 16 (30.21%) patients; pneumonia in the upper lobe of the left lung of 9 (16.99%) patients; pneumonia in the lower lobe of the right lung of 10 patients (18.87%), pneumonia in the lower lobe of the left lung of 18 (33.93%) patients.

In all patients, the main indicators of the clinical course of pneumonia (cough, chest pain, fever, general weakness) and objective signs of the disease (shortening of percussion tone over the affected area of the lung tissue and moist small bubbling rales) were stopped 2-3 days earlier than in patients receiving antibacterial therapy by the intramuscular route of administration, the favorable course of the pathological process was combined with a less painful way of delivering the antibacterial drug to the body, which also contributes to Valo rapid recovery of patients.

The proposed method of treatment is illustrated by the following clinical examples.

Example No. 1. Patient K., 18 years old, a conscript soldier, was hospitalized on December 16, 2007 with complaints of shortness of breath, severe pain when breathing in the chest on the left, painful dry cough, severe general weakness, poor appetite. He became acutely ill on 15.12.07 with a chill, accompanied by a rise in temperature to 38 ° C. The anamnesis is not burdened with anything other than smoking.

At admission - a state of moderate severity. Temperature 38.5 ° C. The skin is moist, pale, light acrocyanosis. The chest is of the correct form, the left half lags behind the right half when breathing. Respiratory rate 28 per minute. Percussion above the lungs on the left in the lower parts of the posterolateral surface - shortening of the pulmonary sound. The mobility of the pulmonary margins on the left is limited. In the lower parts of the left lung along the posterior axillary line, weakened breathing and finely bubbly moist rales are heard. For the rest of both lungs, single dry rales are heard against the background of vesicular breathing. Heart sounds are muffled. Heart rate 120 per minute. HELL 100 and 60 mm Hg The tongue is covered, rather dry. The abdomen is soft, painless. The upper border of the liver at the level of the VI rib, the lower edge - along the costal arch, soft, painless. The spleen is not enlarged.

A blood test from 12/16/07: neutrophilic leukocytosis 10.2 × 10 ⁹ / l (stab nuclear 22%; segmented 66%, aneosinophilia, lymphocytes 9%, monocytes 3%), ESR 16 mm / h.

Biochemical studies from 12/16/07: AlT 0.4 mmol / (h · l); ACT 0.28 mmol / (h · l); protein 75 g / l; C - reactive protein not detected; glucose 5.8 mmol / l; prothrombin 64%; fibrinogen 17.1 μmol / l, amylase 30 g / (h · l); bilirubin 14.5 μmol / l; creatinine 75.6 μmol / L, urea 6.2 mmol / L.

Traces of protein in the urine, single fresh and leached red blood cells in the field of view, leukocyturia.

Sputum analysis dated 12/16/07: the character is mucopurulent, white blood cells densely cover the visual field, and there are no mycobacterium tuberculosis. The species composition of sputum microflora before treatment: Streptococcus haemolyticus, OMC - 10 ⁸ , high sensitivity to ceftriaxone, gentamicin, kanamycin, weak sensitivity to carbenicillin.

X-ray - elements of infiltration in 8 and 9 segments of the left lung.

Diagnosis: community-acquired pneumonia in 8 and 9 segments of the left lung, moderate course. DN I Art.

In the blood serum of 12/17/07: Alt 0.28 mmol / (h · l); ACT 0.17 mmol / (h · l); protein 64.5 g / l (albumin 50%, globulins: α ₁ 8%, α ₂ 11%, β 12%, γ 19%); C - reactive protein ++; seromucoid 0.26; prothrombin 76%; fibrinogen 19, 43 μmol / l.

For 6 days, the patient underwent a course of indirect lymphotropic therapy, according to which once a day at the border of the subscapular and scapular regions on the left, along the scapular line, 32 units of lidase was injected subcutaneously to a depth of 1.0 cm, and then, without removing the needle , after 2-3 minutes slowly 0.5 g of ceftriaxone diluted in 1.5 ml of a 2% lidocaine solution.

A day after the start of therapy, the temperature decreased to subfebrile figures, overall health improved, chest pains decreased, and appetite appeared. After another two days, the body temperature returned to normal, chest pain and coughing stopped. Since the normalization of temperature - a rapid reverse dynamics of the subjective manifestations of the disease. From the beginning of the second decade until discharge, resorption physiotherapy was performed.

Discharged after 20 days of treatment without clinical, radiological signs of lung damage and complete normalization of laboratory parameters characteristic of an active inflammatory process.

Example No. 2. Patient K., 51 years old, reserve officer, was admitted to the pulmonology department on 23.08.07 with complaints of a dry, painful cough, pain in breathing in the chest on the right, shortness of breath, general weakness. The disease began acutely a week before hospitalization with chills, accompanied by a rise in temperature to 38 ° C. The local GP has diagnosed an acute respiratory illness. The patient received treatment at home. During the week, high fever persisted, general weakness increased. A history of smoking and alcohol abuse for many years, pneumonia in 1986.

The condition at admission is serious, somewhat inhibited and disoriented, temperature 39.5 ° C, acrocyanosis. The breath is shallow. Respiratory rate 30 per minute. In the projection of the upper lobe of the right lung - increased voice tremor, dull percussion sound, bronchial shade of respiratory noise and crepitus. Below the angles of the blades are finely bubbly - moist rales, on the right along the midclavicular line in the 4th intercostal space - pleural friction noise. For the rest of both lungs, a boxed shade of percussion tone, scattered dry rales against the backdrop of hard breathing. The area of cardiac dullness expanded in diameter by 2 cm, frequent extrasystoles, significant muffling of tones. Pulse 100 per minute. HELL 110 and 60 mm Hg

Radiological on August 23, 07 - infiltration in 3 and 6 segments of the right lung and in 3 segments of the left lung, a small amount of free fluid in the right pleural cavity.

Peripheral blood upon admission: neutrophilic leukocytosis 12.3 × 10 ⁹ / L (stab 15%, segment 64%, lymphocytes 12%, monocytes 6%). ESR 60 mm / h. Biochemical blood test on 08/24/07: AlT 0, 18 mmol / (h · l); ACT 0, 15 mmol / (h · l); protein 78.5 g / l; C - reactive protein +++; seromucoid 0.36; glucose 6.7 mmol / l; prothrombin 97%; fibrinogen 29.8 μmol / L; amylase 24 g / (h · l); total bilirubin 26.5 μmol / l; creatinine 62.2 μmol / L; urea 6.5 mmol / L.

In urine tests, there are traces of protein, cylindruria, leukocyturia, single fresh red blood cells in the field of view.

Community-acquired pneumonia was diagnosed in 3 and 6 segments of the right lung and in 3 segments of the left lung, severe course, complicated by parapneumonic exudative pleurisy, respiratory failure of the II degree.

Massive bilateral pneumonia necessitated the appointment of a combination of antibiotics. As a result of therapy with penicillin (DM 12 million units) and amikacin (DM 1.5), the condition improved slightly: the temperature decreased to subfebrile, the cough decreased, but by the end of 3 days the pain in the right half of the chest intensified again, the temperature rose to high numbers, the cough intensified with the separation of a large amount of purulent sputum stained with blood. Physical signs of the cavity were revealed in the projection of the upper right lobe.

The nature of sputum is mucopurulent, leukocytes densely cover the field of view, tuberculosis mycobacteria are not detected. Sowing on flora upon admission: St.aureus, OMC-10 ⁸ , high sensitivity to penicillin, gentamicin, ceftriaxone, levomycetin.

Given the onset of the disease, the dynamics of the cough and the nature of the sputum excreted, the inefficiency of the therapeutic complex, a history of malicious smoking and alcohol abuse, abscess formation is suspected.

X-ray tomography 08/26/07: in the foci of lung tissue infiltration determined by the destruction cavity of various sizes. In the costal-diaphragmatic sinus of the right pleural cavity - a small amount of free fluid.

The complication of pneumonia with multiple abscesses was diagnosed.

Antibacterial therapy was continued by indirect lymphotropic therapy, according to which once a day at the border of the chest area and the lateral area of the chest, along the right anterior axillary line, 32 units of lidase were injected subcutaneously to a depth of 1.0 cm, and then, without being removed needle, after 2-3 minutes slowly, 0.5 ceftriaxone diluted in 1.5 ml of a 2% lidocaine solution.

Conducted infusion detoxification therapy, transfusion of native frozen and antistaphylococcal plasma. A day after the start of the course of indirect lymphtropic therapy with ceftriaxone, health improved, the temperature decreased to subfebrile values, chest pains decreased, and appetite appeared.

After two days, the body temperature returned to normal, the pain stopped. Since the normalization of temperature - a gradual steady inverse dynamics of all the symptoms of the disease.

According to X-ray tomography data of September 16, 07, a decrease in the size of the focus of infiltration and decay cavities was noted.

Discharged on September 29, 2007, after 37 days of treatment without clinical signs of lung damage and with full normalization of laboratory parameters. X-ray determined pneumofibrosis in the zone of previous inflammation.

Claims (1)

A method of treating pneumonia by prescribing antibacterial, anti-inflammatory, symptomatic therapy and physiotherapy, characterized in that they carry out indirect lymphotropic therapy, while in case of damage to the upper or middle lobe of the lung, a needle is injected at the border of the chest area and the side of the chest along the front axillary line on the side the affected lung, and in case of damage to the lower lobes of the lung - on the border of the subscapular and scapular regions along the scapular line on the side of the affected lung, moreover, the needle led subcutaneously to a depth of 1.0 cm and injected with a solution of lidase in the amount of 32 PIECES, then after 2-3 minutes a solution of 0.5 g of ceftriaxone is slowly injected, followed by massage of the area along the lymphatic channel, the administration is carried out once a day.