The method of treatment of erosive-ulcerative tracheobronchitis

 

(57) Abstract:

The invention relates to medicine, in particular to pulmonology, and can be used for the treatment of erosive or ulcerative tracheobronchitis. Ozonated isotonic sodium chloride solution with an ozone concentration of 5 mg/l is injected into the top of each ulcer under the mucous membrane and irrigate ozonized solution of the tracheobronchial tree in the number of 60-80 ml Method allows you to accelerate epithelization of erosions and ulcers of the tracheobronchial tree. This reduces the treatment time and prolong the period of remission. table 1.

The invention relates to medicine, in particular to pulmonology, can be used for the treatment of patients with erosions and ulcers of the trachea and bronchi, which are manifested by cough with purulent sputum and hemoptysis. There is a method of treatment of erosive-ulcerative tracheobronchitis with the help of rehabilitation bronchoscopy. Use antiseptic substances and antibiotics that are injected directly into the tracheobronchial tree (Century, singer and other damage to the larynx and trachea. M., 1991, S. 85-89).

As the closest analogue of the adopted method for the treatment of erosive-ulcerative tracheobronchitis, including the introduction anticancer, A. A. Ovchinnikov Bronchopulmonary. M., 1982, S. 311-318). However, the known method has a number of disadvantages. Antiseptic drug does not promote epithelialization of ulcers and erosions, and only contributes to the destruction of purulent secretion from the bronchial tree. Prolonged use of antibiotics causes allergic reactions, especially in patients with bronchial asthma, leads to dysbiosis and does not affect the epithelialization of ulcers. Therefore, such bronchoscopy does not carry medical in nature.

For the first time as a remedy ozone was applied for the treatment of poorly healing wounds, fistulas and burns. The action of ozone diversified, which allows its use in various diseases. The mechanism of bactericidal action of ozone following. Plasma membrane is the primary target of ozone. Under the action of ozone on the cell membrane lipid oxidation it is mainly on the mechanism of ozonolysis of double bonds, the processes of lipid peroxidation play a secondary role. The immediate cause of the death of the bacteria under the action of ozone are local damage of the plasma membrane, leading to loss of viability of bacterial cells and(or) LASS="ptx2">

Intravascular infusion of a solution of ozone leads to the mobilization of humoral immunity - enhancing phagocytic activity of neutrophils. Under the influence of therapeutic doses of ozone increases proliferation of lymphocytes. Describes the effectiveness of ozone as antihypoxic drug and drug detoxification at its introduction intravenously several times a day. Inhalation of ozone at a concentration of 2 to 4 mg/l and the gas flow of 2 l/min) it does not damage the mucosa of the tracheobronchial tree (Aleinikov S. O. , Chuchalin A., Respiratory effects of ozone. Pulmonology. 1997. N 3. S. 81-91).

Pre-experimental part of the work on white rats, which made a cryolysis of the mucous membrane of the trachea to create a model of erosive-ulcerative lesions of the tracheobronchial tree. In the experiment on white Wistar rats aged 6-8 months and weighing up to 120 grams under Nembutal anesthesia at the rate of 40 mg/kg of body weight, produced a cryolysis of the area of the trachea above its bifurcation with the help of the applicator with the base 3 mm, cooled in liquid nitrogen. In the 1st control group treatment was not performed. In the 2nd group were injected ozonated fiziologicheskii mucous ozonated isotonic sodium chloride solution with an ozone concentration of 5 mg/l in the form of an aerosol, cooked in the inhaler of the type "Volcano" for 3-5 days. Rats were killed after 1, 3 and 7 days, produced the fence trachea and tracheobronchial lymph nodes and cooked preparations for scanning electron microscopy. It has been established that the 7th day in the control group defect of mucous epithelials 30% while in the 2nd group - 50%. The study of the proliferative activity of epithelial cells of the mucous membrane of the trachea, labeled monoclonality antibodies, showed that the control group of animals index of labeled nuclei was 2,170,03%, and in the 2nd group - 12,310,09% that indicates a high potency basal cells of the epithelium of the trachea after ozone therapy to mitotic division.

Thus, these data showed that the introduction of ozonized physiological solution topically safe and appropriate, because after ozone therapy accelerates the process of reepithelization and proliferation of a population of basal and immunocompetent cells, which in turn leads to more rapid closure of the mucosal defect. This was the basis for the application of the method in the clinical setting. It was established experimentally that the ozone concentration in the saline solution up to 5 mg/l is safe the Oia, replacing them with antiseptic and antibacterial drug.

The technical result of the proposed method is an accelerated proliferative process with consequent closure of the defect in the mucosa of the tracheobronchial tree.

The technical result is achieved due to the impact on the bacterial flora directly into the bronchial tree with the introduction of ozonized solution of sodium chloride in the area of the damaged area.

The method is as follows. The patient under local anesthesia injected bronchoscope into the trachea. Through the bioptic channel of the endoscope spend needle injector. The needle is shifted by 0.5 cm from the injector. To the outer end of the injector attach the syringe with 2 ml of ozonated physiological solution with an ozone concentration of 5 mg/L. Needle pierce the mucous membrane in the area of the ulcer edge and injected into the submucosal membrane ozonated solution. Then the injector and pull through the bioptic channel spend the catheter. The catheter intratrahealno and intrabronchial enter 60 to 80 ml of ozonated physiological solution with an ozone concentration of 5 mg/L. Manipulation repeat daily.

Way passed the clinical test is their aged 26 to 59 years were 14 men and 6 women. The treatment period ranged from 3 to 5 injections every day, i.e. 5 days.

Results. Under the influence of ozonized physiological solution ulcers epithelialize all patients. At the same time decreased edema and hyperemia of the mucosa visible bronchi, the secret of purulent turned into slimy. To confirm the advantages of the proposed method in comparison with the known below is a comparative table.

Thus, as can be seen from the table, our proposed method of treatment recovery occurred in 100% of patients, whereas a well known method of treatment, no patient has not fully recovered, and improvement was noted in 80% of patients.

Example 1. Patient P., 38 years old, after removal of the uterus with appendages for a long time (1 week) was on a ventilator, and therefore imposed a tracheostomy and put tracheotomies tube. The patient was transferred to an independent breath. To address the question about the possibility of decannulation was performed bronchoscopy, which has multiple deep ulcers of the thoracic trachea size of 1-1,5 cm in diameter on all walls. Bronchial large number of purulent secretions. About bronchial tree 60 ml ozonated isotonic sodium chloride. The treatment was carried out daily. After 4 sessions of ulcers completely epithelialize. In the bronchi secret mucous in moderation. Patient decanulation.

Example 2. Sick Hours, 36 years old, and/b 7493, was admitted with a diagnosis of a bronchial foreign body. Suffers from bronchial asthma for 30 years. By mistake breathed cap from aerosol sprays for 2 days before admission. When radiography of the thoracic cavity revealed no pathology. During bronchoscopy (under General anesthesia) found the cap from the aerosol sprays in the right intermediate bronchus. The sprays captured by the capture type "rat mouth and removed. On the location of the foreign body is visible to multiple deep ulcers, and on the mucous membrane of the trachea - erosion. Bronchial significant amounts of purulent secretions. Produced introduction to each edge of the ulcer in 5 ml of ozonated isotonic sodium chloride with ozone concentration of 5 mg/L. Reorganization of the tracheobronchial tree 80 ml of ozonated isotonic sodium chloride. Rehabilitation was carried out after 1 day, just 5 sessions per course of treatment. Ulcers and erosions fully epithelialize, in the bronchi moderate amount of mucous secretion. The patient was discharged from the hospital. When control is ASS="ptx2">

Thus, the proposed method has the following advantages.

The proposed method allows to achieve complete epithelialization of erosions and ulcers of the tracheobronchial tree in a short time and without antibiotics. Managed to achieve recovery in 100% of patients.

Significantly longer period of remission. All patients treated with the proposed method, recurrence was not observed and the remission lasts 3-6 months.

Reduces the treatment time from 1 month up to 8-10 days.

The method of treatment of erosive-ulcerative tracheobronchitis, including the announcement of a medicinal product to the damage zone, characterized in that as drug use ozonated isotonic sodium chloride solution with an ozone concentration of 5 mg/l, which is injected under the mucosa in the area of the edges of each ulcers and additionally the same solution is injected into the lumen of the trachea and damaged bronchus 60 - 80 ml

 

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