Method for treating pulmonary tuberculosis

FIELD: medicine, phthisiology.

SUBSTANCE: one should create pulmonary atelectasis from inside due to applying bronchial valve in tuberculosis-affected lung in case of bronchoscopy depending upon localization of tubercular process. The method enables to avoid course anatomical alterations and functional disorders, avoid the development of reactive exudative pleuritis and rigid pneumothorax.

EFFECT: higher efficiency of therapy.

3 dwg, 1 ex

 

The invention relates to medicine, namely to Phthisiology, and can be used for the treatment of pulmonary tuberculosis patients, including when it is chronic and complicated forms.

Existing methods of treatment of pulmonary tuberculosis imperfect. This is because modern chemotherapy and fisierele not effective enough.

There is a method of treatment of pulmonary tuberculosis by chemotherapy. However, the possibility of insufficient because of the increasingly emerging recently, drug-resistant forms of tuberculosis (Ursov I.G., borowinski A.I. Modern concept for accelerating the cure of patients with destructive pulmonary tuberculosis. Novosibirsk, 1993, P.205).

Closest to the claimed prototype is a method of treatment of pulmonary tuberculosis, which consists in creating a therapeutic collapse from the outside by introducing into the pleural cavity air (Kharchev K.A. Collapsotherapy in complex treatment of patients with pulmonary tuberculosis. 1972, Moscow. Pp.182).

However, the known method is limited to developing gross anatomical changes and functional disturbances, frequent complications, lack of selectivity, and with obliteration of the pleural cavity requires a prior surgical intervention, or even becomes unusable. However, this is the procedure requires regular insufflate (every 7-10 days) for a long time (3-4 months to 1 year or more), consequently often formed rigid pneumothorax.

The author offers a new method of treatment of pulmonary tuberculosis by use of the valve, which creates the effect of colapsoterapiei. A positive result of the invention is to increase the efficiency of treatment by achieving the state of hypoventilation and atelectasis in the lung affected by tuberculosis, creating conditions for its treatment.

A positive result is achieved that create atelectasis of the lung from the inside by use of the valve in the bronchus, stricken with tuberculosis of the lung, bronchoscopy, depending on the localization of tuberculosis.

The method is as follows. Spend bronchoscopy under General anesthesia. Anaesthesia is conducted according to generally accepted rules, namely after the standard sedation anticholinergic and antihistaminic drugs (atropine 0,1% 1,0; diphenhydramine 1,0% 1,0 intravenous) hold introductory anesthesia barbiturates short-acting (sodium thiopental from 0.5 to 1.0 or hexenal from 0.5 to 1.0) intravenously. Then hold the base anesthetized with a solution of ketamine at a dose of 1-3 mg per kilogram of body weight intravenously. Artificial ventilation of the lungs is carried out for all bronchoscopy through a tube called a bronchoscope respirator, such as Bioart-1”in the mode of high-frequency ventilation frequency 120-200 per minute. is the ass end of bronchoscopy in the recovery of spontaneous breathing and General muscle tone of the patient is transferred to an intensive surveillance.

Holding bronchoscopy.

After the occurrence of myorelaxation perform the intubation tube of Friedel rigid bronchoscope with a diameter of 11-12 mm After inspection of the bronchial tree and removal of mucus to the mouth of the draining bronchus (corresponding to tuberculosis in the lung) fail fixed biopsy forceps valve and install it into the lumen of the bronchus to jamming (until it stops). In this procedure the installation of the valve ends. After restoration of spontaneous breathing patients tube called a bronchoscope is removed.

The valve device.

The valve is made of rubber compound IRP 14-01 and is a hollow cylinder. The inner hole of the valve with one hand has a smooth round shape, on the other hand is made in the form of a falling petal valve, lockable excessive external pressure (the difference between internal and external pressure). Two-thirds of the outer surface of the valve is made of a thin plate radial petals to lock it in place (figure 1). Place of fixation of the valve in the bronchus depends on tuberculosis in the lung (figure 2). The valve allows you to move away from a light air and sputum during expiration and cough, while the reverse intake by inhalation does not occur, thereby creating in a light state of hyperventilation and is of tilactase (figure 3).

Clinical observation.

Patient M 36 years old was admitted to the Department 23.01.2002: diagnosed with fibrous-cavernous tuberculosis of the upper lobes of the left lung in the phase of infiltration and contamination, complicated hemoptysis VK+.

Suffering from tuberculosis for 10 years. During this time, annual and long-passed courses of antibiotic treatment for TB inpatient and outpatient. Treatment gave a brief remission, then followed exacerbation of tuberculosis, usually accompanied by pulmonary hemorrhage or hemoptysis.

The patient's condition upon admission of moderate severity. Complaints about coughing up blood, weakness, elevated body temperature to 38.0°C.

Complete blood count: b 102 g/l, ESR 49 mm/h, er. 3,4×1012L - 10,7×109E - 7, P - 1, p - 54, L - 21, M - 6.

24.01.2002-year-old bronchial blocking valve of rubber compound IRP 14-01 by the described method. Moved well. Hemoptysis stopped immediately.

For clarity, give x-ray dynamics.

Radiograph at admission: left upper portion, and S6 somewhat reduced in volume by pneumovirus. Determined variegated stripe education periapical infiltration. One of them is larger, approximately 5 cm in diameter, the horizontal level of the contents at the bottom. Polymorphic lesions. The left root is moderately tucked up up. Pockets of bronchogenic drop-out rates in both lungs. The shadow of the mediastinum is the median.

Radiograph after bronchoscopy: on the left, in the upper sections of the lung is larger cavity diminished in volume, periclavicular infiltration persists. The top share in hypoventilation.

Radiograph after 3 months: left top share in atelectasis, abdominal education diminished in volume, some of them rubouts, periclavicular infiltration decreased, the number of polymorphic lesions decreased. Marked thickening of the pleura in the upper sections. The number of lesions dropout on both sides decreased significantly. The left root is pulled up. The shadow of the mediastinum is displaced to the left.

Radiograph after 5 months: left top share in atelectasis, it marked pleuro-pneumocystitis changes. Compared with previous x-ray examination at the place of cavitary mass determined scar lung tissue. On both sides of a single dense pockets.

Radiograph 3 months after removal of the valve: left top share in pleuro-pneumoconioses. In the lungs on both sides of a single dense pockets.

Common blood test at discharge: b 115 g/l, ESR - 10 mm/h, er. - 3,4×1012L - 4,7×109E - 7, P-1, C - 54, L - 21, M - 6.

In the cut is litate the treatment, the patient's condition has improved. Body temperature was normalized, the weakness was not bothered, bicilavadora stopped.

18.06.2002 patient M was discharged in good condition on outpatient treatment and monitoring of TB.

The inventive method applied in 6 patients with progressive drug-resistant tuberculosis. All patients were stabilized and process improvement.

The inventive method allows selective treatment of pulmonary tuberculosis, including when it is chronic and complicated forms, regardless of adhesions, does not require frequent re-insufflate air, avoids many complications such as reactive exudative pleurisy, rigid pneumothorax, the formation of the gross anatomical and functional disorders, to exclude the risk of iatrogenic pneumothorax, to avoid surgical treatment. In addition, melodramatically method allows to extend the indications for its use in debilitated patients and in patients with contraindications to other therapies.

The inventive method allows to achieve the state of hypoventilation and atelectasis in the lung, stricken with tuberculosis, by applying the valve.

The method of treatment of pulmonary tuberculosis, which consists in creating a therapeutic collapse, characterized in that create atelectasis l is Gogo from the inside by use of the valve in the affected bronchus pulmonary tuberculosis during bronchoscopy depending on tuberculosis.



 

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FIELD: medicine, phthisiology.

SUBSTANCE: one should create pulmonary atelectasis from inside due to applying bronchial valve in tuberculosis-affected lung in case of bronchoscopy depending upon localization of tubercular process. The method enables to avoid course anatomical alterations and functional disorders, avoid the development of reactive exudative pleuritis and rigid pneumothorax.

EFFECT: higher efficiency of therapy.

3 dwg, 1 ex

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