Method for carrying bronchoalveolar lovage

FIELD: medicine, pulmonology.

SUBSTANCE: one should perform lovage in three stages:during the 1st stage one should carry out lovage of tracheoalveolar tree for 3-4 min with 60-80 ml 0.08%-sodium hypochlorite solution, at the 2nd stage one should introduce 5-7 ml 10%-fluimucyl solution into tracheobronchial tree for 4-6 min, and at the 3d stage one should perform lovage of tracheobronchial tree for 3-4 min with 60-80 ml 0.11%-sodium hypochlorite solution. The present innovation favors secreta release of decreased viscosity into large bronchi that simplifies its evacuation and this, in its turn, simplifies the access of antiphlogistic and antibacterial preparations towards tracheobronchial tree's mucosa that leads to interrupting inflammatory process in more shortened terms.

EFFECT: more prolonged period of remission.

2 ex

 

The invention relates to the field of medicine and is designed for effective bronchoalveolar lavage during fibrobronchoscopy in patients with severe obstruction of the tracheobronchial tree pathological bronchial secret.

The fibrobronchoscopy is one of the most important additional techniques used in pulmonology. In addition to the information that gives a visual inspection of the mucosa of the tracheobronchial tree during fibrobronchoscopy can accommodate a variety of additional therapeutic and diagnostic measures, in particular bronchoalveolar lavage. During bronchoalveolar lavage often intake content bronchi for further analysis.

Therapeutic bronchoalveolar lavage is performed for the purpose of drainage of the tracheobronchial tree to remove abnormal secretions and restore the airway.

By introducing a variety of therapeutic solutions may provide therapeutic effects on the mucosa of the tracheobronchial tree.

There is a method of conducting bronchoalveolar lavage with curative intent using saline solution [1].

The disadvantage of this method is the lack of effectiveness of its therapeutic effects due to the fact that he is reduced to only m the mechanical removal of pathological bronchial secretions. The secret is not pre-diluted, making it difficult to remove and increases the duration of the procedure, which is difficult for patients. Additionally, there is no anti-inflammatory and antibacterial effects on the mucosa of the tracheobronchial tree.

There is also known a method bronchoalveolar lavage, which as lavagno environment is used dioxidine [2]. Dioxidine used to lavage in the form of 1%aqueous solution, has a strong anti-bacterial and anti-inflammatory effect.

The disadvantages of this method are: high frequency of allergic reactions to dioxidine, insufficient latitude antibacterial spectrum (he does not act on all kinds of bacteria), no effect on the viscosity of the secret that makes it difficult evacuation.

There is also known a method of conducting bronchoalveolar lavage with sodium hypochlorite [3]. Sodium hypochlorite has a broad spectrum of antibacterial action, low allergologist (this is a natural product, produced in the body by phagocytosis), cheapness of manufacture.

The disadvantage of this method is the lack of effectiveness of therapeutic effects.

The aim of the invention is to improve the efficiency of treatment of patients with severe obstruction tracheobronchial what about the tree pathological bronchial secret.

This goal is achieved by the fact that produce lavage in three stages: the first stage is conducted for 3-4 minutes washing the tracheobronchial tree 60-80 ml of 0.08%sodium hypochlorite solution, the second stage for 4-6 minutes, enter in the tracheobronchial tree 60-80 ml of 0.11%-aqueous solution of sodium hypochlorite, the phase III hold for 3-4 minutes washing the tracheobronchial tree 60-80 ml of 0.11%solution of sodium hypochlorite.

The proposed method is a therapeutic BALL as follows. Conduct therapeutic and diagnostic fibrobronchoscopy under local anesthesia in the usual manner. After passing fibrobronchoscopy through the glottis proceed to the first stage. At this stage, poignantly lavage (washing) of the bronchi with a solution of 0.08%sodium hypochlorite solution, heated to 37°C. the Total amount of sodium hypochlorite in the first stage is 60-80 ml of 0.08%-aqueous solution. In parallel with the introduction of sodium hypochlorite conducts the removal of abnormal secretions of the main, lobar and segmental bronchi using a suction apparatus. The duration of the first stage is 3-4 minutes. After a large part of bronchial secretions removed from the large bronchi (main, lobar, segmental) conduct phase II bronchoalveolar lavage. The second phase will cover the installation of tracheobronchial the e tree 5-7 ml of a 10%solution fluimucil, which affects the secret, located in the small bronchi, changes its physical and chemical structure, resulting in the secret becomes less viscous and increases in volume. This leads to the release of the secret of reduced viscosity in the large bronchi, which facilitates its evacuation. The total duration of stage II is 4-6 minutes. Then move to the third stage of bronchoalveolar lavage. At this stage, carry out the washing 60-80 ml of 0.11%-aqueous solution of sodium hypochlorite. This completely removes the pathological secret to "clean water" and provide anti-inflammatory and antibacterial action on the mucosa of the tracheobronchial tree with sodium hypochlorite in a higher concentration. The duration of phase III is 3-4 minutes.

CLINICAL EXAMPLES:

1. Patient N., 69 years. Entered in the pulmonary branch No. 2 MMU MSD No. 12 with exacerbation of chronic obstructive pulmonary disease severe. Noted severe shortness of breath, the complete cessation of sputum discharge. Given the pronounced bronchoobstructive, the patient was assigned to the medical diagnostic fibrobronchoscopy. During the FBC implemented a three-stage therapeutic bronchoalveolar lavage using 80 ml of a 0.08% solution of sodium hypochlorite at the first stage, 6 ml of 10%aqueous solution fluimucil the second stage, 70 ml of 0.11%R is the target in the third stage. This allowed us to remove a large amount of viscous purulent secretions, to provide a powerful local anti-inflammatory effect on the mucous membrane of the bronchi. After fibrobronchoscopy the patient's condition improved significantly decreased shortness of breath, began to separate sputum. In a subsequent double-conducted re-fibrobronchoscopy with therapeutic bronchoalveolar lavage according to the described method. This allowed us to quickly remove the aggravation of the disease and to achieve quality of remission. The patient was discharged from hospital in satisfactory condition;

2. Patient M., aged 40. Hospitalized in our clinic №2 MMU MSD No. 12 with community-acquired left upper lobe pneumonia, complicated by the formation of multiple foci of lung tissue destruction. Upon receipt marked critical condition of the patient, who was hospitalized in the intensive care unit and intensive care. Marked shortness of breath, sputum does not depart, there is a lot of wet back of wheezing in the lungs. Was made fibrobronchoscopy using the three-step bronchoalveolar lavage. At the first stage involved washing with 80 ml of a 0.08% solution of sodium hypochlorite, the second stage in the tracheobronchial tree introduced 6 ml of 10%aqueous solution fluimucil, the phase III was carried out about ivanie the tracheobronchial tree 80 ml of 0.11%-aqueous solution of sodium hypochlorite. In the course of conducting lavage removed a large number of viscous purulent lukobrana secret. It is possible to improve the drainage of the bronchial tree, to have a powerful anti-inflammatory effects on the affected areas of the lung tissue. Then repeatedly conducted fibrobronchoscopy with three-stage therapeutic bronchoalveolar lavage. This led to the resolution of pneumonia outcome in focal pneumosclerosis. The patient was discharged in satisfactory condition with significant improvement.

The use of the proposed method can significantly improve the efficiency of bronchoalveolar lavage, which serves to enhance the effectiveness of the treatment of bronchopulmonary diseases associated with severe obstruction of the tracheobronchial tree.

The invention is possible and appropriate to use in pulmonology departments of medical institutions for the treatment of bronchopulmonary diseases.

SOURCES of INFORMATION

1. Crystal R.G., Reynolds H.Y., Kalica A.R. Bronchoalveolar lavage // Chest - 1982 - Vol.90. - P.122-131.

2. Arkin A.I., Short A.I., Pretibial US, Shamonina E.A., gershevich S.D. Local introduction of dioksidina solution in the treatment of respiratory diseases // 11-th national Congress on respiratory diseases/Moscow - 9-13 November 2001 - LVI.24.

3. Steiner M., zhiliakov B.C. sodium Hypochlorite at rehabilitation b is anoscopy // 5-th national Congress on respiratory diseases / Moscow - 14-17 March 1995 No. 1107.

The method of conducting bronchoalveolar lavage using thinning and anti-inflammatory drugs, characterized in that, with the purpose of increase of efficiency of treatment of patients with severe obstruction of the tracheobronchial tree pathological bronchial secret, produce lavage in 3 stages: the first stage is carried out in a period of 3-4 min washing of the tracheobronchial tree 60-80 ml of 0.08%sodium hypochlorite solution, the second stage within 4-6 min injected into the tracheobronchial tree 5-7 ml of 10%aqueous solution fluimucil, the phase III hold for 3-4 min washing of the tracheobronchial tree 60-80 ml of 0.11%solution of sodium hypochlorite.



 

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