Method for treating chronic bronchopulmonary process at inborn defects of pulmonary development in children

FIELD: medicine, pulmonology.

SUBSTANCE: the innovation includes the impact of haloinhalations from table haloinhaler "Haloneb" at the mode of 0.4-0.6 mg/min in pre-school-aged children and the mode of 0.8-1.2 mg/min in schoolchildren for 10 min. Then for 5 min it is necessary to perform deep slow inhalation through haloinhaler, pause 4-5 sec and expiration into flutter, about 10-12 procedures/course at the background of basic therapy. The method enables to decrease sputum stasis due to improved rheological properties of bronchial secreta and activated function of ciliated epithelium, decreased inflammation, edema and obstruction in bronchi, improved local immune and metabolic processes.

EFFECT: higher efficiency of therapy.

2 ex

The invention relates to medicine, in particular to Pediatrics, and, specifically, pulmonology, for treatment of chronic bronchopulmonary process in children with congenital malformations of the lungs and bronchi.

The invention can be applied in conditions of clinic, hospital, sanatorium.

It is known that the chronic inflammatory bronchopulmonary process in 5-20% is based on congenital malformations of the lungs and bronchi. The most frequently encountered defects such as hypoplastic lung syndrome Addition, syndrome ciliary dyskinesia, a syndrome Williams-Campbell. When these defects are observed dyskinesia bronchial hypersecretion and violation of their drainage function, bronchial obstruction, congestion of bronchial secretions and infection, which contribute to the occurrence of severe chronic bronchitis, bronchiectasis, pneumosclerosis.

There is a method of treatment of chronic inflammatory bronchopulmonary process through the use of broad-spectrum antibiotics, taking into account the sensitivity of microflora isolated from tracheobronchial secretions or sputum (semi-synthetic penicillins, cephalosporin drugs 2-3 generations, macrolides) and activities to improve the drainage and ventilation function of the bronchi (mucolytics, mucokinetic, broncholytic, exercise therapy, massage, drainage)./Rachinsky S.V., Volkov I.K. Protracted and chronic disease in children. Guide edited Mastogeniini. - M.: Medicine, 1998/. There is also known a method of therapeutic treatment of chronic bronchopulmonary diseases by applying the CMT therapy (patent No. 2196615).

Lack of drug therapy, in particular, antibiotic therapy, is an individual intolerance to the drugs, disruption of the intestinal microflora and dysfunction of the gastrointestinal tract, the development of fungal complications. Mucolytic and bronchodilator therapy is not always effective enough in this pathology. And physiotherapeutic treatment (CMT) has not received widespread use in this disease, as there are some contraindications to its use: the acute period of the disease, individual intolerance of the current, vagotomies action, heart rhythm disturbances that often accompany this disease.

The closest in technical essence to the proposed method is a method of treating patients, which is to assign a damp inhalations 20-30 ml 2-3% solution of sodium chloride in the form of heat and humidity ultrasonic inhalations, at the rate of 7-10 procedures for 10-15 minutes. Hypertonic solution acts as rehydrant, increasing the absorption of water in the lumen of the bronchi, razzhizhaya and dissolving the tracheobronchial mucus. However, it is prescribed in the absence of the risk of bronchospasm, as it is osmolar stimulus that provokes the increase in bronchial reactivity in patients with various pulmonary disorders./Genpharma, Chiknoverov, AVerVision/ Inhalation therapy. Saint-Petersburg. 1998/.

In addition, the disadvantage of the prototype (damp inhalations with saline solution) are also high doses of sodium chloride, causing irritation and edema of the bronchi. And the dose of sodium chloride, get sick when halogenosilanes therapy, significantly less compared to the dose received by inhalation of wet aerosol of sodium chloride. These extremely small doses do not cause irritation and increase the reactivity of the bronchial mucosa. The use of dry aerosol allows you to avoid the development of edema mucous respiratory ways and bronchospasm. Thus, the disadvantage of the prototype are: irritation of the bronchial mucosa, edema, bronchospasm./AVerVision./Article: Scientific basis and perspectives of practical application halogenosilanes therapy./Questions of balneology, physiotherapy, therapeutic physical culture. No. 1. 2000//.

The technical result of the proposed method of treatment of chronic bronchopulmonary process in congenital malformations of the lungs is reduced stagnation of phlegm by improving the rheological properties of bronchial secretions and activate the function of ciliated epithelium; reducing inflammation, swelling and obstruction in the bronchi, which improves the ventilation function and reduces bronchial reactivity, and finally, improve the overall reactivity of the organism by improving local immune and metabolic processes, which increases the period of remission.

This technical result is achieved by the fact that the patient carry out the exposure haloinhalation from table Caligastia “Haloneb” in 1 mode (0.4-0.6 mg/min) children of preschool age and in the 2 mode (0.8-1.2 mg/min) in children of school age within 10 min, and then for 5 min to produce a deep, slow breath in through calingasta, pause - 4-5 and exhale average intensity in the flutter, the number of respiratory cycles of 15-20 (preschool children) and 20-25 (students) - 1 times in a day, the course of 10-12 treatments, on the background of basic therapy.

Impact gloingalyatsionnui therapy (dry vysokodisperstnogo aerosol of sodium chloride) leads, firstly, to improve the rheological properties of bronchial mucus, which contributes to the functioning of the ciliated epithelium and improve the drainage function of the respiratory tract. Secondly, due to the physico-chemical properties of aerosol this action effectively implemented in all, including a deep and inaccessible parts of the respiratory tract. Third, acting as registrant, gloerson reduces edema of the bronchial mucosa and helps to reduce congestion of blood vessels. Fourth, the dry aerosol of sodium chloride bactericidal and bacteriostatic effects on the microflora of the respiratory tract, stimulates the response of alveolar macrophages, contributing to increased faguoqitirute elements and increased phagocytic activity, exerting a positive influence on the local immune and metabolic processes. As a result of exposure of haloarcula on different pathogenetic links are stimulation mechanisms sanogenesis respiratory tract. Under the influence of flutter therapy due to pressure fluctuations in the bronchi and the change of air flow, fluctuations occur bronchial walls throughout the bronchial tree down to the small Airways, where there is most pronounced mucostasis, this leads to loosening, Otopeni and evacuation bronchial content.

Simultaneous use in the same procedure gloingalyatsionnui and flutter therapy contributes to a significant purification of the bronchial tree due to potentiation of their actions.

Description of method of treatment.

After pre-clinical, laboratory and radiological examinations begin treatment.

A child is prescribed an antibacterial, mucolytic therapy, according to testimony bronchodilator therapy, massage, postural drainage. After 1.5-2 hours after Breakfast, the patient takes a procedure Caligastia and flutter therapy.

Sitting on a chair in the specially equipped inhalatory patient receives the combined effect of gloingalyatsionnui therapy (PCG) using the desktop Caligastia “Haloneb (GIS 01, No. 98/219-331 state registration, issued by CJSC “Euromed”, Russia) and flutter therapy, which is performed using accessories: mouthpiece-flutter (domestic production, produced Cheboksary branch “ Medservice international”).

Exposure is carried out by the following procedure: Aero environment (1-5 microns dry salt aerosol) is formed in the upper chamber and is fed to the patient through a tube connected to the mouthpiece with valve and exhalation (depending on the age of the patient exposure is carried out in 1 (0.4-0.6 mg/min) or 2 (0.8-1.2 mg/min) for 10 minutes, then for 5 minutes to breath through calingasta, then pause for 4-5 seconds and exhale average intensity in the flutter, the number of respiratory cycles of 15-20 (in children of preschool age) and 20-25 (students) - 1 time per day at the rate of 10-12 procedures.

Examples of the method

Example 1. Patient Kiryanov Anton, 10 years old, was admitted in our clinic SC ZV RAMS with a diagnosis of Congenital malformations of bronchus: a syndrome of Addition (full reverse position of the internal organs, chronic bilateral bronchitis, chronic bilateral rhinosinusitis), aggravation. Respiratory failure - 2 degrees.

From the anamnesis it is known that a child from the 2nd pregnancy is proceeding normally, the 2 genera. Birth weight 2600 g, length 51 see Cried at once, but after 7 minutes the child's condition deteriorated due to respiratory failure. The boy was transferred to the intensive care unit of the hospital. Filatov with a diagnosis of Asphyxia at birth, aspiration pneumonia, fungal meningitis. While in the clinic revealed the full reverse position of the internal organs. Inculcated in the individual schedule BCG vaccinated at 1 year and 3 months. Toprobe positive at 6 and 7 years (14 mm). Was examined in TSKB Ministry of Railways, where he was diagnosed with an Infection of the office. Syndrome Addition. Later the child was constantly worried about the violation of nasal breathing, frequent bronchitis. With 8 years annually observed in the ncla RAMS, where he held tracheobronchoscopy study, which was revealed bilateral catarrhal-purulent endobronchitis. The boy is constantly worried about the cough, shortness of breath, exacerbation of bronchopulmonary process on background ORVI - 4-5 times a year.

Upon admission to the Department of state of the child's disease of moderate severity. Concerned about a persistent cough with purulent sputum, difficulty in nasal breathing and purulent nasal discharge, fatigue, and decreased appetite.

Examination: the body is correct, low power, and skin clean, pale, periorbital shadows. Visible mucous membranes pale pink, wet. Zev loose, tonsil gipertrofirovannyy to 3 degrees. Nasal breathing sharply constrained, more to the right. Shortness of breath at rest there. BH-28 per minute. The lymph nodes are not enlarged. Thorax correct form, percussion sound over the light is not changed. Auscultation of the lungs decreased breath, heard a large number of wet medium sized bubble of rales on both sides, more on the right. Heart area is not visually changed, the apical impulse of the heart to the right border of the heart is not enlarged, heart tones are clear, rhythmic. The heart rate of 124 per minute. The belly of the usual form, palpation of the soft, sensitive in the epigastrium. The liver is on the left, is palpated on the edge of the costal arch, bezboleznennaya. Spleen right not palpated.

On the 10th day of hospitalization, the boy's condition has deteriorated due to joining ARI, were observed temperature increase to 38.9, increased cough and purulent discharge from the nasal passages, the physical picture has changed: increased the number of moist rales in the lungs, appeared dry rales.

During the examination in the Department revealed the following abnormalities:

in General, the analysis of small blood leukocytosis: 8,2×10, the EMAS up to 15 mm/h;

- in the sputum on flora and sensitivity to antibiotics: selected pneumoniae and Haemophilus influenzae;

on the chest x - ray: full reverse pitch of the internal organs. Severe deformation of the lung figure in the field With 9, 10 of the left lower lobe. Right rib-diaphragmatic sinus obliterator;

- in the study of respiratory function: moderately reduced FVC=68% under normal index tiffe (104%), FEV1=72% and a moderate decrease in speed parameters KPO (MOS 25=73%, ISO 50=64%, MOS 75=38%);

- Ultrasound of the sinuses: the content in both gaymarvin the sinuses.

In the Department of child treatment, consisting of an antibiotic of the cephalosporin 3rd generation of Suprax 150 mg 2 times a day (10 days), followed by transfer to a second course of antibiotic therapy antibiotic Rozenom - 1 g - 1 once a day for 7 days intravenous bolus; mucolytics of Lasolvan; anti-inflammatory drug Erasala; therapy aimed at treating sinusitis: nasal lavage with saline, followed by instillation of Sofradex; physical therapy, massage, postural drainage. On the 15th day of the child's stay in hospital, on the background of remitting exacerbation, the boy had received a course of halotherapy in combination with flutter, halotherapy was conducted using Caligastia “Haloneb” in 2-Ohm mode (0.8-1.2 mg/min) for 10 minutes, then for 5 minutes exposure was carried out according to the following procedure: inhalation was carried out from the inhaler, pause for 4-5 seconds and exhale in a flutter.

Procedures were performed daily in 1.5-2 hours after Breakfast, in the course of 10 treatments.

After 5-6 treatments, the boy showed improvement in General condition, decrease the viscosity of mucus and facilitate its discharge. By the end of treatment significantly improved the General condition of the patient: increased physical activity, improved appetite, cough was much less, sputum was better to depart and its volume significantly decreased nasal breathing has improved markedly. Auscultation in the lungs significantly reduced the number of listen moist rales, dry no rales were heard.

During the examination after treatment positive dynamics of hemogram: normalization of leukocytes to 6.2×10 and the ESR of up to 4 mm/h

The study of respiratory function showed marked improvement in all indicators to normal: FVC=90%, FEV1=95%, it=136%, MO=85%, MO=72%, MO=70%, which indicates that restore the patency of the bronchi at all levels.

The below-mentioned held the boy before and after each procedure halo and flutter therapy, revealed that the growth after 5 treatments was more than 20%.

Measuring the excursion of the chest before and after treatment in two lines by the method (.Simonova, J.Chevaillier) showed a significant increase in trips is 2 cm

The analysis of the dynamics of immunological parameters (secretory Ig A) revealed a higher level of local immune defense.

Follow-up observation showed a prolongation of the remission period up to 6 months, the boy doesn't hurt when earlier episodes of acute respiratory infections, accompanied by exacerbation of bronchopulmonary process occurred 4-5 times per year.

Example 2. Sick Russian Sergey, 17 years old, was admitted to the pulmonology Department of the ncla RAMS with a diagnosis of Congenital malformations of bronchus. Bronchomalacia right main bronchus. Syndrome Williams-Campbell: common saccular bronchiectasis type bronchi in the right lung and reed segments of the lower lobe of the left lung. Broncho-obstructive syndrome. Respiratory failure 2-3 degrees. Bilateral catarrhal-purulent endobronchitis.

From the anamnesis it is known that a child from 3rd pregnancy occurring with nephropathy, 1-x term labor, proceeding without complications. Birth weight 3400 g, height 51 see Mentioned light asphyxia at birth. Revealed malformations of Macaulay system: hypospadias, scrotal form, about which subsequently operated. Developed by age. Had vaccination on an individual schedule. Heredity and risk factors is not burdened.

For the first time at the age of 1 year ill bilateral pneumonia, toxic form, DN-2tbsp. Was in-patient treatment (1 month in intensive care). 1 year 4 months. - re hospitalization for the bilateral chronic pneumonia, atelectasis, 9, 10 to the right, subdrainage atelectasis of the left. From 2 years of age observed in the pulmonary Department of the ncla RAMS about common malformation bronchus proximal type. Up to 5 years acute exacerbation of chronic bronchopulmonary process every 2 months, then no more than 2-3 times a year, there has been continuous productive cough.

Upon admission to the Department and the boy is the main disease of moderate severity. The shape is correct, the food is satisfactory. The skin is pure white. Zev loose, hypertrophy of tonsils 1 degree. A wet cough is constant, unproductive, sputum mucopurulent 2-3 spit in the day. Nasal breathing is free. Respiratory rate 18 / min. Thorax with funnel-shaped deformation. Percutane-boxed shade pulmonary sound. Auscultation in the lungs breathing weakened, heard from two sides in the lower divisions wet medium sized bubble wheezing and scattered dry rales. Heart tones are somewhat muted, rhythmic. Heart rate is 88 / min. Abdomen normal configuration, palpation painless. The liver stands out from the edge of the rib arc 1 cm, the edge of her soft, painless. Stool and urine output was normal.

During the examination in the Department:

in General, the analysis of minor blood leukocytosis: 7,3×10, ESR - 9 mm/h;

in sputum flora revealed abundant growth of Haemophilus influenzae, a single colony of Pneumococcus, fungi Candida;

on radiographs of the chest: decreased perfusion in the lower lobe of the left lung. The thickening of the walls of the bronchi 9, 10, left lower lobe. Thickening of the walls of the bronchus of the right lower lobe;

- on the indicators of external respiration function revealed moderately expressed generalized disorders of bronchial patency, FVC=92%, FEV1=92%, it=88, MOS=62%, MO=56%, MO=45%;

- at bronchoscopy revealed bilateral catarrhal-purulent endobronchitis.

In the Department of the boy received 3 courses of antibiotic therapy: suprax 400 mg 1 time per day for 10 days, Augmentin 375 mg 3 times a day - 5 days rocephin 2 grams - 2 times a day intravenous bolus within 10 days; mucolytic therapy with acetylcysteine, then abrogation; physical therapy, massage, postural drainage, and calingacion and flutter therapy. Caligastia was conducted from the apparatus Haloneb” in 2-Ohm mode (0.8-1.2 mg/min) for 10 minutes, then for 5 minutes exposure was carried out according to the following procedure: inhalation was carried out from the inhaler, pause for 4-5 seconds and exhale in a flutter. Procedures were performed daily in 1.5-2 hours after Breakfast for a course of 10 treatments.

The improvement of the General condition occurred after the 3rd treatment: decreased sputum viscosity, better to drain freely bronchi and it is easier to depart the sputum. In addition, decreased symptoms of broncho-obstructive syndrome. Boy to the end of the course gloingalyatsionnui and flutter therapy became more active, feel better. Cough disturbed much less, with a small amount of mucous sputum. Auscultation in the number of lung rales decreased, listen to a few wet the medium-bubble crackles, dry single unstable scattered wheezing during forced breathing.

During the examination after treatment positive dynamics of hemogram: normalization of leukocytes to 5.2×10 and the ESR of up to 2 mm/h

The study of respiratory function showed improvement in all indicators: FVC=110%, FEV1=92%, it=90%, MOS 25=77%, ISO 50=67%, MOS 75=52%.

The below-mentioned held the boy before and after each procedure gloingalyatsionnui and flutter therapy, revealed that the growth after 3 treatments was more than 25%.

Measuring the excursion of the chest before and after treatment in two lines by the method .Simonova and J.Chevaillier, revealed an increase in trips by 1.5 see

The analysis of the dynamics of immunological parameters (secretory Ig A) revealed a higher level of local immune defense.

Follow-up observation showed a prolongation of the remission period up to 1 year, the boy during this time was sick 1 time ARVI without acute bronchopulmonary process, when earlier episodes of acute respiratory infections, accompanied by exacerbation of bronchopulmonary process, appeared to 2-3 times per year.

The proposed method of treatment was applied in the pulmonary Department NTS ZV RAMS in 50 patients aged 6-17 years with chronic bronchopulmonary process in congenital malformations of the lungs and bronchi.

As a result of treatment method proposed there was a strong positive dynamics of clinical symptoms by the middle of the course of treatment. By the end of treatment all patients significantly improved psycho-emotional state, physical activity, increased productivity cough, decreased obstructive syndrome, the number of wheezing in the lungs was significantly reduced.

Improvement in clinical symptoms was accompanied by favorable changes of respiratory function and patency of peripheral bronchi. Data analysis peak flow reading, conducted before and after each procedure, showed that the increase in peak exhalation rate (PSV) after each treatment averaged 10-15%, and by the end of therapy ranged from 25 to 50%.

Comparing figures excursions of the thorax (TFE) in children receiving the proposed method, it was observed that after treatment chest excursion increased on average 2-5 see

Thus, the proposed method for the treatment of chronic inflammatory bronchopulmonary process in children with malformations of the lungs and bronchi can improve drainage and ventilation lung function, reduce congestion bronchial content by improving motor skills ciliated epithelium of the respiratory tract, mukoregulirutm actions, enhance the local immune processes, and improves the overall reactivity of the body and prolong the period of remission.

A method of treating chronic bronchopulmonary process in congenital malformations of the lung and bronchus in children by conducting inhalation, characterized in that the patient carry out the exposure haloinhalation from table Caligastia “Haloneb” mode 0.4-0.6 mg/min children of preschool age and mode of 0.8-1.2 mg/min in children of school age within 10 min, and then for 5 min, producing a deep, slow breath in through calingasta, pause 4-5 and exhale in a flutter, for a course of 10-12 treatments on the background of basic therapy.