Complex therapy method for treating children for severe mucoviscidosis

FIELD: medicine.

SUBSTANCE: method involves introducing ozonized physiologic saline once a day during 30 min in addition to traditionally applied drugs. The ozonized solution has ozone in concentration of 100-150 mcg/l in the amount of 100-150 ml when treating children younger than 3 years. Children being elder then 3 years, ozone concentration is 200-250 mcg/l, its amount is 200-250 ml. The total therapy course is 5 days long. The traditionally applied drugs are not to be used within 30 min before and after ozonized physiologic saline application.

EFFECT: accelerated treatment course; no antibiotics being used; reduced risk of adverse side effects.

1 tbl

 

The invention relates to medicine, namely to Pediatrics.

Common treatment option for cystic fibrosis in the period of exacerbation is the use of mucolytic agents, enzymes and kinesitherapy with the mandatory inclusion in basic therapy intravenous courses of antibiotics (Kapranov NI cystic Fibrosis in children. 2003, 76 S.).

The disadvantage is that traditional treatment involves aggressive and prolonged antibiotic therapy in the absence of radically affecting the main pathogenetic syndromes (hypoxemia and tissue hypoxia) components.

In Pediatrics, the known methods of application of ozone therapy in children with appendicular peritonitis (Shamsiev A.M., Yusupov S.A., Atakulov D.O. and other Ozone therapy in the prevention and treatment of postoperative abscesses of the abdominal cavity in children // Children. surgery, 2001, No. 2. P.10-12) and in the treatment of duodenal ulcers (Shamsiev A.M., Yuldashev B.A. the Effectiveness of ozone therapy in children treatment of duodenal ulcers associated with Helicobacter pylori infection, " Vestn. physician General practice, 1997, No. 2, p.7-10).

However, in children suffering from cystic fibrosis, a method of ozone therapy has not previously been used.

The technical result of our invention is to improve the efficiency of complex treatment.

The technical result is achieved by the fact that advanced in trevenna, within 30 minutes, after 30 minutes after the introduction of basic medicines, patients under the age of 3 years is introduced ozonated solution, the concentration of ozone 100-150 g/l when the volume of injectate 100-150 ml, once a day, a course of 5 days, children older than 3 years, 30 minutes after intravenous administration of traditional medicines, within 30 minutes you enter the ozonized solution with a concentration of ozone 200-250 g/l when the volume of injectate 200-250 ml, once a day course of 5 days.

The method is as follows. Preparation of the applied solution of ozone for intravenous use is carried out by passing (sparging) kislorodoterapii mixture through a physiological solution. We used for these purposes, the device with a low concentration and ozone destructor AOT-N-01-AR THE 9444-001-075-13518-97. Certificate N ROSS RV, ME34, W. - children up to 3 years after 30 min after the intravenous administration of traditional medicines, for 30 min being ozonated solution in the amount of 100-150 ml with ozone concentration of 100-150 g/l, 1 times a day, a course of 5 days.

Children older than 3 years after 30 min after the intravenous administration of traditional medicines, for 30 min being ozonated solution with ozone concentration of 200-250 g/l when the volume of injectate 200-250 ml, once a day, the URS 5 days.

Given the strong oxidizing power of ozone, for intravenous use was observed following rules: drugs for 30 min prior to the introduction of ozone and 30 minutes after application of ozonized solutions were not used. The ozone therapy was carried out for 30 min, because this time its half-life.

Monitoring the effectiveness of ozone therapy was conducted in clinical settings: the reduction and normalization of temperature; the improvement of health, the positive dynamics of physical findings in the lungs; the change of gas composition of blood; the achievement of remission occurred on average 3-4 days earlier than patients receiving standard therapy.

Example No. 1. Patient T., born in 2001, case history No. 4035, was hospitalized in the CSTO No. 2 2.06.2004, - 9.06.2004,

Diagnosis: cystic Fibrosis, mixed, severe, acute. Chronic deforming bronchitis. Pulmocare. Emphysema. Malabsorption syndrome and maldigestion. Functional bowel disorders. GIT. Secondary immunodeficiency. Emerging pulmonary heart. Chronic Pseudomonas aeruginosa infection.

She is seen and treated in the cystic fibrosis center of Voronezh for 4 years. The diagnosis of cystic fibrosis was set at the age of 4.5 months, the disease was manifested respiratory syndrome (bronchitis, pneumatic the AI from birth), delay in physical development, steatorrhea. The diagnosis was confirmed clinically, radiographically, laboratory (chlorides sweat - 70 mmol/l).

From the anamnesis it is known that a girl born from a middle-aged parents (mother was 36 years old, father - 34 years). Pregnancy II, proceeding with preeclampsia in the second half, childbirth I, in time, by caesarean section (I pregnancy - med. abortion, after which for a long time the mother had been treated for infertility).

The girl was born weighing 3600 kg, an increase of 53 see To his chest was applied on 4 days, on breastfeeding were up to 7 days, after that received artificial feeding. Discharged from the hospital for 21 days. It was noted colorless, decorated chair with oily luster, bad otstiryvayutsya from the cradle, rich, 4-5 times per day.

At 1 year of life was seen by the neurologist about perinatal encephalopathy. 1 year weight was 8 kg (mass deficit amounted to 35%).

Hereditary anamnesis: the mother - chronic bronchitis, anemia; father - sinusitis.

Last exacerbation in pneumonic type - may 2004 - required inpatient care. The girl was conducted the following laboratory tests:

Complete blood count: HB 128 g/l; L - 5,8×109/l; P - 2%C - 34%; E. - 1%; l - 59%; m - 4%; ESR - 26 mm/h

Urinalysis - without a pathology.

Chest x-ray - pneum is of S 4-5 right on the background obstructive syndrome.

Biochemical blood test: free. bilirubin - 9,5; thymol Ave - 9,3 ed; B - 203; ASAT - 89; total protein and 64.3 g/l; CRP - 2; glucose of 3.28 mmol/l; amylase - 2,02 mg/CL; urea - 2.3 mmol/l; sialic acid - 2.68 mmol/l; creatinine - 0.035 mmol/L.

ECG: HR - 114 min, sinus rhythm, vertical EOS. Signs of overload of the right ventricle: broadening Z.R. in the II century resp. and V1; V2.

A swab from the throat and nose in U.S. Pat. flora of the throat and nose is dedicated mushrooms p. Candidae, bacteria Ps. aeruginosa and St. aureus.

Ultrasound GPDS: signs of hepatomegaly. Liver: other share - 9.8 cm, lion. share - 4,0 see the Contour smooth, homogeneous structure, drawing anti-aliased. Echo is increased. Spleen 6.8 cm × 2.4 cm - structure is homogeneous, hyperechoic line striated. Kidney without pathology.

Coprogram: slime - moderately; lake. - 4-5 p/SP.; epithelium - 1-2; starch uncle. (++), nutrilett. (+); mysen. fiber (+); fiber parivar. (+); neutral fat (++); detritus (+); microbes (+).

KOS - pH - 7,31 mm RT. Art.; pO234,8; RNO2- 44,4; BE -(-4,4) me/l; AB - 21,7 me/l; total CO2- 23,0 me/l;2sat. - 60,3%.

The girl received the following treatment: CREON 10 thousand to 6 caps./day, maxipime, Fortum, aminophylline, Lasolvan, Ambroxol, ATT, multivitamins, Ursofalk, Viferon, nystatin, CA gluconate, laser therapy for gr. CL No. 7, inhalation via nebulizer with berodual, intravenous infusion of ozonated f is srestore 100,0, with ozone concentration of 100 g/l, the rate of 5 days. Ozone solutions were introduced in half-hour time interval from the completion of the introduction of the other components of the infusion, 30 minutes, 1 time a day. Adverse reactions when using ozonated solutions were noted.

Amid conducted comprehensive therapy using intravenous ozone therapy temperature normalized on day 2 of treatment, in the same period, significantly improved health; on the 3rd day of treatment decreased the amount of catarrhal phenomena in the lungs, decreased the degree DN.

After 5 days, i.e. after completion of the course of ozone therapy, significantly improved the performance of blood gas composition: pH - 7,34 mm Hg; pO2-71,4; pCO2- 35,7; BE - (-5,4) me/l; AB - 19,1 me/l; total CO2- 20,1 me/l; O2sat. - 93.1% (see table) and hemogram: HB 128 g/l; L - 5,4 × 109/l; P - 2%; With 56%; E. - 1%; l - 37%; m - 4%; ESR - 12 mm/h

In the complete blood count erythrocyte sedimentation rate decreased to 12 mm/h

On the 7th day of treatment taking into account the stable positive dynamics of clinical and laboratory parameters girl was discharged home. Thus, in a child with severe hypoxemia after 5 days of ozone therapy significantly improved KOS, therefore, stabilized homeostasis, decreased the degree of tissue hypoxia.

Example No. 2. Patient M., born in 1994 extract from a case history No. 2216. hospitalizatio in the Center of cystic fibrosis from June 8 to June 16, 2004

The patient was treated with a diagnosis of cystic Fibrosis, mixed, severe. Chronic bronchitis, exacerbation of bronchopulmonary process pneumonic type, DN. Secondary hepatitis. Emerging pulmonary heart. The lag in physical development.

From the anamnesis it is known that the girl from 1 pregnancy occurring with preeclampsia 1 half against the background of anemia, urogenital candidiasis, was born at term with a weight of 2800, height 50 see behavioral development in accordance with age. It was noted poor gain in body weight, and in the year of underweight was 30%. At an early age repeatedly endured severe pneumonia complicated by pneumothorax. The diagnosis of cystic fibrosis is set at the age of 5 months on the basis of the clinic and the performance of the sweat chloride 95 mmol/l Every 3 months the patient was conducted courses of preventive therapy with intravenous infusions of antibiotics.

Last exacerbation in June 2004 Complaints about constant cough with viscous sputum, loss of appetite, undigested copious stools, flatulence. The state of admission heavy, sharply suffers health. The girl lowered food, lack of mass 5 kg High fever, temperature "candle" to 39 degrees. The pale skin, increased sweating. The breathing frequency was 54 per minute. Nasal breathing is difficult, if the IMS-purulent discharge. The chest is barrel-shaped deformation of the distal phalanges of the type "drum sticks". Auscultation of breath hard, fine bubble moist rales in all lung fields. HR 120 minutes auscultation of the heart sounds are muffled, soft systolic murmur at the point of projection of the aorta and at the top. Abdomen slightly increased in size, soft, painless, liver +1 see the Chair unstable, mixed with fat and pungent smell. Survey data at entry:

1. General. an. blood HB - 110 g/l, er. - 3,7, L - 11,1; p/I - 7%, 54%, e - 2%, l - 33%, m 2%, ESR - 18 mm/h

2. B/chemistry blood - O.B. 57 g/l, glucose of 4.4 mmol/l, amylase 27,

3. KOS and blood gases: pH 7,44, pO2- 50, RNO2- 44, BE - (-1,7), AB - 23,8, saturated oxygen - 89.

4. The sputum is selected Pseudomonas aeruginosa.

5. ECG sinus tachycardia, signs of overload of the right ventricle, p puimonale in the right chest leads.

6. Respiratory function: FEV1-55%, FVC-57%, MO-103. Conclusion combined form ventiljacionnoe failure, with a predominance of obstructive.

7. Ultrasound of internal organs: increased size of the liver parenchyma of the pancreas sealed, non-uniform.

Treatment. Intravenous infusion of amikacin and fortune 5 days, nebulizer aerosol by Lasolvan, fistarol, fluimucil, panzytrat 25000 10 capsules per day. The purpose is erektsii severe hypoxemia and hypoxia, in order correction of metabolism and reduce the activity of inflammation conducted a 5-day course of intravenous ozone therapy in ozone concentration 250 g/l, 1 times a day, a course of 5 days, within 30 minutes, half an hour after traditional therapy. When assigning ozone adverse reactions were not noted positive dynamics of clinical symptoms and laboratory parameters. Temperature returned to normal within days. On day 3 of treatment significantly improved health, normal appetite, increased motor activity, and in the same period of treatment decreased the amount of catarrhal phenomena in the lungs and their prevalence. Indicators of KOS after 5 days of treatment: pH 7,42, pO2- 110, pCO2- 30, BE -(- 2,5), AB - 20, saturated oxygen - 99,7. General an. blood at discharge: HB 132, E. - 4, L - 6,5; p - 1%, C - 70%l - 25%. M - 4%, ESR - 3 mm/h After eight days, the period of exacerbation was stopped and the girl was discharged home.

Our proposed method of treatment of children suffering from cystic fibrosis, technically simple, does not require expensive equipment, can improve the effectiveness of the treatment extremely difficult group of patients. Positive dynamics of clinical symptoms, indicators of gas composition of the blood is high enough to evaluate the possibilities and prospects of additional non-pharmacological treatment of children with severe the th, sometimes fatal diseases. The method significantly improves the quality of care, reduces the duration of treatment of patients, it does not cause acute or chronic side effects.

Indicators of KOS and blood gases sick So 4 HP (venous blood)
Norm dropsBefore the treatmentAfter 5 days of ozone therapy
pH7,32 was 7.457,317,34
Rho283-10834,8**71,4**
pCO238-4844,4**35,7**
BE0±2.3 mmol/l-4,4-5,4
AB18-23 mmol/l21,719,1
O2sat (pulse oximeter)93%60,3**br93.1**
** Statistically significant differences

The method of complex treatment of severe forms of cystic fibrosis in children, including the introduction of traditional medicines, characterized in that it further for 30 min intravenous ozonized physiological solution (ODF) once daily, and for children up to 3 years of COI is lsout ODF with ozone concentration of 100-150 g/l in 100-150 ml, and for children older than 3 years - ODF with ozone concentration of 200-250 g/l in 200-250 ml, therapy ODF - 5 days, but traditional drugs are not used within 30 minutes before and after the introduction of ODF.



 

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