Method of treating broncho-obstructive syndrome in newborns with pneumonia and tracheobronchitis

FIELD: medicine.

SUBSTANCE: for treating broncho-obstructive syndrome combined with pneumonia and tracheobronchitis in newborns, nebuliser inhalations with oxygen supplement 30-60% one session of which consists in consistent introduction of Salbutamol and Budesonid. The initial dose includes 0.15 mg/kg of Salbutamol and 0.125 mg of Budesonid - 2-3 sessions a day. The stabilisation requires 0.15 mg/kg of Salbutamol and 0.25-0.3 mg/kg of Budesonid once a day. The therapeutic course is 3-14 days.

EFFECT: method allows improving respiratory pulmonary function, reducing symptoms of respiratory insufficiency, relieving severity and duration of infectious-inflammatory process in airways.

8 tbl, 2 ex

 

The technical field of the invention: the Invention relates to medicine, more specifically to Pediatrics and neonatology, and can be used for the treatment of broncho-obstructive syndrome, complicating the course of pneumonia and tracheobronchitis in newborn infants.

This is based on the idea of sequential application of two drugs of different mechanisms of action, which is introduced into the airway using the inhaler type nebulizer.

Currently, in the treatment of broncho-obstructive syndrome in newborn infants preferred is a new non-invasive inhalation method using drugs with the help of a nebulizer, which, due to the presence of the compressor, creates an aerosol of a drug in the form of melkodisperstnoy a particle size of 2-5 microns, can quickly penetrate into the area of inflammation and swelling, to have a direct impact on the receptor apparatus of the lower divisions of the tracheobronchial tree. When this happens the moisture bronchial mucosa, is conducive to the discharge of phlegm, improve mucociliary clearance, relief of spasm of smooth muscles of the bronchi. The advantages of nebulizer therapy in newborn infants is also the possibility of integrating the device in the circuit supplying oxygen and loop mechanical ventilation, in which the possibility of the introduction of high doses of medicinal substances of use at any time of the day. Nebulizer inhalation, as a non-invasive method of administration of drugs that significantly reduce the systemic side effects of drugs observed in parenteral [Gribennikov VA, Milenin O., Rumin I.I. Respiratory distress syndrome in newborns. // The Herald of medicine, M., 1995. - 137 S.; I.V. Markov, Shabalov, I.P. Clinical pharmacology newborns. // St. Petersburg, 1993, - 374 S.].

Pathogenetic treatment of broncho-obstructive syndrome in newborn infants is based on the use of two groups of pharmacological drugs that restore the airway. The first group broncholytic, which relax the smooth muscles of the bronchi when they spasm, increase spastic vessels of the lungs. The second group glucocorticoids, which have anti-inflammatory effect, prevent and reduce edema and inflammatory infiltration of the bronchial wall, reduce vascular permeability and mucus hypersecretion reduce the output of the effector cells of inflammation and inhibit the production of inflammatory mediators stimulate mucociliary clearance and facilitate the discharge of phlegm.

Currently, as bronchodilator therapy in obstructive syndrome in newborn infants is used selective β2agonist Korotkov the steps salbutamol (ventolin) [M. Gappa, Gartner M, Poets CF., von der Hardt H., and others. Effects of salbutamol delivery from a metered dose inhaler jet nebulizer on dynamic lung mechanics in very preterm infants with chronic lung disease. // Pediatr. Pulmonol., 1997, Jun; 23(6). - P.442-448]. The disadvantage of this method with the use of salbutamol as monotherapy is a short-term effect of the drug (within a few hours after inhalation) and no anti-inflammatory effect. Save inflammatory changes in the mucosa of the respiratory tract causing new episodes of bronchoobstructive. The use of salbutamol with bronchoobstructive syndrome in neonates with pneumonia and tracheobronchitis cerebral ischemia, mostly 2nd degree, may be followed (according to our data, 4% of children) side effects (tremor of the skeletal muscles, stimulation of the Central nervous system), and according to the literature - expanding peripheral vessels, tachycardia, arrhythmia, reversible metabolic changes (increased concentrations of glucose in the blood, hypokalemia), characteristic of this pharmacological group [Gusel V.A., Markov IV Reference pediatrician for clinical pharmacology. // M, 1989, s-183; Morina P., Herrera M., Venegas J., et al. Effect of nebulized salbutamol on respiratory mechanicsin adult respiratory distress syndrome. // Intensive Care Med., 1997, Vol.23. - P.58-64].

Recently, for the treatment of broncho-obstructive syndrome in newborns was used inhalation is corticosteroid budesonide (pulmicort), which has a strong local anti-inflammatory effect, affecting all phases of inflammation, and has no systemic side effects in children of this age group [S. Arnon Delivery of micronized budesonide suspensia by metered dose inhaler and jet nebulizer into a neonatal ventilator circuit. // Ped. Pulm., 1992; 13 (3); 172-5; Arnon S. Effectiveness of budesonide aerosol in ventilator-dependent preterm babies: a preliminary report. // Ped. Pulm., 1996; 21 (4), 231-5].

The disadvantage of this method is the lack of or weak anti-inflammatory effect with improved lung function in those infants who have violated the airway due to pronounced spasm of the bronchi and hypersecretion of mucus, which makes deep penetration of budesonide aerosol in the respiratory tract and interaction with glucocorticoid receptors [Bettendort M., Albers, N., et all /Longitudinal evaluation of solivary cortisol levels in full-term and preterm neonates. // Horm. Res., 1998; 50 (6): 303-8; Jinsson Century, Eriksson M., Sider O., Broberger u Et all/ Budesonide delivered by dosimetrie jet nebulization to preterm very low weight at high risk for development of chronic lung disease. // Acta Paediatr., 2000, Dec.; 89 (12): P.1449-1453;. Turpeinen M., Nikander K. Nebulization of a suspension of budesonide and a solution of terbutalin into a neonatal ventilator circuit. // Resp. Care, 2001, Jan.4 46 (1): 43-48].

Up to the present time for the treatment of broncho-obstructive syndrome in newborn infants was used isolated monotherapy in the form of a nebulizer inhalation only one drug: selective β2-agonist or glucocorticoid.

We PR is pologili, the most pronounced positive therapeutic effect in bronchoobstructive syndrome in newborn infants with pneumonia and treebranches you can expect when combined salbutamol and budesonide in nebulizer inhalation conducted during a single session.

The purpose of the invention to develop an effective and safe method for the treatment of broncho-obstructive syndrome in newborn infants with pneumonia and tracheobronchitis, reducing signs of respiratory insufficiency, reduce the severity and duration of infectious-inflammatory process in the Airways.

This goal is achieved through the use of serial nebulizer inhalation selective beta-2-adrenomimetic salbutamol and inhaled glucocorticoid of budesonide in infants with pneumonia and tracheobronchitis, acute broncho-obstructive syndrome.

Disclosure of inventions

Inhalation therapy bronchoobstructive syndrome in newborns spend in acute pneumonia and tracheobronchitis after removal of the ventilator in terms of additional oxygen therapy in the form of subsidies 30-60% oxygen (tent or mask) lying in the incubator or cot.

For inhalation use drug salbutamol - ventolin in the form of nebul (2.5 mg of the drug in 2.5 ml of solution, so what. 1 mg/ml), in a dose of 0.15 mg/kg (maximum daily dose of 0.45 mg/kg) and budesonide (pulmicort) in the form of suspensions for inhalation (0.25 mg/ml), in a dose of 0.125 mg (daily dose of 0.25-0.375 mg). All children in the first and second day of therapy is recommended inhalation 2-3 times a day at intervals of 8-12 hours (depending on the length of the obtained positive clinical effect). With 3 days of treatment with stabilization of the positive effect of inhalation is recommended 1 time per day: salbutamol at a dose of 0.15 mg/kg and budesonide - 0,25-0,3 mg Course inhalation ranged from 3 to 14 days.

Inhalation spend on compressor nebulizer "Pary Junior Boy" (Germany) under monitor control continuously recorded indices of heart rate and blood oxygen saturation (SaO2) by pulse oximetry.

Inhalation is carried out through 1-1,5 hours after feeding. 10-15 minutes before inhalation newborn sanitize the upper respiratory tract, removing mucus vacuum apparatus. If the newborn child of a probe for feeding, introduced into the stomach through the nasal passage, immediately before inhalation remove the probe and suck the mucus out of the nasal cavity.

Part of the nebulizer is collected, the device connected to the network. The child lay on his back with head turning to the side opposite to the lungs solee pronounced auscultatory violations. (During inhalation is not allowed to be careful of the cervical spine.) Just prior to inhalation are training inhalation solutions. You must check the expiration date of the drug; pharmaceutical packaging with the medicinal substance should be stored in the refrigerator in a carefully sealed package.

Immediately before inhalation in a nebulizer is filled with saline in a volume of 1-1 .5 ml, and then add the required dose of salbutamol. After complete solution spray salbutamol consistently held inhalation of budesonide. For this re-entered into the nebulizer 1 ml of physiological solution, is added to a suspension of budesonide (pulmicort) in the above single dose.

Immediately prior to inhalation of the medicinal product oxygen mask is applied tightly to the child's face, reduce oxygen flow to 40-50 l/min and hold the inhalation of 30% oxygen in 1-2 minutes for accustoming the child to the mask. In the work, you should use an oxygen mask with a soft obturator, which provides a tight fit of the mask to the face, thereby reducing loss of the aerosol, and also prevents damage to the skin of the newborn. It is important that during inhalation the Cup of the nebulizer was placed vertically relative to the Polo the foster child for more than a quick spray of the solution prepared.

It is desirable that during inhalation the child was calm, because the effect of the cry of a child to contact spray in the deep respiratory tract is not known.

After complete dispersion of drugs related to the first inhalation, the device is switched off. In the Cup of the nebulizer pour cooked in a separate syringe of sterile saline and budesonide in the above doses. Inhalation of budesonide spend up to full atomization of the aerosol.

Usually the session inhalation comes from inhalation of salbutamol, lasting an average of 7-8 min with subsequent inhalation of budesonide 9-10 minutes. At the end of inhalation of salbutamol and pulmicort wipe the mouth of the child with a clean, wet gauze cloth moistened with boiled water for the prevention of mucosal candidiasis of the oral cavity.

Testimony to the completion of the course nebulizer therapy above-mentioned products are: improving the auscultatory picture in the lungs (no moist rales, the presence of small quantities or single wired wheezing), mild tracheobronchitis (possibly minor amounts of mucus in the upper respiratory tract), the relief of broncho-obstructive syndrome, reducing the severity zapadenia compliant seats of the chest (to a small zapadenia), the existence of stable put the nutrient dynamics in cells and positive dynamics in the analysis of acid-base status of the blood.

For each child the individual applies the mask, which is stored in a separate clean signed the diaper and after the course of inhalation soaked for 30 minutes in 0,03% solution "Anolyte", then washed with physiological saline or distilled water and dried. The net mask is stored in a sterile diaper.

After inhalation nebulizer is disconnected from the compressor and disassembled. The plastic parts of the nebulizer rassoedineniya (removable cap, the Cup of the nebulizer is detached from vozduhovodnogo tube), washed under running water (this is to prevent crystallization of drugs and bacterial contamination) and boiled in water for 10 minutes. Processing vozduhovodnogo tube is similar to the processing masks. Must be blowing tube duct for removal of water droplets from her clearance, due to the possibility of bacterial contamination. After boiling the plastic parts of the nebulizer again connected, and assembled nebulizer ready for the next session inhalation (dry form, wrapped in a clean diaper).

Conditions of implementation of action

1. Drug use:

1) Ventolin-Nebula, inhalation solution 2.5 mg/2.5 ml, (Glaxo Wellcom, Germany).

2) Pulmicort suspension for inhalation of 0.5 mg/is l, (Astra, Sweden).

2. Using device:

1) Nebulizer compressor "Stew Junior Boy" (Germany).

2) Oxygen mask with soft obturator.

3) Disposable syringes.

5) the Source of supplemental oxygen (available in any hospital: centralized oxygen supply in the body, gas tank with compressed oxygen and so on).

The efficiency of use of inventions

The effectiveness of the proposed method was evaluated in 41 newborn baby in acute pneumonia and tracheobronchitis after prolonged mechanical ventilation (7,80±0.96 days) units for premature babies in 2006, when this method was widely used and in 20 children with similar disorders in previous years before the introduction of this method. Evaluation of the effectiveness of the method was performed according to clinical and laboratory indicators of the flow of pneumonia are presented in tables 1, 2 (See. Appendices 1, 2:). Children received inhalation therapy from 12 to 23 day of life (from 5 to 14 day extubation). Inhalation rate averaged 3,86±0.38 days.

Improvement in respiratory disorders before and at the end of successive inhalations of salbutamol-pulmicort 41 surveyed newborn presented in table 1 (see Annex 1).

During inhalation of salbutamol and budesonide was observed a significant decrease tachypnea, is liczenie saturation, that is, the blood oxygen saturation (SaO2); the heart rate at the end of inhalation was not significantly changed. Most newborns have improved physical picture in the lungs conductivity auscultatory noise, reducing the number of wheezing. In 80% of patients newborn reduction zapadenia compliant seats of the chest was observed already after inhalation of salbutamol and increased after inhalation of pulmicort in 90% of children. During inhalation there was an increase in the partial tension of oxygen (po2), partial carbon dioxide tension in the blood (RNO2) were not significantly changed.

The dynamics of the flow pneumonia who received sequential nebulizer inhalation of salbutamol and pulmicort and children without inhalation therapy are presented in table 2 (see Appendix 2).

After a course of inhalation therapy in children showed significant decrease in respiratory rate and increase in blood oxygen saturation, when x-ray examination of the chest - a significantly lower rate of segmental atelectasis from 43% to 6%. These children, compared with children not receiving inhalation were significantly shorter duration of dyspnea, depression compliant seats of the chest, physical changes in the lungs reaches treebranch is the pneumonia, oxygen support; faster arose resolution x-ray pneumonia (17,60±1,22 and 25,58±2,44 day after extubation, respectively), the normalization of the parameters of acid-base status of blood (7,33±0,99 against 11.87 per±1,99 days after extubation).

Implementation of the proposed method in clinical practice increased economic efficiency, which is defined as the reduction in bed-days and duration of antibiotic therapy in 2006, when the clinic newborns have been widely used inhalation therapy compared with the previous period before the introduction of this method of treatment. Bed-day stay of children in hospital has decreased in preterm neonates weighing 1001 to 1500 g for 23 days, weighing from 1501 to 2500 g 16.8 days and for full-term infants at 4, 5 days. The duration of antibiotic therapy in children receiving inhaled, was less than the average for 9 days, than in children without inhalation.

The clinical effectiveness of the nebulizer inhalation of salbutamol and budesonide for the relief of broncho-obstructive syndrome is demonstrated by the following clinical examples.

Clinical example 1. Premature boy, the case history No. 7, born 29.12.2001, Clinical diagnosis: Primary: Bilateral small pneumonia, agela form, acute course. Tracheobronchitis, severe. Companion: Cerebral ischemia 2 degree (subarachnoid hemorrhage, reactive meningitis syndrome muscular hypotonia). Phlebitis umbilical vessels. The conjugation jaundice 2 degrees.

The baby was born the 26-year-old mother, suffering from chronic cholecystitis, pyelonephritis, obesity, 2nd degree, and chronic salpingoophoritis, dysfunction of the ovaries. Pregnancy 1, proceeded with preeclampsia and the risk of premature birth in the 3rd trimester. Childbirth is 1 in 35 weeks of gestation by cesarean section, waterless period of 12 hours. Premature boy was born weighing 2500 g, length 48 cm (intrauterine hypotrophy of 1 degree), with rating on a scale of Apgar 5/7 points, a serious condition caused neurological symptoms (depression syndrome of the Central nervous system), it was noted respiratory disorders, in the form of a moaning breath. At the age of 6.5 hours of life were observed occurrence of prolonged apnea, increasing respiratory distress, and therefore was transferred to an artificial lung ventilation (with rigid parameters). On the 5th day of life diagnosed with pneumonia and tracheobronchitis. The lungs to listen to multiple wet and traiterous wheezing, tracheobronchial tree was aspirated with a thick, viscous copious sputum. On the radiograph at 6 den what life was observed 2-sided swelling, small pneumonia. In the analysis of blood experienced moderate leukocytosis to 18.1×109/l, without changing the leukocyte formula. In the analysis of urine: proteinuria to 0,096,, leukocytes 3-4 p/vision. The blood gases were observed decompensated mixed alkalosis. The child was a complex therapy: anti-bacterial, immunogenetically (Pentaglobin), infusion, cardiotonic (dopamine), Antihemorrhagics symptomatic. Exuberan on the 8th day of life. Alone full-blown depression of the sternum, the intercostal spaces; shortness of breath up to 60-70 per minute. Thorax inflated with a wide aperture; moderate retraction of the sternum, the jugular fossa, the intercostal spaces. Leather with grey color, venous network on the chest. In the lungs breathing noises from the hard shade, a large number of medium-bubble wet, traiterously, wired wheezing; 12-13 day life (5-6 days after extubation) - wheezing. X-ray: small inflammatory changes in both lungs, with increased vascular pattern. In the analysis of acid-base status of blood: respiratory acidosis.

Nebulizer inhalation was held from the 12th day of life (the fifth day after extubation) on the 17th day of life (the tenth day after extubation) consistently salbutamol at a dose of 0.15 mg/kg and budesonide at a dose of 0.25 mg once su is key, course of 6 days. An indication for inhalation was the presence of respiratory disorders (respiratory failure 2 degrees), marked symptoms of tracheobronchitis, bronchoobstructive syndrome, impaired gas homeostasis of blood, inflammatory changes on the radiograph of the lungs.

Improvement in respiratory distress and heart rate during the first inhalation of salbutamol and budesonide in the subject of the child, presented in table 3 (see Annex 3).

From table 3 it can be seen that during the 1st inhalation of salbutamol and budesonide decreased symptoms of respiratory distress: tachypnea (60 min before inhalation compared with 48 per minute after inhalation), increased SaO2from 95 to 97%, decreased the number of wheezing, improved conductivity of respiratory sounds in the lungs, decreased depression compliant seats of the chest. During inhalation, the child fell asleep, the skin turned pink, the heart rate did not significantly change.

After the first day inhalation rate was observed following positive trends in the state: the breath in the lungs was done well, from the upper respiratory tract was usacialis less thick sputum, the initial rates of oxygen saturation rose from 95 to 96.5%. Dynamics clinically the symptoms of dysfunction of the respiratory and cardiovascular systems with successive inhalations of salbutamol and budesonide in child,, presented in table 4 (see Appendix 4).

As can be seen from table 4, to 3 day inhalation breathing in the lungs was well done, decreased the number of wheezing (a little wired) and retraction compliant seats of the chest, moist rales were copied, decreased shortness of breath. Indicators of oxygen saturation of blood (SaO2increased to 98%, in the analysis of acid-base status of the blood was observed hypoxemia. Heart rate tended to decrease. Mucus in the upper respiratory tract was significantly less.

After the course inhalation therapy was stopped shortness of breath, tachycardia, increased SaO2decreased retraction compliant seats of the chest, improved auscultatory picture in the lungs (he stopped whistling, moist rales, decreased the total number of wheezing, improved conducting respiratory noise), in the analysis of acid-base status were stopped respiratory acidosis, pulmonary radiograph pneumonia resolved. Mucus in the upper respiratory tract was not.

Dynamics of gas homeostasis of blood are presented in table 5 (see Appendix 5).

As can be seen from table 5, to 3 day inhalation was a decrease respiratory disorders: increased partial pressure of oxygen and decreased partial carbon dioxide tension is about gas. By the end of the course the gas homeostasis is normalized. Indication for completion of the course inhalation improving auscultatory picture in the lungs, mild tracheobronchitis, bronchoobstructive syndrome and respiratory failure. During the course of inhalation no adverse events were noted.

Thus, the inhalation nebulizer therapy with salbutamol and budesonide in preterm newborn baby with pneumonia reduce symptoms of respiratory distress, nausea signs potentiating tracheobronchitis, bronchoobstructive syndrome, contributed to the normalization of gas homeostasis, radiological and clinical resolution of pneumonia.

Clinical example 2. Mature boy And., case history No. 436, born 14.04.2001, Clinical diagnosis: primary bilateral small pneumonia, severe, acute, aspiration of amniotic fluid. Potentiation tracheobronchitis, severe. Complication: right pneumothorax. Concomitant diagnosis: cerebral ischemia 1 degree (syndrome of a muscular dystonia). Phlebitis subclavian vein on the right. Morphofunctional immaturity. Intrauterine growth retardation 1 degree. Intrauterine hypotrophy of 1 degree. Postnatal malnutrition 2 degrees.

The baby was born the 20 year old mother, suffering compression myelopathy, polycystic ovary disease. Pregnancy 1 proceeded in the 1st trimester with the threat of termination in the 2nd trimester - gestational pyelonephritis in 3 trimester - with anaemia, threatened premature delivery. Birth 1, term by elective caesarean section. A full-term boy was born weighing 2690 g, length 48 cm, with rating on a scale of Apgar 7/8 points, in the state of moderate severity caused neurological symptoms (syndrome of hyperexcitability of the Central nervous system). Aged 2 hours of life due to increasing respiratory failure up to 3 degrees on the background of aspiration of amniotic fluid, cerebral ischemia 2 degrees was transferred on a ventilator. The condition was regarded as serious. In a maternity home was conducted: artificial ventilation of the lungs, antibacterial, Antihemorrhagics symptomatic therapy.

In our patient was admitted on day 2 of life in a serious condition due to respiratory failure 2 degrees on the background of acute flow aspiration pneumonia, cerebral ischemia 1-2 degrees (in the form of depression syndrome of the Central nervous system), General edema of 1 degree. The lungs to listen to multiple wet and traiterous wheezing. On the radiograph was observed bilateral edema, multiple the atelectasis left. In the analysis of blood experienced moderate leukocytosis to 20.1×109/l, without changing the leukocyte formula. In the analysis of urine: proteinuria up to 0.06 g, leukocytes 1-2 in sight. The blood gases were observed decompensated mixed acidosis.

Conducted a comprehensive therapy: anti-bacterial, immunogenetically (Pentaglobin), infusion, cardiotonic (dopamine), hormonal (dexasone), Antihemorrhagics symptomatic.

On the 4th day of life was observed development right pneumothorax was conducted drainage of the pleural cavity. With 5 days of life were observed symptoms of severe potentiating tracheobronchitis (the mucus is very thick consistency), the appearance of signs of infectious toxicosis. On the radiograph with 5 days of life - bilateral edema, pneumonia. Exuberan on day 10 of life. Alone noted marked retraction of the sternum, the intercostal spaces; shortness of breath up to 70-80 respiratory movements per minute. Leather with grey color, venous network on the chest. In the lungs was registered respiratory noises from the hard shade, a large number of medium-bubble wet, traiterously, wired wheezing; on the 14th day of life (day 5 after extubation) - wheezing. On the radiograph revealed a pronounced small inflammatory changes in both lungs, with the phenomenon of emphysema on the right. In the analysis kilotonne of the blood - respiratory acidosis. Central nervous system: depression syndrome; cardiovascular system: tachycardia up to 160 beats per min, hemodynamic disturbances were noted.

Nebulizer inhalation was held on the 14 day of life (day 5 after extubation) on the 20th day of life (day 11 after extubation), salbutamol and budesonide at a dose of 0.15 mg/kg and 0.25 mg, respectively, once a day, a course of 7 days. An indication for inhalation was the presence of respiratory disorders (respiratory failure 2 degrees), expressed manifestations potentiating tracheobronchitis, bronchoobstructive syndrome, impaired gas homeostasis of blood, inflammatory changes on the radiograph of the lungs.

Improvement in respiratory distress and heart rate during the first inhalation of salbutamol and budesonide in the surveyed child And. presented in table 6 (see Annex 6).

From table 6 it is seen that during the 1st inhalation of salbutamol and budesonide decreased manifestations bottoms: tachypnea (84 min before inhalation versus 66 min after inhalation), increased SaO2from 86 to 96%, decreased the number of wheezing, improved conductivity of respiratory sounds in the lungs, decreased depression compliant seats of the chest. It should be noted, is that during inhalation the child fell asleep, the skin turned pink. Heart rate during inhalation has not been significantly changed.

After the first day inhalation rate was observed following positive trends in the state: the breath in the lungs have been better, from the upper respiratory tract was usacialis less sputum, the initial rates of oxygen saturation rose from 86 to 92%. After the second day of inhalation: in the lungs breathing noises were performed better, were stopped moist rales, SaO2increased with 92-93% to 98%, were stopped tachycardia (heart rate of 138 per minute).

Dynamics of clinical symptoms of dysfunction of the respiratory and cardiovascular systems with successive inhalations of salbutamol and budesonide in the surveyed child And. presented in table 7 (see Appendix 7).

As can be seen from table 7, to 3 day inhalation: shortness of breath with 84 min decreased to 66 min, breathing in the lungs was better to be decreased in the number of wheezing (single repetirse in lower divisions) and the retraction compliant seats thorax, initial indicators SaO2increased to 97%, in the analysis of acid-base status of the blood was observed hypoxemia. Heart rate to 3 day inhalation tended to decrease, to the end of the course inhalation tachycardia were stopped. Mucus in the upper respiratory tract was the mean is Ino less.

After the course of inhalation therapy, was marked by a decrease in respiratory rate from 84 to 66 min, were stopped tachycardia (heart rate decreased from 162 to 127 min), increased saturation SaO2from 86% to 97%, decreased depression compliant seats of the chest, improved auscultatory picture in the lungs (he stopped whistling, moist rales, decreased the total number of wheezing in the lungs, improved conducting respiratory noise), in the analysis of acid-base status of blood was stopped respiratory acidosis, pulmonary radiograph pneumonia resolved. Mucus in the upper respiratory tract was not.

During inhalation therapy was also monitored the performance of gas homeostasis of blood, are presented in table 8 (see Appendix 8).

As can be seen from table 8, to 3 day inhalation there was an increase of oxygen pressure from 32.8 to 46.8 mm Hg, and the partial carbon dioxide tension was decreased from 61,8 to 53 mm Hg, i.e. to the 3 rd day inhalation respiratory disorders decreased. By the end of the course showed normalization of gas homeostasis.

Indication for completion of the course inhalation therapy was to improve the auscultatory picture in the lungs, mild tracheobronchitis, bronchoobstructive syndrome, respiratory failure up 1-0 Stephen is. During the course of inhalation no adverse events were noted.

Thus, conducting inhalation nebulizer therapy with salbutamol and budesonide in full-term newborn with pneumonia reduce symptoms of respiratory distress, nausea signs potentiating tracheobronchitis, bronchoobstructive syndrome, contributed to the normalization of gas homeostasis, radiological and clinical resolution of pneumonia.

Annex 1.

Table 1
Improvement in respiratory disorders before and at the end of the first procedure of successive inhalations of salbutamol and budesonide in newborns (n=41)
IndicatorsBefore inhalationInhalation of salbutamolInhalation of pulmicort
at the end of inhalationat the end of inhalation
123 4
Symptoms of respiratory failure
1. Respiratory rate / min (M±m)61,00±1,7051,77±1,51***51,83±1,49***
2. Reducing retraction compliant seats of the chest (number of children)
abs.13337
P1,00,80,9
3. Reducing physical changes in the lungs (number of children)
abs.41
P1,0
a) conductivity improvement of respiratory noise
abs. 333031
P0,80,910,94
b) reducing the number of wheezing
abs.413637
P1,00,880,90
4. The relief of broncho-obstructive syndrome (children)
abs.333333
P0,691,01,0
5.SaO2,% (M±M)96,17±0,27of 97.78±0,20***97,88±0,16***
6. Rho2, mmHg (M±m)57,0±to 6.43not defined90,83±8,5**
1234
7. pCO2, mmHg (M±M)44,50±3,28not defined45,0±3,24
The change from the side of cardiovascular system
8. Heart rate in minutes (M±m)142,2±2,07141,04±2,01140,44±1,99
Note: ** significant changes signs DN (p<0,05); *** - high significance of differences (p<0,01).

Annex 2.

Table 2
The dynamics of the flow pneumonia who received sequential nebulizer inhalation of salbutamol and budesonide in children without inhalation therapy (M±m)
The duration of pathological symptoms (days)Newborns with inhalation (n=41)Newborns without inhalation therapy (n=20)
The duration of dyspnea 9,63±0,98***14,35±1,01***
Duration zapadenia compliant seats of the chest14,86±0,96***20,15±1,26***
The weakening of the auscultatory noise in the lungs4,33±0,465,00±0,85
The duration of moist ralesRS 9.69±0,99*12,63±1,54*
The duration of physical changes in the lungs19,11±0,91**24,63±1,62**
Duration tracheobronchitis16,03±0,99***22,38±1,95***
The duration of pneumonia21,23±1,09***35,53±2,21***
The duration of oxygen support (mechanical ventilation, oxygen tent, oxygen mask)26,66±1,44***34,26±2,05***
The duration of broncho-obstructive syndrome2,82±0,553,50±0,91
X-ray resolution quiescent what I pneumonia (day extubation) 17,60±1,22***25,58±2,44***
Normalization of acid-base status of blood (day extubation)7,33±0,99**11.87 per±1,99**
Note: ** - significant differences observed pathological symptoms (p<0,05); *** - high significance of differences (p<0,02); * trend change indicators.

Annex 3.

Table 3
Improvement in respiratory distress and heart rate during the first inhalation of salbutamol and budesonide in a child,
Indicatorsto inhalationafter the 1st inhalation
salbutamolof budesonide
1234
Respiratory rate, min604848
SaO2, %95 9797
Respirationbad is worse on the leftis good everywhereis everywhere
Rales in the lungswet, dry whistling rightwet less dry whistling nowet less sibilant no
Retraction compliant seats of the chest:
a) sternum+++++
b) jugular fossa++++
C) intercostal spaces+++
Heart rate in minutes154157158
Note: ++ - moderate depression, + - small retraction compliant seats of the chest.

Annex 4.

Table 4
Dynamics of clinical symptoms of dysfunction of the respiratory and cardiovascular systems with successive inhalations of salbutamol and budesonide in the subject child, The
IndicatorsUntil of course inhalationOn day 3 inhalationAt the end of the course inhalation
1. The breathing frequency, in minutes605448
2. SaO2, %959898
3. Indrawing compliant seats of the chest:
a) sternum++++
b) jugular fossa++++
C) intercostal spaces+--
Absoltutely picture in the lungs:
a) respirationbad is worse on the leftperformed well in all the departments of the lungsis good
b) Rales in the lungswet, dry whistlingwet and dry no, wired a littlewired at the height of inspiration
5. The manifestation of tracheobronchitisA large amount of thick mucusMucus is less consistency and less denseMucus virtually no
6. acid-base status of bloodRespiratory acidosisHypoxemiaNormalization of indicators
7. Heart rate in minutes154139118

Annex 5.

Table 5 Changing the parameters of acid-base status of blood (pO2PCPs2) the child, in the dynamics of the nebulizer teppei
Indicators, mm Hguntil of course inhalationon the 3rd day inhalationafter a course of inhalation
pO246,052,051,0
pCO261,054,046,0

Annex 6.

tr>
Table 6
Improvement in respiratory distress and heart rate during the first inhalation of salbutamol and budesonide in the surveyed child And.
Indicatorsto inhalationafter the 1st inhalation
salbutamolof budesonide
1234
Respiratory rate, min6666
SaO2, %869496
Respirationbad is worse on the rightis better rightis better right
Rales in the lungswet, repetirse, dry whistling rightwet less dry whistling nowet less sibilant no
Retraction compliant seats of the chest:
- sternum++++
- jugular fossa+++
- intercostal
gaps+++
Heart rate, min162166167
Note: ++ - moderate depression, + - small retraction compliant seats of the chest.

Annex 7.

Table 7
Dynamics of clinical symptoms of dysfunction of the respiratory and cardiovascular systems with successive inhalations of salbutamol and budesonide in the surveyed child And.
IndicatorsUntil of course inhalationOn day 3 inhalationAt the end of the course inhalation
1. the breathing frequency, in minutes846650
2. SaO2 %8697-9898
3. VTA is giving compliant seats of the chest:
- sternum+++++
- jugular fossa+++
- intercostal spaces++0
4. Auscultatory picture in the lungs:
Respirationbad is worse on the rightperformed well in all the departments of the lungsis good
Rales in the lungswet, traiterous, dry whistlingwet, dry, no, repetirsetraiterous at the height of inspiration
5. The manifestation of tracheobronchitisA large amount of thick mucusMucus is less consistency and less denseMucus is almost the et
6. Acid-base status of bloodRespiratory acidosisHypoxemiaNormalization of indicators
7. Heart rate, in minutes162158127

Annex 8.

Table 8
Changing Rho2, RNO2during inhalation rate the child And.
Indicators, mmHguntil of course inhalationon the 3rd day inhalationafter a course of inhalation
1. Rho2(acid-base status of blood)32,846,851,8
2. RNO2(acid-base status of blood)61,85342,8

A method for the treatment of broncho-obstructive syndrome in newborn infants with pneumonia and tracheobronchitis conducted using a nebulizer inhalation, characterized in that during one session is of galazi use consistently salbutamol at a dose of 0.15 mg/kg and budesonide at a dose of 0.125 mg in terms of subsidies 30-60% oxygen (tent or mask), starting with 2-3 inhalations per day, and with the transition when stabilized on one session inhalation of salbutamol at a dose of 0.15 mg/kg and budesonide at a dose of 0.25-0.3 mg per day with the course of treatment from 3 to 14 days.



 

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FIELD: medicine.

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1 ex, 1 tbl

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25 cl, 28 tbl, 243 ex

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27 cl, 9 dwg

FIELD: medicine.

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Powder inhaler // 2376040

FIELD: medicine.

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1 ex, 1 dwg

FIELD: medicine.

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9 cl, 5 dwg

FIELD: medicine.

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7 cl, 8 dwg

FIELD: medicine.

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1 ex

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FIELD: medicine.

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20 cl, 3 dwg, 1 tbl

FIELD: medicine.

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2 cl, 1 dwg

FIELD: medicine.

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2 ex

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