Registration Number
0219U004531,
0114U005305
, R & D reports
Title
Determination of clinic features, diagnosis, treatment and medical rehabilitation in patients with bronchopulmonary diseases
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Head
Pertseva Tetyana,
Registration Date
03-09-2019
Organization
State organization "Dnepropetrovsk medikal akademy of Ministry Health Ukraine"
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Object of research: chronic obstructive pulmonary disease (COPD), bronchial asthma (BA), community-acquired pneumoonia (CAP). The purpose of the research: to optimize the methods of diagnosis and medical rehabilitation in patients with COPD, BA, CAP. Methods of research: questionnaire, clinical, instrumental, functional, laboratory, microbiological, statistical. Theoretical and practical results. Conducting patients with COPD, BA and pneumonia is recognized to be as one of the most difficult tasks of practical health care, as well as one of the most important medical and social problems of the present. Determination of the intrinsic status of patients with COPD contributes to improving the prediction of the course and treatment of this disease. The results of our study proved the possibility of using FEV6 as an alternative (in comparison with FVC), provided that it complicates the performance of a full-scale pneumothachometry maneuver. For the screening of signs of depression in patients with COPD, it is informative to use two questionnaires PHQ-9 and BDI-SF to identify a group of patients requiring additional counseling by a psychiatrist. Hemostasiological disorders develop in more than half of patients with COPD, while CRP is the optimal prognostic indicator for the formation of coagulation disorders in COPD patients: the level of the index above 4.62 mg / L is associated with disturbances of hemostasis in the direction of hypercoagulation. Patients with severe CAP have very high risk of thrombotic complications, both according to the RAM scale and coagulogram and D-dimer levels. This indicates the need to assess the risk of thrombotic formation (using special scales, determination of blood coagulation indexes) and timely correction of the revealed violations, taking into account their dynamic changes. According to clinical analysis, pneumonia in patients during oncohemotherapy is severe in 78,0% of patients, and the severity of the course is due to the bilateral inflammatory process and the development of complications in the form of pleurisy, abscesses and/or respiratory insufficiency. The most frequent indications for hospitalization in pregnant women with CAP is decreasing of oxygen saturation due to the physiological increase in oxygen demand by 10-20% during pregnancy. In this case, adequate oxygen therapy is the most successful measure to correct the state of pregnant women with severe CAP. The prognostic model developed by us allows for clinically-anamnestic and laboratory parameters obtained during the course of the onset of the disease, as well as according to the spirographic study 3 months after recovery, to predict the presence of fibrotic disorders on the X-ray after 6 months and 12 months after clinical recovery with an accuracy of 90.9% (95% CI: 84.9-96.9%). Addition to a standard treatment program for patients with infectious surfactant therapy reduces the destruction of their own protective broncho-alveolar protective mechanisms, which is confirmed by the determination of serum SP-D level. The peculiarities of asthma in the patients of industrially polluted regions, which is the Dnipropetrovsk region, is a frequent combination of this disease with allergic rhinitis, which significantly impairs the degree of asthma control and needs to strengthen basic therapy. Scientific novelty. The features of anthropometric indices and comorbid states in patients with COPD are determined. A proven and clinically proven prospect of using FEV6 as an alternative indicator for assessing lung ventilation function. For the first time the possibility of prediction of vascular-platelet and coagulation disorders in patients with COPD has been proven. For the first time, the existence of a complex relationship between the expressiveness of both clinical and functional manifestations of COPD with expressiveness of symptoms of depression and increased anxiety was determined, for the first time the most informative psychodiagnostic questionnaire techniques for use in patients with COPD were first defined. The group of risk of formation of thrombotic complications among patients with CAP was revealed. The features of the clinical course of hospitalized pneumonia in oncohematologic patients are outlined. In pregnant women with a history of infectious diseases, a low informative level of leukocyte determination is indicated to establish the presence and severity of the reaction of systemic inflammation. The effectiveness of using PCT and CRP levels determination to establish and assess the severity of systemic inflammatory response in pregnant women with CAP, as well as an additional criterion for evaluating the response to antibiotic therapy, has been confirmed. The possibility of assessing the severity of the state of pregnant patients with CAP by considering the term of pregnancy, levels of oxygen saturation and PCT is proved. For the first time, the criteria for predicting the formation of pulmonary fibrosis after a severe CAP were determined, the algorithm of the application of the prognostic model was developed taking into account the establishment of the most informative demographic, anamnestic, clinical, functional, physical indicators and indicators of the levels of systemic markers, and the sensitivity, specificity and accuracy of the proposed model were determined. The possibility and correction of the sweetening system of the lungs after correction of CAP has been substantiated and clinically proven. The possibility of control over the course of asthma were pathogenically grounded and proved. Evidence of long-term anti-inflammatory therapy was proved. The practical significance of the results obtained their implementation into practice. The results of the questionnaires, clinical, laboratory, instrumental, functional, microbiological, laboratory methods of research substantiate the expediency of their use in the evaluation of the characteristics of the course of COPD, asthma and pneumonia, and also used in the development of individual schemes of medical rehabilitation of patients. The methods of diagnostics, prophylaxis and treatment of patients with COPD, asthma and pneumonia are grounded, developed and improved. Practical meaning. In the institutions of practical health care of the country, it is advisable to use the prognostic model proposed by us. It is advisable to apply the determination of the level of procalcitonin and surfactant protein D during differential diagnostics in patients with bronchopulmonary diseases. Effectiveness of implementation: shortening the stay of patients with CAP and COPD into the phase of severe infectious exacerbation in the hospital by 15%, increasing the effectiveness of diagnosis and treatment of patients with CAP, BA, COPD. Sphere of use: pulmonological, therapeutic departments.
Product Description
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Авраменко Ірина Вікторівна
Бєлослудцева Ксенія Олегівна
Бабець Аліна Анатоліївна
Богацька Катерина Євгенівна
Борисова Інна Станіславівна
Ботвінікова Лариса Аркадіївна
Гашинова Катерина Юріївна
Губа Юлія Василівна
Кірєєва Тетяна Володимирівна
Коваль Дар'я Сергіївна
Конопкіна Людмила Іванівна
Кравченко Наталія Костянтинівна
Крихтіна Марія Андріївна
Мироненко Олена Валеріївна
Фесенко Олександр Володимирович
Штепа Ольга Олександрівна
Яковлєва Вікторія Генадіївна
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2020-04-02
