Pleurisy: treatment

Pleurisy - inflammation of the pleura sheets with the formation of fibrin on their surface (dry, fibrinous pleurisy) or accumulation in the pleural region of exudate of various types (exudative pleurisy).

Treatment of patients with pleurisy includes the following measures.

[1], [2], [3], [4], [5], [6], [7], [8],

Etiologic treatment of pleurisy

Treatment of the underlying disease, exposure to the cause of the disease often leads to the elimination or reduction of symptoms of pleurisy. Distinguish the following etiological forms of pleurisy:

1. pleurisy of infectious etiology. They are caused by bacterial pathogens (pneumococcus, staphylococcus, streptococcus, gram-negative flora, etc.), viruses, rickettsia, mycoplasma, fungi, protozoa (amebiasis), parasites (echinococcosis), tuberculosis, syphilis, brucellosis, typhoid. The most common infectious pleurisy are observed at a pneumonia of a various etiology and a tuberculosis, but can meet and in isolation, being caused by the above-named infectious agents;
2. pleurisy of non-infectious etiology. Caused by the following reasons:
   1. tumors (40% of all pleurisy), it can be a primary pleural tumor of mesothelioma; tumor metastasis in the pleura; lymphogranulomatosis; lymphosarcoma and other tumors; Meigs' syndrome (pleurisy and ascites in ovarian cancer);
   2. systemic connective tissue diseases (systemic lupus erythematosus, dermatomyositis, scleroderma, rheumatoid arthritis); rheumatism; systemic vasculitis;
   3. trauma and surgery;
   4. thromboembolism of the pulmonary artery, pulmonary infarction;
   5. Other causes: pancreatitis ("enzymatic" pleurisy), leukemia; hemorrhagic diathesis; postinfarction syndrome; Periodic disease, chronic renal failure, etc.

Practically the most frequent causes of pleurisy are pneumonia, tuberculosis, malignant tumors, systemic connective tissue diseases.

If pleurisy has a tuberculous etiology, specific antituberculous therapy is performed; with pneumonia, appropriate antibiotic therapy is performed; if systemic diseases of connective tissue are diagnosed, treatment with immunosuppressants (glucocorticoids and cytostatics) is performed.

If it is not possible to establish the etiology of exudative pleurisy, it is regarded as an independent disease and prescribe antibacterial therapy, as in acute pneumonia.

[9], [10], [11], [12], [13]

Use of anti-inflammatory and desensitizing agents

Anti-inflammatory drugs contribute to the fastest relief of pleurisy, have an analgesic effect. Assign non-steroidal anti-inflammatory drugs (acetylsalicylic acid - 1 g 3-4 times a day, voltaren or indomethacin - 0.025 g 3 times a day, etc.).

As desensitizing agents, 10% calcium chloride solution is used, 1 tablespoon 3 times a day, and other preparations.

In dry pleurisy and severe painful cough, antitussive agents (dionine, codeine 0.01 g 2-3 times a day, etc.) are prescribed.

Evacuation of exudate

Evacuation of exudate with the help of pleural puncture pursues two goals: prevention of development of empyema and elimination of functional disorders associated with compression of vital organs.

Pleural fluid should be evacuated with large exudates causing shortness of breath, heart displacement or if the dull border reaches the front to the 2nd rib. It is necessary to remove at the same time not more than 1.5 liters of liquid in order to avoid collapse. According to the above indications, pleural puncture is performed even in the early period of exudative pleurisy.

In other cases, pleural puncture with the removal of exudate is best carried out in the phase of stabilization or even resorption, since early evacuation of the effusion leads to an increase in negative pressure in the pleural cavity, which contributes to the accumulation of exudate. In exudative pleurisy of nonspecific infectious etiology after exudate removal, it is advisable to inject antibacterial agents into the pleural cavity.

With the development of acute pleural empyema removal of purulent exudate is necessary, followed by the introduction of antibiotics into the cavity of the pleura.

Chronic empyema is treated by the operative route.

[14], [15], [16], [17], [18]

Increase in the general reactivity of the body and immunomodulatory therapy

These measures are performed with a prolonged course of fibrinous pleurisy similar to the one recommended for the treatment of prolonged pneumonia and chronic bronchitis.

Detoxification and correction of protein metabolism disorders

These measures are performed in exudative pleurisy and empyema of the pleura. With the detoxification purpose intravenous drip infusions of hemodeza, Ringer's solution, 5% glucose solution are prescribed.

To correct the protein deficiency, 150 ml of 10% albumin solution is administered once every 2-3 days 3-4 times, 200-400 ml of native and fresh frozen plasma 1 time 2-3 days 2-3 times, intramuscularly 1 ml of retabolil 1 once every 2 weeks, 2-3 injections.

[19], [20], [21], [22]

Physiotherapy, exercise therapy, massage with pleurisy

In the early stage of fibrinous pleurisy, half-alcohol warming compresses, electrophoresis with calcium chloride are recommended. With exudative pleurisy, physiotherapy is carried out in the resolution phase (resorption of exudate) with the aim of prompt disappearance of exudate, reduction of pleural adhesions. Electrophoresis with calcium chloride, heparin, decimeter waves ("Volna-2" device), paraffin therapy are recommended.

After the abatement of acute phenomena, manual and vibrating chest massage is shown.

After treatment in the hospital, patients can be sent to sanatorium-resort treatment at local suburban sanatoriums and resorts of the Southern coast of Crimea.