Comprehensive treatment of patients with community-acquired pneumonia

The objective of the study: to use of laser Doppler flowmetry for the diagnosis of microcirculatory blood flow disorders in patients with community-acquired pneumonia and determine the possibility of nitric oxide in its regulation.

Subjects and methods. 146 patients with community-acquired pneumonia aged from 21 to 72 years were examined and comprehensively treated. Group 1 included 49 patients who along with standard chemotherapy had therapeutic bronchoscopy and intrabronchial regional lymphatic administration of antibiotics; Group 2 included 82 patients who received complex treatment - standard antimicrobial therapy, therapeutic bronchoscopy, intrabronchial lympharegional administration of antibiotics, and additional NO-therapy; Group 3 consisted of 15 patients in whom only standard antimicrobial therapy and therapeutic bronchoscopy were used. 15 patients from each group had endobronchial laser Doppler flowmetry; LAKK-0, the laser analyzer of capillary blood flow was used for this purpose. The microhemocirculation index (MI) was recorded, then its mean-square deviation (MSD) and variation coefficient were calculated. Blood flow fluctuations were determined and the microcirculation efficiency index (MEI) was calculated.

Results. All tested microcirculation parameters in patients with pneumonia were lower compared with healthy individuals. It was found out that on the 7th day from treatment start only in patients from Group 2, who received NO-therapy within comprehensive treatment, there was a significant increase in PM to 57.4 ± 1.6 pf. units, MSD - up to 8.4 ± 1.2 pf. units, MEI was 0.9 ± 0.02 s.u. By the 14th day of treatment in Group 2, microhemocirculation indices returned to normal, while in other groups there was only a positive trend. This was reflected in the time required of treatment of pneumonia, the best results (14 days on average) were in the group using NO-therapy as a part of comprehensive treatment.

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