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INTRODUCTION

Theme urgency

Last years in case rate and mortality structure the tendency to augmentation of a specific gravity of chronic diseases of lungs from which the cores are chronic obstructive illness of lungs (HOBL) and a bronchial asthma (BA) becomes perceptible.

Exacerbations of these diseases cause long disability and demand the big expenses for treatment (Mapel D., et al., 2004). Now HOBL is the fourth reason smertnoyosti in the world and as it is predicted, the next decades will be nabljuyodatsja augmentation ss prevalence and a mortality from it (Murray C.J.L., Lopez A.D., 1996). In industrially developed countries the quantity of patients BA makes to 5 % of the population (McFaddcn E.R, Draunwald E et al., 2001). In RosYOsii BA suffer about 7 million persons at what about 1 million from them have the serious form of disease (Chuchalin A.G., 1997, 2000). In St.-Petersburg level of case rate HOBL and BA at adults raises. So zabolevaeyomost HOBL with 1999 for 2003 it was enlarged in 1,85 times and has made 0,152%о. Case rate BA with 1991 for 2003 was enlarged in 3,5 times and has made 0,59%о. In 2003 in structure of invalids by illnesses of organs of breath patients BA made 64,9 % of cases. The share of invalids with diagnosis HOBL made 29,4 % of cases (Ilkovich M. M, Ignatyev V. A, Shkljarevich N.A., 2005).

The inflammation plays a dominating role and pathogenesis HOBL and BA (GOLD 2004, GINA 2004), however it seriously differs. Efficiency gljukokortikostsroidnoj therapy at patients BA does not cause doubts. As to HOBL that according to GOLD (2004) it is possible to expect, that protiyovovospalitelnoe treatment GKS by preparations renders the clinical effect consisting in monitoring of symptoms, the prevention an exacerbation and retardation to progress HOBL. Results masshtabyonyh mnogotsentrovyh controllable researches (Copenhagen City Lung are published

Study, EUROSCOP, ISOLDE, Lung Health Study II) in which was ustanovyoleno, that long application IGKS of hormones is accompanied umensheyoniem numbers serious and srednetjazhelyh exacerbations HOBL, improvement kliyonicheskih symptoms of disease and quality of a life of patients HOBL. However the question on efficiency GKS of preparations and according to their appointment as patient HOBL definitively is not solved. Their influence on izmeyonenie indicators of external breath, diffuzionnuju ability of lungs, microcirculation in a small circle of a circulation is not established. Disputable remain voyoprosy about differentiated appointment GKS of preparations at various severity levels HOBL. There are no works and scientifically-proved rekoyomendatsii on application GKS of preparations for patients with sochetannoj patoloyogiej HOBL and BA.

Discrepancy of data of the literature testifies to an urgency of studying and an efficiency estimation gljukokortikostsroidyh preparations in leyochenii patients HOBL and HOBL in a combination with BA.

The purpose research: an efficiency estimation gljukokortnkostsrondnoj therapies and se communications with way of introduction of preparations at lungs sick of chronic obstructive illness and patients HOBL in a combination with BA.

Problems research

1. To estimate changes of activity of inflammatory process in bronchuses at patients HOBL and patients HOBL in a combination with BA at various ways of introduction gljukokortikostsroidnyh hormones.

2. To study dynamics of high-speed indicators of function of external breath and change diffuzionnoj abilities of lungs at patients HOBL and patsienyotov HOBL in a combination with BA against gljukokortikosteroidnoj therapies.

3. To define dynamics of indicators of gas structure of blood at patients HOBL and patients HOBL in a combination with BA against gljukokortikosteroidyonoj therapies.

4. To study changes of perfusion in lungs at patients HOBL and patients HOBL in a combination with L against gljukokortikosteroidnoj therapies.

5. To estimate change of clinical symptoms and quality of a life at bolyonyh HOBL and patients HOBL in a combination with BA against gljukokortikosteyoroidnoj therapies.

Scientific novelty of work

1. It is proved, that at moderately severe HOBL etapnoe application GKS of preparations (in a hospital intravenously driply, and then use inyogaljatsionnyh GKS) throughout six months leads to augmentation ОФВ1, a partial strain of oxygen in blood.

2. At serious current HOBL long therapy IGKS not spoyosobstvuet to improvement of the listed indicators, but, that is very important, does not lead to their deterioration.

3. For the first time efficiency etapnogo treatments by glucocorticoids taking into account gravity HOBL is proved.

The practical importance of work

1. And HOBL in a combination with BA srednetjazhelogo and a serious current in an exacerbation phase it is expedient to patient HOBL to include in the standard scheme of treatment therapy intravenous gljukokortikosteroidnymi hormones, poyoskolku they promote reduction of clinical implications and snizheyoniju to activity of an inflammation.

2. srednetjazhelogo currents it is expedient to patient HOBL to include in the standard scheme of treatment long therapy inhalation gljukoyokortikosteroidnymi preparations as it promotes reduction of expression of a local inflammation, to improvement of high-speed indicators FVD, diffuzionnoj abilities of lungs, to augmentation partial naprjayozhenija oxygen, to depression of number of exacerbations of disease and improvement of indicators of quality of a life.

3. Patient HOBL in a combination with BA srednetjazhelogo currents are necessary for including in the standard scheme of treatment long inhalation gljuko-kortikostsroidnuju therapy as it promotes reduction vyrayozhennosti a local inflammation, to improvement of high-speed indicators FVD, diffuzionnoj abilities of lungs, urezheniju exacerbations of disease and to improvement of indicators of quality of a life.

4. Patients HOBL and HOBL in a combination with BA a serious current accept including in the standard scheme of treatment long inhalation gljuko-kortikosteroidnoj to therapy as its appointment is accompanied umenyosheniem quantities of exacerbations, by improvement of indicators of quality of a life and conservation of level of high-speed indicators FVD.

The positions which are taken out on protection

1. Application of various ways of introduction gljukokortikosteroidov at bolyonyh HOBL srednetjazhelogo and a serious current promotes reduction of expression of a local inflammation that is important for prevention povrezhyodenija tissues of bronchuses.

2. Long application inhalation gljukokortikosteroidov uveliyochivaet high-speed indicators of function of external breath at patients HOBL and HOBL in a combination with BA.

3. Against long application inhalation gljukokortnkostero-idiyh preparations level of a partial strain of oxygen in blood at patients HOBL and HOBL in a combination with BA at the expense of reduction akyotivnosti inflammations raises.

4. According to modified (MRC Dyspnea Scale) scales of symptoms of patients HOBL (Paggiaro) at patients with HOBL after a course of intravenous introduction gljukokortikosteroidnyh hormones decrease clinical implications of disease: degree of expression of a dyspnea, tussis, a sputum becomes usual colour that testifies about clinical effektivnoyosti system gljukokortikosteroidov at patients HOBL and HOBL in sochetayonii with BA.

5. According to the questionnaire of hospital of Sacred George at patients with HOBL and HOBL in a combination with BL in six months of treatment inhalation gljukokortikosteroidnymi hormones quality of a life on such indicators as authentically raises: expression of symptoms of disease, ogyoranichenie activity, influence of illness and the general indicator.

Realisation and work approbation

Work materials have been presented on scientifically-practical konfeyorentsijah: VI, VIII Bulatovsky readings (2001, 2003), on 2nd mezhregionalyonoj scientifically-practical conference with the international participation: the St.-Petersburg scientific readings (2002).

On dissertation materials 5 printing works are published.

Results of research are introduced in practical work of clinic of hospital therapy Sankt-Peterburgskoju state meditsinskoyogo university of akad. I.P.Pavlova.

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Scientific source Yefimova Olga Aleksandrovna. ESTIMATION of EFFICIENCY of TREATMENT GLJUKOKORTIKOSTEROIDNYMI PREPARATIONS of LUNGS SICK of CHRONIC OBSTRUCTIVE ILLNESS. The DISSERTATION on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 2007. 2007

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