The drug of choice for cor pulmonale, with good results in staged treatment

The remission period is mainly for the treatment of the primary disease. Drugs that enhance the body's immunity can be used, such as nucleic acid casein injection (or expired attenuated measles vaccine) subcutaneously or intramuscular injection and (or) nebulized inhalation, 2 to 4 ml each time, twice a week, or nucleic acid casein oral solution 10 ml/vial, 3 times/d, 3 to 6 months as a course of treatment.

1. Treatment during remission

The remission period mainly focuses on the treatment of the primary disease.

The remission period is the key to preventing the development of cor pulmonale. You can use:

① Cold water rubbing, diaphragmatic breathing, and pursed lip exhalation to improve lung ventilation and other cold resistance and rehabilitation exercises.

② Symptomatic treatment such as antitussive, expectorant, antiasthmatic and anti-infection.

③ Drugs to enhance the body's immunity, such as nucleic acid casein injection (or expired attenuated measles vaccine) subcutaneously or intramuscularly injected and/or inhaled by nebulizer, 2-4 ml each time, twice a week, or nucleic acid casein oral solution 10 ml/vial, 3 times/d, 3-6 months as a course of treatment. Subcutaneous injection of tracheitis vaccine, immune RNA, intramuscular injection of placental lipopolysaccharide, ginseng, transfer factor, oral levamisole, etc.

④ Treatment with traditional Chinese medicine. Traditional Chinese medicine believes that the main symptom of this disease is lung qi deficiency, and its main manifestation is lung dysfunction. The treatment should focus on strengthening the body's resistance and improving lung circulation. You can choose from Codonopsis pilosula, Astragalus membranaceus, Adenophora radix, Ophiopogon japonicus, Salvia miltiorrhiza, Safflower, etc. Rehabilitation therapy and home bed work for patients in remission can significantly reduce the onset of acute episodes.

2. Acute Phase Treatment

Respiratory tract infection is a common cause of respiratory failure and heart failure, so it needs to be actively controlled with medication.

Active control of infection is the key to treatment during the acute phase. If there is fever, especially when the cough is accompanied by increased sputum and purulent sputum, antibacterial drugs should be actively administered. Antibiotics should be selected based on sputum culture and drug sensitivity. Before culture results are available, antibiotics should be selected based on the infection environment and sputum smear Gram staining. The selection of antimicrobial drugs should be based on the patient's lung function and common pathogens, combined with the pathogens and drug resistance prevalence in the patient's area, to select sensitive antimicrobial drugs. Refer to the selection of antimicrobial drugs for COPD exacerbation: if Gram-positive coccal infection is considered, high-dose penicillin (4 million units, once every 8 hours) or cefuroxime (2.25 g, twice a day) can be selected for intravenous drip; for Gram-negative bacilli infection, ceftriaxone (2.0 g, once a day) or ceftazidime (1.0-2.0 g, 2-3 times a day) or levofloxacin (0.5 g, once a day) or amikacin (0.4 g, once a day) can be used for intravenous drip [2]. The course of treatment is 5 to 7 days. After 3 days of improvement in clinical symptoms, sequential treatment with oral antibiotics can be used.

Currently, combined medication is advocated. It is advisable to select the drug based on the results of sputum culture and the drug sensitivity test of pathogenic bacteria, but do not be restricted by sputum bacteria drug tests. When the causative bacteria are not clear, penicillin 1.6 million to 6 million u/d can be used by intramuscular injection or gentamicin 120,000 to 240,000 u/d can be used by divided intramuscular injection or intravenous drip. Generally, observation for 2 to 3 days is required. If the effect is not obvious, other types of antibacterial drugs can be considered, such as ampicillin 2 to 6 g/d, carbenicillin 4 to 10 g/d, lincomycin 1.2 to 2.4 g/d, etc. intramuscular or intravenous drip or carbenicillin 2 to 4 g/d, taken orally in divided doses. Cephalothin, cefoperazone, or cefoperazone 2 to 4 g/d, injected intramuscularly in divided doses, or the same amount of ceftriaxone taken orally in divided doses can also be used. But do not change it frequently unnecessarily. For Staphylococcus aureus infection, erythromycin plus chloramphenicol; benzylpenicillin or cephalothin or cefazolin plus kanamycin or gentamicin, etc. can be used. For Pseudomonas aeruginosa infection, carbenicillin, sulfabenzylpenicillin, furobenicillin, oxypiperazine penicillin, ceftazidime or chloramphenicol or gentamicin can be used in combination. In addition to systemic medication, local nebulization inhalation or intratracheal instillation of drugs can also be used. Long-term use of antibiotics should prevent fungal infections. Once fungi have become the main pathogens of lung infection, antibiotics should be adjusted or discontinued and antifungal treatment should be given.