Throbbing pain in left side chest

Throbbing pain on the left side is one of the most common manifestations of tuberculous pleurisy and a health problem that troubles many people. Tuberculous pleurisy is also a particularly serious disease for patients. If it is not treated in time, the condition will tend to worsen, and after worsening, the disease will be more difficult to treat. Below, I will introduce the treatment methods of tuberculous pleurisy in detail.

1. General treatment

If the body temperature is above 38℃, you can rest in bed. Generally, patients can get up and move around appropriately. The total rest time is about the time it takes for the body temperature to return to normal, and it should still last for 2 to 3 months after the pleural effusion disappears.

2. Thoracentesis

Since the protein and fibrin content of the pleural fluid of tuberculous pleurisy is high, it is easy to cause pleural adhesion. Therefore, in principle, the pleural fluid should be drained as soon as possible, 2 to 3 times a week. The first extraction should not exceed 600ml, and each subsequent extraction should be about 1000ml, and the maximum amount should not exceed 1500ml. If too much fluid is withdrawn too quickly, post-expansion pulmonary edema and circulatory failure may occur due to the sudden drop in intrathoracic pressure. If reactions such as dizziness, sweating, pale complexion, weak pulse, cold limbs, and decreased blood pressure occur, stop withdrawing fluid immediately, inject epinephrine subcutaneously, and inject dexamethasone intravenously at the same time, and keep the intravenous infusion catheter in place until the symptoms disappear. If pulmonary edema occurs after lung re-expansion, appropriate rescue should be carried out. Pleural evacuation has the following effects:

(1) Alleviate poisoning symptoms and accelerate fever reduction.

(2) Relieve pressure on the lungs and heart vessels, and improve respiratory and circulatory functions.

(3) Prevent pleural adhesion and hypertrophy caused by fibrin deposition. Some scholars currently advocate that early large-volume fluid extraction or chest tube drainage can reduce complications such as pleural thickening and pleural adhesions.

3. Anti-tuberculosis drug treatment

Generally, streptomycin (SM), isoniazid (INH) and rifampicin (RFP) or a combination of streptomycin (SM), isoniazid (INH) and ethambutol (EMB) is used for treatment. Streptomycin (SM) was injected intramuscularly, and isoniazid (INH), rifampicin, and ethambutol were taken orally at one time. The above oral medications were taken continuously for 9 to 12 months. During the treatment process, attention must be paid to the side effects of anti-tuberculosis drugs, such as changes in hearing, vision, and liver function. When these occur, the dosage should be reduced or the drug should be discontinued according to the situation.

Routine use of glucocorticoids is not recommended for tuberculous pleurisy because of their many side effects. When there is a large amount of pleural effusion, unsatisfactory absorption or severe symptoms of tuberculosis poisoning, prednisone can be used and the dosage can be reduced weekly until the pleural effusion is significantly reduced or the symptoms of poisoning are alleviated. Reducing the dosage too quickly or taking the drug for too short a time can easily lead to rebound of pleural effusion or toxic symptoms. Intrathoracic injection of antituberculosis drugs or corticosteroids has no definite value. The concentration of anti-tuberculosis drugs in the pleural fluid is sufficient, and there is no significant difference in the absorption of pleural fluid and prevention of pleural thickening by intrapleural injection of drugs compared with those who do not take drugs.