RU2470629C1 - Method for integrated treatment of maxillofacial abscesses and phlegmons in children by ointment with furacilin, lidocaine and dibunol - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: offered invention refers to medicine, namely dentistry, and may be used for treating children suffering maxillofacial abscesses and phlegmons. That is ensured by opening of a suppurative focus, wound bathing and drainage. With underlying conventional antibacterial therapy, an ointment containing furacilin, lidocaine and dibunol as active agents and a styrene maleic anhydride copolymer, Lutrol F-127 and purified water in certain proportions as an ointment base is introduced in the suppurative cavity. Furacilin - 0.2, Lidocaine - 5.0, Dibunol - 5.0, Styrene maleic anhydride copolymer - 2.0, Lutrol F-127 2.0 and Purified water to 100.0.

EFFECT: use of the given invention reducing length of wound cleaning and epithelisation in children due to the use of the ointment in presented proportions.

2 ex

Description

The present invention relates to medicine, namely to maxillofacial surgery for the treatment of abscesses and phlegmon of the maxillofacial region in children.

There is a method of treating abscesses, phlegmon of soft tissues, including opening a purulent foci and draining it, conducting antibacterial therapy, detoxification therapy, and subsequently, for complex treatment, wounds are treated daily with low-frequency ultrasound (0.05% acoustic medium, iodopyron aqueous solution) in the first phase wound healing process, in the second - treatment is supplemented with local irradiation of the wound surface with a defocused beam of a helium-neon laser (power density from 0.1 to 100 mW / cm ² ) (Dubinin Yu.A. Kom complex treatment of purulent wounds. Diss. ... candidate of medical sciences. - 1997. - 119 p.). The disadvantages of the proposed method are the need for expensive equipment, the technical complexity of the implementation and the need for appropriate training of personnel.

A known method of treating abscesses and phlegmon of the maxillofacial region by combining active surgical tactics with therapy with nitric oxide. The developed technique consisted of mini-access surgery: evacuation of pus, after which the purulent cavity was treated with a plasma stream of nitrogen monoxide in different modes, the operation was completed by the application of primary sutures. In the postoperative period, starting from the first day, an abscess cavity (phlegmon) was aerated through the drainage system with a cooled plasma stream of nitrogen monoxide and a plasma stream, in the mode of gentle coagulation, to the postoperative zone. Microbiological examination of the discharge from wounds and drains revealed that in patients of the main group, sterility of the discharge was achieved by 3.5 ± 0.7 days, in patients of the control group by 8.7 ± 1.5 days (p <0.05). Clinical and cytological analysis made it possible to establish the average duration of the first phase of the wound healing process in patients of the main group 2.5 ± 0.2 days, in the control group - 7.9 ± 0.4 days (p <0.05). This technique allowed to reduce the duration of inpatient treatment of patients with phlegmons and soft tissue abscesses of the maxillofacial region (10.6 ± 1.8) to (6.4 ± 1.1) bed-days (by 39.6%), and reduce the morbidity operations and dressings, reduce the cost of dressings. The developed method for treating patients with abscesses and phlegmons of the soft tissues of the maxillofacial region with the use of nitrogen monoxide can significantly accelerate the process of reducing the microbial contamination of the purulent foci, activate the cleaning and healing of wounds, reduce the phase of the wound process, reduce the invasiveness of the operation (mini-access) and dressings , reduce the amount of dressing in comparison with traditional methods of treating abscesses and phlegmon of soft tissues and, ultimately, reduce the average time of a hundred ionarnogo treatment (http://www.ekamedcenter.ru/?page=15&article=107).

A known method of treating abscesses, phlegmon of the maxillofacial region (Soloviev MM, Bolshakov OP Abscesses, phlegmon of the head and neck. M .: MEDpress. - 2001. - 230 C.), including opening the purulent focus and its drainage carrying out antibacterial and detoxification therapy, and in the presence of the hyperergic nature of the acute inflammatory process, the appointment of hypersensitizing agents (antihistamines: diphenhydramine, suprastin, tavegil, etc.; analgesics, antipyretics: antipyrine, amidopyrine, paracetamol, etc.), if any the clinical nature of the acute inflammatory process - the appointment of immunostimulating therapy: autohemotherapy, prodigiosan, etc.

A known method of treating phlegmon of the maxillofacial region, comprising the inclusion in the scheme of traditional treatment of phlegmon of the maxillofacial region of the immunocorrector T-activin by endolymphatic or subcutaneous administration. The use of T-activin by its endolymphatic administration is indicated for immunodeficiency, accompanied by a prolonged course of acute purulent inflammatory process. Subcutaneous administration is indicated in a moderately severe immunodeficiency state in patients with less severe inflammatory processes. The introduction of T-activin is recommended according to the following scheme: subcutaneous - 0.1% solution of T-activin 1 ml 1-2 times a day for 5-7 days; endolymphatic - 1.2-1.6 μg per 1 kg of patient weight; the drug is administered slowly (0.6-1.0 ml per minute) (Drobyshev A.Yu. Comprehensive treatment of patients with phlegmons of the maxillofacial region with the use of T-activin: Author. Diss. ... Ph.D. Medical Sciences. M. - 1996 .-- 21 p.).

A known method of treating abscesses, phlegmon, where as an antibacterial, detoxification and immunotropic drugs use a solution of sodium hypochlorite (HHC), which prior to surgery, tissue is infiltrated on the periphery of the inflammatory infiltrate. After the operation, before applying the secondary sutures, dialysis of the purulent wound is performed. At the same time, general hemocorrection is performed by intravenous administration of extracorporeally oxidized autologous blood for 6 days daily, respectively: 3 ml of HHC + 18 ml of blood; 6 ml of NGH + 15 ml of blood; 9 ml of NGH + 12 ml of blood; 12 ml of NGH + 9 ml of blood; 15 ml of NGH + 6 ml of blood; 18 ml of HHC + 3 ml of blood, and after 2 hours the patient every other day is injected with an additional 0.03% solution of HHC at the rate of 3-4 ml / kg body weight, carrying out intracorporal blood oxidation. The method provides a comprehensive local and general detoxification, immunotropic and reparative effects in the presence of antibiotic resistance, which is expressed in the reduction of treatment time by an average of 6.9 days, as well as cost savings for the treatment of one patient in the amount of 2947 rubles (RF patent No. 2284825, 2006 g.).

It is known to use in the treatment of abscesses and phlegmon drugs used to treat purulent wounds of the maxillofacial region and neck, such as Levosin ointment, used to treat wounds in the first phase of the wound process, containing chloramphenicol - 1 g, sulfadimethoxin - 4 g, methyluracil - 4 g, trimecain - 3 g, polyethylene oxide - up to 100 g (M.D. Mashkovsky, Medicines, Moscow, 1996, Part II, p. 301). Ointment "Levosin" has an antimicrobial, anti-inflammatory and analgesic effect. Known ointment "Levomekol" used to treat purulent wounds, containing chloramphenicol - 0.75 g, methyluracil - 4 g, polyethylene oxide - up to 100 g. Ointment "Levomekol" has antimicrobial and anti-inflammatory effects (M.D. Mashkovsky, Medicines, Moscow, 1996, Part II, p. 301). Known liniment of dibunol 5% and 10%, containing dibunol and sunflower oil, used to treat superficial burns of various origins, degree I-II frostbite (treatment, prevention), ulcers (long-term non-healing, trophic, radiation), wounds (sluggishly granulating, poorly scarring, postoperative, traumatic) (Mashkovsky M.D. Medicines. 4.2. - M .: Medicine, 1993. - p.213-215). For the treatment of abscesses and phlegmon, various sorbents are used, for example regenecur, debrisan; hypertonic solution of sodium chloride: methyluracil ointment (in the proliferation stage), etc. (Mashkovsky MD, Medicines, 1-2 tons, M .: Medicine, 2000. The State Register of Medicines. M., 1998). Oflomelide ointment, which is used to treat infected wounds of various localization and etiology in the first (purulent-necrotic) phase of the wound process, including accompanied by severe pain (infected burns of the II-IV stage, bedsores, trophic ulcers, postoperative and post-traumatic wounds and fistulas, wounds after opening abscesses, phlegmon, after surgical treatment of abscessing boils, carbuncles, hydradenitis, suppurative atheromas, lipomas, etc. .). The ointment contains ofloxacin - 1 g, dioxomethyltetrahydropyrimidine (methyluracil) - 4 g, lidocaine hydrochloride monohydrate (in terms of lidocaine hydrochloride) - 3 g; excipients: methyl parahydroxybenzoate (nipagin or methyl paraben), propyl parahydroxybenzoate (nipazole or propyl paraben), propylene glycol, macrogol-1500 (low molecular weight polyethylene glycol-1500, polyethylene oxide-1500), macrogol-400 (polyethylene glycol-low (polyethylene glycol-low) /www.kurgansintez.ru/catalog/view/264/). However, this tool “Oflomelide” has an antimicrobial, anti-inflammatory, local anesthetic, regenerating effect, has contraindications - children under 18 years of age, and has no antiviral effect.

The problem of treating abscesses and phlegmon of the maxillofacial region remains relevant, despite a wide selection of means and methods of treating purulent wounds.

The closest analogue of the invention is a known method of treating patients with purulent wounds after opening abscesses and phlegmons of the maxillofacial region and neck, which consists in the fact that in addition to traditional conservative therapy, the affected area is treated using an ointment of the following composition, parts : thymol - 1.0; glycerin - 20.0; lanolin - 20.0; petroleum jelly - 60.0; ecdisterone - 0.01-0.001 (RF patent No. 2195195, 2002). The disadvantage of this method is its lack of effectiveness due to the reduced osmotic activity of the ointment composition.

The objective of the invention is to develop a method for the complex treatment of abscesses and phlegmon of the maxillofacial region in children, using an ointment that provides high efficiency, taking into account the age-related characteristics of the child's body, convenient to use, without a side effect, with a prolonging effect.

The technical result is a reduction in the time of cleansing and epithelialization of a wound in children aged 6 to 18 years due to the use of an ointment with a pronounced and prolonged therapeutic effect: improves (cavity drainage conditions), antiviral, antimicrobial, anti-inflammatory, anesthetizing, regenerating.

The specified technical result is achieved by the fact that in the method for the complex treatment of abscesses and phlegmon of the maxillofacial region, including opening the purulent foci, washing and draining the purulent cavity, introducing the ointment into the purulent cavity against the background of standard antibacterial therapy, according to the invention, an ointment containing substances furatsilin, lidocaine and dibunol, and as an ointment base, a copolymer of styrene with maleic anhydride, lutrol F-127 and purified water in the following ratio of components, ma from.%:

Furatsilin 0.2 Lidocaine 5,0 Dibunol 5,0

Malein styrene copolymer

anhydride 2.0 Loutrol F-127 2.0 Purified water Up to 100.0.

The proposed method for the treatment of abscesses and phlegmon of the maxillofacial region in children is as follows. After opening the purulent focus, the wound is washed with a solution of furatsilina prepared in a ratio of 1: 5000 on an isotonic solution of sodium chloride 0.9%, and drained. The wound surface is dried with loose gauze swabs and the ointment is applied ointment in an amount of at least 10 ml directly to the purulent cavity with a thin layer (after which a sterile gauze dressing is applied), or the ointment is applied to the gauze dressing, followed by application to the purulent cavity, or ointment is administered with using a syringe under pressure into the cavity after its preliminary purification from pus, or with swabs soaked in ointment, loosely fill the cavity of purulent wounds after their surgical treatment. Ointment is used daily 2 times a day until the end of the exudation period. This method is convenient and hygienic in use, provides a pronounced prolonged effect of drugs, prevents side effects due to the use of ointment, which creates a high concentration of the drug for a short time, has osmotic activity, improves drainage conditions of the cavity, has a pronounced prolonged therapeutic effect, namely anti-inflammatory antimicrobial, anesthetizing, regenerating antioxidant, antiviral effect, convenient and hygienic in use Menenius with high clinical efficacy.

During the first 3 days, the ointment helps shorten the first phase of the purulent process by 2 ± 0.02 days.

The proposed method was used in the Department of Oral and Maxillofacial Surgery of the Republican Children's Clinical Hospital in 34 children with abscesses and phlegmons of the maxillofacial region, which were divided into 3 groups according to the severity of the clinical course of the purulent-inflammatory process. In the first group of patients with a satisfactory condition, the favorable clinical course of the purulent-inflammatory process of the maxillofacial region, the purulent cavity is cleared for 2-3 days, which is clinically manifested by the termination of exudation from the wound. This allows you to impose early secondary sutures and even initially delayed in 75% of patients. Sutures were removed 4-5 days after their application, patients were discharged 7-8 days, which is almost 1.5-2 times faster than in the control group.

In patients of the second group with moderate severity of the clinical course, the purulent-inflammatory process of the maxillofacial region lasted longer. The purulent cavity was cleaned on the 4th-5th day, which also allowed to apply early secondary sutures on the 4th-5th days. Sutures were removed after 4-5 days, patients were discharged on average 10 ± 0.05 days, which is 2 ± 0.05 days earlier than in the control group.

In the third group of patients with severe clinical course of purulent-inflammatory process with abscesses and phlegmons of the maxillofacial region, exudation from the wound was stopped within 4 to 7 days, the ointment was continued to be applied until the wound epithelization, which occurred, on average, by 12 ± 0 , 15 days, while secondary sutures were not always applied, and patients were discharged 1.5 ± 0.34 days earlier than in the control group. All discharged patients of the main group treated with the proposed method formed a gentle smooth scar. All patients during the procedure felt the anesthetic effect of the ointment, and no unwanted effects were recorded. During treatment with ointment, patients in all groups noted a decrease in pain by 2 ± 0.03 days. In 78% of patients, by the end of 1 day of treatment, more pronounced positive dynamics were observed in comparison with the control group. Monitoring in the treatment of patients was carried out according to clinical signs: exudation from the wound, the severity of edema, hyperthermia, the timing of epithelization; clinical analysis results: general analysis of blood, urine. In three groups, a favorable effect was observed on the course of the wound healing inflammatory process in the tissues of the maxillofacial region: already after the first procedure, rapid relief of inflammatory phenomena, reduction of bleeding, suppuration, disappearance of unpleasant sensations began.

The invention is illustrated by the following examples.

Example 1. Patient V., 12 years old, was hospitalized in the Department of Oral and Maxillofacial Surgery of the Republican Children's Clinical Hospital (RCCH) on 01/08/10, 4 days after the onset of the disease with a diagnosis of phlegmon of the submandibular region. General condition of moderate severity, body temperature 38.2 ° C.

01/08/10 - under general anesthesia, phlegmon autopsy was performed by submandibular access. Received pus in the amount of 5 ml with a fetid odor. Drainage left. 36 teeth were removed in the oral cavity. A course of antibacterial therapy (cefazolin - 2 times a day), desensitizing therapy (diphenhydramine 1% -1.0 at night), ointment dressing with furacilin, lidocaine and dibunol 2 times a day, physiotherapy: UHF No. 5 was carried out. The dynamics of changes in the blood composition was as follows: 01.01.10 - erythrocytes 4.0, hemoglobin 135 g / l, white blood cells 13.0 · 10 ¹² , ESR 35 mm Hg, eosinophils 4, neutrophils segmented 61%, lymphocytes 26%, monocytes 13%.

14.01.10 - erythrocytes 3.7 · 10 ⁹ , hemoglobin 127 g / l, white blood cells 8.0 · 10 ¹² , ESR 33 mm Hg, eosinophils 4, neutrophils stab 2%, neutrophils segmented 43%, lymphocytes 41% , monocytes 10% In the general analysis of urine from 10.01.10 pathological changes, except for a slight decrease in specific gravity to 1020, are not determined. The patient was discharged 24.01.10 in satisfactory condition, with recovery. The wound defect was closed by secondary intention. Bed days 9.

Example 2. Patient K., 5 years old, was hospitalized in the Department of Maxillofacial Surgery of the Republican Children's Clinical Hospital on 02.22.10, 3 days after the onset of the disease, with a diagnosis of an abscess of the submental area. General condition of moderate severity, body temperature 38.5 ° C. Under general anesthesia, an abscess of the submental area was opened. Received pus in the amount of 6 ml. Drainage left. A course of antibacterial therapy (cefazolin 300 mg - 3 times a day), desensitizing therapy (diphenhydramine 1% -0.5 at night), ointment dressing with furatsilin, lidocaine, dibunol daily 2 times a day was carried out.

The dynamics of changes in blood composition was as follows: 02/23/10 - erythrocytes 3.74, hemoglobin 100 g / l, leukocytes 9.2 · 10 ¹² , ESR 35 mm Hg, eosinophils 4, neutrophils segmented 47.5%, lymphocytes 45 %, monocytes 7.5%.

02/25/10 - red blood cells 4.01 · 10 ⁹ , hemoglobin 105 g / l, white blood cells 8.3 · 10 ¹² , ESR 33 mm Hg, eosinophils 4, neutrophils stab 2%, neutrophils segmented 43%, lymphocytes 41% monocytes 10%.

In the general analysis of urine from 02.24.10, pathological changes are not determined.

The patient was discharged 03.03.10 in satisfactory condition, with recovery. The wound defect was closed by secondary intention. Bed days 8.

Thus, the developed tactics for the complex treatment of children with abscesses and phlegmons of the maxillofacial region made it possible to significantly accelerate the purification of the purulent foci, to activate the healing and healing of wounds, to reduce the course of the wound process, the number of dressings and dressings, as well as the duration of inpatient treatment compared to traditional treatment methods.

Claims (1)

A method for the complex treatment of abscesses and phlegmon of the maxillofacial region, including opening the purulent foci, washing and draining the purulent cavity, introducing ointment into the purulent cavity against the background of standard antibacterial therapy, characterized in that the ointment containing furatsilin, lidocaine and dibunol as active substances is used and, as an ointment base, a copolymer of styrene with maleic anhydride, lutrol F-127 and purified water in the following ratio of components, wt.%:
Furatsilin 0.2 Lidocaine 5,0 Dibunol 5,0 Maleic styrene copolymer anhydride 2.0 Loutrol F-127 2.0 Purified water up to 100.0