Method for early postoperative treatment of chronic rhinosinusitis

FIELD: medicine.

SUBSTANCE: invention represents a method for early postoperative treatment of chronic rhinosinusitis involves a pre-anemisation of a nasal mucosa with an adrenalin solution, a decrustation involves by the fact that the decrustation is followed by administering the preparation 'Argogel' 1.0 ml 2 times a day for 10 minutes throughout 2 weeks.

EFFECT: reducing the length of treatment by fast elimination of the clinical manifestations of the inflammation, as well as maintaining a stable remission, expanding the range of drugs applicable in otorhinolaryngology.

4 dwg, 2 ex

 

The invention relates to medicine, namely to otorhinolaryngology, and can be used for the treatment of patients with chronic rhinosinusitis in the early postoperative period.

The known method of complex treatment of chronic sinusitis, including the rehabilitation of the maxillary sinuses with a solution of furatsillin them by pre-catheterization through artificially imposed fistula with subsequent introduction into the cavities of 0.5% solution of digidrokvercetina and led phototherapy (see patent No. 2308992, IPC7A61N 5/06, A61K 38/56, publ. 27.10.2007).

The disadvantages of analog is the need to use additional expensive equipment led light therapy to achieve the desired result.

The closest in technical essence and the achieved result is a method of treatment of patients with chronic rhinosinusitis in the early postoperative period, including a preliminary anemizatsii mucosa of the nasal cavity with a solution of adrenaline, removal of crusts (see Shcheglov, A. N. Endoscopic surgery of maxillary sinuses through minimal access. The dissertation on competition of a scientific degree of candidate of medical Sciences, Moscow, 2011).

The disadvantages of this method is the preservation of the clinical manifestations of inflammation is detachable from the cavity h�sa, the presence of the wound surface in a month, and three months later cytological examination of the mucosa of the nasal cavity indicates an inflammatory process.

The objective of the proposed technical solution is the reduction of terms of treatment due to the rapid elimination of clinical manifestations of inflammation, preservation of stable remission, expanding the range of drugs used in otolaryngology.

The solution of a technical problem is achieved in that in the method of treating chronic rhinosinusitis in the early postoperative period, including a preliminary anemizatsii mucosa of the nasal cavity with a solution of adrenaline, removal of crusts, according to the invention in the nasal cavity after removal of the crusts administered drug "Argogel" by 1.0 ml 2 times daily for 1 0 minutes for 2 weeks.

This method will allow to reduce terms of treatment due to the rapid elimination of clinical manifestations of inflammation and also to maintain a stable remission, to expand the range of medicinal drugs used in otolaryngology.

The invention is illustrated by photographs of cytological examination of smears of fingerprints by the mucous membrane of the nasal cavity, where Fig.1 shows a completely polymorphonuclear leukocytes isolated cellular elements slabomineralizovannaja on day 2 after removal of the swab�in, Fig.2 - a significant number of neutrophils, cellular elements without atypia and slabomineralizovannaja 2 week postoperative treatment, Fig.3 - isolated polymorphonuclear leukocytes intact cells - a month after the operation, Fig.4 - clean background after 3 months.

Argogel represents a highly dispersive (cluster) silver in the hydrophilic matrix of the gel of polyethylene oxide. The gel forms on the surface of the wound air - and moisture-permeable coating, provides prolonged action of nanosilver, absorbs exudate, i.e. has a drying effect. The drug has a broad spectrum antimicrobial action against gram-positive and gram-negative, aerobic and anaerobic, spore-forming and asporogenous bacteria in the form of monocultures and microbial associations, including antibiotikoustoichivosti of hospital strains. Argogel exhibits a high virucidal and fungicidal activity, has a pronounced anti-inflammatory action, stimulates reparative processes.

A method of treating chronic rhinosinusitis in the early postoperative period was carried out as follows.

Patients have a toilet of the nasal cavity - anemizatsii with adrenaline and removing crusts - and the subsequent introduction of the common nasal passage of the drug "Argogel�" according to the following scheme: 1.0 ml in each half of the nasal cavity for 10 minutes 2 times a day. The course of treatment was 2 weeks.

The method was tested on 50 patients with chronic rhinosinusitis in history at the age from 25 to 70 years, undergoing two days ago, bilateral endoscopic hyporthyroidism or bilateral radical surgery on the maxillary sinus and bilateral polipotomy nose with a partial opening of the cells of the ethmoid labyrinth. The assessment of the dynamics of clinical manifestations of the disease was performed for 10 days in a month and 3 months after surgery. Account of subjective symptoms on a 10-point scale: function of nasal breathing, the amount of discharge from the nasal cavity, the olfactory function. The course of wound healing was evaluated visually with daily rhinoscopy - hyperemia, edema of the mucosa of the nasal cavity, the number and nature of the discharge from the nasal cavity; and cytological examination of smears-prints from the mucous membrane of the nasal cavity. Smears were taken with a cotton tempfrom soaked in sterile isotonic, in the area of the middle turbinate. Rotational movements without pressure was applied brush strokes in a grease-free glass slides, then dried, fixed and stained by Romanovsky-Giemsa. Microscopy was carried out under immersion with increasing (CA. 7, vol. 90). It was found that the amount of discharge within 2 weeks noticeable�about decreased nasal breathing recover quickly, which was confirmed by cytological examination of smears of fingerprints by the mucous membrane of the nasal cavity (see Fig. 1, 2, 3, 4).

Example 1: a Patient was admitted to the surgical Department of the clinical hospital 3 22.08.11 with a diagnosis of Bilateral chronic polypoid maxillary sinusitis, ethmoiditis. The objective at the time of admission: the mucosa of the nasal cavity pink, wet nose passages are rendered polypoid of education emanating from the cells of the ethmoid labyrinth and from under the middle turbinate. Other ENT-organs without pathology. 23.08.11 produced bilateral endoscopic haymore, ethmoidectomy. The following day produced the removal of tampons. With 25.08.11 the patient was carried out the toilet of the nasal cavity - anemizatsii with adrenaline and removing crusts - and the subsequent introduction of the common nasal passage of the drug "Argogel" according to the following scheme: 1.0 ml in each half of the nasal cavity for 10 minutes 2 times a day. The course of treatment was 14 days.

From the fifth day of treatment the amount of discharge from the nasal cavity decreased significantly and by the end of the second week stopped. The first signs of epithelialization erosive surface appeared with 7 days of starting treatment. Complete epithelialization of the wound surface was observed after 2 weeks of treatment. Long-term results - at 1, 3, 6 months showed persistent remission, i.e. �otsutstvie selections and complete epithelization of the wound surface.

Example 2: Patient V. was admitted to the surgical Department CB # 3 15.11.11 with a diagnosis of Bilateral chronic polypoid maxillary sinusitis, ethmoiditis. The objective at the time of admission: the mucosa of the nasal cavity pink, wet nose passages are rendered polypoid of education emanating from the cells of the ethmoid labyrinth and from under the middle turbinate. Other ENT-organs without pathology. 16.11.11 produced bilateral endoscopic haymore, ethmoidectomy. The following day produced the removal of tampons. With 25.08.11 the patient was carried out the toilet of the nasal cavity - anemizatsii with adrenaline and removing crusts - and the subsequent introduction of the common nasal passage of the drug "Argogel" according to the following scheme: 1.0 ml in each half of the nasal cavity for 10 minutes 2 times a day. The course of treatment was 14 days.

From the fifth day of treatment the amount of discharge from the nasal cavity decreased significantly and by the end of the second week stopped. The first signs of epithelialization erosive surface appeared with 10 days of starting treatment. Complete epithelialization of the wound surface was observed after 2.5 weeks of treatment. Long-term results - at 1, 3, 6 months showed persistent remission, i.e. the absence of discharge and complete epithelization of the wound surface.

Using the proposed method of treatment of chronic sinusitis in the early posleoperatsi�nom period will allow for comparison with the prototype to reduce treatment time due to the rapid elimination of clinical manifestations of inflammation, and also keep stable remission, to expand the range of medicinal drugs used in otolaryngology.

A method of treating chronic rhinosinusitis in the early postoperative period, including a preliminary anemizatsii mucosa of the nasal cavity with a solution of adrenaline, removal of crusts, characterized in that in the nasal cavity after removal of the crusts administered drug "Argogel" by 1.0 ml 2 times a day for 10 minutes for 2 weeks.



 

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