Annotation. A well-chosen tactic for the prevention and treatment of infectious complications in patients with purulent-inflammatory processes of the mediastinum is important in reducing the colonization of the biotope by pathogens, contributes to the reduction of inflammation and accelerates recovery. The aim of our work was to conduct a comparative study of the antimicrobial efficacy of antiseptic drugs (decasan, myramistinum, chlorhexidine, povidone iodine and polyhexamethylene guanidine) on 278 clinical strains of microorganisms (S. aureus, E. coli, K. pneumoniae, Enterobacter spp.), which cause purulent-inflammatory complications of the mediastinum in patients. For the comparative characterization of the antimicrobial action, the method of double dilutions was used; calculated antiseptic activity index (AAI); a quantitative suspension test was performed to evaluate the decontamination effect of antiseptics. Standard methods of descriptive statistics and special and office programs “STATISTICA 6.0”, “Microsoft Excel 2010” were used. Staphylococci showed the highest level of sensitivity to most of the antiseptics under study. The mean MBSC values of S. aureus clinical strains for decasan, myramistinum, chlorhexidine was respectively 1.75±1.27 µg/ml, 3.25±2.27 µg/ml, and 5.53±3.74 µg/ml. The AAI of myramistinum and chlorhexidine before the Pseudomonas was 4.5, which is the threshold for clinical activity. The clinical activity of a solution of povidone iodine against infections caused by P. aeruginosa is doubtful, based on the activity level of 2.6. The studied antiseptics provided a full decontamination effect against most strains at 5 min exposure, the decontamination effect lasted for 15 min, followed by 30 min. There were found single microorganisms, the number of which gradually increased and after 1 hour reached 1.9×104 and 1.5×102 CFU/ml, respectively. The high sensitivity of gram-positive and gram-negative pathogens to decasan and polyhexamethylene guanidine hydrochloride substantiates their high antimicrobial effectiveness and opens wide prospects for their use in the prevention and treatment of infectious complications in modern conditions.
Recently, a tracheostomy was considered the method of choice for provide ventilating of patients with deep neck phlegmons, but current trends recognize that tracheal intubation with bronchoscope is the most rational way of adequate breathing security in such patients. Objective - to investigate the peculiarities of features of adequate intu bating security in patients with odontogenic and tonsilogenic neck phlegmons. 70 patients with deep neck phlegmons of odontogenic 4(7 (67%)) and tonsilogenic origin - (23 (33%)) have been investigated. 47 (67%) suffered from descending mediastinitis. Tracheal intubation was performed using orotracheal laryngoscope, bronchoscope or through tracheostomy. 33 (47.1%) patients underwent orotra cheal intubation with a bronchoscope, 34 (48.6%) with a laryngoscope, and only in three cases (4.3%) tracheostomy was used. Bronchoscopic intubation was performed in 57.4% of patients with odontogenic phlegmons, and only in 26.1% cases of oropharyngeal spaces suppuration. The percentage of tracheostomies was the same in two groups of patients and showed 4.3%. Mortality rate was 12.9%. Thus, 57.4% of patients with odontogenic neck phlegmons need for bronchoscopic tracheal intubation, a tracheostomy is used extremely rarely (4.3%). Intubation with laryngoscope is possible in 70% of patients with tonsilogenic suppuration. Comparison of tracheal intubation in patients with deep neck phlegmons with and without descending mediastinitis is prospects for further research.
Проблема адекватного лікування гострого нагноєння клітковини шиї є однією з найбільш складних у хірургії. Актуальність даного питання обумовлена швидким розвитком таких ускладнень, як медіастиніт, сепсис, арозивні кровотечі, тромбоз шийних вен та ін. [1, 2]. Швидкому розвитку запального процесу на шиї сприяють її анатомічні особливості-наявність великої кількості фасцій, міжфасціальних просторів, рухливість органів шиї, присмоктуюча дія середостіння [3]. Серед причин виникнення флегмон цієї ділянки на перший план виходить орофарингеальна інфекція [4-6]. W. Yang et al. (2015) вивчили 130 хворих із глибокими шийними нагноєннями (deep neck infection), поміж яких фаринго-і тонзилогенні інфекції становили 24,4 %
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