Вплив комплексного лікування на мікробіоценоз ротової порожнини та на імунологічний статус пацієнтів з переломами щелеп на тлі захворювань тканин пародонта

Abstract

У роботі представлені дані мікробіоценозу ротової порожнини та імунологічного статусу пацієнтів з переломами щелеп на тлі запальних захворювань тканин пародонта у результаті застосування розпрацьованої лікувальної схеми, що містила фармакологічні середники загального, місцевого впливу та фізіотерапевтичні заходи. У результаті проведеного лікування у пацієнтів основної групи вдалося покращити динаміку щільності колонізації мікроорганізмів ротової порожнини та збалансувати імунологічні показники крові у порівнянні з даними у осіб, де для лікування поєднаної патології використовувались традиційні лікувальні заходи; В работе представлены данные микробиоценоза ротовой полости и иммунологического статуса пациентов с переломами челюстей на фоне воспалительных заболеваний тканей пародонта в результате применения разработанной лечебной схемы, которая содержала фармакологические средники общего, местного воздействия и физиотерапевтические мероприятия. В результате проведенного лечения у пациентов основной группы удалось улучшить динамику плотности колонизации микроорганизмов ротовой полости и сбалансировать иммунологические показатели крови в сравнении с данными у лиц, где для лечения сочетанной патологии использовались традиционные лечебные мероприятия; The diagnostics, treatment and rehabilitation was and remains to one of actual tasks of oral and maxillofacial surgery. The patients with injuries of maxillofacial area amount to 25% among all patients of the clinics of maxillofacial profile, the increase of number of severe injuries of the bones of facial skeleton, that in 10-12% of cases combine with the damages of other organs and systems is marked, the level of development of complications remains very high, to 15-25%. The fractures of the jaws are often accompanied by other dental diseases, in particular, by lesions of the periodontal tissues. It is paid attention that this category of patients is overcame not enough by attention of professionals, that needs the improvement of early diagnostic, clinical and prognostic measures and demands further improvement of complex treatment methodologies for patients with fractures of the jaws on the background of diseases of periodontal tissues. Purpose of the study is to evaluate microbiological and immunological status of patients with fractures of the jaws on the background of diseases of periodontal tissues as a result of application of developed treatment scheme. The material and research methods. The reposition of bone fragments was conducted all patients on standard methods. At impossibility of conservative treatment (tooth mobility at generalized periodontitis of II-III degree) was conducted immobilization of the jaws through osteosynthesis. The general treatment and style of life answered the generally accepted standards at the surgical support of patients with fractures of the jaws. Thus, it was additionally appointed patients of the main group photophoresis with the napkins „Koletex−MEX” and the drug „Bivalos”. The efficacy of conducted treatment was evaluated after 7, 14 and 21 days after treatment. The identification of species and density of colonization of microorganisms in the oral cavity of patients and indicators of humoral and cellular links of the immunity in the blood were performed by standard methods. The obtained results were worked out statistically. Results of the research and their discussion. It was found that in 30 days after treatment in patients of the main group significantly decreased the density of microbial colonization of fungi of species Candida in 3,4 times, Actinomycetes in 3.7 times, Porphyromonas gingivalis in 4.6 times, Veillonella in 5.2 times and Peptostreptococcus in 7.4 times, p<0.01. At the same time, in patients of the main group microorganisms of the species Lactobacillus, Bacteroides and Fusobacterium were not identified. At the same time, in patients of the control group, where treatment of fractures of the jaws on the background of inflammatory diseases of periodontal tissues traditional methods were used, the density of colonization was significantly increased: Porphyromonas gingivalis, p<0.01 and Fusobacterium, p<0.05 in 1.2 times and fungi of species Candida in 1.6 times, p<0.01, relative to the data before treatment. At determination of efficiency of applied treatment complex in patients with fractures of the jaws on the background of inflammatory diseases of periodontal tissues on immunological status, were taken into account indicators of the blood serum, which before treatment were significantly different from the values of average norm. In 3 months after treatment in patients with fractures of the jaws on the background of inflammatory diseases of periodontal tissues, the treatment of which was conducted according to our developed methodology, the values of all analyzed immunological indicators answered the data of average norm, p1>0.05. The efficiency of application of our proposed treatment complex is emphasized by the increase of content in the patients of the main group of total protein on 20.09%, p<0.01, albumin on 22.95%, p<0.01, titers of lysozyme in 2.3 times, p<0.01, phagocytic index on 45.20%, p<0.01, phagocytic number on 40.16%, p<0.05, index of completeness of phagocytosis on 23.73%, p<0.05 on the background of the decrease of concentrations of ɣ-globulin on 60,50%, p<0.01, C-reactive protein in 4.0 times, p<0.01 and NK cells CD16+ CD56+ on 73.91%, p<0.01, relative to data of patients in the control group, where for the treatment of fractures of the jaws on the background of inflammatory diseases of periodontal tissues used traditional methodologies. Conclusions. Thus, the efficiency of application of our worked out therapeutic measures proved of positive dynamics of indicators of the density of microbial colonization in patients of the main group after 30 days of observations. In patients with fractures of the jaws on the background of inflammatory diseases of periodontal tissues as a result of application of our proposed treatment complex were able to improve immunological status of the organism, that is confirmed by the improvement of indicators of cellular and humoral immunity compared with the data in patients of the control group, where treatment was conducted according to traditional methods.