Вплив цукрового діабету на перебіг гнійно-запальних процесів щелепно-лицевої локалізації

Abstract

У даній статті наведені особливості перебігу гнійно-запальних процесів щелепно-лицевої ділянки у пацієнтів, хворих на цукровий діабет. Наведені основні принципи лікування таких хворих, які сприяють розриву порочного кола (гнійна інфекція - декомпенсація цукрового діабету - прогресування гнійної інфекції). Обґрунтоване комплексне лікування таких хворих, сумісно із лікарями інших спеціальностей; В данной статье приведены особенности течения гнойно-воспалительных процессов челюстно-лицевой области у пациентов с сахарным диабетом. Приведены основные принципы лечения таких пациентов, которые способствуют разрыву порочного круга (гнойная инфекция - декомпенсация сахарного диабета - прогрессирование гнойной инфекции). Обосновано комплексное лечение таких пациентов, совместно с врачами других специальностей; The features of inflammatory processes in maxillofacial area in patients with sugar diabetes are introduced in this article. The basic principles of treatment of these patients contribute to distorting of the vicious circle (purulent infection - decompensation of diabetes - the progression of purulent infection). The comprehensive treatment of these patients, together with doctors of other specialties is grounded. According to the clinic of maxillofacial surgery of “Ukrainian Medical Stomatological Academy” among patients who were hospitalized with diseases of various etiologies to maxillofacial hospital, the incidence of diabetes occurs at 12 % of cases, including 8 % are newly diagnosed. In patients with diabetes there are: traumatic damage to soft tissues and bones of the facial skeleton (51.5 % of cases), phlegmones and abscesses of different topographic anatomical areas (25.5 %), osteomyelitis of the mandible (11.6 %), furuncules and carbuncles maxillofacial area (11.4 %). The clinical course of inflammatory processes of maxillofacial localization in patients with diabetes is more severe than in similar age groups of patients without diabetes, and the incidence of these diseases did not differ significantly. The inflammatory processes have certain features in terms of hyperglycemia, cellular and humoral immunity is destroyed, leading to the rapid spread of pathogens, local signs of inflammation are not always accompanied by systemic signs of infection-inflammation that causes late the patient’s medical care. The main factors of occurrence and progression of inflammatory processes in soft tissues against the background of diabetes are: thrombosis, vascular wall damage, change hemorheological properties of blood, disruption of lipid peroxidation and antioxidant defense. Diabetes causes the atipizm of clinical course of inflammatory process, expressed its frequent generalization. It provides for a two-stage surgical treatment of wounds. The first stage of surgical treatment of wounds is wide radical opening of purulent process, its revision to the disclosure pockets and pus and drainage in the early hours of admission. These actions contribute to breaking of the vicious circle characteristic of inflammatory processes in the background of diabetes. The second stage is radical debridement, which preferably carried out under general anesthesia in terms of compensation for the basic parameters of homeostasis. Well-conducted surgical treatment of wound leads to reduce of acidosis, general intoxication, normalization of metabolic of tissues, creating better conditions for its healing. But not always radical debridement may be done in full, to solve this problem is possible local use of sorbents.