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CHAPTER 5. DISCUSSION OF RESULTS OF RESEARCH AND CONCLUSIONS

Our research has taped presence of the constant tendency to growth of quantity of the hospitalised patients with pyoinflammatory processes of maxillofacial area for the seven-year period (2005-2012) in the basic group of a megacity and control group of a large city on 85 % and 22 % accordingly.

Among variety of the studied nosological forms, in both groups of research the majority of patients suffered abscesses and phlegmons of a dontogenous parentage: 50,1 % from all contingent in Moscow and 47 % - in Smolensk.

Data of the carried out research on polovozrastnomu have shown to structure, that in the basic group and comparison group dontogenous is purulent - with inflammatory diseases of maxillofacial area men - 54 and 56 % accordingly at the age from 20 till 35 years (48,2 %), that is most socially active representatives of the population is more often are ill.

In Moscow phlegmons of several spaces-54,5 of % of patients of a hospital (Smolensk-34,2 of %) prevailed. These pathological processes arose in the left half of person as at inhabitants of a megacity, and a large city (55 % and 57 % of patients accordingly) is more often.

In a megacity the most widespread localisation of inflammatory process of one kletchatochnogo spaces is the cheljustno-LINGUAL chamfer (20,5%случаев), in a large city - phlegmons podnizhnecheljustnogo spaces (25 %). At third investigated «the causal tooth» taps the second molar tooth, in 15 % of cases by a source of an inflammation according to case histories is noted two teeth, in 5 % of observations three and more teeth. The analysis of the given clinical surveys and case histories testifies to presence of complications at 73,5 % of patients of Moscow and 55,5 % of Smolensk.

At revealing of dependence of frequency of complications from localisation of inflammatory process of one kletchatochnogo spaces are in most cases taped patients with phlegmons of the peripharyngeal
Spaces (frequency of complications of 85 %), in the least quantity - patients with an inflammation of infraorbital area (2 %); in comparison group, on the contrary, the in the lead place is taken away to phlegmons of infraorbital area (frequency of complications of 75,4 %), minimum - to an inflammation of sublingual space and the firm sky. Accompanying diseases are taped at 47 % of patients with a pathology of one kletchatochnogo spaces. Sick (38 %) are diagnosed for the majority of illness of system of a circulation. The combination of several accompanying diseases is noted at 16 % of a contingent and registered in process of rising of age of patients (for example, 18 years this indicator aged is more younger met at 0,8 % of a contingent, in 40 years - at 6 %).

polovozrastnoj structure of patients with abscesses and phlegmons cheljustnoyolitsevoj areas within two and more anatomic spaces are comparable to data on a pathology of one kletchatochnogo spaces where men till 40 years were ill twice more often, than women (71 % of a contingent). «The causal teeth» at patients of a megacity in 50 % of cases notes the third molar tooths and at 28 % - the second molar tooths. In a large city in 27 % of cases the reason of phlegmons taps the first and third molar tooths and in 20 % - the second molar tooths.

In 1/3 cases in Moscow patients with mouth floor phlegmons are taped.

The analysis of complications depending on a locating of widespread pyoinflammatory process has taped: the in the lead place is taken away to phlegmons buccal, temporal, infratemporal areas, krylonebnoj fossas and orbits (24,0 %), the least number of complications met at patients phlegmons of buccal and infraorbital areas (1,5 %).

In Smolensk there was a phlegmon diagnosis podnizhnecheljustnogo and is pterygoid-maxillary space (18 % of cases) more often. More often complications are noted at patients with mouth floor phlegmons, forward - a lateral surface of a neck on the one hand (19,0 %), are more rare at
Patients with an inflammation podnizhnecheljustnogo and is pterygoid-maxillary spaces (0,5 %).

At research of patients of the basic group with abscesses and phlegmons of several kletchatochnyh spaces of 68 % of a contingent had accompanying diseases, that on 21 % more than at patients with an inflammation in the field of one kletchatochnogo spaces. Patients with diseases of system of a circulation have made 35 %, level of infectious diseases has increased to 26 %.

The estimation of the social status has allowed to tap the following: 33,6 % of the questioned patients of Moscow (on 25,1 % less, than in Smolensk) are married or have married appeared. Data on level of the got education by patients of investigated group testify to prevalence of patients with higher education in to Moscow over Smolensk on 11 %, indicators of the average vocational education had the return tendency (on 6 % more in a large city, than in a megacity). It is established, that on the first place in a megacity there were employees (31,4 %), on the second workers (24,2 %). In a large city of workers was practically twice more than serving (43,4 % and 20,3 % accordingly).

In a megacity larger, than in a large city on 20,8 % quantity of patients GVZ CHLO, tested influence for an organism of professional harmfulnesses. As for the basic group of research it is characteristic: not normirovannyj the working day (60,2 %) that affected a material prosperity (level of the income four - five minimum wage rates in a month at 27,5 % of inhabitants of Moscow and 13,8 % of Smolensk). The low socially-demographic status of families and municipal disorder is not a prevailing risk factor.

In the basic group persons with an unhealthy way of life - smokers (76,6 %), taking alcohol more than once in a week (24,6 %) prevail. Estimating data about the relation to own health it is necessary to notice, that 58 % of the patients registered in Moscow, not
Have a constant medical card in an out-patient department while in Smolensk in similar position there are 4 % of a contingent. 26,4 % of patients of a hospital in a megacity could not specify the reason not timely visiting of the doctor-stomatologist, 27,5 % have addressed to the stomatologist already at the developed inflammatory process where relatives have insisted on hospitalisation. The principal cause (46,5 %) not regular visiting of the stomatologist taps pavor before treatment and employment (15,7 %). The obtained data testify, that the strongest influence on formation of unsatisfactory indicators of health at patients with dontogenous abscesses and phlegmons renders low level of medical activity and motivation to preventive maintenance of stomatologic diseases. Results of researches confirm necessity of intensifying of attention to sanitary-educational work (the popular scientific literature, video and audioproduction of medical character), allowing to change character of medical behaviour, having aimed socially active patients of a megacity to the careful relation to the health (fig. 46) and careful performance of references of medical workers.

The analysis of system of rendering of specialised medical aid has shown, that the greatest quantity profile sick (60,4 %) are hospitalised by brigades of the first help, 81 % of the questioned workers of brigades SMP seldom or never faced an investigated pathology, hence, are not assured of the put diagnosis and correctness of the chosen algorithm of actions. Addressing to services SMP patients pass a stage of polyclinic treatment (14 % of patients were treated earlier in an out-patient department) that affects a disease current: 48 % of patients, are delivered for 3-4 day, 36,5 % of patients - for 5 day (61 % are taped extended on two and more kletchatochnyh spaces inflammatory processes).

Fig. 47 System of interdisciplinary interaction of rendering of the medical stomatologic help.

Statistical data testify, that 36,2 % of the hospitalised patients are referred from out-patient departments: 87,2 % of patients - from the state out-patient departments, 12,8 % - from commercial.

From the analysis of case histories it is visible, that 5,5 % of a contingent are referred to the first days of disease from out-patient departments of the state submission, from commercial clinics - 1,7 %. For the second day - 29,4 % and 10,5 % of patients
Accordingly. For the third day a percentage parity the following: 14,8 % and 22 % of respondents. For the fourth and fifth day from the disease beginning the state out-patient departments have referred 22 % of a contingent, 47 % commercial. Therapeutic stomatologic treatment is noted in 24 % of cases, surgical treatment was registered at 47 % of patients, at 69 % of patients there is begun a course of antibacterial therapy.

On the channel "samotek" 3,4 % with a maxillofacial pathology (in the first day of disease 7,2 % of patients, 35 % of a contingent - for the second day of disease have addressed, 27 %-s' third) are hospitalised. 78 % of patients from the given group addressed earlier in an out-patient department and have received the advisory or surgical help.

The stationary stage in a megacity is characterised by high level of diagnostic and medical possibilities: the quantity of diagnostic inspections (consultations of experts, laboratory-tool techniques) for the seven-year period has increased in 1,5 times that has led to depression of defects of diagnostics and sorting of patients from 11 % to 4 %. Hospitalization included a surgical method at 100 % of patients (opening of abscesses and phlegmons-100 of %, excision of a teeth-72 of %, a curettage-48 of %, a sequestectomy-4 of %, applying of secondary seams-55 of % etc.). In all cases complex medicamental therapy (antibacterial, antiinflammatory, a vitamin therapy was applied,

antiagregantnaja therapy etc.), local treatment, regenerative treatment and the laboratory-tool control of a condition of patients. The stationary stage passed during the period with 9±2 day to 19±6 depending on gravity a disease current. On our data the invalidism of patients is noted in 0,2 % of cases (physical inability 2nd and 3rd groups). Percent of repeated hospitalisation for the seven-year period-0,09%yo0,03 (fig. 47).

Results of clinical survey have shown, that 78 % of patients leaving a hospital require throughout stomatologic treatment at an out-patient stage-therapeutic, surgical sanation
Oral cavities, rational prosthetics. Work of an office of aftertreatment of stomatologic patients GKB №1 of N.I.Pirogova (local treatment of wounds-100 of % of a contingent, applying of the secondary delayed seams-15 of %, excising of cicatrixes-12 of %, surgical sanation of a cavity of a mouth-38 of % etc.) has affected depression of terms of a temporary invalidity on 12-15 %.

In research it is taped, that a posthospital out-patient stage absence of actions for intensifying of motivation of patients to rising of medical literacy, and as absence of quality assurance of expedient treatment after dispensary and routine inspections. Not full volume of rehabilitational stomatologic actions (there is no system therapeutic, surgical and orthopedic aftertreatment with the control over a treatment end result) at 78 % of a contingent of an office of aftertreatment and 85 % of patients of out-patient departments there is a probability of the further development of various dontogenous diseases.

Fig. 48 Sections of medical aftertreatment of patients with dontogenous pyoinflammatory diseases of maxillofacial area

Conclusions:

1. On the basis of an archival material and own observations of research with 2005 for 2012 it is established, that in structure gnojnoyovospalitelnyh processes of maxillofacial area in a megacity and a large city a prevailing nosology were dontogenous abscesses and phlegmons-58,2yo9,4 of % and 54,6±6,7 % accordingly.

2. According to mediko-social research it is established, that patients with pyoinflammatory processes of maxillofacial area were men (62 %) aged 30,5±0,6 years with an average special both higher education and level podushevogo the income above a living wage (72,4 % of patients with podushevym the income three and more minimum wage rates).

3. According to clinicoradiological research it is established, that in connection with prevalence in a megacity of diffuse forms of pyoinflammatory processes of maxillofacial area within two and more kletchatochnyh spaces at 73,5 % of patients basic disease complications are taped. Dependence to honey by localisation, gravity gnojnoyovospalitelnogo process, presence of accompanying diseases and terms of a temporary invalidity and a disease outcome is noted.

4. It is established, that at a pre-hospital stage patients in a megacity prefer to use medical services of the first help (60,4 %), are characterised by low level of trust to not state medical institutions of an out-patient link (12,2 %) and the late reference behind medical aid (29,4 % of patients address for 2nd day of disease from the state out-patient departments, 25,5 % for 4th day from private). There is no basic difference between tactics of rendering of the medical specialised help in a hospital of a megacity and a large city. At a posthospital stage low level of activity of medical institutions and the lowered medical is taped
Motivation at patients of investigated group (from 15 to 28 % of patients have passed complex stomatologic aftertreatment).

5. Work of an office of aftertreatment of stomatologic patients in a megacity has allowed to achieve reduction of stay of patients in a hospital (average duration of stay on a bed of patients with GVZ CHLO has decreased on 16,7 % from 2005 for 2012), depressions of terms of a temporary invalidity and reduction of frequency of complications (depression of terms of a temporary invalidity on 12-15 %, percent of repeated hospitalisation 0,09%±0,03).

6. The developed system of interdisciplinary interaction of out-patient and stationary service of rendering of medical aid to patients with pyoinflammatory diseases of maxillofacial area allows to standardise medical aid rendering at all stages that will allow to raise medical and social motivation of patients of investigated group and to improve preventive maintenance of stomatologic diseases.

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Scientific source GONCHAROVA ALEXANDRA VLADIMIROVNA. AFTERTREATMENT of PATIENTS With PYOINFLAMMATORY DISEASES of MAXILLOFACIAL AREA In the conditions of the MEGACITY. The dissertation on competition of a scientific degree of the candidate of medical sciences. Moscow - 2014. 2014

Other medical related information CHAPTER 5. DISCUSSION OF RESULTS OF RESEARCH AND CONCLUSIONS:

  1. the Table of contents
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  10. the MAINTENANCE
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  14. INTRODUCTION
  15. Conformity of the dissertation to the passport of a scientific speciality