RU2613081C1 - Method for prediction of abscess in acute tonsillitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology. To predict abscess in acute tonsillitis score index is determined from results of summation of points. Pain in throat at swallowing is assigned with 1 point, infiltration of front and/or rear arche of tonsils – 1 point, edema of peritonsillar fat – 1 point, displacement of the palatal tonsils to the middle line – 1 point, normal value of POH – 0 points, compensation of endogenous intoxication – 1 point, subcompensation of endogenous intoxication – 2 points, decompensation of endogenous intoxication – 4 points. If total score is 4–5 points the probability of abscess is 0–15 %, if total score is 6 points the probability of abscess is 50–60 %, if total score is 8 points the probability of abscess is 80–90 %.

EFFECT: method enables early prediction of abscess in acute tonsillitis without high material costs.

1 cl, 1 tbl, 3 ex

Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used to predict the development of an abscess in acute tonsillitis.

In frequency, the incidence of acute tonsillitis is second only to the incidence of acute respiratory viral infections and influenza and reaches 20-50% of the total morbidity of the population [Grechukhina Yu.A. et al. Features of the immune status and central hemodynamics in patients with tonsillitis depending on the level of cardiac troponin Τ in blood serum // Kazan Medical Journal. - 2003. - No. 2. - S. 89-97].

Conventional diagnostic methods and clinical studies do not always allow predicting the development of complications in acute tonsillitis [Kononova T.V. Clinical and pathogenetic features of the formation and prognosis of paratonsillar abscess in angina: thesis. Cand. honey. Sciences: 14.00.04 - Samara, 2006. - 117 pp.], therefore, the improvement of diagnostic methods and prediction of complications in acute tonsillitis is relevant.

Currently, there are few works on the prediction of complications in acute tonsillitis [Angelovich S.M. Complications of tonsillitis in young adults and some issues of their prediction: Dissert. Cand. honey. sciences. L., 1989 - 144 p.]. Most studies are aimed at improving laboratory diagnosis of tonsillitis [Izvin A.I. Paratonsillar abscesses and their treatment in the conditions of the North of Siberia: Abstract. dis. Cand. honey. sciences. L., 1989 .-- 24 p .; Balabanova P.M. et al. A modern view of diagnostic methods and principles of therapy for Α-streptococcal pharyngeal infection // Consilium medicum. 2004, - T.6.- No. 10.- S. 788-792; Pluzhnikov M.S. et al. Angina and chronic tonsillitis. St. Petersburg, 2003 .-- S. 152; Polyakova T.S. et al. Chronic tonsillitis: diagnosis, treatment, prevention // Russ. honey. journal - 2004.- T. 12. - No. 2. - S. 65-69; Bisno L.A. Acute pharyngitis: etiology and diagnosis // Pediatrics. -1996. N 97. - P. 949-954; Patent RU No. 2188422 C2 of 08/27/2002] and predicting the effectiveness of treatment, mainly based on the results of microbiological studies [Patent RU No. 2377035 C1 of 12/27/2009].

Methods for predicting the development of abscesses in the lungs are described [Patent RU No. 2407010 C1 of 12/20/2010; Patent RU No. 2185100 C1 of 07.20.2002; Patent RU No. 2063039 C1 of 06/27/1996], in the cornea [Patent RU No. 2195663 C1 of 12/27/2002] based on a study of the blood of patients, determining the amount of DNA, the concentration of diene conjugates and the use of ultrasound diagnostics. The above methods do not allow to predict the development of abscesses in acute tonsillitis.

As a prototype, we have chosen a method for scoring the tactics of treating abscesses [Patent RU No. 2408292 C1 of 01/10/2011]. Based on the age of the patients, the previous treatment, its effectiveness, the relapse after surgical treatment of the abscess, and the degree of spread of the purulent process, the authors predict the tactics of treating the patient at the stage of abscess. Based on the proposed methodological approach, we have developed a method for predicting the development of an abscess in acute tonsillitis.

The objective of the present invention is in the early stages of the disease with acute tonsillitis to establish the possibility of developing an abscess in order to choose the tactics of treating patients.

The technical result is simple, not requiring large material costs and is based on a clinical examination of patients and the determination of the reactive response of neutrophils (ΡΟΗ). Depending on the activity of the pathological process, a score index was used to predict the possibility of developing an abscess in patients.

The technical result of our proposed method is achieved on the basis of the following criteria: sore throat when swallowing, infiltration of the anterior and (or) posterior arch of the tonsils, edema of the peritoneal tissue, displacement of the tonsils to the midline, normal ΡΟΗ, показателя, indicating compensation for endogenous infection , indicator ΡΟΗ, indicating subcompensation of the infectious process and indicator ΡΟΗ, indicating decompensation of the infectious process.

ΡΟΗ is determined by the following formula:

where is mts. - myelocytes;

Yu. - young neutrophils,

n. - stab neutrophils,

from. - segmented neutrophils,

lymph - lymphocytes,

b. - basophils,

mon - monocytes,

e. - percentage of eosinophils.

Note:

If stab neutrophils less than 1, then (p. + 1). If eosinophils are less than 1, then (e. + 1).

The normal value of ΡΟΗ is 10.6 ± 2.1.

Indicators ΡΟΗ 15-25 - compensation for endogenous intoxication,

Indicators ΡΟΗ 26-40 - subcompensation of endogenous intoxication,

Indicators ΡΟΗ more than 40 - on decompensation of endogenous intoxication.

The technical result is achieved by the fact that according to the invention, a point index is calculated by summing up the points obtained according to the following criteria: sore throat when swallowing - 1 point, infiltration of the anterior and (or) posterior tonsil arch - 1 point, edema of the peri-aminous tissue - 1 point, palatine tonsil displacement to the midline - 1 point, normal value ΡΟΗ - 0 points, endogenous intoxication compensation - 1 point, endogenous intoxication subcompensation - 2 points, endogenous intoxication decompensation - 4 points, with a total amount of 4-5 points c - the probability of an abscess is 0-15%, with a total of 6 points - the probability of an abscess is 50-60%, with a total of 8 points - the probability of an abscess is 80-90%.

The proposed method is carried out in the following ways.

In patients admitted to the hospital with a diagnosis of acute tonsillitis, a laboratory blood test is performed: a general blood test. The next day, a clinical examination of the patient is carried out and ΡΟΗ is determined. Based on the tests performed, a point index is calculated by summing up the points obtained according to the following criteria: sore throat when swallowing - 1 point, infiltration of the anterior and (or) posterior arch of the tonsils - 1 point, edema of the peri-amindial tissue - 1 point, palatine tonsil displacement to midline - 1 point, normal value ΡΟΗ - 0 points, endogenous intoxication compensation - 1 point, endogenous intoxication subcompensation - 2 points, endogenous intoxication decompensation - 4 points, with a total of 4-5 points - the probability of occurrence Nia abscess is 0-15%, with a total amount of 6 points - the likelihood of abscess is 50-60%, with a total of 8 points - the likelihood of abscess is 80-90%.

Examples of practical use of the proposed method.

Example 1. Patient H. 31 years old, I. b. No. 1699. I was admitted to the reception department of the hospital with complaints of weakness, malaise, sore throat when swallowing more on the right, difficulty swallowing. T-37.8 ° C. From the anamnesis, it is sick 4 days. The onset of the disease is associated with hypothermia.

According to the results of the examination, the diagnosis was made: Follicular tonsillitis (acute tonsillitis).

Analyzes (at the time of receipt). General blood analysis. Er 4.2 x 10 ¹² / l, L 12.9 x 10 ⁹ / l, HB-138 g / l, e-2; b-1; p-1; s-62, l-27; m-7; ESR - 13 mm / h. The definition of ΡΟΗ is carried out. ΡΟΗ = 7.1. Value ΡΟΗ healthy person.

Based on the clinical and laboratory examination, a point index was calculated: sore throat when swallowing - 1 point, infiltration of the anterior and (or) posterior arch of the tonsils - 1 point, edema of the periendicular tissue - 1 point, palatine tonsil shift to the midline - 1 point, normal value ΡΟΗ - 0 points,

The patient's score index is 4. The possibility of developing an abscess is predicted in the range from 0 to 15% of cases of acute tonsillitis.

On the 7th day of illness, the patient was discharged in satisfactory condition. The formation of an abscess is not registered.

Example 2

Patient U. 28 years old. I.b. No. 3240 was admitted with complaints of sore throat when swallowing on the left, weakness, malaise, increase Τ to 38.3 ° С. Sick for 3 days. Diagnosis at admission: Catarrhal tonsillitis (acute tonsillitis).

Analyzes (at the time of receipt). General blood analysis. Er 4.2 x 10 ¹² / l, L 12.9 x 10 ⁹ / l, HB-138 g / l, e-2; b-1; p-5; s-69, l-16; m-6; ESR - 21 mm / h. The definition of ΡΟΗ is carried out. ΡΟΗ = 29.6. Value ΡΟΗ - subcompensation of endogenous intoxication.

Based on the clinical and laboratory examination, a point index was calculated: sore throat when swallowing - 1 point, infiltration of the anterior and (or) posterior arch of the tonsils - 1 point, edema of the periendicular tissue - 1 point, palatine tonsil shift to the midline - 1 point, subcompensation of endogenous intoxication - 2 points.

The patient has a point index of 6. The development of an abscess is predicted in 50-60% of cases of acute tonsillitis.

On the 5th day of the disease, the patient was diagnosed with catarrhal tonsillitis (acute tonsillitis), complicated by a left-sided paratonsillar abscess.

Example 3

Patient H. 36 years old, I. b. No. 1893. I was admitted to the reception department of the hospital with complaints of weakness, malaise, sore throat when swallowing more on the right, difficulty swallowing. T-37.8 ° C. From the anamnesis, it is sick 2 days. The onset of the disease is associated with hypothermia.

According to the results of the examination, the diagnosis was made: Follicular tonsillitis (acute tonsillitis).

Analyzes (at the time of receipt). General blood analysis. Er 4.2 x 10 ¹² / l, L 12.9 x 10 ⁹ / l, HB-138 g / l, e-2; b-1; p-6; s-69, l-16; m-5; ESR - 21 mm / h. The definition of ΡΟΗ is carried out. ΡΟΗ = 54. ΡΟΗ value: decompensation of endogenous intoxication.

Based on the clinical and laboratory examination, a point index was calculated: sore throat when swallowing - 1 point, infiltration of the anterior and (or) posterior arch of the tonsils - 1 point, edema of the periendicular tissue - 1 point, palatine tonsil shift to the midline - 1 point, ΡΟΗ - 4 points.

The patient's score index is 8. The development of an abscess is predicted in 80-90% of cases of acute tonsillitis.

On the 3rd day of illness, the patient was diagnosed with follicular tonsillitis (acute tonsillitis), complicated by a right-sided paratonsillar abscess.

The examples given illustrate the possibility of using this method for predicting infectious complications in acute tonsillitis, namely the occurrence of abscesses.

The proposed method for predicting an abscess in acute tonsillitis will allow you to change the tactics of treating patients who have a high risk of abscesses in acute tonsillitis, which will significantly reduce costs during inpatient treatment of patients.

A method for predicting an abscess in acute tonsillitis was tested on the basis of the infectious ward of GBUZ TO OKB No. 1. Under observation were 26 patients aged 15-58 years. The incidence of abscesses in acute tonsillitis corresponded to the materials presented in this application for invention. With a total number of 4-5 points - the probability of an abscess was in the range from 0 to 15%, with a total of 6 points - the probability of an abscess was 50-60%, and with a total of 8 points - the probability of an abscess was 80-90% .

Based on the forecasting of abscesses in 20 patients and changes in treatment tactics, the costs of treating patients decreased in the amount of 23.0 thousand rubles.

The table shows the economic effect based on the forecasting of abscesses in patients with acute tonsillitis.

The proposed method for predicting an abscess in acute tonsillitis is easily reproducible, does not require large material outlays, in the early stages it allows predicting the possibility of developing abscesses and can be performed in medical institutions.

Claims (1)

A method for predicting an abscess in acute tonsillitis is based on calculating a point index by summing up the scores obtained by the following criteria: sore throat when swallowing - 1 point, infiltration of the anterior and (or) posterior arch of the tonsils - 1 point, swelling of the okolomindalny fiber - 1 point, displacement of the tonsil to the midline - 1 point, the normal value of the neutrophil reactive response (ΡΟΗ) - 0 points, endogenous intoxication compensation - 1 point, endogenous intoxication subcompensation - 2 points, endogenous intoxication decompensation - 4 b lla, when the total number of 4-5 - the likelihood of abscess is 0-15%, with a total amount of 6 points - the likelihood of abscess is 50-60%, with a total of 8 points - the likelihood of abscess is 80-90%.