P.N. Volotov, N.N. Volotov, A.V. Gulin

Topical problem. Nowadays special attention all over the world is paid to the quality improvement and simultaneous reduction of costs while treating patients. To change treatment expenses without providing the criteria for therapy improvement does not appear to be rational. The concept of «demonstrative medicine» is based on the ability to choose a therapeutic method taking into ac-count a number of factors including treatment costs. The use of air-plasma streams is conditioned by the ability of exogenous NO to normalise microcirculation, to have an antibacterial effect and to weaken inflammation; to activate phagocytic and cosecreting functions of macrophages. The possibility of directing NO containing gas streams through aspirating needles and drainage tubes makes it possible that NO-therapy can be intro-duced in treatment schemes of acute bacteriemic sinusitis. Purpose: to study clinical and economic efficiency of air-plasma streams application in the treat-ment of patients with acute maxillar sinusitis. Materials and methods. The results of treating 46 patients (men of 18-22 years old) with acute maxillar sinusitis are evaluated. In 64,3 % of cases process was unilateral, in 35,7 % of cases it was bilateral. The patients of the control group (n = 14) received traditional treatment: antibacterial therapy with the account for microflora sensitivity; desensitizing therapy; vasoconstrictive nasal drops; puncture, maxillar sinusitis drainage and its lavage twice a day with sterile Sodium chloridum isotonic solution; physiotherapeutic treatment. The patients of the main group (n = 17) along with received traditional therapy had maxillar si-nusitis after lavage through drainage processed with air-plasma streams, generated by "PLAZON" apparatus in NO-therapy regimen. It was done 5 times, with the duration of 15-20 seconds each time (or before any unpleasant sensations occurred). In the third group (n = 15) the platsebo-effect was studied. The treatment of the patients was car-ried out according to the same principles, as in Group 1, i. e. applied daily drainage of sinus cavity with processed air stream for 5 days during 15-20 seconds (or before any unpleasant sensations occurred). Clinical inspection of all the patients included otorhinolaryngological survey (estimated pain dy-namics in the projection of the affected sinus, recover time for natural anastomoses passability, rhinedema termination, nasal breath restoration and maxillar sinusis sanation). Treatment expenses were evaluated according to the treatment standards for Military Hospital MМD No 1273. Results. Painful sensations with the patients of the main group have disappeared in 2,6 days on average, 1,1 days earlier than in the control group and the platsebo-group (р < 0,05). During the same period of time natural anastomoses possibility was restored. Average terms of maxillar sinusis sanation from mucus in the main group made 4,1 days, in the control group - 6,2 days, in the platsebo-group - 6,1 days (р < 0,05). The edema of nasal cavity mucosa with these patients disappered, on average, within 6,3 days (against 9,5 days and 9,4 days in the first and the third groups respectively, р < 0,05). Nasal breath restoration with the patients of the second group ap-peared, on average, within 6,9 days (in the first group within 9,8 days and in the third group within 9,4 days, р < 0,05). Antibiotic treatment has not exceeded 5-6 days (8-10 days in the control group and the platsebo-group). Average treatment duration in the control group made 10,8 days, with the patients of the main group - 7,3 days, with the patients of the platsebo-group - 11,0 days (р < 0,05). No side-effects were noted with air-plasma streams application. In the main group there was no case of diminished NO-therapy medical effect. At the same time with 3 patients of the control group showing clinical signs of recover and preparing to leave the hospital mucopurulent content in the sinus was found again during control puncture. In the platsebo-group there were 4 patients with such problems. Treatment time was extended and with 2 patients of the control group and at 1 patient of the platsebo-group it was necessary to resort to maxillar sinusis surgical intervention. Total treatment costs of one patient in the control group made 7466,4 rbl., in the main group - 5425,9 rbl., in the platsebo-group - 7583 rbl. Positive economic effect of air-plasma streams ap-plication in the treatment of acute maxillar sinusitis made 2040,5 rbl. (27,3 %, р < 0,05). The total treatment cost of one patient in the platsebo-group has slightly exceeded the figure noted in the control group - by 116,6 rbl. (2 %). Conclusion. Air-plasma streams application of in complex therapy of acute maxillar sinusitis leads to the improvement of quality and the efficiency in treatment, it also reduces its time and costs.