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Ожоговая септикотоксемия
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Ожоговая септикотоксемия

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by admin02.05.2015
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Ожоговая септик токсемия (III период ожоговой болезни) наблюдается лишь при более или менее обширных и глубоких ожогах, эта стадия присуща обычно больным с ожогами ШБ-IV степени, однако при обширных ожогах ША степени, если происходит значительное нагноение ожоговых ран, могут также наблюдаться явления септик токсемии.

Этиология, патогенез. В начале этого периода (11-12-е сутки и до конца 4-5-й недели) ожоговая септик токсемия обусловлена отторжением -некроза в ране, нагноением. В дальнейшем, после освобождения ожоговых ран от некротического струпа и развития грануляционной ткани, все нарушения связаны со значительными потерями белка через рану и продолжающимся нагноением. Отсюда значительная роль в патогенезе септик токсемии принадлежит микробному фактору.

По миновании периода токсемии в организме постепенно начинают восстанавливаться и приводиться в действие защитные механизмы. Так, на 7-е-9-е сутки в крови появляются специфические гуморальные факторы защиты — ожоговые антитела и повышается фагоцитоз, постепенно отграничиваются и отторгаются некротические ткани, развивается грануляционная ткань, служащая защитным валом для проникновения в кровь бактерий и их токсинов. Своевременно проведенная адекватная терапия, направленная на возможно раннее отторжение некротических масс и закрытие ожоговой раны с помощью аутодермопластики, может прервать развитие ожоговой болезни или уменьшить ее проявления.

В тех случаях, когда такие мероприятия провести не удается, при обширных и глубоких ожогах можно ожидать генерализацию инфекции, переход ее в активную форму с появлением тяжелых осложнений. Этому способствует обширность и глубина поражения, пожилой возраст, невозможность за счет собственных ресурсов кожи дефект кожного покрова.

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