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Химическая некрэктомия ожогового струпа
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Химическая некрэктомия ожогового струпа

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by admin27.09.2015
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Химическую некрэктомию ожогового струпа применяли на 7-й день после травмы с использованием 40% мази салициловой кислоты. Одномоментно мазь накладывали в количестве, не превышающем 200 г на струп площадью не более 10% поверхности тела. Через 48 ч происходило отторжение струпа по демаркационной линии. При этом вследствие антисептического действия салициловой кислоты резко уменьшалась воспалительная реакция со стороны соединительной ткани. С помощью такой некрэктомий можно было уже на 10-11-й день после ожога производить аутопластическую операцию.

Лечение больных в палатах-изоляторах с инфракрасным излучением сопровождалось резким снижением числа и тяжести инфекционных осложнений ожоговой болезни. Так, количество микробных тел в 1 г ткани, взятой из ожоговой раны больных, лечившихся в палатах с инфракрасным излучением, уменьшалось в течение 7-10 дней с 107 — 10’° до 103. В обычных палатах при лечении традиционным методом с помощью повязок в эти же сроки этот показатель равнялся 106 -107. Грамотрицательная флора в посевах из ран исчезала через 5-8 дней после помещения больного в палату-изолятор. Транзиторная бактериемия была выявлена у 2 из 72 больных первой группы, тогда как в контрольной группе она имела место у 13 из 54 больных с глубокими ожогами. Пневмония у больных, лечившихся в палатах с инфракрасным излучением^ возникала в 5 раз реже, чем у больных, находящихся в обычных палатах.

При измерении температуры тела в подмышечной области у больных с глубокими ожогами контрольной группы гипертермия (до 39°С) определялась у 38 из 54 в течение 52 дней. У 21 больного с поверхностными ожогами той же группы гипертермия (до 38,7°С) была в течение 15 дней. У больных же, лечившихся в палатах с инфракрасным облучением, температура тела до 39°С наблюдалась в течение 9,3 дня у 31 из 45 больных с глубокими ожогами и в течение 4,3 дня у 13 больных из 27 с поверхностными ожогами.

Исследование метаболизма по уровню потребления кислорода показало, что у больных, лечившихся традиционным методом в обычных палатах, основной обмен в среднем составлял 170%, достигая у отдельных лиц 220-230%. Увеличение этого показателя до 200% имело место у больных в первые 3 сут после поступления их в палату-изолятор с инфракрасным облучением. Однако в последующем одновременно со снижением температуры тела с 39-40°С до субфебрильных цифр наблюдалось уменьшение основного обмена до 120-130%.

Градиент между температурой на коже тыльной поверхности I пальца стопы и температурой в ампуле прямой кишки у больных, лечившихся в палатах с инфракрасным излучением, достигал нормальных значений (2-3°С) в течение 3-4 сут при поверхностных ожогах и 9-10 сут при глубоких ожогах, в то время как у больных с глубокими ожогами, лечившихся в обычных палатах с помощью масляно-бальзамических повязок, градиент температур длительное время (в среднем 52 дня) оставался повышенным. Большой градиент температур на фоне лихорадки свидетельствовал о существовании продолжительного энергетического дисбаланса, т. е. чрезмерно высокого уровня энергетических процессов.

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