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Угнетение иммунологической системы у обожженных
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Угнетение иммунологической системы у обожженных

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by admin19.04.2015
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Все же следует учесть, что проблема дополнительного угнетения иммунологической системы у обожженных с уже и без того ослабленной сопротивляемостью к инфекции, несомненно, представляет серьезную опасность. Объективным доказательством измененной реакции реципиента в ответ на применение иммунопрессорных веществ, кроме продления выживаемости аллотранеплантатов, может служить уменьшение в этот период количества лейкоцитов. Учитывая опасность развития сепсиса, целесообразность такого метода лечения для удлинения времени выживания гомологичного трансплантата многими авторами оспаривается. В некоторых случаях следует использовать расщепленный сетчатый алло-трансплантат, который создает условия для достаточного дренажа инфицированной раны и благодаря меньшей площади контакта удлиняет время жизнеспособности его.

Учитывая возрастающие потребности в заменителях кожи, широкое распространение за последнее время получило применение расщепленных кожных ксено-трансплантатов. Показания к ксенотрансплантации идентичны с показаниями алло-трансплантации. Ксено-трансплантат способен плотно прилегать к поверхности раны, однако в отличие от алло-транеплантатов не воспринимается тканями человека и не васкуляризируется. При наложении ксено-трансплантатов возникает характерная немедленная интенсивная иммунологическая реакция отторжения.

В настоящее время чаще всего используют свиные ксено-трансплантаты. Сходность свиной кожи с человеческой позволяет считать ее удовлетворительным заменителем кожи человека, хотя некоторые авторы отдают предпочтение коже зародыша теленка. Свиную кожу применяют в свежем виде сразу после взятия ее у животного или после замораживания в камере и сохранения в жидком азоте. Лиофилизированная форма может храниться неограниченное время, она продается в стерильных пакетах в виде одинаковых по ширине и толщине пластов. После закрытия ожоговой раны свиной кожей быстро уменьшается боль. По эффективности в подготовке гранулирующей поверхности раны к ауто-дермопластике на первом месте стоит свежая свиная кожа, за ней следует ее замороженная форма. После 30-минутного оттаивания она практически может быть использована. Лиофилизированная кожа хуже прилипает к ране. Замороженная свиная кожа сохраняется на ране не более 3 дней, тогда как свежая- в течение 4-5 дней и требует соответственно меньшего числа смены покрытия.

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