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304CURRENT ASPECTS IN THE TREATMENT OF BURN
WOUNDS
Salakhiddinov K.Z.1, Alekseyev AA.2, Kilichev M.R.3,
Niyazova ZA.4
1Salakhiddinov Kamoliddin Zuhriddinovich - MD, Docent, DEPARTMENT OF FACULTY AND HOSPITAL SURGERY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN; Alekseev Andrey Anatolevich - MD, Professor, DEPARTMENT OF WOUNDS, WOUND INFECTIONS AND
THERMAL LESIONS, RUSSIAN MEDICAL ACADEMY OF CONTINUOUS PROFESSIONAL EDUCATION, MOSCOW; Kilichev Mahmud Raufjanovich - Assistant, OF DEPARTMENT OF FACULTY AND HOSPITAL SURGERY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN; 4Niyazova Zebiniso Anvarovna - Doctoral Candidate, DEPARTMENT OF OPHTHALMOLOGY, TASHKENT PEDIATRIC MEDICAL INSTITUTE, TASHKENT, REPUBLIC OF UZBEKISTAN
Abstract: in the complex treatment of burn wounds, regional lymphatic antibiotic therapy was used. The technique of Regional lymphatic antibiotic therapy was carried out once a day for 5-6 days. A comparative analysis of patients using RLAT and treatment in the traditional way. It was revealed that RLAT significantly affects the course and outcome of the inflammatory process in the wound, bacterial contamination, and reduces the frequency of complications. As a result of the use of RLAT, a decrease in edema, perefocal inflammation is noted, the time for restoration of the skin is reduced.
Keywords: burns, regional lymphatic antibioticotherapy.
All burns, especially broad ones, are accompanied by inflammatory processes, expressed by external lymphorrhea (plasmorrhea), in which the vital elements of proteins, electrolytes sharply decrease [2.4]. It should not be forgotten
about the often accompanying wound process of burn infection [1, 3, 5, 7, 8].
In the genome of post-burn plasma loss, the main role belongs to the local disruption of the integrity of vessels and capillaries, increase of their permeability [2, 4]. Inter-intestitial space leading to vascular compression increases, which exacerbates the disruption of lymphocirculation and blood flow, contributing to stagnation and thrombus formation.
In microcirculation disorders leading to massive blood stagnation in the vessels, there is a local compensatory increase in lymphoproduction. During this period, the lymphatic channel may be one of the main drainage links of the interstitial.
The lymphatic system is not only a derivative of the venous system, but also provides a high degree of communication of the inter-intestitial with other sections of the blood channel [2, 4, 6].
An important circumstance of the lymphatic system is the factor of accumulation of damaged cells, microorganisms and toxins with subsequent neutralization and removal of them naturally.
Washing or so-called capture takes place by lymphatic capillaries, not by blood microvulls, because the wall of the first, without having a histological structure by the basal membrane, is able to procure microbial bodies and other particulate particles having a large molecular weight through it. This provides the ability of lymphatic capillaries to expand due to the mechanism called "anchor" or "stropol." After such a device, lymphatic capillaries in inflammation and tissue hyperhydration are always in working condition, thus do not decline to drain intestitium, which is advantageously different from blood capillaries, which can be compressed by inflammatory infiltration up to the complete closure of the lumen and their disconnection from blood flow.
The method of regional lymphatic antibithiotherapy (RLAT) was used in complex treatment as prevention of complications of burns associated with wound process.
Objective: improve methods of prevention of wound complications in treatment of burn wounds by application of regional lymphatic therapy.
Materials and methods.
We studied 58 patients with burns of III A century, various localization. Of these, 28 are patients with the basis of the group, which included regional lymphatic antibiotic therapy in the complex of therapeutic measures. 30 patients made up the control group who received traditional treatment. All studied patients were mainly with burns of the upper or lower extremities.
A clinical evaluation of the treatment results was carried out on the basis of visual monitoring of the course of the wound process, the amount and nature of the discharge, the timing of the reduction of edema, the timing of epithelization from the start of treatment, bacteriological and cytological studies, and suppuration of the wound. Changes in the main clinical and laboratory parameters (general blood and urine analysis, biochemical blood analysis) were studied in patients in dynamics.
The RLAT technique was as follows:
The skin is pierced with a thin needle and 5,000 units of Heparin solution are injected into the subcutaneous tissue in the interdigital space in 3.0 ml. 0.25% Novocaine (the needle is not removed), through the same needle, a solution of Furosemide 40 mg is injected. 3.0 ml. 0.25% Novocaine, then a single dose of the antibiotic is administered as indicated, in our case we used Gentamicin at a dose of 80 mg, after which the needle is removed. Manipulation is performed once a day, for 5-6 days.
Research Results:
Comparing the clinical and laboratory data of the compared groups, we received the following: against the background of complex treatment of RLAT in 17 (60,7%) patients, by the beginning of the 2nd day, a significant and sometimes complete decrease in edema and perefocal inflammation was noted, in the control group these indicators appeared at a later date for 3-4 days.
A decrease in the level of microbial contamination of burn wounds during complex treatment was noted from 103.6 to 101.2 CFU per 1 cm2 of the wound surface. Microbial contamination of burn wounds on the background of traditional treatment decreased from 105.5 to 103.4 CFU per 1 cm2 of the wound surface.
The cytological pattern before treatment in all patients of the main and control groups was as follows: inflammatory (75%) and inflammatory-regenerative (25%) types of cytograms dominated. Against the background of treatment on day 5 in control, the type of cytogram in 20 patients changed to regenerative-inflammatory, remaining inflammatory-regenerative in 6 (21.4%) and inflammatory in 4 (14.2%) patients. In the comparison group against the background of RLAT, the inflammatory-regenerative type of cytogram is observed in 2 (7,1%) patients, in 8 (26,6%) -regenerative-inflammatory and in 17 (60%) regenerative-inflammatory with an autoimmune component.
Complications in the form of suppuration of wounds were noted in 4 (13,3%) cases of the control group and 2 (7,1%) in the main group.
Thus, regional lymphatic antibiotic therapy in complex treatment of burn victims aimed at prevention and treatment of burn wound complications significantly affects the course and outcome of the inflammatory process in the wound, bacterial contamination, reduces the frequency of complications. As a result of the use of RLAT, there is a decrease in edema, inflammation, Reduction of the time of skin restoration. In addition, RLAT is: possibility of more targeted introduction of medicines to the lesion focus (achievement of high concentration of antibiotics), ease and possibility of application at all stages of treatment, economic efficiency.
References
1. Alekseev A.A., Krutikov M.G., Yakovlev V.P. Burn infection // Etiology, pathogenesis, diagnosis, prevention and treatment. Publishing house "University Book", Moscow, 2010. 413 p.
2. Borodin Yu.I., Sapin M.R., Etingen L.E. et al. // General anatomy of the lymphatic system. Novosibirsk.: Sib.otd.1990 science. 243 p.
3. Samartsev V.A., Yencheva Y.A. et al. Features of infection of burn wounds. // Surgery News. Tom 22. № 2, 2014. P. 199-202.
4. Jumabayev S.U., Hakimov V.A., Jumabayev E.S., Saidlyaeva D.G. et al. // Reference Book Clinical lymphology. Ibn Sino, 1999. 325 pp.
5. Klyachkin L.M., Pinchuk V.M. // Burn Disease. Prod. Medicine. 478 pp., 1969.
6. Nechepelenko G.V. // Segmental theory of lymphatic system M.: Chemistry, 1990. 160 p.
7. Sidenov O.I., Fishdalov D.D. Congress "Combustiology at the Turn of the Century." Theses of reports. M, 2000. 129.
8. Clodius L. Die klinische Bedeutung des lymphterritorium nach Kubik // Schweiz. Rundschau Med.1983 Bd. 72. № 46. S. 1455-1458.
