CC BY
34CENTRAL ASIAN RESEARCH JOURNAL FOR INTERDISCIPLINARY STUDIES (CARJIS) ilmiy jurnali bilan hamkorlikda.
УДК 616-001.17-617.586-089
METHODS OF EARLY SURGICAL TREATMENT OF BURNS
Khursanov Yokubjon Erkinovich
Samarkand State Medical Institute student 2st course specialty surgery Samarkand branch of the RSCEMP ABSTACT
The study analyzed 114 case histories of patients with deep burns, as well as patients with thermal trauma complicated by burn disease. The main method of treatment was early necrectomy, which was compared with patients those basic treatments were chemical necrolytic therapy, landmark necrectomy with remote split skin grafting in 74 cases. An assessment of the following main statistical indicators: temporary disability, radicality of the operation, the number of daysuntil the early days of surgery, some of the statistical differences in men and women was carried out.
Key words: deep burns, burn disease, early surgical treatment, early necrosectomy.
Introduction. According to the WHO, burns are the third most common type of injury and the second most common in some countries. Every year, 4-5 out of 5,000 people on the planet receive thermal burns. Among them, 8 to 12 percent of the victims are elderly and elderly. Every year, 60,000 to 70,000 people around the world die from burns [4,12]. The relevance of the treatment of burn wounds remains at an all-time high despite years of experience in studying this problem. Among other things, the issue of the high cost of treatment required for this type of injury is acute: the average number of hospital stays per year is 23 days, and the cost of one day of treatment. For the United States - about 3000USD, for India - 250 USD [8].
Within the framework of the state policy in the field of public health protection and taking into account its implementation in accordance with the legislation of the Republic. The Republic of Uzbekistan "Health" is a state guarantee of public health, and the issue of treatment of burn patients is relevant not only in medicine but also in the economic sphere [4,16].
The burning process is a complex set of biological reactions that respond to tissue damage and usually end with their treatment [2, 3, 6, 7]. However, it is accompanied by a complex of biological reactions: disruption of homeostasis (burn shock), infection with resistant flora (resistance to most groups.antibiotics), developmental deformity, keloid, hypertrophic scars, as well as the possible development of disability. The range of surgical interventions used in the treatment of burn patients is quite wide. The free skin grafting method has been of the greatest practical importance for restoring lost skin in deeply damaged areas. The duration of treatment, its functional and cosmetic
CENTRAL ASIAN RESEARCH JOURNAL FOR INTERDISCIPLINARY STUDIES (CARJIS) ilmiy jurnali bilan hamkorlikda. outcome depends on how well the instructions for surgery are defined and the method of skin restoration is chosen [1]. The proliferation of early surgical treatment of burns with primary or delayed skin grafting helps to quickly restore the integrity of the skin, reduce the development of possible serious complications, and improve the emotional state of patients. reducing the economic cost of treating the patient.
Objective: This study evaluates the main methods of treatment of patients with deep burns, as well as patients with thermal trauma complicated by thermal trauma, compared with patients with early surgical treatment. on the basis of improvement to improve the outcome of treatment of burn victims.
Materials and methods: From 2019 to 2020, 43 patients with deep burns of various localizations treated in the Department of Combustology of the Emergency Hospital of the RSFSR, as well as patients with deep burns with complications of burns, according to the classification MKB-10 The results of a comprehensive examination and treatment of 14 patients were analyzed. health facility The comparison group consisted of 27 patients comparable in age, sex, severity of burns, and depth of injury. Patients were divided into 3 groups. Statistical data processing was performed using the software package Statistica 6.0. The distribution was evaluated using the Shapiro-Wilk test (for small samples). If the distribution of the values in the sample obeys the law of normal distribution, then similar data are M -arithmetic mean and 95% IO - confidence interval (average mean value of the population) and ma that do not obey the law of normal distribution. The data are described using Me (median) and Pc (percent). ) is a measure of distribution because they are less affected by the extreme variant [7]. If these conditions are not met, the non-parametric Mann-Whitney U test and the Kolmogorov-Smirnov Z-test are used. If the samples were independent and used in 26 comparisons of the two groups, the Mann-Whitney test was used. All three groups were evaluated using the Kraskes-Wallace statistical method [7]. In this study, the significance level in testing the statistical hypotheses was 0.05.
The results of the study and their discussion: Gender distribution: men - 71 people (75.5%), women -23 (24.5%). Age of patients (Me 42 years (35 - 49.5)), 8 patients over 60 years (8.7%). Burns occurred as a result of contact with fire (52%), hot liquid (15%), chemicals (15%), steam (8%), heated object (10%).
Cause of burning Fro m the fire Issiq suyuqlik H ot liquid S team Contact with heated object
Percenta ge 52 % 15% 15 % 8 % 10%
Gender Male 71 Woman 23
CENTRAL ASIAN RESEARCH JOURNAL FOR INTERDISCIPLINARY STUDIES (CARJIS) ilmiy jurnali bilan hamkorlikda.
Often, lower extremity injuries, including leg injuries, are more common in women with deep localized burns than in men, and upper limb injuries, including hand injuries (Z = -2,24526; p = 0.025) .The area of deep wounds is 6-12% (M 9.14% (95% CI: 5.91%); 12.36%). All patients underwent early surgery at 4-8 days (M 6,525 (95% CI: 4.81; 8.24)).
Early necrectomy consists of incision of known necrotic tissue of the skin at a time or delayed plastic surgery with a total area of not more than 10% of the total area after 3-5 days. In the total sample, 14 patients (24.5%) corresponded to patients with deep burns of different localization complicated by burns. Among fatal burns - 5.2% (3 patients), the area of deep burns - more than 30%. The injury is complicated by severe burns and respiratory distress syndrome. Quantity of operations: one intervention - 50%, two interventions - 18%, 3 or more interventions - 32%. Patients with burns, local deep burns using EN, and patients with statistically significant necrectomy burns necrolytic preparation of burns (Z = -2,6473; p = 0.002287) by bed days: Me 48 days, Me 22 days, Me 46 days. Complications after early necrectomy: anemia - in 5 patients (8.7%); thrombocytopenia - 3, (5.2%); hematoma - 2 per day (3.5%); partial lysis, requiring additional surgeries - in 7 patients (12.28%).
Conclusions:
• Early surgical treatment of burns is not in vain. As the duration of injury increases, the appropriateness of its use decreases.
• Achieving satisfactory rapid and long-term clinical results is possible only at the border of radical, healthy tissue, in the conditions of removal of burn necrosis.
• Early necrectomy is a highly traumatic operation associated with the risk of significant disruption of hemo and homeostasis.
CENTRAL ASIAN RESEARCH JOURNAL FOR INTERDISCIPLINARY STUDIES (CARJIS) ilmiy jurnali bilan hamkorlikda. REFERENCES / СНОСКИ / ЩТИБОСЛАР:
1. Азолов В.В. Эпидемиология ожогов и состояние помощи пострадавшим в России / В.В. Азолов, М.М. Попова, В.А. Жегалов // Восьмая Всероссийская научно-практическая конференция «Проблемы лечения тяжелой термической травмы». - Н.Новгород, 2004. - С. 27-29.
2.Евтеев А.А. Неудачи аутодермопластики. - М.: РА ИЛЬФ, 2011. -160 с. З.Зайцев В.М.Прикладная медицинская статистика. - СПб: Фолиант, 2003.
- 428 с.
4. Жегалов В.А. Ожоговый центр: проблемы организации и управления /
B.А. Жегалов, С.А. Христо // Научная конференция «Актуальные проблемы травматологии и ортопедии». - Ч. 2. Термическая травма. - Н.Новгород, 2001. -
C. 14-16.
5.Лищенко Е.А. Влияние раннего хирургического лечения на тяжесть течения ожоговой болезни у тяжелообожженных // Материалы международной научно-практической конференции «Актуальные вопросы комбустиологии, пластической хирургии и лечения ран». - Донецк, 2011. - С. 113-115.
6.Назаренко Г.И. Термические и радиационные ожоги. Система информационной поддержки действий по диагностике и лечению. - М.: Медицина, 1996. - 248 с.
7.Хурсанов Ё.Э. Амниотической оболочка- как эффективное биологическоераневое покрытие /Хурсанов Ё.Э, Жуманов Х.А// УЗБЕКСКИМ МЕДИЦИНСКИЙ ЖУРНАЛ- №SI-1 (2021) С 30-36. DOI http://dx.doi.org/10.26739/ 2181-0664-2021-SI-1
8. Алексеев А.А. Актуальные вопросы организации и состояние медицинской помощи пострадавшим от ожогов в Российской Федерации / А.А. Алексеев, В.А. Лавров // Сб. науч. трудов II Съезда комбустиолог. России, М. 2008. С. 3-4.
9. Алексеев А.А. Принципы патогенетической терапии ожоговой болезни и профилактика ее осложнений/ А.А. Алексеев, Т.Л. Заец // Международная конференция «Интенсивное лечение обожженных». - М., 2005. - С. 226-228.
10. Авазов А.А. Ожоговый шок: патогенез,клиника,принципы лечения/ А.А.Авазов ,Карабаев Х.К// Проблемы биологии и медицины.-2018-№4(104) С.226-230.№ 365. http : //www.who. int/mediacentre/factsheets/fs365/ru/index.html.
9.Всемирная Организация Здравоохранения. Ожоги. Информационный бюллетень. 2012.
10. Khursanov Y.E. Optimization of intensive therapy for burn shock/ Khursanov Y.E., Jumanov X.A// УЗБЕКСКИЙ МЕДИЦИНСКИЙ ЖУРНАЛ- №SI-1 (2021) С 30-36. DOI http://dx.doi.org/10.26739/ 2181-0664-2021-SI-1
CENTRAL ASIAN RESEARCH JOURNAL FOR INTERDISCIPLINARY STUDIES (CARJIS) ilmiy jurnali bilan hamkorlikda.
11. Хурсанов Ё.Э. Амниотической оболочка- как эффективное
биологическоераневое покрытие /Хурсанов Ё.Э, Жуманов Х.А // УЗБЕКСКИМ МЕДИЦИНСКИЙ ЖУРНАЛ- №SI-1 (2021) С 30-36. DOI http://dx.doi.org/10.26739/ 2181-0664-2021-SI-1
12. Хурсанов Ё.Э. Хирургическая реабилитация пострадавших от сандаловых ожогов/ Шакиров Бобир Магрупович, Мустафакулов Ишназар Бойназарович,Авазов Абдурахим Абдурахманович, Хурсанов Ёкуб Эркин угли.// Проблема биологии и медицины https ://doi. org/10.38096/2181-5674.2021.6.1
13. Saloydinov, S. Q. (2021). Paxta tozalash zavodlarida energiya sarfini kamaytirishning texnik-iqtisodiy mexanizmini yaratish. "Academic research in educational sciences", 2(9), 886-889. https://doi.org/10.24412/2181-1385-2021-9-886-889
14. Saloydinov, S. Q. (2021). Creation of feasibility studies to reduce energy costs in ginneries. "Экономика и социум", 9(88), 147-149.
15. Caлойдинов, C. К. (2021). Образовательные кредиты в Узбекистане. "Экономика и социум", 12(91), 470-472.
16. Caлойдинов, C. К. (2021). Спрос на рынке дифференцированных продуктов. "Экономика и социум", 12(91), 473-476.
17. Салойдинов, С. К. (2022). С паровой турбиной 471 МВт на Талимарджанской ТЭЦ расчет электрических режимов при максимальной зимней нагрузке. "Central Asian Research Journal for Interdisciplinary Studies (CARJIS)", Special issue, 116-121.
18. Сaрдoржoн Кoдиржoн Ynm Сaлoйдинoв. (2022). Иннoвaциoннoе решение для пoлyчения биoгaзa. "Central Asian Research Journal for Interdisciplinary Studies (CARJIS)", 2(3), 280-285. https://doi.org/10.24412/2181-2454-2022-3-280-285
