Method for treating gunshot wound

FIELD: medicine, traumatology.

SUBSTANCE: one should puncture the wound with perfluorane at the dosage of 30 ml, not more/kg affected area once daily for 14 d, not more. The present innovation provides prophylaxis of reperfusion and purulent-necrotic complications in case of gunshot wounds and that of anaerobic infection due to oxygen supply to ischemized wound tissues at adequate quantity during pre-hospital period.

EFFECT: higher efficiency of therapy.

1 ex

 

The invention relates to medicine, namely to traumatology, military surgery, disaster medicine, and can be used to aid in any variant of a gunshot wound.

There is a method of treatment of gunshot wounds, including acceptance of delivery of oxygen to the superficial tissues of the wound (Svehicles. Experimental and clinical substantiation of the possibility of preserving the viability of the tissues in gunshot fractures. Abstract of Diss. CMN, 1996, 18 C.).

The disadvantage of this method is the lack of techniques to ensure the delivery of oxygen to the deep layers of the wound and removal of regional hypoxia prehospital and related reperfusion, purulent-necrotic complications, prevention of anaerobic infections.

The closest in technical essence and the achieved effect is a method of treating gunshot wounds, including the packing of the wound with the healing tool and around the wound with antibiotics (Naeimeh. Military field surgery, 2002, pp.37-38, 58).

The disadvantage of this method is the lack of techniques to ensure the delivery of oxygen to the deep and superficial layers of the wound and removal of regional hypoxia prehospital and related reperfusion, purulent-necrotic complications, prevention gone anaerobic the first infection.

The technical result consists in the prevention of reperfusion and purulent-necrotic complications of gunshot wounds, anaerobic infections and improved quality of care by improving oxygen delivery to chemisorbant tissues gunshot wounds in pre-hospital stage.

The technical result is achieved in that a method of treating gunshot wounds, including the packing of the wound with the healing tool and around the wound drug, characterized in that as a therapeutic and medicinal use of perftoran, and around the wound drug produced in a dose of not more than 30 ml per kilogram of the affected area once a day for no more than 14 days.

A specific example of the method. For example, the patient after a gunshot wound to the upper third of the right tibia at the scene conducted tamponade wounds with perftoran and soft tissue of lower leg put perftoran in a dose of 30 ml per kilogram of body weight of the affected limb. The weight of the leg 5 kg (150 ml) of perftoran. Delivered to the clinic within 1 hour after injury. After preparation after 3 hours of operation - primary debridement, the wound was not usualis the abandonment of drainage. Tamponade wounds with perftoran and around the soft tissue around the wound was conducted four days. On the fourth day the wound and with no signs of infection, sutured tightly. Healing without suppuration.

The significance of differences between the invented method is the following. Studies found that a gunshot wound in the vast majority of cases lead to suppuration. It is promoted as the nature of the injury and the period of traumatic disease. Tissue hypoxia leads to degeneration and necrosis of muscle tissue, the development of secondary tissue necrosis, and this contributes to the reproduction of micro-organisms, particularly anaerobic flora and progression of sepsis (Naeimeh. Military field surgery, 2002, 58 S.).

With the availability of modern equipment for the evacuation of the wounded, the average timing of the wounded on the specialized stage are 12-36 hours. And in 82% of the transactions are of a savings nature, and the specialized phase of the 2nd and 3rd echelon received within the first 7 days after the injury. At the same time, the first medical aid to all injured for 1.5 hours (Vamapaull. Features staging treatment of the wounded with gunshot fractures of the long bones of the limbs during the antiterrorist operation in Chechnya in 1994-1996 / 7th Congress of traumatologists and orthopedists Russia. So 1, 2002, s) Thus, prevention of reperfusion, purulent-necrotic complications and anaerobic infections and improve the quality of treatment by Ulu is the relationship of oxygen delivery to chemisorbant tissues of a gunshot wound at the prehospital stage is pathogenetically justified.

The determining factor contributing to tissue necrosis in a gunshot wound, is a violation of microcirculation. The study has shown the occurrence immediately after wounding four zones disorders of the circulatory system: the first is the area of primary necrosis, a second zone Subtotal disorders of microcirculation with reduced blood flow to 75% and followed by a complete cessation of blood circulation with the development of secondary tissue necrosis on the day 3, the third focal area of microcirculation disorders with reduced blood flow by 55% and plots jet-destructive changes in the tissues with subsequent restoration of blood flow and functional indicators in uncomplicated wound healing process to the 14th day after the injury, and in complicated cases - with the deepening of microcirculation disorders and the formation of new spots secondary necrotic tissue, the fourth area of functional disorders of microcirculation with reduced blood flow by 23% and reactive changes in the tissues with subsequent normalization of the micro-circulation makes on the 7th day after injury (Naeimeh. Military field surgery, 2002, pp.52-53).

These data indicate that tissue hypoxia at gunshot wound is necessary to remove not less than 4 and not more than 14 days.

Perfluorocarbon emulsion dissolved in the lipid is x cell membranes, carry yourself in oxygen and carbon dioxide and become part of the transport system of oxygen in cells and tissues of the body. Incorporating into the structure of cell membranes, these emulsions are capable of stabilizing the structure of the endothelium of blood vessels and cell membranes (Whichmakes and others In kN.: Performancesee compounds in biology and medicine. Pushchino, 1999, s-145). Perftoran eliminates spasm of peripheral vessels, restores perfusion circulation and microcirculation, reduces swelling of the endothelium of blood vessels, improve microcirculation, tissue gas exchange and metabolism (VMS, Nilow, 1999, ibid, p.26-30). Perftoran increases the saturation of hemoglobin with oxygen and facilitates the delivery of oxygen to the tissues due to its own oxygen capacity, low viscosity, small particle size, large aggregate surface and mobility in the bloodstream (Grievance, 1999, ibid, s). Perftoran reduces the content of lipid peroxidation in the tissues, allowing vasospasm, weakening of microcirculatory disorders and ischemia tissue (Haushalten and others, 1999, ibid, p.62-69). The introduction of perftoran reduces the severity of toxemia and has a favorable effect on the rheological properties of blood (Gastronom and others, 1999, ibid, p.21). The ability of the PFC to stabilize the membrane of cells leads to a reduction of edema, diuretic effect and uluchsheniyu gas exchange. Perftoran reduces the viscosity of whole blood. It is effective for the violation of microcirculation and tissue gas exchange, cell metabolism for elimination of circulatory and tissue hypoxia, detoxification, and protection of organs and tissues from hypoxia and reperfusion complications. Thus, the favorable effect of perftoran on the fabric in the claimed method is caused, mainly, it kislorodotransportnu, lipoic, antiexudative, antiulcerative and detoxification effect. According to the claimed method summary of perftoran to the affected tissues as a result of a gunshot wound allows you to improve nutrition and respiration, to ease the development of ischemic edema, reduce the plasma loss and thickening of the blood, causing secondary circulatory hypoxia of the tissues around the wound, which leads to myonecrosis, Milito, toxemia, purulent-necrotic complications and possibly to the development of anaerobic infections.

The significance of differences between the complete method also consists in the following. The tension of oxygen in the tissues around the gunshot wound affects cellular processes, development of capillaries and the formation of hydroxyproline, the precursor of collagen (Hunt AS Et al., Standards for wound healing research //Surgeri/ - 1973. - Yol.73, No. 1. - P.153-154). Instruction perftoran intravenously injected at a dose of 5-30 ml/kg by weight of the graft body. In the proposed method perftoran enter paravonian in the affected limb. With the introduction of drainage with perftoran and parvularia introduction of the proposed method are excluded complications such as air embolism and thrombosis. In the proposed method, the dose calculated for parvularia the introduction of not more than 30 ml/kg of the affected area. Dose, calculated on the weight of the affected area, provides adequate dosage depending on the mass of the affected tissues. Because the mass of the affected area is only part of the weight of the entire body, the dose of at parvularia the introduction of perftoran not more than 30 ml/kg of the affected area that does not exceed the maximum single dose, so when gunshot wound parvularia administration of high doses of perftoran preferably 1 kg mass of the affected area, which increases the quality of treatment and achieve the intended technical result.

The significance of differences between the execution of the claimed method also consists in the following. The wound healing process is a complex series of biological reactions in response to damage organs, usually ending their healing. During his have the destructive and regenerative changes of the tissues forming the wound - connective, epithelial, nerve, muscle, bone. So W is rokai well aerated wound, not contain large amounts of dead tissue, anaerobic microbes are killed and develops coccal flora (Migukin, Bmostacedo. Wounds and wound infection. Hands. for physicians. M.: Medicine, 1981, s-641). Furthermore, it is known that hypoxia leads to a decrease of intraosseous pressure, and this leads to a slowdown of reparative regeneration (Eaasier and other journal of traumatology and orthopedics named. Nemyrova, No. 1, 2003, s-95). Therefore, in the proposed method daily administration of perftoran paravonian 1-x and up to 14 days after injury improves quality of care and achieve the intended technical result.

Tamponade of a gunshot wound with perftoran and parvularia around the soft tissues of the affected area with perftoran possible during the first medical aid (medical center shelf), in conditions of emergency medical care in the coming hours and minutes after the injury, and further introduction of perftoran feasible in terms of in-hospital phase, which is important in helping the victim to skilled or specialized stages such as military actions, technological accidents, terrorist attacks or natural disasters. The performance of reception tamponade wounds with perftoran and parvularia introduction of perftoran possibly as a health worker and sposate is eat and police prehospital, i.e. does not require special skills, which speeds up the rendering aid in an emergency situation. To implement receiving parvularia introduction of perftoran and swab moistened with perftoran, requires no special equipment, enough except perftoran to have a sterile syringe and a bandage, which reduces the way and makes it available.

The use of the claimed method for assisting victims with gunshot wounds, especially occurred during the hostilities, terrorist acts, will reduce the severity of local and systemic complications, will increase the number of survivors who will help to heal wounds without suppuration, to reduce the number of complications with anaerobic infection and save their limbs. Reducing length of stay affected in a hospital bed and reducing the cost of expensive inpatient treatment and rehabilitation, as well as reducing the level of disability, the method provides significant economic benefits.

The method may also in veterinary medicine.

A method of treating gunshot wounds, including the packing of the wound with the healing tool and around the wound drug, characterized in that as a therapeutic and drug use perftoran, and around the wound drug produced in dose is not more than 30 ml per 1 kg of the affected area once a day for no more than 14 days.



 

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