Solution for the healing of purulent wounds. Purulent wound. Altai homemade ointments for rotting wounds

Let's start by defining what a purulent wound is. This is damage to the integument and underlying tissues and penetration into the infection. These processes are accompanied by intense pain syndrome. Treatment of purulent wounds on the legs can be lengthy and very difficult. For achievement positive result it is imperative to apply a whole range of measures, which includes washing and draining wounds, opening abscesses. Medical dressings and antibiotic therapy are used. It is extremely important to reduce the intoxication of the body, support the immune system, and also stimulate the recovery processes.

Diagnostics

The treatment of purulent wounds on the legs will be the more effective the sooner it is started. By themselves, they are not the most pleasant sight, but doctors are not interested in the aesthetic side, but in the depth of suppuration. Depends on how the process is running further treatment. Delay in seeking medical attention can lead to an abscess. As a result, gangrene develops. Therefore, before starting the treatment of purulent wounds on the legs, it is necessary to show the patient to the doctor and determine the stage of healing.

Kinds

Mainly in therapy skin surgeons. It is their share that accounts for the treatment of the most severe cases. Treatment of purulent wounds on the legs is just from the same category. There are several stages of scarring:

• Wet - this is usually the first stage immediately following tissue damage. Blood and lymphatic fluid ooze from the wound, and if an infection gets into it, then pus. It is extremely important at this stage to regularly clean the surface.
• dry stage. The acute phase in this case is already behind, and pinkish films are formed on top.

If the process is successful, then scars appear instead of wounds. The process of tightening large and deep wounds takes from six months to several years.

Antibiotic treatment

If the patient is admitted in a serious condition, then the doctor has two options: either clean the outer surface of the wound with an instrument and connect drugs in order to stop the infection, or operate. The first option is preferable, so if there is such an opportunity, then doctors choose it.

Antibiotics for purulent wounds

If there is a little time to wait, then a series of tests are done to determine which infection has entered the open wound. Based on this, we can conclude which drug will be most effective. If there is no time and an urgent need to start treatment, then broad-spectrum drugs have to be prescribed. Antibiotics for purulent wounds should be chosen only by the attending physician. Modern drugs able to lift any patient out of bed, because they defeat almost all pathogenic microflora.

Main difficulties

Why not prescribe them to all patients, then you won’t even have to go to the hospital to prescribe treatment? The fact is that in addition to indications, each of the drugs has a number of contraindications. It will be difficult for some patients to endure and drink the entire course of the prescribed medication. This is primarily due to the fact that it affects the liver and kidneys, the organs of the digestive tract. Of course, when it comes to saving lives, there is no choice. In this case, the doctor usually injects the drug with a dropper.

Different pathogens and groups of drugs

The healing of purulent wounds requires great experience medical personnel, time and often financial investment. The main pathogens are the following infections: Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. They are widespread, and therefore infection of wounds occurs in most cases. Especially if the body's immune system is weakened.

The listed bacteria have good sensitivity to the following groups of antibiotics:

• Most often, treatment occurs with penicillin and its derivatives.
• Cephalosporins give good results, but you need to consider side effects and contraindications.
• Aminoglycosides.
• Tetracyclines.

Direct effect on the wound

In the process of healing purulent wounds, not only systemic, but also local therapy. In the past, surgeons tried to powder wounds with antibiotics. But the effectiveness of this method was low, so this practice was quickly abandoned. Much best effect was achieved by irrigating the wound with antiseptic solutions, as well as by applying a gel with an antibiotic.

Even when the wound becomes dry, it is necessary to continue treatment, that is, apply ointments and creams with an anti-inflammatory effect. It is extremely important to prevent secondary suppuration. This often happens when, with a false impression of recovery, a person stops performing regular procedures. Of course, the results of his labors go to dust. Now you need to start all over again.

Antiseptic solutions

When choosing which ointment to treat a purulent wound on the leg, it must be remembered that the therapeutic composition can only be applied to a clean surface. To prepare the wound, it is washed with special, antiseptic solutions. These are furacillin and hydrogen peroxide, boric acid and some others. However modern research show their low antibacterial activity against most pathogens. In this regard, work began on the development and implementation of new antiseptic solutions. They were iodopyrone and dioxidine. They are used by surgeons to treat hands, they are also great for wounds. Only the concentration changes. In the first case, it is higher.

We remove inflammation

This is one of the most important tasks, because at this stage there is redness and swelling, the patient experiences severe pain, and fever is possible. Removal a large number pus is possible only when draining the wound.

In order for the procedure to be effective, tampons are moistened in special formulations. Treated with chlorhexidine and hydrogen peroxide, after which a swab is applied with a 10% solution of sodium chloride. Change the bandage every five hours. Next, you need to decide how to treat a purulent wound. At night, "Levomikol" or "Levosin" is distributed over the wound. They will provide good swelling purulent contents from the inside. This is the most modern, safe and effective drug that helps to quickly relieve inflammation and pain.

What ointment to use

The abundance of medicines today is so great that it is sometimes difficult for a doctor to decide how to treat a purulent wound. But there are basic principles that modern surgeons follow. Thanks to numerous studies, Vishnevsky's ointment and synthomycin emulsion, tetracycline and neomycin ointments can be considered the most effective today. However, such ointments do not provide an outflow of wound secretions. Therefore, new formulas of hydrophilic ointments have been developed. This mafined acetate and many others. They contain antibiotics that easily pass into the wound. Their activity exceeds the effect of hypertonic solution by 15 times, and the effect lasts up to 24 hours.

Therapy of necrotic processes

Purulent leg wounds in diabetes mellitus are one of the most common complications, but treatment does not become easier from this. Therefore, to increase its effectiveness, necrolytic preparations are used. These are trypsin, chymopsin, terrilitin. They are needed for the speedy removal of dead tissue. But these medicinal solutions I have flaws. The enzymes in their composition remain active for no more than five hours, and it is impossible to change dressings so often. Therefore, they began to be included in the composition of ointments. This is how a drug called "Iruksol" appeared, which contains the enzyme pentidase and the antiseptic chloramphenicol.

Complex therapy

Even the most effective ointment from festering wounds will not give desired effect when used as monotherapy. Therefore, most often doctors prescribe a course of vitamins C and B, as well as antibiotics. Daily Systems allow you to get the first results in a few days.

To treat damage and improve skin nutrition, methyluracil and solcoseryl ointment, as well as Trifodermin, are used. In the healing process, you need to regularly change dressings, clean wounds from microorganisms, dead tissues and foreign bodies.

Seeking help from nature

Treatment of purulent wounds on the legs in the elderly often takes a long time. Daily dressings require large financial investments. However, there are simple inexpensive means who can help. But there are several conditions here. It is very important that treatment begins as soon as possible. early stages. Any folk remedy for a purulent wound has a limited degree of antibacterial effect, therefore, with running processes, it can only play an auxiliary role.

The most effective recipes

• Chamomile. A simple and affordable tool that can help in most cases. Leaves and seeds have strong antiseptic properties. There are two use cases. The first is to moisten a napkin in a decoction of herbs and apply to the wound. In this case, you will have to change it often. The second method suggests applying a slurry of plant leaves to the wound.
• Onion. Almost everyone knows about its antiseptic properties. A solution of fresh onion is used for washing, and baked scales are tied to wounds when warm. Such a compress contributes to its rapid healing.
• Propolis. An ointment is prepared from it, which has long been famous for its unique properties. This will require a tablespoon of propolis tincture, the same amount of honey and butter.
• Aloe. The plant, rich in bioactive compounds, promotes rapid cell regeneration. That is why it is the best remedy for tightening purulent wounds. To do this, the leaves are crushed into gruel and applied to wounds.

Instead of a conclusion

Festering wounds are usually the result serious violations in the body's metabolic processes. Very often this complication accompanies diseases such as diabetes mellitus. Therefore, it is very important to be examined by a doctor and find out the cause. Soft tissue lesions are always secondary, but also require the most serious attitude. Complex therapy allows you to effectively solve the problem, but the regeneration process will still be lengthy. Therefore, stock up on patience, medicines and the help of an experienced nurse.

A purulent wound is characterized by the presence of pus, tissue necrosis, the development of microbes, tissue edema, absorption of toxins. The principles of the treatment of purulent wounds are based on the doctrine of the processes occurring in the wound during its healing, and the conditions conducive to regeneration. Treatment objectives: removal of pus and necrotic tissues; reduction of edema and exudation; fight against microorganisms.

For the treatment of purulent wounds, it is necessary to provide for factors of local and general effects on the body. These factors differ in different phases of wound healing and this was mentioned in the section on how to treat festering wounds.

Stages of the wound process: inflammation, regeneration, epithelialization.

All therapeutic measures are carried out in strict accordance with the stages of the wound process. Each stage has its own treatment objectives, as well as ways to achieve them.

Inflammation

The stage is characterized by the presence of all signs of a purulent wound process. In a purulent wound there are remnants of non-viable and dead tissue, foreign objects, pollution, accumulation of pus in cavities and folds. Viable tissues are edematous. There is an active absorption of all this and microbial toxins from the wound, which causes the phenomena of general intoxication: fever, weakness, headache, lack of appetite, etc.

In this regard, it is necessary to ensure:

1) rest of the diseased organ (immobilization, rare dressings);

2) the introduction of antibiotics and antiseptic substances both locally into the wound, and inside or intramuscularly;

3) increased hyperemia and exudation into the wound using dressings with hypertonic solutions table salt(5-10%), this improves the processes of melting in the wound and creates unfavorable conditions for the vital activity of purulent microorganisms;

4) activation of immunobiological reactions, primarily by increasing the phagocytic activity of leukocytes, using transfusions of small doses of blood, etc.;

5) reduction of purulent intoxication by creating a reliable outflow of wound exudate by wide opening of the purulent focus and draining it;

6) careful attitude to the tissues of the wound, prevention of injury to its walls to preserve the emerging barrier.

Tasks of the stage treatment: drainage of the wound in order to remove pus, necrotic tissues and toxins; fight infection. This sequence is valid even when the wound is festering. Wound drainage can be active (using suction devices) or passive ( drainage tubes, rubber strips, gauze wipes and turundas moistened with water-salt solutions of antiseptics. Medicinal (medicinal) means for treatment.

The most commonly used by surgeons is a 10% sodium chloride solution (the so-called hypertonic solution).

Used in surgery various ointments on fatty and vaselinelanolin basis; Vishnevsky ointment, synthomycin emulsion, ointments with a / b - tetracycline, neomycin, etc. But such ointments are hydrophobic, that is, they do not absorb moisture. As a result, tampons with these ointments do not provide an outflow of wound secretions, they become only a cork. The use of new hydrophilic water-soluble ointments - Levosin, levomikol, mafenide-acetate - is pathogenetically justified. The osmotic activity of these ointments exceeds the effect of hypertonic solution by 10-15 times, and lasts for 20-24 hours, so one dressing per day is enough for effective action to the wound.

The arsenal of antiseptic and disinfectants is huge and necessary for the treatment of purulent wounds. Unfortunately, antiseptics, with which our medical and sanitary institutions are equipped, do not meet modern requirements. In the "National List of Essential Medicines and Products medical purpose» the group of antiseptics includes: preparations boric acid, iodine, hydrogen peroxide, potassium permanganate, ethanol, brilliant green, chlorhexidine bigluconate, i.e., for the most part, those means that were used back in Lister's time. So far, in many medical institutions furacillin is used, which is not only not active against many microorganisms, but is also an excellent breeding ground for some pathogenic and opportunistic bacteria.

For the speedy removal of dead tissue, necrolytic preparations are used. Widely used proteolytic enzymes - trypsin, chymopsin, chymotrypsin, terrilitin. These drugs cause lysis of necrotic tissue and accelerate wound healing. However, these enzymes also have disadvantages: in the wound, the enzymes retain their activity for no more than 4-6 hours. Therefore, for effective treatment festering wounds dressings should be changed 4-5 times a day, which is almost impossible. It is possible to eliminate such a lack of enzymes by including them in ointments. So, the ointment "Iruksol" (Yugoslavia) contains the enzyme pentidase and the antiseptic chloramphenicol. The duration of action of enzymes can be increased by immobilizing them in dressings. So, trypsin immobilized on napkins acts within 24-48 hours. Therefore, one dressing per day fully provides a therapeutic effect.

Physiotherapy begins on the 2nd day after surgical treatment of the wound. Before carrying out procedures in the first phase (if necessary, in the second phase) on open wound(not through a bandage) it should be cleaned of purulent masses. In the first phase of the wound process, bactericidal, anti-inflammatory, necrolytic and immunostimulating methods are used to treat the inflammatory syndrome; in the second phase, the same methods are used, with the exception of necrolytic ones. Analgesic methods are used mainly during the first, less often the second phase of the wound process. Reparative-regenerative and vasodilating methods aimed at treating the syndrome of metabolic and trophic disorders are prescribed in the second and third phases, and fibromodulating - in the third.

Bactericidal methods: UV irradiation, local aeroionotherapy, aeroiontophoresis of antibacterial drugs, electrophoresis of antibacterial drugs, local aerosol therapy of antibacterial drugs, local darsonvalization (spark discharge), local baths with potassium permanganate.

Regeneration

In the second phase, therapeutic measures should mainly be aimed at enhancing regeneration processes and protecting the wound from damage. In this phase, a strong wound barrier has already been created, the number of microbes in the wound discharge and their virulence have sharply decreased, and granulation maturation occurs.

Treatment of purulent wounds should prevent the development secondary infection. Apply a dressing with fish oil, vaseline oil or other indifferent ointment, which helps to fill the wound with granulations and epithelialization.
These tasks are:
a) ointments: methyluracil, troxevasin - to stimulate regeneration; fat-based ointments - to protect granulations from damage; water-soluble ointments - anti-inflammatory effect and protection of wounds from secondary infection.
b) herbal preparations - aloe juice, sea buckthorn and rosehip oil, Kalanchoe.
c) the use of a laser - in this phase of the wound process, low-energy (therapeutic) lasers are used, which have a stimulating effect.

In order to preserve and restore the function of the affected organ, indications for the use of physiotherapy exercises and physiotherapeutic procedures should be expanded. With a wound on the leg, recovery occurs first by slow walking.

Scarring

The stage begins after the execution of the bottom of the wound and its cavity with granulation tissue. Tasks of the stage: to accelerate the process of epithelialization and scarring of wounds. For this purpose, sea buckthorn and rosehip oil, aerosols, troxevasin - jelly, low-energy laser irradiation. At this stage, the use of ointments that stimulate the growth of granulations is not recommended. On the contrary, it is recommended to switch back to water-salt antiseptics. It is useful to achieve drying of the dressing to the surface of the wound. In the future, it should not be torn off, but only cut off along the edges, as it detaches due to the epithelialization of the wound. From above, such a bandage is recommended to be moistened with iodonate or other antiseptic. In this way, healing of a small wound under the scab is achieved with a very good cosmetic effect. The scar is not formed.

According to the military doctor, it is also possible to treat purulent wounds at home if the wounds are small and there are no complications.

Classification of purulent wounds

1. Primary purulent wounds

Initially, a purulent process occurs in the depths of the tissues (abscess, phlegmon, lymphadenitis, etc.), then after an operation or a breakthrough of pus, a wound occurs (damage to the integumentary tissues), which is purulent from the first moment.

2. Secondary purulent wounds

Initially, a defect in the integumentary tissues appears, then purulent inflammation occurs in the existing wound (usually for 3-4 days)

Clinic of purulent wounds

I. Local symptoms

A purulent wound is a tissue defect, in the edges of which 5 classic signs of inflammation are determined, and in the lumen there is a purulent exudate.

Signs of inflammation:

2. hyperemia

3. local hyperthermia

— inflammatory warm at the edges of the wound, corresponds to the zone of hyperemia, is caused by impaired blood flow in the area of ​​inflammation

— reactive cold distal to the wound, no hyperemia is observed, caused by a violation of the lymphatic drainage, due to compression lymphatic vessels swelling in the area of ​​inflammation.

5. dysfunction (due to pain and swelling)

Pus morphologically is a liquid containing dead leukocytes, tissue detritus and microorganisms. The nature of pus depends on the type of microflora. For anaerobic microflora, fetid brown pus is characteristic, for streptococcus - liquid yellow or greenish, for staphylococcus - thick white or yellow, for Escherichia coli - liquid yellow-brown, for Pseudomonas aeruginosa - yellow, acquiring a blue-green tint in the upper layers of the bandage under the action of oxygen.

The walls and bottom of the wound can be filled with necrotic tissues, granulations.

II. General symptoms

Hearth purulent inflammation is a source of intoxication, the manifestations of which are: fever, chills, weakness, sweating, loss of appetite, leukocytosis, shift to the left, acceleration of ESR, the presence of protein in the urine, and in severe cases- increased levels of bilirubin, creatinine and urea in the blood, leukopenia, anemia, hypo- and dysproteinemia, impaired consciousness from lethargy to delirium and coma.

III. Immediate complications

The course of purulent wounds complicate:

- lymphangitis - red stripes on the skin in the direction from the wound to the regional lymphatic collectors

- lymphadenitis - enlarged, painful regional lymph nodes;

— erysipelas- inflammation of the skin around the wound - its hyperemia, soreness, increased intoxication syndrome.

- thrombophlebitis - painful hyperemic bands along the saphenous veins

- contact spread of infection in tissues - purulent streaks, periostitis

- sepsis

All complications make adjustments to the clinic of purulent wounds.

Purulent wounds always heal by secondary intention (the biology of the process is discussed above)

In foreign sources, the term is found - chronic wound. By this is meant a wound that shows no tendency to heal within 4 weeks. These include long-term non-healing wounds, trophic ulcers, bedsores.

A long-term non-healing wound is a wound in which regeneration is not expressed after the normal healing time of a purulent wound.

A trophic ulcer is a lesion in which degenerative processes predominate over regenerative ones.

TREATMENT OF PURULENT WOUNDS

Treatment of purulent wounds is carried out in accordance with the phase of the wound process according to the developed principles.

Principles of active surgical treatment of purulent wounds

1. Surgical treatment of a purulent focus

Operation steps

- dissection of the tissues of the edges of the wound or over a purulent focus

- evacuation of pus

- revision of the wound

- opening leaks

– necrectomy

– hemostasis

- washing the wound with antiseptic solutions

- wound drainage

The imposition of sutures on the wound is possible only with the use of flow-wash drainage

At present, as a result of a constant search for ways to optimize the wound process in purulent wounds, a number of methods have been developed that increase the radicalness of the surgical treatment of a purulent focus. These include:

1) Vacuum therapy.

The method is based on the creation of a dosed discharge in the wound within 0.1-0.15 atm., during several sessions, lasting 1 hour. Negative pressure is easily transmitted deep into the tissues of the peri-wound zone. In this case, exudate is eliminated from the wound and edematous fluid from the tissues, blood flow and the influx of local protection factors (phagocytes, lysozyme) to the wound are increased, the pH of the environment in the wound tissues is normalized, aerobic glycolysis and energy supply of the wound process are enhanced. The effect of increased blood flow lasts at least a day. In the wound, there is a rapid cleansing and early manifestation of reparative processes. The most effective use of vacuum therapy in the phase of inflammation. During the regeneration phase, moderate tissue stretching under negative pressure stimulates regeneration.

2) Local ozone therapy.

The wound is affected by a stream of air passed through an ozone generator. Ozone has an antimicrobial effect, dilates small vessels, activates phagocytosis.

3) Hyperbaric oxygenation.

The impact on the wound with oxygen under pressure is especially effective when anaerobic infection. Oxygen under pressure is better absorbed by tissues, hypoxia is eliminated, energy supply to the wound process is improved. In addition, oxygen has a direct bactericidal and bacteriostatic effect on microbes, increases their sensitivity to antibiotics, and activates phagocytosis.

4) NO-therapy

Impact on the wound of nitric oxide obtained at high temperatures (3000-3500 degrees) from the air, for example, when generating air plasma. Nitric oxide has a pronounced local vasodilating effect, which increases blood flow.

5) Laser treatment of the wound.

The use of high-intensity laser radiation leads to evaporation of necrosis, bacteria, and inflamed tissues from the wound surface. A scab forms on the surface of the wound. Wound healing in time approaches the primary one. However, complete sterilization of the wound is difficult to achieve, and in half of the cases, the development of wound infection continues under the scab. The application of the method is limited in anatomically significant areas, and it is also unsafe for the doctor, as it leads to structural damage to the eyes, skin, and functional changes in the cardiovascular system. Low-intensity laser radiation is a method of physiotherapy and does not have a pronounced effect on the wound process.

6) Treatment of the wound with a pulsating jet of antiseptic.

On wound surface an antiseptic jet is supplied under variable pressure. The wound is freed from bacteria and necrotic tissue. However, it has been proven that bacteria and toxins are forcibly penetrated into the wound tissue. In addition, an epidemiologically dangerous antiseptic aerosol with bacteria is created in the room.

7) Ultrasonic treatment of the wound.

An antiseptic solution is poured into the wound and an ultrasound generator is placed in the solution. In the liquid during the passage of ultrasound, the effect of cavitation occurs, which leads to the death of bacteria and the rejection of necrotic tissues. At the same time, the antiseptic penetrates deep into the tissues (also along with bacteria and toxins).

8) Cryotherapy.

Extremely exposed fabrics low temperatures, turn into a scab and are rejected, the wound is cleansed.

9) Application of sorbents.

Sorbent substances are introduced into the wound, which eliminate exudate and toxins.

10) Treatment of the wound in a controlled abacterial environment (gnotobiological isolation).

The wound is isolated from the external environment, air passed through the filter is supplied to it. The method prevents reinfection of the wound. It is most often used in the treatment of burn wounds.

Despite the presence of technical, biological and economic shortcomings in some of the listed methods, all these methods significantly accelerate the course of a complicated wound process.

2. Active wound drainage

Active wound drainage is opposed to passive gauze and glove drainage, it allows you to achieve a greater intensity of wound cleansing from exudate. It is possible to increase the draining properties of passive drainages by using osmotically active substances as part of the dressing - a hypertonic (10%) solution of sodium chloride, sorbents or hydrophilic-based ointments (levosin, levomekol).

Actually active drainages are: aspiration drainage (according to Redon), flow-flushing drainage and a combination of these two methods.

3. Local drug treatment wounds

4. Rational antibiotic therapy

5. Immunocorrection

6. Early restoration of anatomical relationships in the wound area

1) Suturing:

early secondary and late secondary

Indications for the imposition of secondary sutures are:

1 - complete cleansing of the wound from pus and necrotic tissues

2 - the absence of pronounced inflammatory changes in the tissues of the peri-wound zone

3 - the ability to match the edges of the wound without tension

When using such methods active influence on the wound, such as vacuum therapy, laser exposure, ultrasonic treatment of the wound, it is possible to accelerate the suturing of a purulent wound. Such an early (3-5 days after the operation) suturing was called forced-early secondary suture.

2) Skin plastic

1. Islet method according to Reverden (grafts 0.5x0.5 cm in size are applied to the granulations, taken with a blade to the thickness of the papillary dermis and containing cambial skin cells)

2. Branded method (similar to the previous one, only the size of the grafts is up to 1.5 cm)

3. Plasty with opposite flaps (relaxing incisions are made in the wound area or flaps are cut out from the edges on a wide base so as to adapt the edges without tension)

4. Plasty with a free skin flap

a) a split skin flap (removed using a dermatome to the depth of the papillary dermis, restoration of the donor site is independent due to the cambial elements preserved on it, the flap dimensions are measured in tens of centimeters, in addition, they can be increased due to perforation of the flap)

b) non-split skin flap (transplantation of the entire thickness of the skin is associated with the appearance of a wound in the donor site, therefore, it is performed only on functionally and cosmetically important areas of the body - face, feet, hands, in the area of ​​\u200b\u200bthe joints)

5. Plasty with a skin flap on a vascular pedicle

a) Filatov stalk (multi-moment surgical movement of the skin graft on the base from the donor site to the wound)

b) microangiosurgical connection of the vascular systems of the graft and the edges of the wound

6. Application of own epithelial cell cultures

In any case, successful graft engraftment requires: high-quality granulation, good blood flow at the wound edges, absence of necrotic tissues and pronounced exudation, good hemostasis during plasty, tight fit of the graft to the bed, absence of general unfavorable factors (poor nutrition, cardiovascular pathology, metabolic disorders, oncopathology, etc.).

7. Detox

(infusion therapy, forced diuresis, use of detoxifying plasma substitutes, extracorporeal detoxification)

Implementation of the principles of active surgical treatment of purulent wounds in different phases of the wound process

Various injuries of the skin are called wounds. Most often they are harmless and are treated at home. But sometimes even a small damage to the skin leads to inflammation. Often suppuration occurs on the arms or legs, especially in the warm season. Various skin lesions can become inflamed due to poor hygiene, reduced immunity, or the presence of chronic diseases. In some cases self-treatment purulent wounds on the legs does not help, and you have to spend it in a hospital. It is very important to notice the appearance of pus in time and use the drugs necessary to remove it. If this is not done, inflammation can lead to the development of various complications.

wound?

This is damage to the skin, accompanied by the development in it pathogenic microorganisms. Pus begins to form in the wound, swelling and redness are observed around it. The tissues are painful and often hot to the touch. There is a dull throbbing pain, often severe. In severe cases to local symptoms common ones join: fever, intoxication of the body, headache.

Causes of purulent wounds

The inflammatory process may develop due to infection of the wound. This happens due to getting into. Very often this happens in the summer, especially if the skin on the legs is damaged. The appearance of a purulent process can also happen after surgery. Therefore, it is recommended to perform operations in the cold season and observe sterility in patient care. Such purulent wounds are called secondary. But there are also primary wounds. They are characterized by rupture of the internal abscess without external damage to the skin. It can be an abscess, phlegmon or a common boil.

Such wounds are treated mainly by surgical opening and antibiotics. The appearance of a purulent process is influenced by the age and state of immunity of the patient, the presence of chronic diseases, especially diabetes, in which suppuration often develops. Most often, purulent wounds appear in the elderly, full and weakened by diseases. Treatment at home will be difficult in this case.

Phases of development of the wound process

Features of the treatment of a purulent wound depend on the stage of its healing. Most often, two phases of the wound process are distinguished:

At the first stage, it is necessary to eliminate edema, remove dead tissues, and also eliminate hemorrhage and inflammation;

At the second stage, tissue regeneration and scar formation occur. The healing of purulent wounds at this time can be accelerated by the use of special preparations. Modern medicines help to regenerate tissues faster without the formation of a highly visible scar.

Purulent wound - treatment

Ointments for fast healing are now available to everyone. Therefore, treatment can take place at home. But if the inflammation is not dealt with in time, it may appear serious complications. Proper treatment of purulent wounds on the legs includes several areas:

Wound treatment - removal of pus, dirt and dead skin.

Removal of inflammation, swelling and soreness of the skin.

Fight bacteria.

Acceleration of wound healing and stimulation of tissue scarring.

General treatment aimed at increasing immunity and combating intoxication. It consists in taking immunomodulatory and vitamin preparations.

In severe cases, the treatment of purulent wounds on the legs may require surgical intervention: opening and cleansing the focus of inflammation, and sometimes amputation.

How to properly treat a wound?

For faster healing and prevention of complications, it is very important proper care over the affected area of ​​the skin. In mild cases, you can do it yourself. Treatment of purulent wounds is carried out 1-2 times a day and includes:

Thorough disinfection of hands and tools used for this, most often done with alcohol.

Removing the old bandage. Moreover, this must be done very carefully, and when the bandage dries, it must be soaked with "Chlorhexidine" or hydrogen peroxide.

Careful removal of pus from the inside of the wound, treatment of its edges with an antiseptic in the direction from it to the edges and drainage with a sterile swab. Sometimes it is recommended to lubricate the edges of the wound with brilliant green or iodine.

Application medicinal product or napkins moistened with it. If the wound is very deep, tampons or drainage are introduced into it for a better outflow of pus.

Closing the wound with sterile gauze in several layers and fixing it with adhesive plaster or bandage. It is necessary to ensure that there is air access to the wound, otherwise an anaerobic infection may develop.

In a serious condition of the patient, open purulent wounds are treated 3-4 times a day, each time leaving them in the air for 20-30 minutes.

Physical Therapies

used to practice open way healing of purulent wounds. It was believed that under the influence of air and sunlight microorganisms die faster. IN last years refused this, and a bandage is necessarily applied to the wound. Of the physical methods of treatment, quartz treatment, ultrasonic cavitation, UHF and laser irradiation are now used.

Antibiotics for purulent wounds

In severe cases, antibacterial drugs are used to prevent the development of a general blood infection and to more quickly free the wound from infection. If their use is required at the first stage, when the pathogen is still unknown, they are prescribed. They can be used in the form of tablets, injections and topical solutions or ointments. Assign antibacterial drug only a doctor should, after taking an analysis for the causative agent of the infection. After all, the inflammatory process can be caused not only by common staphylococci or streptococci, but also by xybella, proteus, E. coli, and even shigella and salmonella. Most often, sulfanilamide antibiotics are used for purulent wounds, an emulsion of streptocide and sulfidine is applied externally. The best known antibacterial drug is penicillin.

External means to relieve inflammation

At the first stage of the development of the purulent process, it is recommended to use water-soluble products and ointments, it is better if they contain antibiotics. The most commonly used are Levomekol, Levosin and others.

Treatment of purulent wounds on the legs can be complicated by the fact that inflammation is caused by many microorganisms, often even a fungus joins. Therefore, it is advisable to use complex means, for example, "Iruxola". Antiseptic solutions are often used to treat the wound. The most famous of them are "Furacilin", hydrogen peroxide and sometimes turn out to be ineffective due to the appearance of microorganisms resistant to their action. Now new drugs are being produced: Dioxidin, Iodopyron, Sodium Hydrochloride and others.

Folk remedies

The healing of purulent wounds during the regeneration stage can be accelerated by various herbs and other home remedies. They are used both to treat the affected surface, and to strengthen the immune system. Most often there are frivolous purulent wounds. Treatment at home is possible if the focus of inflammation is small and there is no general intoxication. Often, folk remedies are also used in medical institutions, due to the fact that many bacteria have developed resistance to drugs, and besides, they are safer. But their use is permissible only in mild cases, with a small area of ​​​​damage. What can be done to treat a wound?

Most commonly used alcohol tincture or calendula.

Treat the wound fresh juice aloe, plantain leaves or burdock.

For lotions, you can use gruel from grated carrots, radishes, beets or a cut onion.

You can prepare an ointment for the healing of purulent wounds: mix the powder from the herb of caustic stonecrop with petroleum jelly or honey with lard and xeroform. Well cleans the wound from pus mixture of goat fat, salt and grated onions.

To improve tissue regeneration in the process of wound healing, it is used fish fat And sea ​​buckthorn oil.

Complications from purulent wounds

If you do not start treatment on time or treat the affected area incorrectly, complications may develop, or the purulent process becomes chronic. Why are festering wounds dangerous?

Lymphangitis or lymphadenitis, that is, inflammation, may develop lymph nodes.

Sometimes thrombophlebitis appears, especially with purulent wounds on the legs.

The pus may spread and cause periostatitis, osteomelitis, abscess, or phlegmon.

In the most severe cases, sepsis develops, which can be fatal.

Prevention of inflammation

To prevent the appearance of purulent wounds, you must carefully observe the rules of personal hygiene, especially if the skin is damaged. If processed on time minor abrasions and scratches, you can protect them from infection. In addition, it is necessary to strengthen the immune system so that the body can independently fight bacteria that have got under the skin.

Relevance of the topic. The history of the treatment of wounds and wound infection is rooted in the mists of time. Another prehistoric man treated various wounds and damage received during hunting and during military clashes. S.S. Girgolav in his monograph “Gunshot Wound” wrote: “Hardly for any other purpose in medical practice a greater number of individual agents and their combinations, as well as entire methods and systems, have been proposed than for the treatment of wounds. As a result of the scientific and technological revolution in the last 30-40 years, new powerful chemotherapy drugs, antibiotics, immunotherapeutic agents and substances have been obtained that accelerate the cleansing of the wound and its regeneration. The wound care technique itself has improved significantly. New technical possibilities have arisen to maintain asepsis during surgery and wound treatment. There were operating rooms and dressing rooms with sterile air. It became possible to create an environment favorable for its healing around the wound. In view of the fact that wounds and wound infection often occur in the practice of a doctor of any specialty, it seems actual problem applications modern methods wound treatment.

Purpose of the lesson

The student must know : morphology and pathogenesis of the wound process, microbiology of wounds, the state of local and general immunity with wound infection, the clinic of the wound process, local and general treatment of purulent wounds, physical methods to improve the results of treatment of purulent wounds.

The student must be able based clinical examination determine the stage of the wound process, draw up a treatment algorithm depending on the stage of inflammation, perform secondary surgical treatment, perform dressing in patients with various stages of the wound process, be able to choose drugs for the treatment of a purulent wound in various stages wound process. Apply various methods anesthesia, choose the method of drainage, wounds, decide on the timing of suturing.

Purulent (nonspecific) infection - inflammatory diseases different localization and nature, caused by pyogenic microbial flora; occupies one of the main places in surgery and determines the essence of many diseases and postoperative complications.

The factors that determine the onset of development, the course and outcome of diseases associated with infection in surgery are:

1 The state of the immunobiological forces of the macroorganism. With high protective forces of the body, even the entry of highly virulent flora into it can pass without a trace, and, conversely, with their low potential, even saprophytes can begin to behave aggressively and cause a severe purulent process.

2 Quantity, virulence, drug resistance and other biological properties of microbes that have entered the internal environment of the human body. The higher the dose and the higher the virulence of microbes that have penetrated the body, the more likely the development of the disease.

3 Anatomical and physiological features of the focus of microflora penetration Microorganisms encounter significant resistance in areas of the body with good blood circulation. So, on the head and face, where there is a dense network blood vessels, purulent processes develop less frequently than in other areas. plays an important role in preventing inflammation local immunity, which is most pronounced in places of constant contact with the infection. For example, inflammatory processes in the perineum are less common than in other areas, and regeneration processes develop faster here. critical level, in which the inflammatory process develops, 10 5 microbes per 1 g of tissues are considered. Along with this, it takes time to adapt microbes that have entered the wound to a new biological environment. The incubation period is about 6-12 hours, its duration depends on the biological characteristics of the micro- and macroorganism. For this reason, it is believed that the primary debridement most appropriate during this period.

4 The state of general and local circulation.

In addition, the development of the inflammatory process is facilitated by disorders of the blood and lymph flow, the presence of necrosis, hemorrhage, and a number of other factors.

5 The degree of allergization of the patient.

Important in the development of inflammation is the immunobiological state of the body, which is due to such concepts as reactivity and resistance.

The reactivity of the organism, depending on the degree of manifestation, can be normergic, hyperergic, hypergic and anergic.

Normergic reactivity is characterized by an adequate response of the body to the focus of irritation, in particular to an infectious agent. Hyperergic reactivity is manifested by an exorbitant pathological, sometimes tanogenic reaction of the body in some cases to a small stimulus. The classic example is the Arthus phenomenon in pathophysiology, and the clinical example is anaphylactic shock, malignant hyperthermia and other hyperergic reactions, sometimes to the most harmless, at first glance, factors (taking analgin tablets, antibiotics, bee stings, wasps, etc.).

Hypo- and especially anergic reactivity, manifested by a slight or no reaction at all, even in the presence of a severe inflammatory process, usually indicates a serious condition of the patient and is prognostic. unfavorable factor. Examples of such reactivity are normal and low temperature body, reduced. leukocytosis in the presence of a severe purulent process, sepsis.

The resistance (resistance, or resistance) of the infection organism can be normal, increased or decreased.

The normal resistance of the body to the ingress of an infectious agent is manifested by an adequate response, corresponding in strength to the irritant.

Increased resistance, in contrast to hyperergic reactivity, is a positive acquisition of the body, which easily copes with inflammatory process even in the case of a virulent infection.

The reduced resistance of the body in case of purulent surgical infection largely determines the severe course of the disease with the generalization of the process, and therefore therapeutic efforts should be directed to increasing the body's defenses.

Resistance, or resistance, may be specific or non-specific. Specific resistance is due to immunity due to the presence of antibodies to a specific microbial antigen, and nonspecific resistance is determined by the activity of phagocytosis, the level of lysozyme, complement and other protective mechanisms that are designed to protect the body from microbial aggression, regardless of the species composition of the microflora.

Classification of surgical infection

Depending on the type of microflora

1 acute surgical infection: purulent, putrefactive, anaerobic, specific (tetanus, anthrax, etc.).

2 chronic surgical infection:

Nonspecific (pyogenic);

Specific (tuberculosis, syphilis, actinomycosis, etc.).

Along with this, sharp and chronic infection It is advisable to subdivide into general and local.

According to the localization of the lesiondistinguish purulent-inflammatory diseases:

Skin and subcutaneous tissue, muscles.

glandular organs.

Lymphatic and circulatory systems.

Integuments of the skull, brain and its contents

Chest wall, pleura, lungs.

Mediastinum.

Peritoneum and abdominal organs.

The pelvis and its organs.

Bones and joints.

By etiology:

Staphylococcal.

Streptococcal.

pneumococcal;

colibacillary.

Pseudomonas aeruginosa.

Anaerobic, non-clostridial.

Mixed etc.

If the inflammatory process is caused by one pathogen, there is a monoinfection, with several - a polyinfection. It should be noted that the inflammatory process caused by a monoinfection, as a rule, proceeds more easily than a polyinfectious process.

Taking into account the structure of the pathology:

Infectious surgical diseases.

Infectious complications of surgical diseases.

Postoperative infectious complications;

Infectious complications of closed and open injuries

Morbidity and mortality

Surgical infection occupies one of the main places in surgical clinic. Frequency of wounded infectious complications in different areas of surgery reaches 14-20%. About 40% deaths after surgery due to purulent-septic complications.

According to the materials of the All-Russian Congress of Surgeons (Krasnodar, 1995), the frequency of purulent complications in cardiac surgery (up to 26%), in urology (up to 30%), and traumatology (up to 40%) has sharply increased. Mortality in such purulent complications, according to some authors, reaches 30-60%.

Acute purulent infection is an acute inflammatory process of various localization and character, caused by pyogenic microflora. For its development, three elements are necessary:

Causative agents of purulent surgical infection

Purulent-inflammatory diseases have infectious nature, they are caused by various types of pathogens: gram-positive and gram-negative, aerobic and anaerobic, spore-forming and non-spore-forming, as well as pathogenic fungi. Under certain favorable conditions for the development of microorganisms, the inflammatory process can be caused by opportunistic microbes: Klebsiella pneumoniae, Enterobacter aerogenes, saprophytes - Proteus vulgaris. The disease can be caused by one pathogen (monoinfection) or several (mixed infection). The group of microbes that caused the inflammatory process is called a microbial association. Microorganisms can penetrate into the wound, into the zone of tissue damage from the external environment (exogenous infection) or from the foci of accumulation of microflora in the human body itself (endogenous infection).

Entry gate of infection

In the development of the purulent process importance have pathways for the introduction and spread of pathogens.

Damage to the epidermis or mucosal epithelium through which microbes can enter may result from mechanical injury, impact chemical substances and other traumatic factors. The size of the damage is relative. On the contrary, often microtraumas are a particular danger, which consists in the fact that they do not cause significant subjective sensations, often go unnoticed and are not processed.

Through a defect in the epithelium, microbes enter the intercellular gaps, the lymphatic vessels and the lymph flow are brought into the underlying tissues.

The reaction of the macroorganism

The further spread and development of the inflammatory process depends on the number and virulence of the microbes that have entered, as well as on the immunobiological forces of the body. The virulence of microbes is due to their ability to secrete toxins (hemolysin, leukocidin, necrotoxin, etc.), enzymes (plasma coagulase, proteolytic enzymes, etc.) and other biologically active substances.

Based on the foregoing, it can be seen that the form of inflammation depends on the complex interaction of etiological, local and general biological factors, and in the focus there may be a predominant predominance of alteration, exudation or proliferation.

Clinical picture and diagnosis

The nature of the manifestation of the local and general reaction of the body, i.e., the course of the disease, largely depends on the combination of the above factors.

The nature of local manifestations disease is determined by pathophysiological and pathomorphological changes in tissues that develop in the focus of inflammation.

In particular, reactive hyperemia develops at the site of microbial invasion as a protective reaction, which is based on the accumulation of vasoactive substances, metabolites in tissues, and a change in pH to the acid side. As a result of this, blood flow is accelerated, blood flow increases, metabolism increases, respectively, reactive hyperemia has a sanogenic effect and many therapeutic effects designed to achieve it. Along with or after this, the permeability of blood vessels in the lesion increases, exudation and tissue edema increase due to extravasation of the plasma component of the blood. This leads to a slowdown in blood flow in the capillaries, stasis shaped elements, the formation of microthrombi, which causes a violation of tissue metabolism, tissue hypoxia, the development of necrosis and congestive hyperemia, clinically manifested by cyanosis of the skin, venous stasis.

Leukocytes, macrophages and other uniform elements migrate to the affected area, providing phagocytosis, proteolysis of non-viable tissues by proteolytic enzymes of microbes, dead leukocytes and tissues. This leads to the melting and rejection of dead tissues with the formation of a purulent focus, the development of granulation tissue around it and the formation of a pyogenic capsule.

In addition to the progression of the process according to the above scenario, the focus of inflammation can also undergo reverse development, i.e. have an abortive course. In this regard, in the clinical course of the inflammatory process, two stages of development of the local focus are distinguished: serous-infiltrative and purulent-necrotic. The first stage is reversible and subject to conservative therapy, the second is irreversible and requires surgical treatment.

Typical local clinical manifestations The foci of inflammation are:

Ruber(redness),

Calor(local heat)

Tumor(swelling),

Dolor(pain),

Funciolaesa(impaired function).

With the development of purulent diseases, it is possible development local complications: inflammation of the lymphatic vessels (lymphangitis) and nodes (lymphadenitis), thrombophlebitis.

The formation of necrosis is associated with the activity of microorganisms, as well as with a violation of microcirculation due to the inflammatory process. At the same time, black areas appear in the area of ​​\u200b\u200binflammation.

Lymphangitis is a secondary inflammation of the lymphatic vessels. With stem lymphangitis, hyperemia is noted in the form of separate bands running from the focus of inflammation to the zone of regional lymph nodes - to the axillary fossa or inguinal fold. On palpation, painful seals are noted in the form of strands, “cords” along the course of the lymphatic vessels.

Lymphadenitis is an inflammation of the lymph nodes that occurs as a complication of various purulent-inflammatory diseases and specific infections. Lymphadenitis begins with soreness and swollen lymph nodes. With the progression of the process and the development of periadenitis, the lymph nodes, merging with each other and the surrounding tissues, become motionless. The process can go into a destructive form up to the development of adenophlegmon.

Thrombophlebitis - inflammation of the veins, through which the outflow of blood from the area of ​​​​inflammation is carried out. Such thrombophlebitis is called ascending. Usually we are talking about superficial veins. Clinically, a painful infiltrate along the course of the vein is determined, having the form of a tourniquet, a roller. Above it, the skin is hyperemic, may be slightly raised.

Along with local signs, a surgical infection is also characterized by a general reaction of the body, especially in the case of the development of a severe inflammatory process, which is manifested by a number of symptom complexes expressed to one degree or another. Among them, it is necessary to highlight the general symptoms of toxicosis, manifested by weakness, headache, aching joints, bones, muscles, weakness, apathy, as well as the development of fever, increased heat production and impaired thermoregulation.

In the case of a severe course of a purulent process, almost all body systems, to one degree or another, react to the presence of infectious toxicosis.

In particular, on the part of the central nervous system, excitation, euphoria, poor sleep, hallucinations, psychosis are noted, which can be replaced by depression of consciousness, prostration, delirium.

On the part of the cardiovascular system, tachycardia, hypotension, a decrease in CVP or its increase with the development of heart failure, a decrease in BCC, expansion of the boundaries of the heart, muffled tones, the appearance of systolic murmur, ECG changes due to myocardial dystrophy;

Reaction gastrointestinal tract on intoxication is manifested by a decrease or loss of appetite, nausea, in some cases, aversion to food and vomiting, diarrhea or constipation, yellowness of the skin, an increase in the size of the liver, and a violation of its main functions.

The urinary system reacts to purulent intoxication with oliguria, proteinuria, cylindruria, microhematuria, and in some cases anuria and acute renal failure occur.

On the part of the hematopoietic system, there is an increase in the spleen and lymph nodes, their pain, especially regional nodes, the development of leukocytosis with a shift of the formula to the left to young forms, neutrophilia and toxic granularity of neutrophils, increased ESR, hypochromic anemia with anisocytosis and poikilocytosis, hypoproteinemia her, mainly due to hypoalbuminemia with a decrease in the albumin-globulin coefficient, azotemia with an increase in the level of residual nitrogen and creatinine, hyperbilirubinemia due to its indirect fraction, fermentemia with the development of DIC in some cases. The development of multiple organ failure, even with adequate intensive care, often leads to the death of the patient.

Changes in laboratory data

Determination of the severity of the general reaction of the body to the occurrence of a focus purulent infection is of great importance for correct assessment the patient's condition, predicting complications and choosing the best methods of treatment.

leukocytosis, shift of the leukocyte formula to the left, increased ESR.

Changes in biochemical analysis blood: increase in nitrogen indicators (creatinine, urea), acute phase proteins are determined ( C-reactive protein, ceruloplasmin, haptoglobin), a change in the composition of protein fractions (an increase in the number of globulins).

Blood culture for sterility. Produced at the height of fever and helps to diagnose sepsis.

Changes in the clinical blood test: proteinuria, cylindruria, leukocyturia.

Integral indicators of the level of intoxication: leukocyte index and hematological index of intoxication, the level of medium molecules.

Principles of treatment

Character medical measures and their volume primarily depend on the stage of the inflammatory process and the severity of general and local manifestations of the disease.

With a serous-infiltrative stage, the patient is subject to conservative treatment, and with a purulent-necrotic stage, surgical treatment. In addition, treatment can be local, aimed mainly at the focus of inflammation, and general, designed to reduce intoxication and its harmful effects on the patient's body.

Local treatment

It should be noted that the basic principle of the surgical treatment of a purulent process, formed by Hippocrates: “Where there is pus, remove it, where there is pus, there is an incision”, and at present has not lost its relevance and practical significance.

The main principles of local treatment:

Opening of the purulent focus,

Adequate drainage of the abscess,

Local antiseptic effect,

Immobilization.

In the serous-infiltrative stage in order to stop the inflammatory process and direct it to the mainstream abortive course a complex of therapeutic measures is applied. First of all, it is necessary to provide peace to the local focus and the body as a whole, to carry out anesthesia with the help of non-narcotic analgesics, apply blockades with an antibiotic-novocaine mixture, use antibiotics together with sulfonamides, nitrofurans and other antiseptics. Bandages, baths, compresses with antiseptics, such as chlorhexidine, dimexide, dioxidine, furacilin, etc. are shown locally.

The use of physiotherapy procedures (UHF, UVR, diadynamic currents, paraffin, ozokerite, etc.), which increase reactive hyperemia, improve microcirculation, metabolic processes in tissues and give a significant therapeutic effect.

In the purulent-necrotic stage, the main goal of local treatment is to limit the progression of the process, accelerate the release of the focus from purulent-necrotic contents and improve wound healing processes. To do this, it is necessary to resort to timely surgical treatment, during which the purulent focus is opened, necrectomy is performed, and adequate drainage of the purulent wound is ensured. Distinguish between active and passive wound drainage. Active drainage is carried out using tubular drains placed in the wound with their connection to vacuum sources (water jet or electric suction, centralized vacuum system, devices for autonomous wound evacuation, etc.). Along with this, continuous or fractional wound lavage can be used. For passive drainage, swabs with antiseptics are used, hypertonic saline table salt, hydrophilic ointments, as well as tubular drains, rubber strips, cigar swabs, charcoal swabs and other means.

For antiseptic purposes, the use of proteolytic enzymes, ultrasonic cavitation purulent cavity, high-energy laser radiation, plasma jet and other methods. After cleansing the wound from purulent-necrotic masses, to stimulate regeneration and accelerate wound healing, the use of biostimulating ointments (methyluracil, sodium uspinate, sea buckthorn oil, solcoseryl. "Turnip-ref-2", etc.), wound dressings, physiotherapy, low-intensity laser radiation are indicated. (helium-neon, semiconductor, etc.), the imposition of secondary seams.

General treatment

The general treatment of a patient with an inflammatory process should begin from the moment he enters the hospital. Initially, preoperative preparation is carried out, after surgery - postoperative treatment, and its intensity and volume are the greater than the pronounced intoxication.

Common treatments for surgical infection can be divided into four types:

antibacterial therapy,

detoxification therapy,

Immunocorrection,

symptomatic treatment.

Antibacterial therapy.

Antibacterial therapy is carried out taking into account the type and sensitivity of the microflora.

Ways to administer antibiotics.

There is superficial antibiotic therapy (washing of wounds), intracavitary (introduction into the chest, abdominal cavity, into the joint cavity) and deep antibiotic therapy: intramuscular, intravenous, intra-arterial and endolymphatic administration, as well as oral administration. Superficial and intracavitary therapy are topical treatments.

Doses of antibiotics should be the maximum therapeutic to exclude the development of microflora resistance to them. The course of treatment should be no more than 8-10 days, and if necessary, its continuation is indicated by the appointment of another drug with a different mechanism of action on the microbial cell. In this case, an anti-candidiasis drug (nystatin, levorin, etc.) must be introduced into the treatment complex.

Detoxification therapy.

In order to detoxify the body, first of all, it is carried out infusion therapy, the speed and volume of which are determined under the control of the CVP. As infusion media, first of all, in the absence of hemodynamic disorders, glucose-crystalloid solutions are used (5% or 10% glucose solution, isotonic solution sodium chloride, Ringer-Locke solutions, disol, trisol, acesol, etc.), with the help of which, in addition to normalizing the electrolyte balance and metabolic disorders, hemodilution and hyperhydration of the body are achieved, leading to a decrease in the concentration of toxins (the dilution principle). Against this background, in the absence of impaired renal function, a large detoxifying role can be played by forced diuresis, achieved by the introduction of diuretics (furosemide, lasix, etc.). Volume infusion therapy, especially in persons young age, can reach 5-7 liters per day, subject to adequate diuresis (the principle of excretion).

The same goal (detoxification) is facilitated by the binding and neutralization of toxins, for which you can use protease inhibitors (kontrykal, trasylol, tsalol, gordoks, etc.), antihistamines, sorbents ( Activated carbon, biospecific sorbents, etc.), hemodez. neocompensan, polydez, etc. (the principle of binding). Intravenous laser therapy, oxybarotherapy, reinfusion of irradiated own blood with ultraviolet radiation (RUFOSK), etc., have an indirect detoxifying effect.

Methods of extracorporeal detoxification.

Sorption methods promote the removal of hydrophilic and hydrophobic, associated with albumin, substances of medium and high molecular weight.

Main types: hemosorption, plasmasorption, lymphosorption.

Extraction methods based on the removal from the body, along with blood components of all types of toxic substances. The main method is plasmapheresis.

Drainage of the chest lymphatic duct allows you to remove lymph from the body, which is much more toxic than blood in many purulent diseases.

Electrochemical oxidation of blood. The method is based on the use of an active oxygen carrier.

Methods of quantum therapy. Quantum irradiation of blood causes the formation free radicals, functional changes in many plasma proteins, changes the charge and shape of blood cells, promotes the release of biologically active substances. These also include a large autohemotherapy using ozone and an infrared laser.

Immunocorrection.

Immunocorrective therapy is divided into:

- Immunostimulation(activation of immunity), which happens specific– a specific clone of cells is stimulated, and non-specific- increases the overall strengthening of immune protection. Vaccines, serums, preparations are used as immunostimulants. bacterial origin(bronchomunal, ribomunil), pyrogenal, prodigiosan and others.

- Immunomodulation - drug, non-drug (UVI, laser, magnetic field) or other effects aimed at restoring altered links of immunity, and not affecting normally functioning cells and fully occurring reactions. Immunomodulators are divided into preparations of synthetic and natural origin (thymus preparations, bone marrow and herbal remedies).

- Immunopotentiation - influence on the immune system in order to activate immunological mechanisms through immunopotentiating agents and non-immunological regulatory mechanisms. Herbal preparations (chamomile, lemon balm, sage, eucalyptus), as well as preparations synthetic origin(diucifon, levamisole).

Immunosuppression - a type of immunotherapy aimed at suppressing the activity of the immune system. Used in the treatment of autoimmune, lymphoproliferative diseases, transplantation of organs and tissues.