ПУТИ УЛУЧШЕНИЯ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ ПОСТРАДАВШИХ С ГЛУБОКИМИ ЭЛЕКТРООЖОГАМИ

Abstract

Aim. improving the results of treatment of victims with electrical injury, through early diagnosis of the depth and extent of the lesion and the introduction of methods of active surgical tactics.Material and methods. We examined 674 patients with electrical injuries admitted to the RSCEMP in the period from 2001 to 2017. the patients used the methods of bilateral comparative dermal thermometry and X-ray densitometry. To assess the severity of burn shock, the indicators of central and peripheral hemodynamics, blood oxygenation, Frank’s index, thermometry and neutrophil-lymphocyte index were assessed. The calculation of statistical indicators was carried out using the Microsoft Excel 2010 software package, including built-in statistical processing functions. The significance of differences between the groups in the quantitative values of the parameters was determined by the Student’s test. Statistical indicators were considered reliable, with p <0.05. Results. It was found that the temperature difference in the armpit and the first interdigital space of the foot by 0.5-1.5 ° C corresponds to a mild degree of burn shock, and in severe and extremely severe burn shock, the temperature difference in these zones was 1.6 -4 ° С and above 4 ° С. It is noted that active surgical tactics by early fasciotomy on the first day of injury and early necrectomy contributes to a significant decrease in the frequency of amputation and disarticulation of the extremities from 55.8 to 9.8%, makes it possible to perform early autodermoplasty, improves the survival rate of autografts and shortens the period of inpatient treatment. Active surgical tactics contributed to an improvement in the engraftability of autografts (95.2% versus 87.4%), a 2.6-fold decrease in the frequency of repeated autodermoplasty at sites of non-engraftment, a significant decrease in the frequency of mutilation operations (amputation and disarticulation of the extremities) and a reduction in the duration of inpatient treatment with 41.1 ± 12.3 to 37.7 ± 10.4 days. Conclusions. Early fasciotomy on the first day of injury and early necrectomy contribute to a significant decrease in the frequency of amputation and disarticulation of the extremities from 55.8 to 9.8%, make it possible to perform autodermoplasty in the shortest possible time and reduce the time of inpatient treatment. The process of osteonecrosis is completed within 2 weeks after the injury, and by this time it is possible to start osteonecrectomy, including one-stage radical osteonecrectomy over the entire surface of osteonecrosis.