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Infection in Surgery


The main type of surgical pathology. It causes the inflammatory processes are the basis of more than 35% of surgical diseases and complications. To introduce germs into the internal environment of an organism requires "entrance gate", ie violation of the integrity of covers - skin, mucous membranes. The higher dose of pathogens and their virulence and above the weaker defenses, the greater the likelihood of inflammation. Study immunnogicheskih forces and widely used methods of stimulation determine PERSPECTIVES treatment.
Acute infection. Most often it is caused staphylococci, E. coli, streptococci, pneumococci, gonococci, Pseudomonas aeruginosa, and others., Often in symbiosis with anaerobic microorganisms. Caught in the wound bacteria begin to show their ability to live and multiply in it after an average of 6-12 hours. At times, favoring their development, are: a) the presence of injury nutrient medium for their area (hemorrhage, necrotic tissue); b) the simultaneous coexistence of several species of microbes (poliinfektsiya); c) the penetration of microbes increased virulence, for instance, contamination of the injury site purulent discharge another patient; g) the weakness of immune-biological reactions; d) violation of local and general blood circulation in a patient.
On the emergence of bacterial organism responsible local and general reactions. Local tissue reaction. It is expressed above all, a change krovoob-
rashchenija nervnoreflektornoy nature. Develops arterial hyperemia (ie redness of the skin), then venous stasis with formation of edema, there is pain, local (in the wound) increase in temperature, and others. A large number of neutrophils accumulate in the inflammatory foci.
There are hyperergic, normergicheskuyu and gipoergicheskuyu reaction. Suppurative process may be rapid with the rapid spread it on okruzhaschietkani ityazhelymi extensive phenomena. It hyperergic reaction that, in spite of the timely and rational treatment often leads to death of the patient. Sometimes purulent process develops less rapidly. Inflammation capture fewer tissue swelling is small, slight rise in temperature, changes in blood composition are not pronounced character. This normergicheskaya response to pyogenic infections more easily eliminated. In some patients, local abscess occurs when poorly celebrate reaction (gipoergicheskoy). Inflammation in these cases is limited to the process area, the surrounding tissue edema is almost there, lymphangitis, lymphadenitis, thrombosis was observed. Such purulent lesions can be treated easily (and some patients are not), but the main condition - if the reaction is due to a high degree of the body's defenses. Otherwise, the infection takes a languid, but a prolonged duration.
Overall reaction to the introduction of pyogenic bacteria occurs simultaneously with the local. Its degree depends on the amount of bacterial toxins and decay of tissue products as well as the body's resistance. Particularly virulent microbes, highlighting the strong toxins that usually cause severe general reaction of the organism.
Its manifestations are fever, darkening, and sometimes loss of consciousness, headache, malaise, weakness, increased heart rate, pronounced changes in the blood (composition and biochemistry), abnormal liver function, kidney. There arousal or, conversely, sluggishness of the patient, blood pressure, congestion in the pulmonary circulation. The clinical picture is very similar to that in sepsis and some infectious diseases (typhus, brucellosis, etc.), And therefore need takiebolnye vtschatelnom survey to identify the primary purulent focus and the entrance gate of microbes. In patients with severe body's reaction to a local purulent process it is always necessary to avoid possible infection, and sepsis.
Treatment:
It has a number of features related to their specific weight as a result of purulent intoxication. Apply conservative and surgical treatment tactics, the best effect is produced by a complex. The main objectives: 1) The full opening and drainage of purulent lesions. 2) Detoxification all available methods (removal, destruction, adsorbitsiya toxins).
3) Promote patient immunobiological forces. 4) The impact on the microflora of the calling process (destruction or suppression of their activity). 5) Reducing the flow phase of purulent process (brine purification and regeneration of it - healing).






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