Pislyoperatsіynі infectious acceleration in surgery. Prevention of anaerobic infections Diagnostics of anaerobic infections

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Wound anaerobic infection is screwed up to the respect of surgeons, infectious diseases, microbial specialists, and others. The reason is that the infection is anaerobic because of the heavy burden of sickness, the high lethality (14-80%), frequent errors of the disease. Anaerobes and their associations with aerobes in this hour to lay one of the provincial missions in the infectious pathology of people.

Anaerobic infection can develop as a result of injuries, operative involvement, reports, and also in case of accelerated transfer of hospitals and chronic abominable diseases of small tissues and atherosclerotic cases The reasons for the infectious disease of soft tissues, the nature of the disease and the localization of microorganisms, occur in 40-90% of cases. So, according to the data of the authors, the frequency of seeing anaerobes in bacteria does not overtake 20%, but in case of phlegmons of shia, odontogenic infections, and internal diabetic processes, it reaches 81-100%.

Traditionally, the term “anaerobic infection” is used only before infection, when clostridia occurs. However, in the current minds, they do not take part in infectious processes very often, only in 5-12% of cases. The main role is to introduce non-sportive anaerobes. Obviously, offended people see those who have pathological influx on the fabric and organize them in the minds of foreign abnormal hypoxia on the basis of anaerobic metabolism.

Code for MKH-10

A48.0 Gas gangrene

Anaerobic infections

Behind the great rakhunk until the anaerobic infections. However, there is a large group, so called facultative anaerobes (streptococci, staphylococci, proteus, intestinal palichka, etc.),

Anaerobi is widened everywhere. In the slunk-intestinal tract of people, who are the main people of their life, 400 species of anaerobic bacteria have been seen. With a wide range of aerobics to anaerobics, become 1: 100.

Below is a list of the most frequent anaerobes, the fate of which in infectious pathological processes in the body of people is brought to light.

Microbiological classification of anaerobes

• Anaerobic gram-positive sticks
  • Clostridium perfringes, sordellii, novyi, histolyticum, septicum, bifermentans, sporogenes, tertium, ramosum, butyricum, bryantii, difficile
  • Actinomyces israelii, naeslundii, odontolyticus, bovis, viscosus
  • Eubacterium limosum
  • Propionibacterim acnes
  • Bifidobacterium bifidum
  • Arachnia propionica
  • Rothia dentocariosa
• Anaerobic coca
  • Peptostreptococcus anaerobius, magnus, asaccharolyticus, prevotii, micros
  • Peptococcus niger
  • Ruminococcus flavefaciens
  • Coprococcus eutactus
  • Gemella haemolysans
  • Sarcina ventriculi
• Anaerobic gram-negative sticks
  • Bacteroides fragilis, vulgatus, thetaiotaomicron, distasonis, uniformis, caccae, ovatus, merdae,
  • stercoris, ureolyticus, gracilis
  • Prevotella melaninogenica, intermedia, bivia, loescheii, denticola, disiens, oralis, buccalis, veroralis, oulora, corporis
  • Fusobacterium nucleatum, necrophorum, necrogenes, periodonticum
  • Porphyromonas endodontalis, gingivalis, asaccharolitica
  • Mobiluncus curtisii
  • Anaerorhabdus furcosus
  • Centipeda periodontii
  • Leptotrichia buccalis
  • Mitsuokella multiacidus
  • Tissierella praeacuta
  • Wolinella succinogenes
• Anaerobic gram-negative coca
  • Veillonella parvula

In a large number of pathological infectious processes (92.8-98.0% of infections), anaerobes appear in association with aerobes and for all of streptococci, staphylococci and nephritic bacteria of the genus Enterobacteriaceae.

Among the ineffective classifications of anecdotal infections in surgery are the most common and meet the needs of the clinicians in respect of the classification, proponated by A.P. Kolesov from the spyvavt. (1989).

Classification of anaerobic infection in surgery

For microbial ethology:

• clostridial;
• non-clostridial (peptostreptococcal, peptococcal, bacteroid, fusobacterial and in.).

Behind the character of microflori:

• monoinfection;
• polyinfection (cyclical anaerobes);
• zmіshanі (anaerobic-aerobic).

For a lost part of the body:

• Infections of soft tissues;
• інфекції internal organs;
• Infections of cysts;
• Infections of serous empty;
• Infections of the bloodstream.

For the expansion:

• mіscevі, obmezhenі;
• not interchangeable, which may tend to expand (regional);
• systemic or generalized.

For Dzherela Infections:

• exogenous;
• endogenous.

For walks:

• pozalikarnyany;
• internal carnivals.

For the reasons for the disagreement:

• traumatic;
• spontaneous;
• iatrogenic.

Lots of anaerobes є natural sackcloths of shkinny curves and mucous shells of people. More than 90% of all anaerobic infections are endogenous. Before exogenous infections, it is possible to diagnose clostridial gastroenteritis, clostridial post-traumatic cellulitis and myonecrosis, infections caused by human bites and tvarin, septic abortion and malignancies.

It is endogenous anaerobic infection to develop in the event of the appearance of mentally pathogenic anaerobes in places that do not have power for their living. The penetration of anaerobes into the tissue and the bloodstream is carried out before an hour of operative work, with injuries, invasive manipulations, swelling, with translocation of bacteria from the intestine in case of severe septicemia.

However, for the development of infection, there is a lack of simple consumption of bacteria in a non-natural time. For the introduction of anaerobic flora and the development of an infectious pathological process, the fate of preschool officials is necessary, before they suffer a lot of blood loss, tissue ischemia, shock, starvation, stress, reversal. An important role is in the development of patients with diabetes (diabetes mellitus, colagenosis, malignant puffiness, etc.), trivial intake of hormones and cytostatics, first and second immunodeficiency disorders in chronic diseases

One of the main factors in the development of anaerobic infections is the reduction of the partial pressure in the tissues, such as in the result of extravagant causes (shock, blood loss, etc.). a number of shell-shocked, rocked, undead-printed fabrics.

It is non-rational and inadequate to antibiotic-co-therapy, it is mainly based on the suppression of antagonistic aerobic flora, as well as to the non-pereshkodny development of anaerobic flora.

Anaerobic bacteria may cause a number of authorities to allow them to manifest their pathogenicity only when they have friendly minds. Endogenous infections are diagnosed when the natural balance is disturbed between immune cells and virulent microorganisms. Exogenous anaerobic infection, especially clostridial, more pathogenic and clinically anti-infectious, less infectious, non-spore-causing bacteria.

Anaerobi may be the factor of pathogenicity, they take infection in tissue, multiply and manifest ailing powers. Before them enter enzymes, products of life and loss of bacteria, antigens of cells and in.

So bacteria, which are mostly lagging in the early stages of the intestinal tract, the upper parts of the secondary paths and the lower parts of the sectarian paths, the development of these factors, until the end of the period. Important problems of micro-hemocirculation are supervised by increased vertebral penetration, sludge erythrocytes, micro-thrombogenesis with the development of immunocomplexes of vasculature, as well as to improve the progressive generation of interruptions. Heparinase of anaerobes in the diagnosis of vasculitis, micro- and macrothrombophlebitis. The capsule is anaerobic as a factor, it is very fast and responsive, and it helps to bring them to the first place in associations. Secretion of neuraminidase, hyaluronidase, fibrinolysin, superoxidismutase and cytotoxic action by bacteroids to destruct tissue and widen infection.

Bacteria of the genus Prevotella viroblyyut endotoxin, the activity of which transforms lipopolysaccharides of bacteroids, and also produces phospholipase A, which destroys the integrity of the membranes of the epithelial clitin, which leads to consuming

The pathogenesis of the lesion, which is caused by bacteria of the genus Fusobacterium, accumulation of secretion of leukocydin and phospholipase A, causes a cytotoxic effect and lays down invasion.

Gram-positive anaerobic coca normally populate the empty mouth, the intestine, the upper ends of the shorts, the pichva. Virulent and pathogenic power of vivchenia is insufficient, unaffected by those who often smell when developing even more important necrotic processes of localization. Possibly, the pathogenicity of anaerobic cocoons is explained by the appearance of the capsule, including lipopolysaccharides, hyaluronidase and colagenase.

Clostridiums are exogenous as well as endogenous anaerobic infections.

The natural place of living is the soil and the intestines of the people and the creatures. The main genus-forming sign of Clostridia is sporulation, which will summarize its stiffness to the unfriendly factors of the new middle-class.

In C. perfringens, most often develop pathogenic microorganisms, no less than 12 toxin enzymes and enterotoxin are identified, which may cause this pathogenic power:

• alpha-Toxin (lecithinase) is dermatonecrotic, hemolytic and lethal.
• Beta-Toxin - wiklica necrosis of tissue and volodya lethal dynu.
• sigma-Toxin - shows hemolytic activity.
• theta-Toxin is a dermatonecrotic, hemolytic and lethal effect.
• e-Toxin is a lethal and dermatonecrotic effect.
• k-Toxin (collagenase and gelatinase) is a ruined reticular tissue of mucus and semi-tissue collagen fibers, which produces necrotic and lethal effects.
• lamda-Toxin (proteinase) - degrades, similar to Fibrinolizin, denatures collagen and gelatin, enhancing necrotic power.
• gamma і nu-Toxini - create a lethal effect on laboratory creatures.
• mu- and v-Toxini (hyaluronidase and deoxyribonu-clease) - increase tissue penetration

Anaerobic infection in the region is rarely seen in monoinfection (less than 1% of infections). Anaerobic bacteria show their pathogenicity in association with other bacteria. Symbiosis of anaerobes one with one, as well as with some types of facultative anaerobes, especially with streptococci, bacteria of the birthplace Enterobacteriaceae, non-enzymatic gram-negative bacteria, allowing the development of synergistic associations of power

Does it manifest itself as an anaerobic infection of soft tissues?

Clinical manifestations of anaerobic infections, which oppose the participation of anaerobes, are caused by ecology, metabolism, factors of pathogenicity, which are realizable in the minds of lowering the forces of foreigners.

Anaerobic infection, independent of the localization of the region, there are a number of characteristic clinical signs. To them are admitted:

• the wear and tear of the classical signs of infection with the symptoms of foreign intoxication;
• localization of infection in the places of living of anaerobes;
• unacceptable rotten smell of eksudatu, like a trace of anaerobic oxidation of bilkiv;
• perevazhannya processes of alterative firing over the exudative development of tissue necrosis;
• gasification with the development of emphysemia and strengthening of soft tissues for the preparation of poorly dissolving products in water that are anaerobic to the metabolism of bacteria (water, nitrogen, methane, etc.);
• serous-haemorrhagic, haemorrhagic and haemorrhagic exudate from brown, gray-brown color, seen in new small specks of fat;
• staining of wounds і empty in black color;
• development of infection on aphids of trivial consumption of aminoglycosides.

With the presence of a sick person, two or more described viscera is a sign of the participation of an anaerobic infection in the pathological process of the arch.

Gn_no-necrotic processes, which go against the participation of anaerobes, can be cleverly divided into three key groups:

1. The degenerative process is of a muscular character, it is against without a swelling intoxication, it can be quickly stopped if it is a surgical process, or if it is done without it, the ailments do not require intensive supplemental therapy.
2. The infectious process after the critical interruption is practically not related to the invisible gnarial processes, it is hostile, as it is due to phlegmon and other symptoms of intoxication.
3. Gn_yno-necrotic process is bursting, not very malignant; progress, occupying large areas of soft fabrics; important sepsis and PON develop quickly with an unpleasant prognosis of ill health.

Anaerobic infection of soft tissues is not uniform and developmental due to the severity of the pathological processes caused by them, as well as due to the pathomorphological changes in tissue development. Rizni anaerobes, as in both and aerobic bacteria, may suffer from the same type of disease. In the same hour, one and the same bacteria are in the minds of the health problems. However, without affecting the price, it is possible to see a few of the main clinical and pathomorphological forms of infectious processes due to the participation of anaerobes.

The development of serous and necrotic cellulitis, fasciitis, myositis and myonecrosis, combined damage of some tissue and tissue structures.

Clostridial anaerobic infection leads to a rotational aggressiveness. In most cases of ailment, it is important and fast, with a quick development of sepsis. Clostridial anaerobic infection develops in ailments due to the early types of tissue injuries in small tissues and cysts with the presence of singing minds, before which are seen massively obstruction of tissue in the earth, in the early days of lateness of the tissue on the side of the dead Endogenous clostridial is anaerobic infection of vinicum in case of gostrich paraproctitis, during operations on the organs of black emptying and lower symptoms in ailments with obliterated illnesses of judges with children. Before it is developed, it is anaerobic infection, it develops in the case of a human bite, or twarin, one of the drugs.

Clostridial is anaerobic infection against two main pathomorphological forms in vigilance: cellulitis and myonecrosis.

Clostridial cellulite (crepitant cellulite) is characterized by the development of necrosis of the pediatric or intermittent cellulite in the area of ​​the wound. Wine is very friendly. Wide range of times and sizes of unpublished fabrics in a large number of types of clothing.

In sick people with a disease of diabetes and an irregular disease of the lower symptoms, there is less chance for a successful result of ailment, as in the case of cellulose, an infectious process is less likely to appear on the first stages, kistki). There is a secondary gram-negative anaerobic infection with the disease in the necrotic process in the whole complex of soft tissues, loops and cyst structures. To form a vologue of gangrene of the kidney of any segment, in connection with which it is not easy to go into amputation.

Clostridial myonecrosis (gas gangrene) is the most important form of anaerobic infection. The triviality of the incubation period is to become as decimal years up to 3-4 dB. Vinikak is strong, open in early, yak є the most early muscular symptom. It’s when it’s overflowing with no visible change. There is a progressive embankment. The wound becomes dry, it appears stinky with gas bulbs. Shkira nabuvak bronze barn. Internal bulbs are quickly formed with serous-hemorrhagic exudate, midsection of vologic necrosis of crimson-cyanotic and brown barnacles. Flue gas in fabrics є I will familiarize myself with anaerobic infections.

Parallel to the signs of mintsevoy, the zagalny camp of the ailing one is lost. Dysfunctional processes of all organs and systems with the development of an important anaerobic sepsis and septic shock, such as ailment, as there is no need for surgical assistance in general will not be needed at all.

A characteristic familiarity of infection є defeat by the necrotic process of mucous membranes. The stench will melt withered, dark, bleed shitty, do not speed up, swell a brude-brown bartender and give the consistency of "boiled meat". When the process is progressing, it is anaerobic infection, it is easy to switch to the іnshі groups of mucousins, susіdnі fabrics with the development of gas gangrene.

Ridky cause of clostridial myonecrosis and drug use. Lіkuvannya of such ailments є foldable employees. Vryatuvati life is given to some ailments. About one of such vipadk_v to indicate below the history of the ailment.

Anaerobic streptococcal cellulitis and mitosis occur as a result of early injuries of soft tissues, surgical operations and manipulation. The stench is viciously gram-positive facultative anaerobes of Streptococcus spp. і anaerobic coca (Peptostreptococcus spp., Peptococcus spp.). Anxiety is characterized by development in the early stages of predominantly serous, and in the period of necrotic cellulite or myositis and against the symptoms of acute intoxication, it is not easy to go into septic shock. Local symptoms of infection. A load of fabric and a hyperemia does not roll, fluctuations do not start. Gas supply vinikak rіdko. In case of necrotic cellulitis, the cellulite is viglyadu with bleeding, filthy bleeding, gray colora, clearly seeped with serous and serous exudate. Shkіrnі pokrivi to be drawn into the ignition process suddenly: there are cyanotic beaches with uneven edges, bulbs with serous vimist. Urazheni m'yazi viglyadayut swarmed, nasty speed, leaked serous, serous-gn_ynym exudate.

Through zhayugіdnіy muscular clinical signs and prevalence of symptoms of important endotoxicosis, it is not promptly carried out from the beginning. Timely surgical treatment of the ignition burner with intensive antibacterial and disintoxication therapy rapidly digests anaerobic streptococcal cellulitis or myositis.

Synergistic necrotic cellulite vaschke, Shvidkoproprosyuyu gnіyno-necrotic infestation of Klіtkovini, as a result of associative non-clostridial anaerobic infections and aerobes. Poisoning against the non-visible destruction of the cell line and the secondary entrapment in the necrotic process of the susceptible tissues (shkiri, fastsii, myaziv). Shkira most often gets involved in a pathological process. Z'yavayutsya crimson-cyanotic zlivni beaches without a clear boundary, pass more necrosis in vologues with curves. When the disease progresses in the infectious process, a great mass of young tissues and persh are involved in all the diseases, non-clostridial gangrene develops.

Necrotizing fasciitis є synergistic anaerobic-aerobic bistroprogressive gn_necrotic process with lesions of superficial fascias. In addition to anaerobic non-clostridial infection, it is not easy to catch streptococci, staphylococci, enterobacteria and sygnosis sticks, which, as a rule, start, as a rule, in association one with one. In a large number of vapors, the ignition process suddenly gets drawn in for a bottle of wine, shkiri, surface balls. Namely, necrotic fasciitis develops with injuries of soft tissues and operative ones. Minimal signs of infection will prevent you from becoming ill and weary, and we will expand the ruin of tissue, as it appears intraoperatively. Recorded diagnostics and less promptly involved, it is not easy to lead to a fatal result.

Fournier's syndrome (Fournier J., 1984) is one of the types of anaerobic infections. It is manifested by progressive necrosis of the scrotum and the deep-lying tissues of the scrotum with quick lesions in the process of the skin of the perineum, pubis, statical member. Most often, an anaerobic gangrene of the tissue of the crotch (Fourne's gangrene) is formed. Illness develops spontaneously as a result of minor injuries, severe paraproctitis, or other gnarly illnesses in the area and against important symptoms of toxemia and septic shock. It is not easy to end the death of ailments.

In a real clinical situation, especially at the various stages of the infectious process, it will be necessary to complete the description of the clinical morphological forms of disease, which are often anaerobic and anaerobic. Most often in the course prompt engagement Determine the level of decay of anatomical structures in necrotic fasciocelluitis or fasciomyositis. It is not uncommon for the progressive nature of the disease to lead to the development of non-clostridial gangrene due to the infection in the infectious process of all our soft tissues.

The vicious anaerobic necrotic process can be spread on the tissue and on the side of the internal organs of the black and pleural empty, which are affected by the infection. One of the factors, which should be screwed up to the full, is inadequate drainage of a severe gnarium, for example, in case of pleurisy and peritonitis, in the development of such anaerobias it takes almost 100% of cases.

Anaerobic infection is characterized by a brown ear. On the first plan, start to develop symptoms of important endotoxicosis (fever fever, chills, tachycardia, tachypnea, appetite feeling, mischievousness and inn.) If you have a problem, you may have lost a part of the classic symptoms of malignant inflammation (napryak, hyperemia, ailments and inn.) Characteristically, it is often the patients themselves who do not tie their “nezduzhannya” with the micro-ignition process before the start.

There are few caveats, especially with anaerobic necrotizing fasciocelluitis or myositis, if in the muscle symptoms there are only some hyperaemia, or tissue gain in the presence of low blood pressure, bloating Ailments are often hospitalized for the diagnosis of peaks, thrombophlebitis, lymphovenous insufficiency, ileofemoral thrombosis, thrombosis of glib veins, pneumonia and inn. The diagnosis of the important infection of soft tissues for bagatech ailments is fatal.

How can I be anaerobic infection?

Anaerobic infection of soft tissues is differentiated from the onset of diseases:

• gn_necrotic lesions of soft tissues and infectious etiology;
• different forms peaks (erythematous-bullozoan, bullosic-hemorrhagic);
• hematomas of soft tissues with toxicity;
• michurovo dermatoses, important toxico-dermis (polymorphic erythema, Steven-Johnson syndrome, Layul's syndrome and in.);
• thrombosis of glibular veins of the lower bones, ileofemoral thrombosis, Paget-Schrötter syndrome (thrombosis of the subclavicular vein);
• syndrome of tricky tissue crushing at the early stages of illness (at the stage of gnarial acceleration, anaerobic infections begin to occur, as a rule);
• ice cream II-IV stage;
• gangrenous-ischemic wrinkles of soft tissues on aphids and chronic thrombosis-affecting arteries of symptoms.

Іnfektsіynu emfіzemu m'yakih tkanin, rozvivaєtsya in rezultatі zhittєdіyalnostі anaerobіv, neobhіdno diferentsіyuvati of emfіzemoyu іnshoї etіologії, pov'yazanoї of pneumothorax, pneumoperitoneum, perforatsієyu porozhnistih organіv cherevnoї porozhnini in zaocherevinnomu klіtkovinu, operational vtruchannyami, promivannyam wounds i porozhnin rozchinom peroxide Water is the іn. With a wide range of crepitus of soft tissues, you can see the signs of an anaerobic infection.

The intensity of the broadening of a necrotic-necrotic process in case of anaerobic infection is due to the nature of the interaction of macro- and microorganism, due to the possibilities of the immune system against the factors of bacterial aggression. Bliskavichnaya anaerobic infection is characterized by that, but even with the first extension of the pathological process, which is hostile to tissue in great times and supervises the development of important sepsis, uncorrected PON. The whole evil option is to stop the infection from producing more than 90% of the ailments to bend. When the form is ill, such damage in the body develops by a stretch of decilkoh dib. A subacute anaerobic infection is characterized by the fact that the macro- and microorganism is more balanced, and with a quick complex surgical treatment, the result is greater.

Laboratory diagnostics of anaerobic infection is extremely important not only in connection with scientific interest, but also necessary for practical needs. Until now key picture becoming ill є the main method of diagnostics of anaerobic infection. However, only the microbiological diagnostics from the identification of the infectious disease specialist is melodiously told about the participation in the pathological process of anaerobics. Timing for an hour I negatively refer to bacteriological laboratories, in any case it is not possible for anaerobics to develop ailments, since for some reason there are close to 50% of anaerobics є uncultured.

Anaerobic infection is diagnosed with high-precision methods of indication. Prior to them, in the first place, gas chromatography (HRC) and mass spectrometry, based on the reconstruction and improvement of metabolism and volatile fatty acids, were introduced. These methods correlate with the results of bacteriological diagnostics in 72%. Sensitivity of GLC becomes 91-97%, specificity - 60-85%.

Prior to the most promising methods for the detection of anaerobic diseases, including the blood systems Lachema, Bactec, Isolator, prescribing drugs for the detection of bacteria or antigens in the blood, enzyme enzymes, immunoassays

Important to the staff of clinical bacteriology on happy stageє Expansion of the species warehouse for all types of diseases, which take part in the development of the wound process, including anaerobic infection.

Vvazhaєtsya, there is a great part of the infection of soft tissues and cysts of small changes, polymicrobial character. According to the data of V.P. Yakovlev (1995), in case of widespread infestations of soft tissues, regional anaerobes grow in 50% of cases, in some cases with aerobic bacteria in 48%, in monocultures, anaerobes grow in 1.3%.

However, on the other hand, it seems that the role of the facultative, aerobic and anaerobic microorganisms in practice seems to be twisted in practice. In the great world, the folding of the appearance of anaerobic bacteria is explained by virtue of certain objective and sub'active reasons. To the first, it is possible to bring the laxity of anaerobic bacteria, general growth, the need for special possession, high-life midst of specific additives for cultivation and in. Prior to others - the significant financial and vitrati hours, the need for high-quality protocols for rich and complex and bagatorazovyh dosages, shortage of qualified faculties.

In addition to academic interest, the identification of an anaerobic microfloria is of great importance for the etiology of the primary necrotic necrotic disease and sepsis, as well as in stimulating antibiotics.

Below are shown the standard schemes for the production of microflora of the gnarium and blood in the presence of clinical signs of an anaerobic infection, which can become stagnant in the bacteriological laboratory of our class.

Skin dosage is repaired from a gram-stained smear from a large tissue of a gn_ynogo vognisch. The process of advancing with one of the methods of express diagnostics of early infections and, for a period of one year or so, gives an approximate account of the nature of the microfloria, which is a presence in a gnarly war.

It is obligatory to be vicious to get rid of microorganisms in the form of toxic diy acid for whom to be vicious:

• microanaerostat for cultivation of crops;
• commercial gas generator packages (GasPak or HiMedia) for the development of minds to anaerobic disease;
• Indicator of anaerobic disease: sowing P. aeruginosa for Simons citrate in anaerobic sinks (P. aeruginosa Get rid of kidachi citrate, with a wide range of middlings it does not change).

Immediately during the operation, smears and biopsy samples are taken from one locus to the laboratory. For the delivery of samples, special transport systems of several species.

In case of suspicion for bacteremia, it is carried out visually in the blood in parallel in 2 vials (10 ml for dermal) with commercially available means for preliminarily on aerobic and anaerobic microorganisms.

Putting disposable plastic loops on the center spout:

1. for fresh blood razvorya Shedler's agar with the addition of Vitamin K + Hemin complex - for cultivation in a microanaerostat. At the first time, for the establishment of elective minds, a disk with kanamicin is victorious (most anaerobes are naturally resistant to aminoglycosides);
2. 5% blood agar for cultivation in aerobic sinks;
3. in the middle of the preparation for cultivation in a microanaerostat (to improve the appearance of pathogens, tioglycolic abnormal sulfite during adolescence on clostridial infection.

Microanaerostat and a cup of 5% blood agar are placed in a thermostat and incubated at +37 C for 48-72 years. The smears delivered on the glasses are fished for Gram. It’s not bad for the hour of the operation to take a swab of early smears.

Already with microscopy in a number of vypadkіv it is possible to create more information about the nature of the infection, as well as some of the same microorganisms may have a characteristic morphology.

Rejection of pure culture to serve as a means of diagnosing Clostridial infection.

The end of the year 48-72 years of incubation, which grew in the aerobic and anaerobic minds of the colony, were judged according to their morphology and the results of microscopy.

Colonies that have grown on Shedlar-agar are converted to aerotolerant ones (according to the number of skin-type colonies). Їх Зітра in parallel sectors on two plates: from Shedlar agar and 5% blood agar.

Colonies, which have grown on different sectors in aerobatic and anaerobic minds, can be used up to the point of sourness and continue to use the same methods for facultatively anaerobic bacteria.

Colonies, which have grown only in different minds, have grown as regional anaerobes and identified, with a look at:

• morphology and size of colonies;
• the appearance of the presence of hemolysis;
• the manifestation of the program;
• embedded in agar;
• catalase activity;
• childbirth sensitiveness to antibiotics;
• morphology of clitin;
• biochemical specialties to the staff.

Significantly, the identification of microorganisms in the testing of commercial test systems will be significantly reduced, so that more than 20 biological tests can be taken, so that it is not only possible to identify the microorganism, but the first type of microorganism.

Micropreparations of various types of anaerobes, seen in pure culture, are presented below.

The appearance and identification of an anaerobic fecundum from the blood is introduced into the fertile droplets of yak, for example, P. niger culture, seen from the blood of a sick person with a picture of an important wound anaerobic sepsis on the background of phlegmonic stegna.

Some in the warehouses of the associations of microorganisms can be present contaminants, but they do not have an independent ethological role in the infectious-ignition process. The appearance of such bacteria in monoculture, or in associations with pathogenic microorganisms, especially when analyzing biopsy from various types of wounds, may be evidence of a low nonspecific resistance to organisms and diseases. Some of the results of bacteriological pre-illness are not common in important weakened ailments, in patients with diabetic diabetes, with immunodeficient camps on at least young hospitals and chronic ailments.

With the manifestation of the gn_jnogo vognischa in soft fabrics In the case of small numbers of anaerobic infections (clostridial or non-clostridial), the frequency of anaerobic infections, according to our warehouse data, is 32%. The frequency of occurrence of regional anaerobes in the blood with cychic disease is 3.5%.

How can I be anaerobic infection?

Anaerobic infection is mainly used as a method of operative involvement and complex intensive therapy. In the basis of surgical treatment, there is a radical HOGO with more repeated remnants of the great wound and closure with the available methods of plastics.

The factor of an hour in the organization of surgical assistance is very important, but sometimes it is most important. Covering the operation until the widening of the infection on a large area, the death of the patient and the growth of the patient's own risk. The poorly progressive nature of the interruption of anaerobic infection is shown before an extreme or a term operative treatment, as it is guilty that it is guilty for short-hourly before the beginning of the preoperative preparation, when the children are rude in the field. In ailments with septic shock, surgical intervention is possible only when it is stabilized arterial vise and the permission of oligoanuria.

Clinical practice has shown that it is necessary to adapt to the conduct of a widely accepted ten years ago, and not forgotten by the so-called "lambaste" development without a healthy inconsistency. The tactics are similar to the death until the sick people die in 100% of the cases.

In the course of surgical processing, it is necessary to obtain a wider distribution of fabrics, to improve infection, and to start up to the level of visually unchangeable fabrics. The widening of anaerobic infection leads to a change in aggressiveness, to the podolannyy of young pereshkod in viglyadi fascias, aponeuroses and other structures, which is not typical for infections that do not occur at home. Pathomorphological changes in the midst of infections can be very heterogeneous: the serous inflamed dylyans are scorched with the head of the surface and / or tissue necrosis. Remaining can be seen from one place to one at a time. The maximum pathological changes in tissue in a number of types of tissue appear far from the input ports of the infection.

In zv'yazku of zaznachenimi Especially poshirennya at normal body іnfektsіyah guilty provoditisya retelna revіzіya vognischa broken-winded from countless mobіlіzatsієyu shkіrno fats i shkіrno-fascial klaptіv, roztinom fastsіy i aponevrozіv of revіzієyu mіzhm'yazovoї, paravazalnіy, paraneural klіtkovini, group m'yazіv i skin m'yaza okremo. Lack of revision of the wound to lead to an underestimation of the wideness of phlegmon, ossification and reduction of tissue, which leads to a lack of HOGO and inevitable progress of disease with development of sepsis.

With HOGO, it is necessary to see all the undeveloped fabrics, and right away from the obsyagu battle. Vognischa shkіri blіdo-cyanotic abo crimson barbling in the same reduced blood flow through thrombosis sudin. The guilty stench comes from a single block of fat cells. Likewise, you can see all the attacks of the fascias, aponeuroses, mucus and interstitial cells. In areas where є susids with serous empty spaces, great Sudden and nerve stovburs, slopes, with non-correctness, it is necessary to show a singular streak.

Writing to a radical HOBO edge and the bottom of the wound, fold it visually without changing the fabric. The area of ​​the wound during the operation can occupy from 5 to 40% of the surface area. It’s not easy to fight to illuminate even the great wounds on the surface, so as only on the other hand, it’s not correct є A palliative and surgical treatment will inevitably lead to a progression of phlegmon, a syndrome of systemic ignition of a disease and a deterioration in the prognosis of a disease.

With anaerobic streptococcal cellulitis and myositis in the stage of serous inflammation, it is guilty that it is more effective. A wide spreading of fatty valves, circular discoloration of a group of lesions from the spreading of a small blood cell is sufficient for stopping the process with adequate and intensive treatment of anti-toxicity and anti-sprains. In case of necrotic cellulitis and myositis, surgical tactics are similar to those described above.

In case of clostridial myositis in the fallowness of the ossification, there is a lot of myaz, a group or a few of myaz groups, non-published children of shkiri, adipose cells and fascias.

Even in the revision of the operative wound, there is a significant exchange of tissue damage (gangrene or the possibility of remaining) with insignificant prospects of saving the functional health of the picture, then in the given situation the amputation of the disease is shown. To radical vtruchannya in viglyadі usіchennya kіntsіvki slіd takozh vdavatisya from ailments of the great urazhennyam tkanin one chi dekіlkoh segmentіv kіntsіvki at yavischah vazhkogo sepsis i nekorrіgіruemoy pon, if the prospect zberezhennya kіntsіvki zagrozhuє vtratoyu Zhittya patsієnta and takozh at bliskavichnomu perebіgu anaerobnoї іnfektsії.

Amputation of the disease in case of anaerobic infection of its own peculiarity. Vaughn is carried out in a circular way, without the formation of shkіrno-myazovyh valves, in the boundaries of healthy tissues. For rejection of the big kuksi of the picture A.P. Kolesov with sp_vavt. (1989) to carry out amputation at cordon of pathological process with rosin and breeding of soft tissues of kuksi. In all vipads, the wound of the stumps is sewn in, it is carried out with a puffy tamponade with ointments on a water-borne basis, or with iodophoria. A group of patients who have had an amputation of the picture, are the most important. The risk of lethality, not affecting the complex intensive therapy, is high - 52%.

Anaerobic infection is characterized by the fact that it is hot to wear prolonged character due to the reliance on the phases of the wound process. The phase of wound cleansing from necrosis is dramatically delayed. The development of granulation will be trapped in a connection with polymorphic processes in the soft tissues of processes, which is tied to coarse microcirculatory damage, secondary infections of the wound. In the same way, there is a need for repeated surgical processing of gnarly-necrotic disease (Fig. pulsating stream of antiseptic, ozonation and in.). Progress in the process of expanding anaerobic infection on new dilyanka to serve the demonstration until the extreme repeated HOGO. It appears from the stage of non-correctness of the energetic only due to the rapid suppression of the muscular fusion-ignition process and the manifestations of SIRS.

The most acute period of surgery in patients with an important anaerobic infection, it is necessary to take place in the minds of reanimation, if an intensive disintoxication therapy, antibiotic therapy, disability is carried out. It is shown before the transfer of a sick person in the surgical procedure to the stationary to serve as a positive dynamics in the recovery of the wound process, completion of the stage of repeated surgical treatment of the disease, and in some cases of plastic surgery,

Antibiotic therapy is an important Lanka in the treatment of ailments from such ailments, as anaerobic infection. I will look at the microbial etiology of the primary necrotic process, the first for everything, the drugs are recognized wide range diy, including antianaerobic preparations. Most often, such combinations of drugs are used: cephalosporin II-IV generation or fluorochinoloni in combination with metronidazole, dioxidine or clindamicin, carbapenemi in monotherapy.

Control over the dynamism of the early process and sepsis, microbiological monitoring of the vision from the wounds and the other biological centers, allow you to bring free correctives to the change of the warehouse, and the method of introducing antibiotics. So in the course of the treatment of important sepsis on the background of an anaerobic infection of the antibacterial therapy scheme, it can change from 2 to 8 and more times. Shown before the beginning of the day to serve the style of suppressing the igniting symptoms in the first and second ones in the first place, starting the wounds due to plastic involvement, the negative results of the blood and the appearance of the fever in the last decade.

An important component of a complex surgical treatment of ailments from anaerobic infections and diseases of the wound.

The stagnation of that chi іnshih ligation rate planes in the fallowness of the stage of the wound process, pathomorphological changes in the early, the type of microflora, as well as sensitivity to antibiotics and antiseptics.

In the first phase of the wound process in the form of anaerobic and / or malignant infection with preparations of vibor and ointment on a hydrophilic basis with an antianerobic dosage - dioxycol, streptonitol, nitacid, iodopyrone ointment, 5% dioxidine ointment. If gram-negative flora is evident in the early stages, ointments on a hydrophilic basis are formed, as well as antiseptics - 1% of iodophoria, 1% of dioxidine, miramistin, sodium hypochlorite and sodium.

In the rest of the world, we are widely used for the aplication-sorption therapy of wounds with biologically active swelling sorbents of multicomponent action for the early process such as lizosorb, Collado-sorb, diotevin, anilodiotevin. The purpose of the treatment is to rotate anti-firing, hemostatic, anti-bacterial, anti-microbial action practically on all types of bacterial flora, allowing the health of necrolysis, repetition of the wounds in the form of toxins in the gel, and sorbing The stagnation of biologically active draining sorbents allows in the early term a necrotic process, ignition in the area of ​​injury and preparation up to plastic closure.

Osvita of great wound surfaces, which are found as a result of surgical treatment of a widened nasty war, creates the problem of yaknayshvidshih zakritta by different types of plastics. Viconuvati plastics need to be done earlier, as long as the wound and the sick will allow. Practically, the plastic should be given not earlier than the end of the other - the ear of the third type, which is tied to the peculiarities of the course of the wound process described in an anaerobic infection.

Early plasty of a gnarly wound is involved in one of the most important elements of a complex surgical treatment of an anaerobic infection. Yaknayshvidsha lіkvіdatsіya great defektіv runs through SSMSC zdіysnyuєtsya massive vtrata bіlkіv i elektrolіtіv, vіdbuvaєtsya kontamіnatsіya Rani gospіtalnoї polіantіbіotіkorezіstentnoy Florio of zaluchennyam tkanin in vtorinny gnіyno-necrotic Process, Je pathogenetic vipravdanim i neobhіdnim hіrurgіchnim sunset, spryamovanim on lіkuvannya sepsis i pereshkodzhaє Yogo progresuvannyu.

In early terms of plastics, it is necessary to use simple and the least traumatic methods, before carrying out the plastics with muscular tissues, dozing the tissues without stretching the tissues, ADP, and combining these methods. I will (one-time) shkіrnu plastics vdāsniti in 77.6% of the ailing. In the case of 22.4% of ailments, there is a defect due to the peculiarities of the early process and its spaciousness.

Mortality in a group of ailments, for example, a complex of plastic interventions, which is 3.5 times lower and lower, less in a group of ailments, where plastic was not carried out, but was carried out in the middle of the term, approximately 12.7% and 42.8%.

The initial lethality in case of severe anaerobic infection of soft tissues, with the broadening of the necrotic necrotic tissue on an area of ​​500 cm 2 becomes 26.7%.

The knowledge of key features will allow the practical surgeon at the early stages to find it, and it is not safe for the life of a sick person, as an infection and planning complex of early diagnostics and any other Timely radical surgical treatment of the great necrotic-necrotic disease, repeated stages of necrotic surgery, early plastic surgery in conjunction with a complex component-based intensive therapy and adequate antibacterial dosage of the disease

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The Danish hour is principled a new problem gniynoyinfektsii became suppurations, viclikans non-sportive anaerobes.

In 1861-1863, Pasteur first described the possibility of developing bacteria without access to food. Indication of anaerobic disease and the introduction of a number of anaerobic bacteria gnіynykh accelerated already on the cob XX century made it possible to see three groupies Anaerobic infections. persha - Botulism and right, friend- clostridial gangrene of soft tissues. The stench, due to the characteristic class and the peculiarities of the animals, were respected by specific infections, as they become an insignificant part in the backward transmutation of anecdotal infections of people. The third group -"Banal" nasty-rotten processes But, as a rule, for the fate of indisputable anaerobes, they become the most important category of ill-fueled illnesses.

In 1898, when a person was sick with destructive appendicitis, anaerobic bacteria were first identified with pre-existing pus from a void with a destructive appendicitis. In the course of time, premonitors should be aware of the presence of asporogenic regional anaerobes in the presence of surgical localization, as well as clarify the basic way of living in the organisms of people.

However, the technology of robots for anaerobes was even more important, and for anaerobes in a gn_ynik it is not easy to supervise aerobes. As a result of the infection, it became not so bad, as it would be, if a clinical microbiology was introduced as a microbiology of aerobics and anaerobics in the early world.

Significant respect for the non-sportive anaerobes of the clientele in the early 60s of the 20th century, since the Polytechnic Institute of Virginia Bilk understands the methods of cultivation, the vision of and non-identification The advances in laboratory technology allowed Moore, already in 1969, to establish that non-spore-forming anaerobics were detected in 85% of cases with bacteriological pre-existing material. With such a rank, it was for the first time brought about the rearing of asporogenous anaerobes in case of gniynoyinfektsii over usima potentniy zbudniki.

In our country, the priority among the population of anaerobic infections among people is to establish the St. Petersburg Medical Academy (Kolesov A.P., Stolboviy A.V., Borisov I.V., Kocherovets V.I.) and the Institute of Medical Sciences. A. V. Vishnevsky (Kuzin M. I., Kostyuchenok B. M., Kolker I., Vishnevsky A. A., Shimkevich L. L., Kuleshov R. I.).

The lucky stage in the vivchenna of infection is justly vvazhayut the era of the revival of the vchenya about anaerobi, which they call "zabutoyu" microflora.

Ethiology and pathogenesis. In the given hour, it was established that non-spore-forming anaerobes є the pathogens of gn_infections from 40 to 95% as a warning (Kolesov A.P. ta spivavt., 1989; Kuzin M.I. and sp_vavt., 1990; Kocherovets V.I., 1991; Bezrukov V.M., Robustova TT., 2000; Leshchenko IT., 2001; Sharogorodskiy AT., 2001; Finegold SM, 1980; Bachetal M., 1988; Maddaus M. et al., 1988).

The majority of anaerobic non-spore-promoting bacteria є with anaerobes, i.e., To tolerate the presence of acid in a concentration of 0.1-5%. The stench lingers in the mouth emptying, in the intestinal tract, in the nasopharynx, in the genitalia, on the skirts of the people. In the given hour, representatives of non-spore-forming anaerobic microorganisms in the early canopies (Finegold S. M., 1977):

Gram-positive anaerobic coca: Ruminicoccus, Peptococcus, Peptostreptococcus;

Gram of anaerobic coca: Veilonella, Arachnia;

Gram-positive anaerobic bacteria: Actinomyces, Lactobacillus, Bifidobacterium, Eubacterium;

Gram of anaerobic bacteria: Bacteroides, Fusobacterium, Butyrivibrio, Campilobacter.

The cyclones of asporogenic anaerobes include up to dozens of species of henchmen, which can be seen for morphological signs, pathogenic powers and the level of sensitivity before chemotherapy.

Based on the results of the last and foreign ones, it was established that the microflora of the foreign vognisch to be of a polymicrobial character and is represented by viglyadi associations. At the same time, non-clotting anaerobics prevail in the etiology of dental infections (Kocherovets V. I., 1990; Vgook I., 1988).

Frequently, the aerobic-anaerobic association shows synergy. Tse pidtverzhutsya classy warnings. So, the association of species of microbes, which are of little pathogenic environment, often viciously important and infectious, but not against the development of destructive-necrotic processes and sepsis (A. Kolboviy, P., 1989; etc.).

Awareness of pathogenic aerobes in the presence of facultative-anaerobic microorganisms has been brought. At the same time, the most typical are the second generation of species of bacteria and fusobacteria with intestinal palichkoy, proteum, aerobic coccal microflora (Borisov V.A., 1986; Kocherovets V.I., 1990; Leshchenko IT., 2001). The price of provision and our presentence (Leshchenko I. G., Novokshe-niv B. C., 1993), in which without a special selection of bullets 180 sick from a wide range of infectious diseases localization from the establishment of aerobic-anaerobic microbiological methods. Otriman's data showed that purely aerobic microflora was seen in 33.9% of classroom wards, aerobic-anaerobic - in 37.2%, non-clostridial anaerobic - in 20%. In 8.9%, anaerobic clostridia were susceptible to some germs. However, in all vipads, the appearance of anaerobic Clostridia did not appear clinically. Bulo was established, with the main causes of anaerobic non-clostridial infection (ANI) bacterioids (38.3%), peptostreptococci (27.3%) and peptococci (17.8%). The other canopy of asporogenic anaerobes are seen significantly higher - from 0.8 to 2.3%. The frequency of the manifestation of ANI is due to the nature of the localization of the ignition process, and it rises in the boundaries of 33.3% with post-traumatic inflammation of soft tissues up to 77.8% with severe infection of soft tissues individualsі shiї.

The pathogenesis of anaerobic non-clostridial and malignant infections is caused by three mutual exchanges of officials:

Localization of the infection;

By the type of pathogen, its pathogenicity and virulence;

Immunological and nonspecific reactivity to the body.

Appointment of power to create the opportunity for the appearance of non-clostridial anaerobes in non-powerless living places. Most often ANI grows close to mucous membranes, when bitten by humans or creatures.

Pathogenetic mechanisms of endogenous infections, which are prone to non-spore-causing anaerobes, as long as there is a lack of vaccination. Їх pathogenicity is imovirno pov'yut with the manifestation of their toxic polysaccharides and proteins. Osvita capsules in some species of bacterioids can be seen as a pathogenetic sign (Ezepchuk Yu. V., 1985; Tabachaji S. et al, 1982; Brook I. et al., 1983).

Significant in the pathogenesis of ailments, how to suffer from as-porogenous anaerobes, may ferment mothers, and how to avoid tolerance to a sour tissue and navkolishny middle; superoxide dismutase and catalase (Bergan T., 1984; Bjornson A., 1984), as well as enzymes, antibiotics(Tajama T. et al, 1983).

Bacteroids have the ability to seize antibiotics and species of bacteria, so that they can be found in associations (Brook I. et al., 1983). Tse maє more important for clinics, so as to reveal the reason for unsuccessful antibiotic therapy in case of small infections due to the participation of bacteroids.

АНІ counter, as a rule, on the secondary immunodeficiency - the imputation of clitine and humoral immunity (Vasyukov V.Ya., 1974; Korolyuk A.M. and spivavt., 1983; Glynn A., 1975). At the same time, a decrease in the absolute and relative number of T-lymphocytes, a decrease in the concentration of immunoglobulin and complement is being restructured. Depression of the opsono-phagocytic system and destruction of leukocytes is evident.

Klinika. In connection with the difficulties in the organization of microbiological dosages in wide dental practice, the basis in the diagnosis of ANI is to serve as a clinical symptomatology.

Oskіlki at ANI іnfіkuvannya vіdbuvatsya Autoflora, an important clіnіchnuyu especialty є winnіnіnіa fired up close to the natural life of anaerobіv. In case of infection of soft tissues, the shell of the company can be mutilated with such muscles.

Naybіlsh typical clinical picture of ANI develops in case of severe soft fabrics of the type of poured, without cordon - phlegmon. At the same time, the shkіra has been changed into the menshіy world. The infectious process develops, as a rule, in pediatric fat cells (cellulitis), in fascias (fasciitis), in myases (myositis). Firing can come as all anatomical statements, so it is important one of them.

Gn_iniks, in which they are set to take on the fate of anaerobes, are characterized by great growth. Misty classic signs of fading soft tissues at the touch of the cymb are weakly turning, but, as a rule, I do not see any symptoms of infection. At the same time, he was amazed at the inconsistency of ignition changes on the screen and the extensive reduction in the tissue: fodder fat cells, fascias, mucous membranes. At the same time, on shkіrі inodі you can be dull, very painful when palpating with beaches - "tongues of half" (Salskiy Ya. P., 1982).

From the beginning, there is an intense stinky rotten smell, which is a great deal of surgery before the vegetation of the intestinal stick. However, in 1938, W. Altemeier showed a smell that is specific for anaerobes (cited: according to A.P. Kolesova and spivavt., 1989). In connection with the cim Tally and Gorbach (1977), it means that I want the smell є pathogomonic, but in 50% of the types of infections, they can be seen.

From the wound, a poor serous exudate is often caused by a dark gray color, to avenge specks of fat and fragments of necrotic tissue. If eksudat take revenge on shelter, then yogo color can be intensely nasty.

The presence of gas in soft tissues is typical for bacterioids, anaerobic streptococci and corynebacteria. As a rule, it doesn’t get so sharp as with Clostridial infection. Before the opening of the gaseous burnout of the gas supply, it is possible to confirm it by x-ray, the splinters of the breakdown, as a sign of gas supply, do not occur often. In the first days of the ANI diagnosis, it is not possible to develop subicterity of the sclera and sclera during the period of exposure to microbes and toxins, hemolysis of erythrocytes and toxic liver disease (Smitin et al.

With a respectful look at the wounds, it is possible to visit the area that is defeated by the infection. For non-clostridial necrotic cellulitis, melting of fatty cells without a tendency to abscess is characteristic. However, with the concomitant staphylococcal infection of the pediatric patient, Klitkovin on the basis of the distribution of the nagadu "gniynі stylniki". In case of an interlocking process, the skirting above the vognisch is slightly changed. If there is a great deal of damage to fabrics, then the necrosis of the skin is caused by the destruction of the tissue. During the transition to the process of fascial disease, a dark color swells, a wider structure in conjunction with lysis. In exudates there are urivi of necrotic fascias.

With the development of infection in the meat, the stench will melt into swarms, vyyalimi, siro-chervony kolora, dark. Do not bleed on rozrіzі, at the same time there are large zhovtuvatі dіlyanka easily tearing tissue, leaking serous-hemorrhagic visions.

In case of severe myositis, it is necessary to carry out a differential diagnosis of both ANI and clostridial myositis. A slid of memory, which is characteristic of the new hospitality, an ear of disease, swelling of local pains, but not to pass through the introduction of narcotic analgesics. The colors of boiled meat can be easily swollen and prolapsed from wounds, it is easy to crumble like dots with pincers, leaked with a grain of brown exudate. The current view of wounds and navkolishnykh tissues, on the basis of ANI, allows, as a rule, the formation of changes about the depth and breadth of the pathological process.

Let's start with the characteristic sign of ANI є in the direction of confidence in the phases of the wound process - suppuration and purification. So, the phase of suppuration with a spontaneous interruption is 2-3 times. Weakly disturbed macrophage reactions lead to non-effective wound cleansing. Reparative processes of control in cases of secondary suppuration of granulations and bends (Kuleshov S.S., Kaum R.I., 1990).

With such a rank, muscular clinical signs of an anaerobic non-clostridial infection є:

The inconsistency of mіzh weakly swirling classic signs fired on skіrі and great different types of small fabrics: pedunculated clitches, fascias, muses; from a gn_ain wound, a stinking rotten smell is seen;

The vision from the wound is a wretched, gray or dark gray color, to avenge specks of fat and fragments of necrotic tissue changes;

Inodі in fabrics є gas;

For non-clostridial necrotic cellulite, melting of fatty cells is characteristic;

During the transition to the process on fascial symptoms, the fascial swelling of a dark color, a widespread structure in conjunction with її lisis. In exudates there are urivki of necrotic fascias;

With the development of infection in the meat, the stinks melt into swarms, vyyalimi, siro-chervony kolora, dark; do not bleed on rozrіzі, with great zhovtuvaty dіlyankas it is easy to tear tissue, leaked serous-hemorrhagic visions. Hirurgi, who may be the great news of the diagnosis of the ailments from ANI, back, but the restoration to find two of the descriptive key points of knowledge should be given a diagnosis of Nekla acute taus, M., 1989; 1990 .; Leshchenko I. G., Novokshenov BC, 1993).

Zagalna reaction organism with ANI, toxic-resorb-normative fever is manifested as a result of wetting of products from the wound, tissue and microbes, and toxins. Signs: nezduzhannya, headache, chills, increased temperature, darkening in important drops, or the loss of svidomosti, rukhove zbujennya, madder. The variability of these symptoms lies in the spaciousness of the ear tissue, the peculiarities of the severe wound and the generality of the surgical treatment.

Diagnostics. Yak can be seen, for the classy manifestation of ANI characteristic deyak of particularity. However, the specificity of the symptom-complex still does not change, but it is anaerobic that non-clotting monoinfection is developed (1.3-20%); In the case of cich vipadkakh, clinical diagnostics cannot have an independent, provincial meaning. Tim bolshe, you won’t transfer the performance of the ethological diagnosis, which is necessary for the organization of effective antibacterial therapy.

There is a role in the development of ANI, it’s crazy, to lay the laboratory microbiological methods in advance. Among such methods of diagnostics, such as microscopic, bacteriological, immunological, biological, chromatographic, not all of them are known to be practically fixed in the analysis of ANI.

At the hungry CLINIC PRACTICE for express diagnostics of the ANI perevagu, the microscopic examination of the wound smear, prepared according to Gram, and gas-liquid chromatography is shown. Victory of bacterioscopic exudate allows already in 10-15 minutes to judge about the microflora, as it will take part in the suppuration. However, in a large number of ANI students, there are morphological features that allow differentiation between different types of bacteria and optionally different types of bacteria, which can be classified into one genus. The informativeness of the microscopic method is significantly increased in the course of the modification of the smear test according to Co-Pelovit (Kocharovets V. I. et al., 1986). Three of the results with bacteriological tests in the diagnosis of gram-negative anaerobes were estimated at 72.7% of the warning (Kolker I. I. Spivavt, 1990).

Ultraviolet analysis of the native smear allows the identification of B. melaninogenicus according to the characteristic appearance of colonies. In the case of gas chromatography in pre-existing materials, specific for anaerobic bacteria of volatile fatty acids appear. Practically significant chromatographic analysis, which borrows close to 60 minutes, is large, unaffected by those that do not all asporogenny anaerobics in the process of metabolism set up fatty acids. In a given hour, the method of gas chromatography preserves the confirmation of clinical diagnostics in case of ANI of soft tissues from 5 to 58% (Kuzin M.I. and spivavt., 1987; Shimkevich L.L. and spivavt., 1986; Іstratovt. spivavt, 1989).

Achieve a high rate of analysis of ANI with a one-hour test of chromatographic and bacteriological methods - from 52 to 97% (B.A. A., 1989).

However, the main method of ethiological diagnostics is ANI є Bacteriological. It is unimportant for those who do not need to be technically foldable and trivial, depriving the method of being able to lend themselves to the curtain of the children’s powers, allowing the most accurate and generally based on the ethological structure of the burned.

For special medical installations, which may not be standard anaerobic diagnostic laboratories, it is possible to carry out bacteriological diagnostics (Bochkov I.A., Pokrovskiy V. I., 1983; Kolker I. I., Borisova O. I.).

The first stage of microbiological reading is є edbir, zbir and delivery of preliminarily material, which is carried out according to the singing rules. An hour, which has passed between taking material and cultivation, will be minimal.

Another stage is microscopic advancement of a native smear, framed by Gram, - it allows the creation of microorganisms about a number of microorganisms and gram-accessories, and serves as a control of the later appearance of anaerobics.

The third stage is the sowing of preliminarily material to the living middle ground, the extravagant particularity of those є the presence of reductive words in them, which are necessary for lowering the pH of the middle ground. Here you can use a number of methods:

1. Seeding the culture with an injection of red agar into a visoky stovpchik.

2. Vidalennya povіtrya vikachuvannyam (victoriannya of ana-erostats of rіznіh types).

3. Replacement of power supply with indifferent gas (warehouse and supply of gas sums can be made up of different types).

4. Mechanic zahist in the midst of food (method of Vinyal-Veyon).

5. Chimіchny poglinannya kisnyu povіtrya (for example, a lull of pyrogallol).

Quarter stage - viroshuvannya of anaerobic bacteria. At the same time, it is necessary to be able to grow up with a growing speed.

P'yaty etap - a vision of pure culture.

The first step is the identification of anaerobic bacteria. Vaughn ґruntuєtsya on vivchennі morfologії i klіtin culture її Especially, bіohіmіchnih reaktsіy (s vikoristannyam modifіkatsіy systems apb i Minir. Ec), ruhlivostі, zdatnostі to sporoutvorennya, chutlivostі to antibіotikіv, produktsії pіgmentu i t. D. Іdentifіkatsіya anaerobіv for viznachennyam їh produktіv carried fermentatsії for the help of gas chromatographs, with the whole term of setting the diagnosis I do not change for 1 year. A promising method for identifying anaerobic bacteria behind an additional computer. Kene and Ke1 ^ has been broken down a program for a computer, which includes 28 screens and 238 types of anaerobes, including biochemical and chromatographic tests. The system is designed for quick, accurate and highly productive development of non-home crops. Hour of identification in decile seconds up to 40 minutes.

We re-insured methods of folding and labor, providing special equipment and qualifications for medical personnel. To this, the actual problem of the development of vіtchiznyh express-methods and systems і systems, wіll not provide timely diagnostics аnd adequately lykuvannya ailment, scho wiklikayutsya with anaerobic bacteria.

In tsomu vіdnoshennі nashі spіlnі vosmirіchnі NAUKOVO-praktichnі doslіdzhennya (Department vіyskovo-polovoї hіrurgії Samarskogo vіyskovo-medichnogo іnstitutu i Department of Samara mіkrobіologії Who sovereign medichnogo unіversitetu) completed rozrobkoyu novoї zhivilnogo seredovischa for kultivuvannya aerobіv yak, so i anaerobіv (Buchin that P. I. spivavt., 1989). At the core of the base of the bicorisation is glucose indicator agar, which is used to release the Makhachkala NDI of the living centers. Our colleagues, microbiologists, have been developing, testing and patenting thermostable, prozorium stimulant to the growth of microbes in asporogenic anaerobes. The drug is prepared on the basis of blood milk microbial hydrolyzate and to replace a number of other growth spines. Wine is thermostable, to be sterilized in an autoclave at 0.5 atm for 30 minutes. Save in the refrigerator. Before glucose-indicator agar, it can be added in the quality of 10-15% of the middle, so it is possible to fill the eyes of the violet colors in sterile drains and pour it into the Vinyal tubes.

Aerobic pyogenic bacteria, as well as anaerobic-peptococci, pep-tostreptococci, develop on piece, lively middlings. For bacteroids (obligate anaerobic gram-negative mace-shaped bacteria), characteristic growth patterns. At the end of the cycle, there is a visual assessment of the results after the seeding of the material before the first time in the Vinyal pipe, it will take five days (the border term is cautious), and on the middle of the border, it will take three days. About the process of changing the color of the indicator living substrate, as well as the establishment of microscopic colonies in the middle, easily removed from the small microscopic microscope (object 10x) with the microscopic tubes of the side of the sample.

For the development of all asporogenous anaerobic pathogenic bacteria, fermenting to acidic acid is characteristic of the fermenting medium in carbohydrates, a change in the color of the substrate from the cob violet to the zhovty without the appearance of puffy gas in the comrades is characteristic. Virazhene of gas supply on the other side of the middle in the pipes is typical for anaerobic clostridia (potential diseases of gas gangrene), as well as some optional anaerobic bacteria, as if they will stop growing in strictly anaerobic.

For growth on the beveled middle in the samples of staphylococcus, streptococcus and proteus, a change in color to the substrate from cob purple to zhovtiy is characteristic, for blue-green bacteria - from violet to blue. For escherichi is characterized by either the visibility of the violet color of the middle in the case of massive growth, or the restoration of the substrate - in the case of the grown growth.

When the results are presented, after the seeding of the preliminarily material according to the Vinyal-Veyon method, on the beveled middle, it is necessary to use the data, pointing in the table. eleven.

Table 11

Evaluation of results in aerobic-anaerobic sowing of pre-juvenile material

You can vvvazat, who first described the key manifestations of anaerobic infections given by his ancestors Hippocrates. The works of Galen will guess about the appearance of a "povitrya" in the area of ​​wounded m'yaziv. Ambroise Paré, obviously, describing an anaerobic infection under the name "hospital gangrene". The works of M. І. Pirogov's class of anaerobic infection of wounds is described in detail under the names of "muscular stupor", "methic gangrene", "gostry evil nabryak". In the "Ambushes of the Foreign-Polish Surgery" N. І. Pirogov said that "the persha is a sign of the transition of an acutely severe and infiltrated infiltrate into gangrenous є trisk (crepitacy), which is a sign of the transition from the shkiroi."

In 1899 r Lіdental і Hіchman (0. Lidenthal, F. Hitschman) after 7 years of writing CI. perfringens Welsh and Nuttall (W. H. Welch, G. H. F. Nuttall) correctly assessed the role of the microbe in the diagnosis of anaerobic infections; the stench wrote that the winery became ill as a result of the infection, but the main role was to be CI. perfringens. Death is the result of toxemia. Toxins are seen as microbes and appear as a result of the distribution (proteolysis) of the bottle.

Anaerobic infection of wounds in the peace hour is very rare, because the main statistical material is presented before the hour of peace. The frequency of anaerobic infections, such as accelerated wounds, depends on the factors that are most important - the nature of the injury, the term and the quality of the necessary surgical aid.

The frequency of anaerobic infections, according to the statistical data of Radianskih surgeries, rotates in the advancing figures: according to the data of M.N. Akhutin, the frequency of anaerobic infections every hour of battles for Lake Khasan (1938) dropped 1.5%; per hour of battles in Mongolia (1939) - 1.4%. Per hour of Radiansko-Finnish war (1939 - 1940), the frequency of anaerobic infections, according to M.N. Akhutin, is 1.25%; according to N.N.Burdenko - 0.8%; by S. І. Banitesu - 0.8%; according to B.A.Petrov - 2-4%; according to M. B. Rivlin - 2.4%.

According to the data of foreign authors, which should lie before the rock of the Other light, the frequency of an anaerobic infection should be: according to WA Altemeier -4.2%, according to F. Langley - 1.6%, according to Fisher and Fіlor , M. H. Florey) -0.15%. If the numbers are adjusted, it is possible to come before the visit, where the infection of the veins' wounds is anaerobic in about 1-2% of the wounded. The significance of the peculiarities and localization of wounds can be characterized as follows:

According to statistical materials, 58-77% of all types of anaerobic infections were found in the wounds of the lower children (I. V. Davidovskiy). For the materials of the authors (I. Sh. Blumin, I. B. Kolodner, A. N. Berkutov and others), the largest number of cases of anaerobic infections (35.8-46%) fell on a wounded stegna. Another place is occupied by wounded women, in some cases, 27 to 35% of cases of anaerobic infections were brought in from 27 to 35%. In іnshіh dіlyankas tіla wona іnstrіchaєt sigma. So, for a shoulder injury, a drop of 10 -12%, before a shoulder - 4%, a day - 8.6%, a foot - 3.9%. Described and a large number of localization of anaerobic infections, such as wounds to the brain (N. I. Grashchenkov), liver wounds (I. V. Davidovskiy). Naybilsh is often anaerobic infection in wounds caused by shell fragments, as noted by N.I. Pirogov, who wrote: "... especially often they slept with mephitic gangrene when they were wounded by artillery shells." This regularity has been confirmed by all victories, including on the notice of the Great Victory Day. According to the statistical data of MN Akhutin, 92% of cases of anaerobic infections were diagnosed with shrapnel wounds.

The lethality in case of anaerobic infection was rather high. For statistical data, like to lie down to the first svitovoy war, won, according to N.N. A . A. Opokina - 40%. Approximately the same figures, for the data of the first holy war, were given by the foreign surgeons. So, lethality, behind the caution of Ombredan (L. Ombredanne), Lera (W. Lohr) fell 50-60%, Klose (F. Klose) 43 - 68%, Frenkel (A. Frankel) - 75%.

Lethality in case of anaerobic infection during the Great Victory Day medical institutions also has a significant value.

Infections of anaerobic infections - pathogenic clostridia (marvel Clostridium). The main ones are є offensive.

З 1.perfringens types A, B, C, D, E, F - short polymorphic sticks, without jugs, set up subterminal super-links, rather central. clitini new strains one form of one size (0.6-1 µm × 4-8 µm). In the material from the wound and in the middle, the capsule is taken from the syrovatkoy, gram-positive. On the wild middlelands (meaty or casein) grow quickly (3-8 years), give more turbid conditions with burlivic gas solutions, change the pH of the middle ground to acidic bic. Sereda Vilson - Blaire chornin and roasted in 1-2 years, when sowed, milk is curdled in 3-5 years with a fluffy bunch. Razrіzhuyut povіlno razrіzhuyut zgornutka or boiled shmatochki of meat, gelatin razrіzhuyut. All foods ferment (with acid and gas) glucose, galactose, maltose, lactose, levulose, sucrose and do not ferment manit and dulcite. They put glucerin and іnulіn with pins. Set up smooth colonies (S), slimy (M) and short (R), you can set up a small colony (0) option.

CI. perfringens can be divided into 6 types according to their health and 12 different types of antigenic powers of lethal and necrotic toxins and enzymes, designated by the letters of the walnut alphabet: α, β, γ, δ, ε, η, θ, ι, κ λ, μ, ν. Type A viroblyaє in a great number of α-toxin - lecithinase C, as volodya lethal, necrotic and hemolytic powers and the main role in the pathogenesis of gas gangrene. In a significant minority, the toxin circulates all of the typical microbes. CI. perfringens type A virobly also θ-toxin - hemolizin, κ-toxin - collagenase, μ-toxin - hyaluronidase і, possibly lethal & eta -toxin. Z 1. perfringens types B, C and F viroblyaє β-toxin - lethal, necrotic offal - head toxic factor of cich types, as well as a small amount of γ-toxin. Type B і С vibrate δ-hemolytic, lethal factor, θ-hemolytic toxin, type C - also κ-collagenase. Type B may include ε-toxin, λ-gelatinase. Type D viroblyaє in a great number of ε-toxin is a strong lethal, necrotic protoxin, which is activated by proteolytic enzymes. Type E viroble is a lethal ι-toxin. All types of CI. perfringens viroblyuyut deoxyribonuclease - ν-toxin. The main source of wounds of anaerobic infections є CI. perfringens type A, before - іnshі tipi.

Argue oval, subterminal, strict anaerobic. Growing up in the middle of the earth will lead to light turbidity and a fluffy siege, gas supply to the world. Sereda Wilson - Blaire Chornin in 16-24 years. Proteolytic power is weak, milk does not burn before 12-24 years, gelatin grows, and does not burn out. CI. oedematiens types A, B, C, D enzymes glucerin, glucose, fructose and maltose. Do not put glucerin with type B plugs. On blood or hepatic agar, there is a sire of humpbacked colonies with a raised center, porous edges and outgrowths. On blood agar with benzidine, colonies of types A and B, when taken out on a second stretch for 30-60 minutes. stepwise chorniyut, є hemolysis zone. Glybin agar has the form of a colony in viglyadi vaty breasts, snakes or linzi. CI. oedematiens types A, B and D virobules 8 different antigens - toxins and enzymes. Type A and B types create thermolabile lethal and necrotic atoxin, which is a strong capillary spine, which will rupture the penetration of the bladder. In addition, type A viroblya - γ-toxin - lecithinase, δ-toxin - oxygen-labile hemolizin, ε-toxin - lipase. Type B virobly β-toxin - lecithinase, as well as ξ-toxin - hemolizin and η-toxin - tropomyosinase.

G1. oedematiens type A, B, C and D - large sticks (1-2 µm × 4-10 µm), crumbling, may 20-25 jugutik, capsules are mute, gram-positive.

People have an anaerobic infection wiklikє C1. oedematiens types A and B, type C are not pathogens.

3 1.septicnm. Designed to type 2 (A and B). Polymorphic gram-positive stick (0.8 µm × 4-5 µm), roll (perіtrikh). Dispute oval, subterminal, capsules are mute. Falsely, from the middle class, they can be transformed in short form and thread, which often appear on the serous membrane of the liver, spleen or on the diaphragm. Strict anaerobic. In the middle of the wild growth, giving rise to dim and gas. Sereda Vilson - Blaire Chornin in 3-6 years. Milk zgorta in general, gelatin rozrіdzhu. On the surface of the middle-class living areas, I set up blisky napivs of colonies with a diameter of 4 mm with irregular, pointed edges. On blood agar, established colonies near dewdrops and hemolysis zone. In glybin agapa, it is established colonies with a diameter of 1-2 mm from the center of the hole, or radially come out with threads. Distribution of glucose, lactose, maltose, salicin, galactose, fructose; do not distribute glucerin and manit. Add sucrose with each type A and all with type B. Chi does not over-etch the coagulated substance and the egg block. CI. septicum viroblyaє not less than 4 toxins: α-toxin, which is volodymy, necrotic and hemolytic powers, β-toxin - deoxyribonuclease, γ-toxin - hyaluronidase, and δ-toxin - oxygen labile hemolysin. Filtrates of CI. septicum reveals fibrinolysin, collagenase and zagalny antigen from CI. histolyticnm, over-neutralizing with antitoxic agents against bacteria. In case of internal infection of the guinea pig CI. septicnm develop a type of anaerobic infection C1. histolyticnm - small stick, ma dzhgutiki, ruhliva, gram-positive, I will not accept capsules. Argue subterminal, in the form of a racket or a head. When growing up in the wild, it is cloudy without gas. Establish proteolytic enzymes, which can be used to wipe out a selection of liver shmatochki, minced meat, egg whites in a savory midst. Milk shvidko peptoneiziruyut without pomaty sigoronnya, gelatin shvidko razridzhu. Do not fold in carbohydrates. I do not approve of the endolu, the water is seen in a great time. Colonies on agarwood are compact, volokhati, incorrectly shaped. On blood agar - drip, gleam, like a speck of dew, with a zone of hemolysis. CI. histolyticnm viroblyaє α-toxin - lethal and necrotic factor, (5-antigen, or collagenase, yak ruinuє native and denatured collagen, azocoll and gelatin.

Krim collagenazi, CI. histolyticum viroblya γ-antigen - proteinase, δ-antigen, ruin elastic fibers, azocoll and gelatin. This enzyme in conjunction with the good differentiation of elastic fibers of names by elastase. Introduced 0.5 ml of fresh culture in the guinea pig's ointment wikliko shvidnaya melting tissue and the bend of the creature through a sprinkle of godin abo dib.

З 1. sordellii set up a lance of 3-4 segments, capsules are not ma, crumbled, and only grows in viglyadi of large threads. Easily fit oval super-streams, on the wild midst of the wikklica, the turbid and gas-fired. Volodya with proteolytic powers. Milk increases peptonizates in a stretch of 2-3 dib, razridzhuє gelatin; fermenting glucose, levulose and maltose with acid and gas, weakly - sucrose. On agar with blood, a round or incorrectly formed colony with a hemolysis zone. Virulentnі with CI. sordellii is a highly active lethal toxin. Microbial activity also includes hyaluronidase, oxygen-labile hemolizin type θ-toxin, as well as fibrinolizin and other proteolytic enzymes.

With an experimental infection of the creature, the guinea is anaerobic infection for 1-2 days.

In addition to being overwhelmed, ethiologically unimportant, there may be mothers and other clostridia: CI. fallax, CI. sporogenes, C.I. putrificus, C.I. bifermentans. In addition, early botulism should be seen as an anaerobic infection.

Anaerobic streptococcus can be found in an anerous infection with a classic picture of an anaerobic infection.

Bacteriological analysis of materials taken from a wound in case of an anaerobic infection, the head of a microbial association of a growing warehouse, in some order, due to an anerobic presence of microorganisms. Mayzhe, as a rule, the presence of pyogenic microbes - staphylococcus, streptococcus, often known as Proteus, blueburn stick and other microbes. It’s insanely, that there’s a lot of associations that may be a singing inflow for the transition to anxiety.

Marvel at the same anaerobi.

The natural place of anaerobic diseases, including anaerobic infections, is the intestines of animals, especially herbaceous ones, as well as all-purpose ones (pig). In their intestines, as a rule, they know CI. perfringens, but sometimes they are not infectious; here the stench is multiplying yak saprophies, but don’t chuckle the beast. from the intestines great people a number of authors have also seen the order of the minor anaerobes and CI. perfringens. Gentlemen's activity of people - kindly watered with feces, vipas for thinness and so far - for a significant expansion of diseases of an anaerobic infection in the middle of the world, in the first place in the ground. In some soils, with the presence of lively speeches, sufficient vologosti and temperature, pathogenic anaerobes can increase in number. Ale і with the unfriendly minds of the outgoing middle-class, anaerobic bacteria of the building take another hour in the mill; at the same time with feed the stench is known to be consumed in the intestines of the creatures.

Pathogenic anaerobes are not often found on the clothes and on the shkiri people, and the intensity of the change can be found in some of the common, sanitary-hygienic minds and can be significant. The idea has been broadened even further, so that in the epidemiology of an anaerobic infection of battle wounds, the soil factor is not important, also, the geographic, climatic and seasonal minds, as they start to fall on the ground, and mean the earth soldier і їх shkіri. Timing an hour, the number of precautions, which were carried out in winter latitudes at different temperatures and on older soils, can be increased, as well as factors of classy, ​​soil, meteorological and So, the frequency of anaerobic infection during the hour of death from Finland, since the fight was carried out at even low temperatures, did not appear from the frequency, registered by McLenpan (JD Mas-Lennan) N. an hour of fighting for the little river Khalkhin-Gol in hot weather.

Є To be careful, how to show that there is a wound, accelerating an anaerobic infection, being in hospitals of one and the same group, as they were on the same mission, at the same hour. So, a whole lot of changes in the period, if there were a small number of wounded, and if there was a massive hope, it was especially trivial for an hour. Oskіlki character wounded, geographic and seasonal minds became unimportant. The recognition of a factor in the quality of the head cause can reduce the frequency of anaerobic infections. I will insist on the role of the ground, wait, if the fate of the demobilizuvatime of the surgeon, so it’s the reason it’s uncomfortable to suppose.

At a peaceful hour, infection is anaerobic to develop sporadically, even as an acceleration of important injuries, transport or in the event of a visitor to the civilian robots. In children with infants, anaerobic infection can occur as a result of the operative process, call for autoinfection. Gl. perfriiigens in humans was not only in the intestines, but in the empty mouth (with the presence of carious wubes), in females - in half. CI. perfringens, which is located in the first place, the child can serve as an anaerobic infection during the period of time, and often for post-carnial abortions.

Descriptions of the diagnosis of anaerobic infections for children, internal and external diseases. On the thought of A.N. Chistovich, the diagnosis of anaerobic infection in the number of infections caused by the introduction of a large dose of information material, as the mechanical injury itself is insignificant.

It was accepted to develop two classical forms of anaerobic infections: emphysematous (gas gangrene, gas phlegmon) and edematous (malignant swelling), like tying the head of the infection to Gl. oedematiens. It’s good, however, it’s cleverly good, so it’s just as easy to get started when you start gas supply. For this form of anaerobic infection, it is characteristic of a progressively deadening tissue with a drop and a widening of pathogenic microflora due to wounds.

There is no single thought for the drive of the anatomical substrate; Someone authorizes such a substrate for myazovy tissue and strong cases of infection as a clostridial myositis; on the mid-range of the cells and cells of the neurovascular bundles. The broadening of the process of living tissues is absorbed by the inflow of toxins and enzymes, such as collagenase, hyaluronidase, protease, cytolytic powers, volodymy, and the microbes. Bacterial toxins, getting wet from the infection, produce an ogalotoxic effect, which appears in the form of toxic-resorptive fever. The progressive embryo swirls to the accumulated age in the tissue spaces, to the swelling and the development of the significant part of the fibrillar structures. In that case, as long as the tissue is alive, it has sufficient support, it can be asserted that it is enclosed in a fire, in the form of a gas abscess.

Necrotic snakes with anaerobic infections occur in the development of the term. M'yazi, klitkovina, sudini, nerves are necrotized. Such changes are especially swirling in the meat of the fabric, as it becomes dark and gray (the color of boiled meat). In some cases, it draws in the adherent springiness, it is easy to rub it with your fingers, and according to the consistency it is gelatinous (a symptom of "raspberry lysis of tissue" according to A. V. Melnikov). with bulbs gas (color fig. 2 і 3). In case of otdechennyh forms of over-infestation of tissue in a rіdinoy, and gas alimentation slightly absent. I want the presence of the young microbes themselves, like CI.perfringens, when the tissue drops, it can lead to the development of the processes, which can be superimposed on the visible gas. rotten microfloria, especially in the fumes, there are houses of sirkovodnya, amiaku and other stinks in the gases sneeze cheeky spoluk. The appearance of an anaerobic infection of the foot, a vicious CI was observed. histolyticnm. At the same time, there was an increase in the development of all the soft fabrics, the crust of the shkiri and the ringing apparatus, so the skeleton of the foot emerged, we put it in the tiny little bear, reminiscent of the ridino. In case of anaerobic infections, they develop metastatic symptoms, which most often end up in vices, pricks, hammered mischiefs, wanting some of them in the wrong cells. In case of anaerobic infection, there are changes in internal organs. The time of change is circulating in hemolysis, igniting and degenerative-necrotic changes in internal organs. In some cases and in reference septicemia - anaerobic sepsis. Uninvolved on significant changes in internal organs in case of anaerobic infections, to be involved, as the main cause of lethal results in a large number of diseases, damage to the central nervous system and products of tissue diseases. Tim is not, obviously, cannot be respected, but the cause of death is from an anaerobic infection nervous systems... Death is caused by an anaerobic infection, mabut, the result of the infusion of toxins on the entire body as a whole, which can lead to functional and morphological changes in various organs and systems. The causes of lethal symptoms, established at rosters, are most often susceptible to advancing rank: 1) the expansion of the specific process and intoxication - 85%; 2) pneumonia - 1.5%; 3) changes characteristic of sepsis - 4.5%; 4) gostra anemia - 2.7%; 5) specific process in the event of severe injury - 1.3%; 6) metastatic disease of anaerobic infection - 0.5%; 7) the reason has not been established - 0.5%.

About the causes of fatal diseases of foreign surgery, it is even more unimportant and important, but the nature of the toxemia is still insufficiently vivified, so the “life of the center” itself, as there are toxins, the author doesn’t want to play a role in the same hour. sumnіvu [Hampton (O. Hampton), Paterford and Evans (R. Putherford, IR Evans), Tarbiat (S. Tarbiat) and іnshі]

The fact of frequent detection of anaerobic infection in case of shrapnel wounds is associated with the peculiarities of the pathogenesis of the wound accelerated. Fragments of injuries occur when there is always a large number of necrotic fabrics and fabrics in them with a very low life; In addition, in case of shrapnel wounds, the force of the lateral impact is more pronounced, so that the extended energy to injure the projectile in the direction of the wound, as a result of which additional values ​​of the tissue are displayed. In teenage fabrics, a traumatic embryo develops quickly, and the stench squeezes in the aponeurotic case, squeezes and other judges of the mouth, breaks down the microcirculation, and the tissue becomes sour. As a result, a dilyanka of ishemized fabrics is established, in which anaerobes are known to be friendly and for reproduction.

For the force of a lateral blow of the wicker, a trivial spasm and larger arteries, which will even more ruin the blood circulation. Especially significant are the dylyanki of ishemized fabrics, they are set up to pull the knots of blood back with jgut. The energy to injure the projectile expands on the nerves of the storm, temporarily damaging its function, in the event of changing and neurotrophic processes in the injured zone. Fragments of wounds are often difficult to deal with, and sometimes wounds are often inadequate, but they also have to be friendly to develop other bacteria. It is necessary with a great deal of time and those, where the scale of microbial obstruction of fragmented fragments is likely to reach the mark, shards of fragments often burst into the wound of the shmat, oily, swollen, pieces of earth. Otzhe, in the mechanism of development of anaerobic infection. take the fate of a number of factors, moreover, in order to respect the specialty of the ear, in any order with necrotic fabrics, there are fabrics with damaged microcirculation, which can be found in the minds of ischemia and acid deficiency. Microbial wounding can be done by a bureaucrat, since only one of the left minds is left in the middle of the ear. At the same time, the infection of wounds with pathogenic anaerobes (including CI. Perfringens) is less often, less anaerobic infection of the wound. Bigger, sporadic occurrence of anaerobic infections with non-fired wounds can be explained by the fact that with such inconsistencies, it is rare to think about it, allowing for the development of anaerobic bacteria. Out-of-the-box fractures are significantly more severe to anaerobic infection, less injury to soft tissues. Tsya regularity is rotated by tim viraznishe, chim less myazov masi of the single segment. So, according to A.N. Berkutov's cautions, 49% of cases of anaerobic infection of stegna were restructuring in case of injured soft tissues, 51% - in case of extravaginal fractures, on homilous women, 30% of cases of anaerobic infections - in case of extra-focal fractures, in the frontal area - approximately 10 and 90%. Significant fracture of the official, the development of an anaerobic infection. So, in GP Kovtunovich's preludes, the introduction of 100 million microbial substances in the ointment of quilted guinea pigs was anaerobic infection did not develop; in quiet cases, since the introduction of microbes is a fracture of the cyst, the infection is anaerobic in all cases. The meaning of the knot in the development of an anaerobic infection, especially in the case of a wound in the fire, can be explained, in Perche, Tim, that the architecture of the knot-knot wounds in the development of a more poorer tissue on the other hand, in case of an out-of-the-box fracture, the zone of soft tissue breaks out into loose cyst fragments, and, in case of an out-of-the-line fracture, it is more significant, but in case of wounds of soft tissue, part of the tissue in front of

There is a very large number of classifications of forms of anaerobic infection. In Europe and America there is a great expansion of the classification of Weinberg - Seguin (M. Weinberg, P. Seguin) The group of virulent anaerobic infections is divided into five forms: 1) emphysematous, or classical; 2) edematous, abo toxic; 3) change of form; 4) rotten forms; 5) phlegmonous form. On the thought of the authors, their classification before the act of the world is placed in the context of microbial associations, as well as on the basis of these classifications. The classification of Weinberg - Seguin, being completely overwhelmed, is even static, so that in the first place there are no special features that characterize the interruption of the infectious process. In the CPC (official "Tables on the morbid-Polish process.

Corrosive classifying, it is possible to formulate a dynamic diagnosis, which, in the world, serves and is critical to the day. For example, the diagnosis "rapidly expanding the form of an anaerobic infection" clearly requires radical ways lykuvannya.

In the United States, the classification has been expanded;

I. Traumatic wounds of infections.

It is simpler to get involved.

Anaerobic cellulite.

Anaerobic myonecrosis:

a) clostridial myonecrosis;

b) streptococcal myonecrosis.

II. Non-traumatic infections.

Idiopathic.

Sudden gangrene is diagnosed.

By the term “simple obstruction”, one thinks only about the knowledge of Clostridial flora in general wounds without a twisted zagalny reaction.

To anaerobic cellulite, it is possible to tolerate the effects of massive clostridial wound healing, if the infectious process grows in unpublished fabrics, not going beyond the boundaries, and the health of the tissue does not fade. Anaerobic cellulitis was previously described under the name "gas abscess" or "a form of gas gangrene is localized."

From the name "clostridial necrosis" or "clostridial necrosis", there is a classic clinical manifestation of anaerobic infections with progressive necrosis and degradation of the tissue of the tissue, swelling of the organisms. Streptococcal myonecrosis is clinically not recognized as a clostridial and diagnosed less on the basis of bacteriological indications. With anaerobic cellulitis in early visions, there are abundant leukocytes and gram-positive sticks and flora; with clostridial myonecrosis, there are few leukocytes, the presence of gram-positive sticks and іnsha flora; gaps in streptococcal myonecrosis in patients with high leukocytes, in daily gram-positive and іnsha flora, except for streptococci, which appear in a large number.

Overcoming anaerobic infections can be bliskavichny, quickly progressing and torpedo. With a bliskavichny overrun, even after a few years, when a wounded thing is wounded, dangerous things develop, which can be produced to death after 1 - 2 dobies; Likuvannya in a large number of vypadkovy appear to be ineffective. When there is a rapidly progressing recession, signs of an accelerated time will not be earlier than 24 years old. if you get hurt (wake up in 2-3 dB); death can occur in 4-6 days; The most common view is seen most often. Torpedo interruptions are characterized by a decrease (not earlier than the 5-6th day) by the development of an anaerobic infection, the widening of the infection in general and to a lethal result can be brought about in 2-3 days. With a fast progressing, and even more with a torpid interruption of an anaerobic infection, the life of a wounded person can be hidden by timeless and radical drug visits. The most friendly form of an anaerobic infection - for better education of a gas abscess, start about outside body for a splinter of a brush.

Diagnostics of anaerobic infection is guilty even earlier, as in case of rapid expansion of forms of toxemia in a short term of swelling, nonvolatile character. For early diagnostics of anaerobic infections, especially in the case of massive injuries, it is necessary to have a bandage up to the age and to look around at the wound of a shukati, when symptoms of a slowing down are seen. At the same time, we especially respect for those injured, for some wounded children, especially splinters, wounded stegna, homosexuals (more so, for example, a fracture in the fire) and the central region. In the most coarse period of an anaerobic infection, it means that a person who has been wounded is badly hurt, and that part of skarg for pain in the early days, which sometimes characterize how they are "bursting" Drugs often do not absorb more, and it hurts to spend nights without sleep (a symptom of a sleepless night). It is even more pathognomonic to the increase in the frequency of the pulse - 110-120 beats per 1 chilin, the temperature of the body starts to rush in between 38-38.5 °. In larger stages, there is a slight icterus of the sclera, which can be a lot of hemolysis. Even more, when an important intoxication has come, there is an euphoria, a snake of an individual of the type facies hippocratica. When looking around the area of ​​injury, especially when the bandage is known, it is possible to notice the development of a bandage, and in case of emphysematous forms, for additional percussion and palpation, gas crepitus and a high tympanic sound can appear. When you look around the wound, you will start to see the size of the fill and the area to expand the gas. At the same time, in addition to percussion and palpation, it is followed by auscultation with a phonendoscope: pressing the membrane against the skin in the area of ​​the wound, it feels like crunching bulbs to the gas in the cob stages of gas release. The lesser value is maє so zv. a razor's symptom is a special, ringing crunch of hairs, shaving from the circumference of the wound. An important early sign of an anaerobic infection is pain during palpation along the vascular bundle, proximal to the area of ​​injury. A characteristic familiar anaerobic infection is to serve as an extension to the distant end of the run or to the embryo of the whole posed segment. To watch out for the build-ups, the embryo was propelled (N.N.Burdenko, A.V. Melnikov) tied the tip with a seam thread and behind the step, it was time to judge about the growth of the embryo. Qia signs are unreliable, so how to appear in case of non-releasing (for example, cracked) fractures with a build-up traumatic bulge. Besides, yogo vyavlennya Veda before the second hour. At the circumference of the wound, it is possible to develop a landscape-like landscape with the beaches of bloodshed in the non-vineyard barnacles (colorium fig. 1.) and sub-dermal bulbs. Kolir to the beaches zumoviv such naming of anaerobic infections, such as "brown phlegmon", "bronze erysipelas", "bila erysipelas", "blakytna phlegmon". The colors of the beaches are unbearable (in the world of spreading extravazate they can change) and the connection with the character of microflora is not possible. The former viglyad to lie down in the first place in the first place because of the growths: with a small wound opening, it is possible to mean only poor vision, as there is a serous-bloody character. In some way it can be pinistic (diagnostic signs are important). In case of early significant changes, or in case of anaerobic infection, it is already possible at the earliest possible time for a change of mucus, which becomes wax-like, and in a larger term - syrimy ("jam"). If there is a significant defect in shkiri and fascias, or at some early stage, it is possible to bachiti, but the swelling of the tongue can be seen (vypiraut) from the wound (symptom of A.F. Berdyayev). The smell of vision (the smell of sir, sour cabbage, the smell of the bear, and so far) is not a symptom, so as to lie down on the step of spreading the meat fabric. An important stinky smell of vision is not characteristic of an anaerobic infection and is caused by a rotten process, suddenly developing in dead tissues.

X-ray diagnostics. Even more diagnostic data can be recognized for additional radiography. Vaughn allows you to get rid of the gas as well, as it doesn’t come out of the way of percussion and palpation. Zastosuvannya X-ray showed that there are cleverly subdivided forms of anaerobic infection for emphysematosis and swelling. According to the roentgenogram, it is possible to stand up in the same way, in some tissues, gas will grow, and therefore - to judge about the depth and width of the process. In quiet drops, if the tissue is impregnated with gas, on the roentgenogram, the fish is represented by a malunky, which is a nagadu alinka (Fig. 1).

When the gas is expanded, only small cells are shown on the image of small cells (Fig. 2), when the gas is not purchased, the presence of a gas abscess (anaerobic cellulite - for the American term) is indicated.

Laboratory diagnostics.

For bacteriologic dosage during the first operation, take exudate, small pieces of tissue (2-3 g) from the wound between the healthy tissue, as well as blood from the vein (5-10 ml).

Corpse material (seeing a wound, little wounds of changes, blood from the heart, little little spleens and liver) should not be lost, not after a few years of death, that you will not be able to recognize posthumous pathogens

Taking material into a sterile hermetically sealed glass or plastic dishes and overpowering them in a bacteriological laboratory. Inadvertently, when the material is brought into the laboratory, the samples are microscoped. For the sake of thinking, prepare brushstrokes and use Gram. The presence in the test of the great gram-positive sticks to serve as an informal sign of anaerobic infection.

The solid material is sterilely trimmed with knives and wiped at the hub with a sterile break in a sterile manner in a practical way. The blood or exudate is centrifuged at 3000 rpm with a stretch of 30 quills and sieges are placed on the middle (blood agar, middle Villisa - Hobbs, Wilson - Blair agar and benzidine agar).

Try to incubate in different minds at t ° 37 ° (in a micro- and macroanerostat with pyrogalola), look in the middle of Wilson-Blair to look at it in 3-6 years, and sit in the middle of it - on a skin day until 7 days. Colonies have grown, so that hemolysis occurs on blood agar, opalescence, or a pearl halo appears in the middle of Willis-Hobbs, that is blackened in the middle of Wilson-Blair, that is added to a bit of pure agaric acid 'clear or casein-mushroom middling with a ball of vaseline oil with meat pieces of meat anyway. Try to incubate in thermostats for 24-48 years, to reconsider the purity of cultures for additional microscopy and to set a neutralization reaction with antitoxic diagnostics to determine the type of toxin. Put the reaction in six test tubes: add 0.9 ml of the centrifugate of the pre-juvenile culture to the skin test tube; in the first five test tubes add 0.6 ml of monovalent syrovates, to replace the antitoxin against the skin infection in the amount of 50 -100 ME, add 0.6 ml of the physiological rose into the control test tube. Sum toxin with antitoxin vitrify 40 quiline at t ° 20 ° in a dark muscle and then inject intravenously 0.5 ml of small mishmash or 0.2 ml of guinea pigs. Result re-start after 5 6 years and on the 3rd add. The type of belonging of the pre-juvenile culture is established by the neutralization of the toxin by the syrovate.

In case of the bend of all food, the neutralization reaction should be re-set with typical specific diagnostic tests C1. perfringens types A, B, D and E.

Culture CI. perfringens to type D and E, protoxin viroblates, for the detection of such stasis, the activation method for the additional proteolytic enzymes - trypsin or pancreatin.

Doslidzhuvana 5-6 years old culture G1. perfringens, trimmed on a raw meat or casein middle, should be centrifuged or filtered. Vyhіdny 1% roschin trypsin in a amount of 1 ml add up to 10 ml of pre-juvenile cultural origin. If trypsin is substituted for 4% of the pancreatin levels, then the cultural level of pancreatin is reduced in equal volume and the pH of the sum is adjusted with the help of 10% NaOH to 8.0-8.4.

Otrimanі іdіnі put in a thermostat at t ° 37 ° for 1 year. When the specified term ends, a neutralization reaction with CI syvates is set. perfringens type D and E.

In laboratories, where robots can work with tissue cultures, the neutralization reaction can be delivered on the first trypsinized tissues of 10-11 days old chicken membranes.

Laboratory diagnostics can be carried out by accelerated methods.

1. It is possible to reject a great number of remarkably pure images from wounds, to set up a reaction of neutralization with a centrifugate of the family. For the purpose of testing lecithinase, it is also possible to put a reaction with a pre-juvenile stage in vitro; Attracting reaction with syrovates against CI. perfringens, C.I. oedematiens is too small, to establish the specificity of evolved lecithinase, hemolysin.

2. Methods of identification of pure toxigenic cultures of CI. perfringens type A, CI. oedematiens, Gl.septicum і і іnhhh to a pro-active agar on the basis of Hottinger's broth or Marten add one of homologous antitoxins at a concentration of 8 IU per 1 ml. It is necessary to make a cup of tea with different antitoxins, in order to start to grow into a culture. After 48-72 years, about the colonies, they have grown from a homologous syrovate to form a circle of precipitation.

3. One of the accelerated methods of in vitro diagnostics of growth on the basis of changes in the morphology and character of growth of anaerobes during cultivation in the presence of specific antitoxic agents (O. A. Komkova).

With the help of a vicorizing mixture, it is possible to store with Pope's broth with 0.1% agar, 0.4% gelatin and 0.5% glucose. Seedling is poured into test tubes of 10 ml and sterilized with flowing steam 2 times and 20 quilins each with a break.

Afterwards, the material will help you to get a few pieces of stuff in ten test tubes with a similar middle course; Five test tubes are heated at t ° 80 ° with a stretch of 20 khvili. At the dermal a couple of testicles - the program and the non-progression - add the development of monovalent diagnostics of the anti-gangrenous cyst with such a rosette, in 1 ml of the middle layer of the anti-toxic anti-toxic agent CI. perfringens type A not less than 200 ME, Gl. oedematiens type A - not less than 300 ME, Gl. septicum i CI. histolyticum - not less than 50 ME. In the remaining two tubes, the syrovat is not added.

Instead of a skin test tube, re-mix and place all test tubes in a thermostat at t ° 37-38 °. After 10 - 18 years. read the result. Streptobacillary form and growing by isolated colonies in test tubes with any antitoxic somatous disease and the number of cychic diseases in these test tubes to indicate the presence in the pre-existing material of an antibiotic

Detection of streptobacillary forms in test tubes with growths to indicate the presence of anaerobic infections of decilcous species.

4. Another acceleration method, proponation of O. A. Komkova, is a thorough reaction of neutralization of toxin with antitoxin after additional internal introduction to guinea pigs. One analysis requires 3 - 5 guinea pigs For those who are too late, they depilate the surface of the abdomen. Lead alone should be injected into 0.1 ml of viprobuvanic ridin with 0.1 ml of physiological growth, and 0.1 ml of pre-juvenile ridini in total with 0.1 ml of monovalent diagnostic anti-gangrenous serum against the skin type. Watch the pigs for 24 years. Diagnostics is based on a fast-moving winter color of a group of guinea pigs (farbury in violet, erythematous, blue toni) in case of muscular blood circulation. The method allows one to diagnose toxigenic strains from anaerobic infections in the period from 30 minutes to 4 years.

For the purpose of lecithinase, the final dilution of the cultured culture filtrate in borate aboacetate buffer (pH = 6.0) with calcium acetate (0.005 M) was used. For a good mix, manually fix a chlorinated plate with 72 holes. Pour 0.5 ml of buffer into the wells. At the first bottom of the well, DO NOT pour the buffer, pour 0.5 ml of viprobuvan culture rіdini each. Add 0.1 ml of specific anti-toxic diagnostic syrovat into the first well, and take not less than 50 IU in 1 ml. At the third hole, add 0.5 ml of viprobuvanny rіdini і, changed її with a buffer, prepare the last two breeding times. The plate is covered with 30 min. at t ° 20 ° in a darkened place. Specific syrovat for a whole hour rises to neutralize the homologous lecithinase. At the dermal well, add 0.1 ml of lecite-telin, change the sides with circular pouches and place the plate in a thermostat at t ° 37 ° for 2 years. Reactions to the lightness, by the way, the dimness of the line in the holes with an additional three-plus system. The specificity of the reaction is confirmed by the appearance of the cloudy in the first moon, in order to avenge the homologous antitoxic substance.

It is necessary to admit it, but the bacteriological until it is impossible to help the term diagnostics of anaerobic infection, as it seems, it is possible to get rid of it through a few years of illness and to get it in 2-3 years. In addition, the appearance of pathogenic anaerobes is worthless if there are clinical symptoms of an anaerobic infection, so as to induce CI. perfringens are even more often found in wounds, as they do not have any signs of an anaerobic infection and do not go to waste.

Dani bacteriological doslіdzheny can, however, be a vicary in the case of a frivolous treatment, especially in serotherapy.

Histological diagnostics, like K.P. Ulezko-Stroganov and P.V. The forgiveness method, the introduction to the development of the early and cytological characteristics of the wound, can serve as sooner an indicator of the reactive and reparative processes, and not the etiology of the infectious acceleration, I want the authoritative method (M.P. It is possible to recognize specific cytograms - the visibility and decrease of the symptoms of phagocytosis, the appearance of monocytes, the presence of leukocytes with the symptoms of a drop, as well as the manifestation of a great positiveness of gram.

The other methods of diagnostics of anaerobic infections: serological, immunological, tests for the specificity of toxins, the reactions of the principle and inspiration - were based on experimental studies of early clinical studies

Hematological pre-diagnosis with anaerobic infection of the diagnostic value is not a problem. Pіdsumovuyuchi chislennі doslіdzhennya can vvazhati scho hemogram at anaerobnoї іnfektsії vіdobrazhaє zmіni, vlastivі vzagalі duzhe vazhkoї ranovoї іnfektsії: Shvydko nastupayuchu gіpohromnoyu anemіyu of neytrofіlnim leukocytosis, eozinopenієyu, lymphopenia, POE priskorennyam i morfologіchnimi zmіnami eritrotsitіv. Bacteriological appearance in the blood of anaerobic bacteria є is a prognostic even unpleasant symptom, so as to serve as a sign of the rapid incidence of these mechanisms in the body.

The treatment of anaerobic infections is carried out in a comprehensive manner. Wounds, accelerated by an anaerobic infection, guilty due to a certain amount of blood loss due to the method of distribution - hanging: a wound guilty of being widely disseminated, the edge of it is not necessary to spend in gags, it is often necessary ulcers along the entire course of the uranium canal. The criterion for the living of the mucous membranes is the rapidity of the muscular bundles in case of bleeding from the cross-hairs of the mucous membranes. The end of the surgical treatment is necessary with great late (stripe) or Z-shaped openings to open all the cyst-fascial cases on the ear segment and the sound of the connection from the health. The growth of fascias on the non-scalded proximal segment is required to rotate, as on the whole segment, to indicate the filling, and more gas.

When a fracture is evident, a circular gypsum dressing is applied and an internal fixation of contraindications. For immobilization of a skeletal knit, or immobilize a picture for an additional gypsum splint. The wound is obov'yazkovo become widespread and fluffy to swab with dry gauze swabs. For the spirits of tampons, there is a proponent of free-flowing antiseptic solutions, as long as they are not available with volatile passages. In the name of the blame for the blame, but also the hypertonicity of the fabric of the age and the power of the antiseptic authorities. Good diet hypertonic (10-20%) solution to sodium chloride, roses, such as moisture (water peroxide), oily-balsamic emulsions and so on. Krym tampons, inject a thin gum tube into the wounds, through the yak without interruption or periodically inject a sum of antibiotic solutions with sulfamilone and antimicrobial drugs. It is necessary to stagnate internally drip without interruption without interruption of the introduction of polyvalent anti-gangrenous syrovat, yak in 3-5 times it will be released physiological discernment... It is necessary to enter not less than one drug dose for doba. good luck official instructions, Consolidated by the Ministry of Health Protection of the CPCP, the drug dose of anti-gangrenous syrovatka in the warehouse is 150,000 ME (50,000 IU each of anti-perfragens, antiseptikum, antidematiens). For the establishment of a bacteriological diagnosis, it is necessary to introduce only a syrovat, the same with the vision of the child. Before the introduction of the sirovatka for the detection of the increased sensitivity to the kinsky bottle, conduct an internal sample with a dilution of 1: 100 syrovat, taken from the test ampoule, in a box with a set of syrovatok. 0.1 ml of syrovatka from the test ampoule should be injected before the shkiru. The test is negative, if the diameter of the papule will not be more than 0.9 cm, positive - if the diameter of the papule is 1.0 cm and more, the papule will be otochened by a large zone of pochvoninnya. In case of a negative internal test, inject 0.1 ml of syrovat into a small amount, and if there is a reaction after 30 minutes. inject vnutr_shny'yazo the entire prescribed dose, or repair the drip of the introduction. In case of a positive sample, inject the sample only after the absolute indications. It is recommended to inject before the cim into a breeder at intervals of 20 quiline in doses of 0.5; 2.0; 5.0 ml. When there is a reaction to the dose, inject 0.1 ml of underexposed syrovate, when the reaction is repeated, inject the entire dose internally, or proceed to the intrinsic injection. In quiet cases, if it is uncomfortable to use a drip of syrovatka (for example, when evacuating), inject unreduced syrovatka internally. In the process of administration, inject internally or internally large doses of antibiotics.

Є positive admission of penitentiaries, which is to be introduced internally and internally at 2-10 million OD per add. In order to unicutize the emergence of penіtsіllin-resistant races of microbes, it is worthwhile to add more antibiotics to them: sygmomіtsіn, tetracycline, kanamіcin and іnhih. Conduct blood transfusions. The dose of blood transfusion starts with the level of blood loss and the degree of anemia. Massive blood transfusions in case of anaerobic ailments should be tolerated badly, so that part of the transfusion should be consumed in a dose of 250 ml per dose. A great effect is spared during direct transfusion without prior to the donor to the recipient. Shown is the internal introduction of polyionic solutions of 1-3 liters per addition, for the addition and distribution of toxins, a change in blood viscosity and normalization of hemodynamics. In the case of an anaerobic infection, it has a gaseous muslin, which theoretically is responsible for the loss of anaerobic bacteria. Already in 1917 B.S. VD Sokolov in 1927 vyroblyav vduvannya sour into the circumference of the wound without the middle of the balloon. In 1941 r Almeida (J. D. Almeida) zastosovav kissen in a vice of 3 atm. All the author, who were stuck with the kissen, could not see the meaning of the lіkuvalnogo efectu... When an anaerobic infection is involved, the mussel stagnates in the form of the so-called oxybarotherapy. Oxybarotherapy is guilty of stagnation only for the purpose of identifying surgical methods for treating anaerobic infections.

Viprobovalasya and regional perfusion of the picture. For an additional method, they magnetized a high concentration of antibiotics in the tissues of the kidney, caused thrombosis and suffered a vertebral spasm (I. L. Krupko with co-authors, B. S. Grekov). In the experiments, bully otrimanі zadovіlnі results. A. N. Sizganov for the treatment of an anaerobic infection, impose on the root of the kintsivka dzhgut, which is guilty of squeezing only the veins; the surge of arterial blood will not break down. Then it is possible to inject intraosseous razchin, to avenge antibiotics, tissues will not seep out as a razchin, an excess of which will infinitely enter through the wound.

Anaerobic infections are often driven before the amputation of a child The second is indicated before amputation to be placed in the presence of clinical symptoms, a rapid increase in anaerobic infections due to a clear and important external reaction, especially in the case of the great and glibiously rosy diagnostics. Vіdsіkannya kіntsіvki vyroblyayut vische vyshche vіnfіktsії; at all we see the widening of the gas and the embryo can not serve as an operator, and the level of amputation starts only after the mill of the textile fabric to send the rosette of the shkiri and fascias. With the appearance of a healthy age, you don’t speed up and don’t bleed. The method of amputation of a special meaning is not possible, if I want to be more beautifully koristuvaty klaptevymi razryzy. During the display of the picture, the child is drawn in the proximal direction and the development of all cyst-fascial cases. Do not apply Shvi, cover the kuksa with gauze tampons.

The most effective way to prevent an anaerobic infection and the primary surgical treatment of wounds, the Viconan in the early term when wounded However, one must pass for an hour, the first time there are no hostilities, or the losses will be delivered to the installation, if the Viconan is the first to have a surgical treatment, then there are a lot of prophylactic visits that can be done at the same time to strangle the microbial process of the infection. Vaccine prophylaxis of anaerobic infectious diseases due to the injections of the associative vaccine preparations - nolianatoxins. Anatoxini C1. regfringens i CI. oedematiens to enter the warehouse complex drug- sorbed typhoid vaccine with sextanatoxin. 1 ml of vaccine (dose per cutaneous flakes) to avenge 30 ЄC to toxoid C1. regfringens i 10 ° C CI. oedematiens, When the population is immunized, people are vaccinated from 17 to 60 years of vaccine injections in two doses with an interval of 25-30 dob. Crushed ones are revaccinated after 6-9 months and then through the skin 5 years, for some special indicators. With the correct dosage of vaccination, it does not lead to immunological competition, as antigens enter the drug. The practical importance of active immunization with anatoxins in an anerobic infection has not yet been assessed in a general way.

Seroprophylaxis of anaerobic infection during the Great War was carried out against the introduction of a sum of anti-gangrenous antitoxic agents.

It was recommended to introduce an internal dose of 5000 ME (antiperfiringens 1500, antidematins 2500, antiseptikum 500 and antigistolitikum 500). The visibility of the effect served as a drive for an increase in the dose of the introduced dose up to 14,000 ME (Inquiries on the European-Polish surgery, 1944). Prophylactic introduction of syrovaty, which was lost in case of wounded upper and lower symptoms and children, to supervise great mutilation, and in case of wounds, obstructed by the earth, overlays of clothes, and also in bunches. In military rock, it is recommended that a prophylactic introduction of 30,000 ME is recommended (10,000 ME each antiperfiringens, antidematiens and antiseptikum). Protigangrenous bacteria are recognized as horses, immunized with toxoid and toxin from microbes. Syrovates are dispensed in a rare or dry viglyad, for purification and concentration by the method of enzymatic hydrolysis (diaperm-3) in a set of ampoules, skin from which to place a monovalent syrovate (antiperfusion, antidematous ...

However, without affecting an increase in dosage, the effect of seroprophylaxis is insignificant, but there is no overwhelming evidence of dignity, and the prophylactic introduction of an anti-toxic agent will be injured during the war hours. Bacteriostatic and bactericidal preparations have become more effective. In numerical robots that have assigned the sensitivity of anaerobic bacteria to penicillin and other antibiotics, it is possible to induce an overconfusion of experimental and clinical materials, such as to indicate a toxic culture that is in use in the preparation of antibiotics. Zmins are especially clear, as in the early days there are high concentrations of antibacterial drugs, which can be reached with a one-hour introduction of them - to the microscopic, so that without the middle in the wound, either in the tissue around it. In quiet people, if behind the minds of a combat or a medical situation, the wound cannot be given a surgical treatment in the early term, the introduction of antibiotics allows the introduction of antibiotics to create a primary surgical treatment. Using the same method, inject into the wound a sulfanilamide drug - sulfamilone, one of the only ones in the form of penicillinsulfamilonovy sum.

Are you categorically not vlashtovu prospect bezpovorotno to know the light? Do you want to live another life, having started it all over again? Do you want to live one more life without the mercy of the congregations in the whole life? Do you want to live another life, having lived in this world, did not get angry in the whole life? Proceed for the following:

The frequency of development is based on the type of operational involvement: with clean wounds - 1.5-6.9%, clean wounds - 7.8-11.7%, contaminated ones - 12.9 -17%, frail wounds - 10-40%. 1 In the number of publications, attributing to the problems of nosocomial infections in surgery, the bullet has been re-reported, increase the lethality; increase the triviality of the hospital; Increase the parity of stationary treatment. 1.1. Pislyoperatsіynі infectious diseases as a special category of internal infectious diseases. It’s insane, so readily the meaning of someone who knows how is ambiguous is ambiguous. It is legitimate and common for such a phenomenon, as "internal infections" (VLI). Naybіlsh away i dosit Povny slіd vvazhati viznachennya VLІ, zaproponovane Єvropeyskim regіonalnim Office WHO in 1979 p:. Vnutrіlіkarnyana іnfektsіya (lіkarnyana, gospіtalna, vnutrіgospіtalnaya, nozokomіalna) - whether yak klіnіchno rozpіznaєtsya іnfektsіyne zahvoryuvannya, yak vrazhaє ailing in rezultatі Yogo nadhodzhennya in lіkarnyu abo Infectiousness in her absence for the benefit of the disease, for the infectious disease of a physician or physician in the same period of time has been established, right away, if symptoms appear in the absence of symptoms until after an hour of transfer.

Naturally, the most significant part of VLI is brought to infected patients in hospitals.

The frequency of VLI should not be less than 5%. 2 Officials show only a small part of surgical VLI, and for the data, guided by foreign prehistorians, 16.3-22% are brought to the part of surgical infections. 2 The history has saved the attention and the prevention of household drugs about the problem of internal drug infection. Among them are the words of M.I. Pirogov: "If I look back at the pantries, de Pookhayte infected in hospitals, I do not know what is more astonishing: the cost of the surgeries or the fortune, which we can continue to suspend. , leave the family and do not take part in the new way, and do not be worn out by the vast forces of knowledge and the henchmen of hospital miasmas. " Abo became the classics of the caution of I. Semmelweis, as having established a link to the high incidence of "flat hot" in the obstetric wards of the Viennese hospital in the other half of the 19th century because of non-observance of the rules of the city. Put such words in the general sense of the word internal lycopene infection can be known in a greater period of time. In 1959, they described a sleepless pislyapologic mastitis in females, as a common denomination of the great Moscow lichens. 2 Most of the ailments turned out and were taken away because of the surgical treatment of polyclinics with the same disease. In all vipadniks, there are buvs of staphylococcus, visions of abscesses of milk.

It is characteristic that an analogous staphylococcus of visions in case of systematic bacteriological preliminaries, which appears in a gentle view. During the planned sanitary visits, the number of ailments on mastitis has changed, and in the world of bacterial complications, the number of cases of mastitis has changed. In the present hour, it has not become clear that the destruction of the sanitary-hygienic regime in the medical facilities can lead to the growth of sickness and the failure of sleepers in VLI. The price is most typical for the diagnosis of respiratory and intestinal infections.

However, the category VLI is special, yak will respect rіznykh fakhіvtsіv, Persh for all the surgeries, and not an unambiguous decision. One can find out about the fast-paced operations in the surgical procedures that are suitable for the profile and effort of the lazy fund, the pitoma in which to reach the great.

Deyaki authori vvazhayut, scho quick operation warehouse from 0.29 to 30% 2, but more to produce more one-sided data - 2-10%. 2 Most often it’s about bending down the groin of the operative wound, 2 protesting operations, visiting people who are sick, suffering from diffuse peritonitis, often (1.8-7.6%) developing abscesses of the disease. 2 According to N.N. Filatov and spіvavtorіv, 2 the frequency of septic-septic patients operating in hospitals of the surgical profile of Moscow to become 7.1%. The higher frequency of surgical early infections (from 11.5% to 27.8%) was produced by M.G. Aver'yanov and V.T. Sokolovskiy, 2 moreover, the monitoring of the health problems by them has resulted in a high level of low-speed wounds (9.7% -9.8%) for I-II classes of operative wounds, for which it is practically innocent, but at an acceptable level option - not more than 1%. For more than 53 yew. The operative frequency of the septic-septic patients becomes less than 1.51%. 2 Superechlivіst hover danih not znizhuє znachuschіst problemi pіslyaoperatsіynih runs uskladnen, rozvitok yakih pomіtno obtyazhuє rozvitok main zahvoryuvannya, podovzhuє hour perebuvannya ailing in statsіonarі, zbіlshuє vartіst lіkuvannya, nerіdko cause lethality rezultatіv i negatively poznachaєtsya termіnah vіdnovlennya able to work on nostі operovanih ailments. 1.2. Classification of surgical infections. The understanding of "surgical infection" includes early infections, sensitization of infectious pathogenic microorganisms in the wound, cut off in case of injury, or surgery and treatment of infection by methods.

Development: 1. First of all surgical infections, so that they can be diagnosed spontaneously. 2. In the case of injuries and surgeries that have developed rapidly.

Hirurgical infections (including secondaries) are also classified 3: I. Regarding the type of microflori: 1. State medical institution: a) gnijna; b) rotten; c) anaerobic: d) specific (pravets, sibirska virazka and in.). 2. Chronic surgical infection: a) nonspecific (pyogenic): b) specific (tuberculosis, syphilis; actinomycosis, etc.). II. Falsely from ethology: a) stafilokokova; b) streptococcal: c) pneumococcal; d) colibacillary; e) gonococcal; f) anaerobic non-spherical; g) clostridial anaerobic; h) change and in. III. With regard to the structure of the pathology: a) infectious surgical ailments: b) infectious accelerated surgical ailments; c) pislyaoperatsіynі infectious acceleration; d) Infectious acceleration of critical and acute injuries. IV. For localization: a) the battle of the school and the child; b) urazhennya curvature of the skull, brain and th shell; c) training shia; d) urazhennya breast cancer, pleural emptying, leg; e) improvement of the middle (mediastinitis, pericarditis); f) urazheniya queue and organs of the worms; g) damage to the organs of the pelvis; h) the reduction of banks and slopes. V. Falling back key overrun: 1. Gostra gnіyna іnfektsіya: a) zagalnaya; b) misceva. 2. Chronic infection. 1.3. Ethiology of operational and infectious diseases. badly ignited May the infectious nature, the stench is wicked by the different species of animals: gram-positive and gram-negative, aerobic and anaerobic, spore-producing and non-sportive and microorganisms, as well as fungi. In case of singing, good for the development of microorganisms in the minds, the ignition process can also be wicked with intellectually pathogenic microbes: Klebsiella pneumoniae, Enterobacrer aemgenes, Proteus vulgaris saprophytes, etc.

You can get sick with a wicked person (monoinfection) or decilcom (change of infection). A group of microbes that have wicked the ignition process are called microbial associations.

Microorganisms can penetrate into the wound, into the zone of tissue loss from the outer middle (exogenous), or from the stores of the purchased microorganisms in the very body of humans (endogenous infection). The ethiological structure of hospital infections in the surgery of the field of evidence in the fallowness according to the patient's profile and the type of operational involvement (Table 1). A provincial child of early infections in the case of an out-of-town profile is given a golden staphylococcus; coagulase-negative staphylococcus most often suffer from post-transplant infection; kishkova palichka and representatives of the Enterobacteriaceae family are dominant pupils in abdominal surgery and infection in food and gynecology (Table 2). However, the author identifies a high level of P. aeruginosa (18.1%) and E. coli (26.9%) 2; staphylococcus buv visions in 36.6% of cases, E. coli - in 13.6, P. aeruginosa - in 5.1%. 2 For visible hospital strains, temporal strength to antibiotics is characteristic; 2 Stability to the most viable antibiotics can reach 70-90% 2. Due to high resistance to penicillin and good sensitivity to fluoroquinolones. 2

Razrіznyayut such factors riziku Pislyaoperatsnіh infectious diseases: 1 Factories, tied for ailments: over 70 years old; stanchuvannya (hypotrophy, malabsorption syndrome, obesity); supportive infections; destruction of the anti-infectious disease systems, including the immune status (oncological process, exchange therapy, elimination of corticosteroids and immunosuppressants, parenteral treatment); alcoholism and drug addiction; supportive chronic illness (diabetes, chronic ignition processes, chronic nirkova or pechinkova lack, lack of blood circulation). PERIOPERATSIYNO factor: the triviality of the preoperative period; incorrect preparation of the operating field; traumatic hair loss in the area of ​​surgery; cleaning shkіri with alcohol and revealing chlorine with antiseptics; antibiotic therapy a few days before the operation.

Intraoperative factors: triviality involved; steps of the study of anatomical tissues; overwhelming storage of electrocoagulation; lack of hemostasis; Implantation of third-party materials (ligatures, prostheses); deterioration of sterility of possession and tools; blood transfusion (whole blood); type of dressing; draining rani; destruction of hemodynamics and gas exchange before the hour of the operation; low level of quality of the surgeon.

Factors tied by zybudniks: the nature of the bacterial contamination: - exogenous, - endogenous; virulence of bacteria; synergism of bacteria (aerobi + anaerobi). Otzhe, it is not safe to know about an operational wound to accumulate in the form of a contamination of microorganisms.

The step of contamination risk is in its own place to lay down in the type of operational involvement (Table 3). Vidіlyayut clean, cleverly clean, contaminated and difficult operations. 1 Prior to clean planning operations, if there is no contact with the lumen of the empty organ and the asepsis will not be disturbed.

Cleverly clean operations transfer the opening of an empty organ, often of the entire shlunkovo-intestinal tract, or to educate the dysfunctional nobles. When contaminated by operations, there may be on the grounds, for which there is inevitably an obstruction of the operative wounds (as a rule, there is a need for operative work on the gut and sextuples in case of infection of the stage, on the intestinal tract. ... Brudnі - a group of operative involvement in the drive of gnіynyh processes.

For example, in the case of the ailments from the staphylococcal infection, who are overwhelmed at the same time with the ailments from the synognition, they will have to use the synognition; in ailments with an infectious disease, which are treated at once with ailments in a proteanus, a proteanus will appear (they did not prevent the infection from being infected). In abdominal surgery, 50% more than 50% of the prevention of the diagnosis of black emptying is polymicrobial in nature, so it is also possible to talk about the widening of the phenomenon of cross-cutting information and superinformation. 1 Internal infections are characterized by morbidity key forms, Viklikanikh with one and the same zabudnik. 1. 4. Pathogenetic aspects and possible clinical manifestations of infectious diseases.

Tissue necrosis is characteristic of all surgical infections. In case of secondary surgical infection, tissue necrosis does not develop as a result of tissue ruin by bacterial enzymes (as in the case of primary infection), but mainly due to mechanical abnormal physical factors.

Firing in response to the reaction of the organism to the pathogenic microorganisms, so that it develops in the singularity.

A handful of references to the production of fabrics is the misconception of the ignorant reaction. As macrophages do not want to phagocytose all bendings of cells, they become overwhelmed with necrotic tissues, as they serve as a miraculous center for bacteria. At their own devil, bacteria see toxins that can destroy non-smart fabrics. At the end of the stage, there are classic signs of firing: swelling, hyperemia, temperature adjustment and bile (tumor, rubor, calor, dolor). The growing igniting reaction of pragne zupiniti expanded infection, localized and strangled. It seems that the necrotic tissue on and microorganisms rises, and the infiltrate rises.

Zapalennya is a folding pathophysiological process, in which case the fate of the lifeless biologically active speeches of mediators is fired.

The initiators of the ignition reaction, mabut, serve as a presence in the blood of humoral factors: the components of the guttural system, anti-dysfunctional, calcareous-kinin systems and complement, cytokines, eukozanoids and іn. Tsi supervisingly straining and mutually modulating as a factor will not be able to: - at a high blood flow and penetration of the vertebrae. - as a result of a reaction and a reaction in the ignition reaction of neutrophils and macrophages of cells, phagocytic microbes and surplus of waste tissues. - from the synthesis and secretion of supplemental mediators. In such a rank, up to the symptoms of surgical (surgical) early infections, there may be: Misceva eritema.

Illness.

Swelling.

The development of the regions of the operative early.

Early in the Kremlin.

Triva hyperthermia for a friend of a feverish woman.

Risky soreness in the area of ​​an operative scar.

Improvement of reparative processes in the early stages.

Leukocytosis, increase in SHOE. Symptoms of intoxication. I’ll look at those who have a lot of signs that are fired up in some way, it’s important to interpret, and early on, I’m talking about how to see it.

Let your mother know that the diagnosis of an operational early infection can be delivered, if bacteriological confirmation for some reason is not recognized. 1 Development of infection.

Clitini and humoral factors, which take part in the ignition reaction, are responsible for pathogenic microbes.

The variability of the inflammation and its result lies in the level of tissue tissue, some of the tissue penetration into the wound of microorganisms, and also because of the internal forces of the organism.

You can show such clinically infectious diseases: Igniting information. Abscess. As soon as the feet of the ear tissue, some and the virulence have penetrated into the wound, the microorganisms are so large, but the organism is not in the place of localization and strangling the infection on the very cob, abscesses develop.

The exudation of fibrinogen, to repair at an early stage, burned, to produce pyogenic shell near the end of the infection.

To move phagocytes and microbes see enzymes that melt instead of an empty abscess. When the osmotic forces flow into the empty space, water flows, and the grip in it grows.

jelly i lively speeches Mayzhe does not penetrate through the pyogenic membrane, as well as anaerobic glycolysis. As a result, an empty abscess is formed ideal for anaerobic bacteria in the middle of a high grip, low pH and low sourness.

Antibiotics with pracea penetrate through the pyogenic membrane; Moreover, in the acidic environment, the antimicrobial activity of aminoglycosides is reduced.

An abscess has formed, as it is not possible to open up mimically, in the form of a surgical treatment.

Empіma tse abscesses, scho vinikє in the empty room or in the middle of the body (the pace of the pleura, the pace of the chewing mikhura, etc.). In case of self-induced abnormal growth of abscess and emptiness, a fistula fistula is established, which will open an empty abscess with a lasting middle line. A fistula can be formulated by a double-sided tear through an abscess or an abscess. In general, the fistula is a pathological canal with two different anatomical structures (for example, bronchial, pararectal, stravochid-tracheal fistula). Sepsis. As the organism is not permanently localized, it strangles the infection in the middle, microorganisms penetrate into the bloodstream and the bacterium bacterium. In the bloodstream of the bacterium, it multiplies and produces toxins that accumulate the development of sepsis.

Bacterial ekzo- endotoxins destroy the functions of the organisms.

Stretch wikid endotoxin to produce up to septic shock... Even though endotoxin reaches 1 μg / kg vagi, shock can be irreversible and can lead to death after 2 hours.

The diagnosis of sepsis should be set if there is a minimum of two signs of the chotiroh: Tachypnoe: frequency of response> 20 min -1 or p a CO 2 Tachycardia: HR> 90 min -1. The temperature was 38 ° C or less than 36 ° C. Leukocytosis or leukopenia (> 12,000 μl-1 or -1) or more than 10% of immature forms of leukocytes.

Trauma, shock, bacterium, wikid to endotoxin and tissue degradation, trigger a fiery reaction that can lead to sepsis, respiratory distress syndrome (shock legend) and multiple organ failure. Polyorganna lack, as a rule, is developed in stages, accompanied by the small energy needs of the client.

Oscillations with sepsis decrease the synthesis of ATP, fabrics and organisms, which require an increased amount of energy, go to the pearl.

There is a clear picture of sepsis and polyorganic deficiencies in some way to develop due to the presence of an active infection. When blood is sowed, it will be found that there are no intellectually pathogenic microorganisms (for example, polyresistant coagulase-negative staphylococci, Pseudomonas spp.). A number of terms “syndrome of systemic fiery reaction”, “syndrome of visual self-tolerance”, “third peritonitis” have been proponated for the development of the future. Due to recent findings, the role in the pathogenesis of polyorganic deficiency is not the pathological stimulus itself (bacterium, opioid, trauma, ischemia, hypoxia, autoimmune damage, etc.), as well as anti-inflammatory hormones). The main role is to introduce intestinal microflora, penetrating through the mucus of the intestinal tract into the systemic bloodstream.

Mechanisms, which start and stop the ignition reaction, go out to the control.

There is no effective treatment. 1.5. The basic principle of the treatment and prevention of infectious diseases. 1.5.1. Treatment of operational infections Antibacterial therapy.

To carry out the treatment of fiery illnesses based on the principles of the bath and the peculiarities of the nature and localization of the pathological process (phlegmon, abscess, peritonitis, pleurisy, arthritis, osteomyelitis, etc.). The main principle of treating ailments from surgical infections: ethiotropic and pathogenetic directing of medical visits; the complexity of the treatment carried out: treatment of conservative (antibacterial, disintoxication, immunotherapy, etc.) and operational methods of treatment; Carrying out of personal visits to the urahuvannya of individual features of the body, character, localization and stage of development of the ignition process.

The development of such methods of treatment of surgical infections: 1. Conservative treatment. In the cob period, fired up the pump, go straight to the fight against microflora (antibacterial therapy) and on the vicoris tannya by pouring it into the ignition process, so that you want to go back to the development or interchange. In Tsei perіod vetch zuyut konservativnі techniques: antibakterіalna terapіya іnfuzіyno-transfuzіyna terapіya, Pere was imparted krovі, krovozamіnnikіv dezіntoksikatsіyna terapіya enzimoterapіya іmunoterapіya fіzіoterapіya, teplovі proce durepi UV opromіnennya, UHF terapіya, lazeroterapії I zastosuvannya antiseptichnih zasobіv zastosuvannya protizapalnih i protinabryakovih koshtіv elek troforez medicinal words i іn. Even the ignition process has passed at the next phase: puncture of abscesses, emptying with antiseptic breakdowns, decontamination and drainage.

Obov'yazkovyu mind є stem calm for the ailing organ active members, Post-mode and in. 2.Operative lykuvannya. The transition from the ignition process to the normal phase, the ineffectiveness of the conservative treatment to serve as indications until the surgical stage.

It is not safe to transfer a localized infection to a localized infection (sepsis) in the presence of a severe deterioration in the amount of surgical operation.

Signs of an important abnormally advanced inflammation and ineffectiveness of conservative therapy.

Lіkuvannya gіiny wounds, as they settled in during the operational period, Follow the rules.

Antibacterial therapy: Find out about the scheme of treatment of internal carnial infections.

However, unimportant on the іstotnі vіdminnostі in pіdkhodov, the main role in all schemes is to lay down antibacterial drugs.

The frequency of antibiotics being prescribed for therapeutic use is 23.5 to 38% in new cases, up to 50% in cases of intensive therapy. The main principle of the rational treatment of antibacterial drugs is based on a whole lot of low officials: the quality of the ear and the etiopathogenetic primed triviality of the drug.

Vibrating the preparations at the presentation of the information about the species warehouse and the politic sensitiveness of the suppurations.

For the determination of the optimal doses and methods of introducing antibacterial drugs in accordance with the characteristics of the pharmacokinetics and antibacterial spectrum of the drug.

Urahuvannyam to the nature of the interaction of antibiotics, including those with other drugs. In case of elimination of internal carnial infections, the development of empirical and ethiotropic therapy is followed. Vibir of drugs for empirical therapy seems to be foldable enterprises, so it is necessary to lay down the structure of antibiotic resistance in a particular diet, as well as in the manifestation / visibility of this locality, mono-polyphysiology.

The main principle of empirical therapy is to vibrate drugs, which are active in the main medical institutions.

In addition, there is a combination of drugs, or drugs of a wide range of diy. In order to reject the results of microbiological predictions and assessments of the clinical efficacy of the drug, it is possible to find out the need for a correction of the therapy, as it is possible to identify the combination of drugs for a larger range of monotherapies.

The main approach to ethiotropic antibiotic therapy (Table 4) is due to the phenotype of antibiotic resistance in diseases and a number of other officials.

Infection of transmission of a significant number of microorganisms, which are responsible for the pathogenic effect.

The exact number is actually the opposite; Mabut, it is possible to lay down in the form of microorganism, and also in the form of factors in the risy, enveloped by the camp of the sick.

Risic factors, linked to pathogenic microorganisms, sprouts, such as virulence, in a simple manner, such as their role in the bagatofactorial ethology of early infections.

However, the factor of risk, tied with the sick person's camp, the peculiarities of the operative involvement, the nature of the pathological process, having become a guide for the surgical operation, to take the

The management of nonspecific prophylaxis occurs during the period of preoperative training for ailments. They are referred to: the normalization of homeostasis and the exchange of words and the frequency of blood loss, the normalization of the white, electrolyte balance, in order to better understand the technology of the operation, in addition to the improvement of the tissue repair, rapid hemostasis , obesity, optimization of the operation, qualification of the surgeon, provision of services, as well as support (sa Harne diabet, Immunosup Resso, chronically inflamed). However, suvorogo attention to the rules of asepsis and antiseptics when carrying out surgeries of some operations in a number of vypadkiv appear deficient. For specific visits, it follows the reason for the development of the appearance and form of the influence of the inheritance on the bacteria of the bacteriological acceleration, so that the accumulation of methods and methods is injected into the microbial flora, and the first for all the prizes of antibiotics. 1. Form vplivu on zbudnika: sanatsіya vognisch іnfektsії zastosuvannya antibakterіalnih zasobіv on Shlyakhov peredachі іnfektsії (vseredinі Venne, vnutrіshnom'yazove, endolіmfa matic administration antibіotikіv) pіdtrimannya mіnіmalnoї perevazhnoї kontsentratsії (IPC) antibakterі cial preparatіv in zonі operatsії - mіstsі poshkodzhennya tkanin (antiseptichny suture material, immobilized antibacterial drugs on implants, delivery of anti septic agents through microirrigator) 2. Immunocorrection and immunostimulation.

Pіslyaoperatsіynі іnfektsіynі uskladnennya mozhut Buti rіznoї lokalі zatsії i nature, ale osnovnі of them takі: nagnoєnnya Rani pnevmonіya vnutrіshnoporozhninnі uskladnennya (abdomіnalnі, plevralnі abscess, empіema) zapalnі zahvoryuvannya sechovih shlyahіv (pієlіt IT pієlonefrit, cystitis, urethritis) sepsis Pid profіlaktichnim zastosuvannyam antibіotikіv in Surgery reasons before the operation are introduced with the method of lowering the risk of development of the operational early infection.

The main provisions of antibiotic prophylaxis (Table 6), which are responsible for the antibiotic drug, which indicate that antibiotic, antibacterial drug for prophylaxis and antibacterial drug for prophylaxis, begins with the onset of antibiotic antibiotic is not guilty of vicious development of resistance of pathogenic microorganisms; the drug is guilty of good penetration into the tissue - the zone of information; the period of antibiotic administration after a one-time injection is guilty but sufficient for the maintenance of bactericidal concentration in the blood and tissues throughout the entire period of the operation; antibiotic is guilty of minimal toxicity; the drug is not guilty of injecting into pharmacokinetic parameters for anesthesia, especially muscle relaxants; the drug is guilty of being optimal in terms of the position / efficiency.

Dose one dose, so as a bagatorazu wall doesn’t allow you to go overboard.

Antibiotic prophylaxis is not shown in selective proximal vagotomy.

Cholecystectomy (including laparoscopic) in chronic cholecystitis Actual microorganisms: staphylococcus, intestinal palichka, enterococci, Streptococcus, anaerobic bacteria.

Antibiotic prophylaxis - one dose of cephalosporin I or II generation or one dose of amoxicilin / clavulanic acid.

Deliver one dose.

Prior to that, antianergic drugs are not necessarily viscous. In case of operative involvement with the drive of the hospitable cholecystitis, cholangitis, and in case of mechanical disease, antibacterial therapy is recommended.

Operations on the rim and rectum Actual microorganisms: aerial and anaerobic, the leading rank of gram-negative bacteria. Antibiotic prophylaxis - one dose of amoxicilin / clavulanic acid and a second generation cephalosporin in combination with metronidazole.

Oral decontamination of the intestine with antibiotics є bazhanov (for which you can use fluorochinoloni (ofloxacin, ciprofloxacin, pefloxacin), aminoglikosidi (gentamicin, amikacin), polymixin). With Crohn's ailment, prophylaxis can be continued in the operational period.

Apendectomy Actual microorganisms: anaerobic bacteria, intestines having dropped points and іnshi enterobacteria.

Antibiotic prophylaxis: In case of nonperforating appendicitis - one dose of amoxicilin / clavulanic acid and a second generation cephalosporin in combination with metronidazole. With perforated appendicitis - antibacterial therapy.

Local ginny peritonitis in the presence of hepatic-nirkovo deficiency - amoxicilin / clavulanic acid or cephalosporin II generation in combination with metronidazole + aminoglikosidi.

Peritonitis diffuse, gnarium feces (with the presence of abnormal hepatic-nirkova deficiency) - cephalosporin III or IV generation + metronidazole, pperacylin / tazobactam abo ticarcillin / clavulanate a. With laparoscopic apendectomy - one dose of II generation cephalosporin.

Pancreatitis Actual microorganisms: golden and epidermal one hundred phylococcus, intestinal stick.

Antibiotic therapy of obov'yazkov - cephalosporin II-III generation + aminoglycosidi.

Operations in obstetrics and gynecology: Kesariv rostin Antibiotic prophylaxis: one dose of cephalosporin I or II generation (if the umbilical cord is squeezed) or one dose of ampicilin / sulbactam (amoxicilin / clavulanic acid)

Pererivannya vagіtnostі that INSHI vnutrіshnomatkovі vtruchannya (gіsteroskopіya, dіagnostichne vishkrіbannya) Antibiotic prophylaxis: a single dose of cephalosporin I abo II pokolіnnya (in kombіnatsії of metronіdazolom at temple riziku іnfіkuvannya) abo single dose ampіtsilіn / sulbactam (amoksitsilіn / klavulanovoї acid) abo single dose of the piperacillin / tazobactam or one dose of ticarcilin / clavulanate.

Hysterectomy (vaginal or abdominal) Relevant microorganisms: non-clostridial microflora, enterococci, enterobacte rii (partly intestinal palichka) are anaerobic. Antibiotic prophylaxis: one dose of cephalosporin I or II generation (in case of vaginal hysterectomy in combination with metronidazole) or one dose of ampicilin / sulbactam (amoxicilin / clavulanic acidosis / abocylate

Operations in orthopedics and traumatology: Promptly engaging on slopes without implantation of alien body Actual microorganisms: golden and epidermal hundred phylococci, intestinal stick.

Antibiotic prophylaxis - one dose of cephalosporin II generation before surgery.

Prosthetics of slopes Antibiotic prophylaxis - one dose of cephalosporin I or II generation before the operation and two more doses with a stretch of the first dob ​​(with prosthetics of a tazostegnum slope, perevagu will be used for cefuroxime). Operations on the hand Up-to-date microorganisms: golden and epidermal staphylococcus.

Antibiotic prophylaxis - one dose of cephalosporin I or II generation, during reconstructive surgeries on the vessels and nerve ends, additional two doses are indicated with a stretch of the first dob.

Penetrating wounds of the loam Topical microorganisms: golden and epidermal staphylococcus, intestinal tract Alochka, anaerobic bacteria.

Antibiotic prophylaxis - one dose of II generation cephalosporin intraoperatively, then progression in the operative period in 72 hours. When the wound is 4 years old, antibacterial therapy is recommended.

Osteosynthesis with applied metal structures for isolated supercritical fractures of the upper symptoms. Actual microorganisms: golden and epidermal staphylococcus.

Antibiotic prophylaxis - one dose of cephalosporin I or II generation before surgery.

Osteosynthesis with applied metal structures in case of isolated, severe fractures of the upper symptoms. Actual microorganisms: golden and epidermal staphylococcus.

Antibiotic prophylaxis - one dose of cephalosporin I or II generation before surgery and after 8 hours.

Critical fracture of ideas Actual microorganisms: gram-positive and gram-negative bacteria.

Antibiotic prophylaxis is indicated in case of type I acute fracture (the point of injury to the skin curvatures in the middle of the cystic ulcer) - cephalosporin of the II generation, once before the operation.

Slide the beasts to respect on the term of wound processing.

Heart-sudinna surgery, thoracic surgery, slit-facial surgery: Cardiochirurgia Actual microorganisms: golden and epidermal staphylococcus, gram-negative bacteria.

Sudinna surgery Actual microorganisms: golden and epidermal staphylococcus, intestinal stick.

Thoracic surgery Actual microorganisms: staphylococcus, streptococcus, gram-negative bacteria.

Scalloped-face surgery Actual microorganisms: microorganisms microorganisms: empty company microorganisms.

Antibiotic prophylaxis: one dose of II generation cephalosporin in combination with metronidazole or one dose of amoxicilin / clavulanic acid, or one dose of clindamicin.

Prophylaxis with antibiotics is not necessary for all people, however, one can only be cinnamon for the most sick person, as well as from a certain point of view.

The effectiveness of antibiotics Surgeons are guilty of initiating on the basis of a bath of the transmission of an infectious disease. Vibir to the drug for prophylactic antibiotic therapy lie in the form of malignant diseases, most often the reason for the quiet hypooperative bacterial diseases.

However, the infection can be developed, without affecting antibiotic prophylaxis, and it is not a matter of underestimation of the importance of these methods of preventing the onset of operative bacterial acceleration. Thus, the prophylaxis of operational acceleration is necessary at all stages of endo exogenous infection (on the middle of infection, transmission routes, on operational technology, fabrics in the area of ​​operational involvement); it is also suvoro dotrimuvatisya rules of asepsis and antiseptics. Chastina 2. Basic types of operative infectious diseases. 2.1. Wound infection. Most often, there is a type of internal infection of the wound. About early infections, the suppuration of the wound and the burning of navkolishny tissues can be seen directly from the fact that it was possible to identify pathogenic microorganisms in the process of sowing.

Wound infection - acceleration of the wound process, which is caused by the proliferation of ailous microorganisms in the early stages; It can appear not only muscular (suppuration), ale and zagalny (feverishness, weakness, early visceral) symptoms. Important forms of early early infections - sepsis, right. Development of superficial (supra-facies) and early infections.

Superficial early infections develop in 4-10 dB. writing operations.

The first symptoms of pain, heart failure and blistering.

More pain in the area of ​​early wounds, albeit, unfortunately, is often a sign of the development of infection, especially with vicious gram-negative microorganisms. They open the wound (shkіra and pіdshkіrnu klіtkovin), I see him.

Antibiotics are not recognized. In case of non-obstructive problems, there are some specimens of the operative infectious diseases (likarnyana microflora). Stretching 3 4 dB. dry the wound with tampons, as long as granulation tissue does not appear. Then put on a second seam or tighten the edge of the wound with adhesive.

Glyboki early infectious diseases thrive on fabrics, but lie under the fascias, often in the middle of empty spaces. Most often abscess, inability to anastomosis, prosthesis infection and acceleration.

Provide a drainage system; Establish the cause of infection and conduct ethological treatment.

Wounds of infections of children and soft tissues: Erysipelas, phlegmon, lymphangitis. Erysipelas was one of the main accelerated wounds in hospitals in the pre-antiseptic period.

Peaks of peaks (very hot dermis) are streptococci of group A, which add toxins.

It is characteristic of the widespread infection. The shkira is filled up and overwhelmed, the problems of the little ones may be clear. Iaksho to get involved in the pathological process lymphatic system, On the shkіrі there are chervonі smuga (lymphangitis). Streptococcus viklikayut also pour the hot spot of the pediatric cell and phlegmon.

Zahvoryuvannya, scho viklikayuyutsya streptococcus group A, prot_kayut important; before the incidence, the lethality rate was 90%. Likuvannya: benzylpenicillin (1.25 million units. In / in the skin 6 years) to produce to the bend of all the diseases. For 50 years, before they passed the test of penicillin, they didn’t lose their role in streptococcus to peniciline.

Ін'єкційний abscess.

Infectious diseases can be accelerated by any drug or drug addiction. In the United States, 80% of drug addicts practice intravenous cocaine administration in non-sterile minds, producing fired inflammation, abscesses, phlegmon, and thrombophlebitis to the point of approval.

The buddies are anaerobically different bacteria.

Characteristic signs: pain, pain on palpation, hyperaemia, fluctuations, leukocytosis, lymphadenitis and fever.

Antibiotic therapy in the case of emergencies and abscesses has given good results. 2.2. Infections of vertebral transplants.

Frequency of infectious accelerated growth during the installation of leg prostheses. In most cases (75%) infections develop in the groin area.

Zbudniki beckon є staphylococks.

Investigation of the vessels of that shunt can be brought to the need for its visualization and before the loss of a reduced diagnosis; Coronary artery bypass grafting can be a cause of death.

Development of early and early infections of vertebral transplants.

Early surgery for transplant infections does not occur from early infections. Most often they wake up gut sticks, which are less expensive than staphylococks.

Likuvannya: open the wound and make it look like pus.

Conduct bacterioscopy of a smear prepared for Gram, seeding and test for sensitivity to antibiotics.

Empty the wound with tampons, leak the povidone with iodine (use a bare graft). Tampons regularly change, as long as the wound is not cleaned and granulation tissue does not appear. Then we put on a second coat.

Meaning antibiotics in the middle; Vibir antibiotics accumulate among the results of bacteriological prescription.

Vankomitsin is not recognized as long as the presence of staphylococcus, resistant to methiciline, is not brought. Infections of transplants develop through a lot of time or months of surgery, if it is created, but the wound was caused by the primary interference without any acceleration. As a rule, the area in the area of ​​the wound is easier to harden, then it is possible to repair the pus through a small opening in the operative scar.

Infections of Staphylococcus epidermidis. Likuvannya: open the wound and see him. If necessary, barely expose the graft dilenk.

The visualization of the entire transplant is not necessary. Naivazhche accelerated distribution of the ship's seams, which can be brought up to not safe for life bleeding. 2.3. Infectious diseases of the sečovyh gentry.

The diagnosis should be made if, when a freshly released slice is made, more than 100,000 bacterial colonies per 1 ml.

Infections of the seich nobles do not expect to be superfluous.

The hematologic cystitis is an infection of Escherichia coli. In case of cystostomy, the risk of infection is lower than in the case of installation of the Foli catheter.

Chronic pyelonephritis can lead to development of nirka abscess or paranephritis.

Mimovilne roztin abscess to produce peritonitis.

Likuvannya: at the early stages of cystitis, they stimulate the urine output and see a permanent catheter. As a rule, you can do without antibiotics. I am not going to do it anyway, it shows signs of sepsis, it means antibiotics in the middle. Vibir antibiotics accumulate all the results in the sech. 2.4. Catheter infection. In the cutaneous third venous catheter, 2 dB. for the installation there are bacteria. In 1% of ailments with a venous catheter, if we are placed more than 48 years later, bacterium develops. With a small increase in the term, replacing the catheter in the veins of the growth rate of bacteria increases up to 5%. Likuvannya: seeing a catheter; If a patient is suspected of sepsis, the tip of the extended catheter is inserted, inserted into a sterile tube and sent for bacteriological prescription and inoculation.

Occasional infection of the arterial catheter; similarity. 2.5. Pneumonia.

Pislyoperatsіynі іnfektsіі legenіv reduce up to 10% of surgical involvement in the upper version of the black emptying. Bіl і trivially, moving to the position lying on the back, overshoot the normal arms of diaphragms and breast cells. The result is atelectasis, and pneumonia. In addition to pneumococci, there are also streptococci, staphylococci, gram-negative intestinal sticks, anaerobic empty bacteria and fungi.

Aspiracy pneumonia get sick of anaerobic bacteria of the empty company.

Ingestion of sour slunk juice in the dormant way will change your mind for the development of important pneumonia (Mendelssohn's syndrome). Likuvannya: dichal gymnastics, spiro-trainer, stimulation of cough, massage, postural drainage, etc. Iakshcho a fever woman is overwhelmed with atelectasis;

Lichomaniac, puffed up with pneumonia, does not pass. If you are susceptible to pneumonia (fever, gnarium sputum, if the infiltrate appears on the chest x-ray), antibiotics are indicated. Before the ear of antimicrobial therapy, fibrobronchoscopy can be used to eliminate phlegm that is not obstructed by external microorganisms.

Conduct seeding education and start the IPC antibiotics. 2.6. Infections of breastfeeding.

Empima pleurisy can be a legacy of infection abo empty operations... The role of anaerobic microflora in the development of pleuria is often underestimated.

Lіkuvannya: drainage of pleural emptying, thoracotomy with visible pleural adhesions and mooring or pleurectomy. Before the signs of antibiotics, conduct bacterioscopy of a smear prepared according to Gram.

Antimicrobial therapy is guilty of including a drug that is active as an anaerobic microflori (metronidazole or clindamicin). Abscess legends.

Legeneva infection can lead to an abscess.

Zbudniki zazvychay staphylococks, as well as obligatnі anaerobes, which do not expect to be seen.

Likuvannya: call for installation of drainage in the empty abscess is required.

Antimicrobial therapy is guilty of including metronidazole, an active anaerobic microflora.

Mediastinitis. Tsya infection is characterized by high lethality. Most often, mediastinitis is caused by resection, or penetrating injuries to the stratohode. At early stages, carry out drainage and prescribe antibiotics, actively produce endotoxin of gram-negative microorganisms and regional anaerobes.

Effective cefotaxime in combination with metronidazole. May be used with imipenem / cilastatin. Antibiotic Oscillations surgical engagement(To the point of confusing pus for sowing), the interpretation of the results of bacteriological preliminaries is complicated. When antibiotics were vibrated afterwards, the spectrum of antibiotics was recognized earlier than the drugs.

Osteomyelitis of the sternum. Qiu іnfektsіyu, gradually accelerate to increase the sternotomy, start to wick the staphylococci. As empirical antibiotic therapy is ineffective, the wound is opened for surgical treatment and drainage.

Endocarditis and pericarditis are carried out to surgical infections.

Infection in the main secondary can develop as an accelerated mediastinitis, liver abscess, nasty pleurisyі ін. With tuberculous pericarditis, there may be a need for pericardiotomy. In case of endocarditis, enterococcus, Streptococcus viridans, pneumococci and other bacteria, can also be surgically affected.

Infectious endocarditis is susceptible to infection with strains of Streptococcus viridans (70% of vipads), Enterococcus faecalis or Streptococcus group D. Mayzhe all pupils are sensitive to penicillin.

Likuvannya: high doses of penicilin stretching for 4 hours. , Yak, as a rule, produce until the day.

The strains of Enterococcus faecalis are developed according to their sensitivity to antibiotics; ci microorganisms of the stike to cephalosporins and aminoglycosides. In case of infection, viklikanoy enterococci, the drug Vibor ampicilin. Streptococcus bovis is sensitive to benzylpenicilin. 2.7. Infections of worms.

Pislyaoperative peritonitis. 15 20% of cases of peritonitis and abscesses of empty blood are brought to the part of the operative delay.

The diagnosis is easy to set nicely, in the middle for this additional writing of the operation. Nayposhirenish is the reason for the failure of the operative technique, which leads to anastomosis, necrosis, and the end of the intestine in the empty space to a lack of blood flow.

This is the reason why the hollow organ is damaged during the operation. If an intra-abdominal hematoma can fester and lead to an abscess development.

Necessary surgical treatment.

An effective method for the treatment of abscesses is percutaneous drainage under the control of ultrasound or CT. Antimicrobial therapy is difficult, some antibiotics in the preoperative period should be produced before resistant forms of microorganisms appear.

Antibiotics are meant to be guilty of not only being seen in the presence of bacteria, but also optional and obligatory anaerobic intestinal microflora.

I mean the third generation cephalosporin in combination with metronidazole (500 mg skin for 12 years) or imipenem / cilastatin. A combination of antibiotics in actives and as well as enterococks. I have found resistant strains of Pseudomonas spp., Enterobacter spp. and Serratia spp., antibiotics for aminoglycosides in combination with beta-lactam antibiotics.

Vysnovok: Nutrition of ethology, pathogenesis, diagnostics, clinics, prevention and treatment of infectious diseases in surgery, monographs, conferences, conferences, plenaries.

Development in the last rocks of clinical microbiology, clinical immunology, biochemistry and other fundamental disciplines allowing the assessment of new positions in the pathogenetic aspects of diagnosis, development of

Development and implementation of modern methods of antimicrobial, detoxification therapy, immunotherapy, enzyme therapy, physiotherapy, new developments lykarsky zasobiv and antiseptics, in-depth treatment technologies and prevention schemes, allow to reduce the frequency of diagnosis and change the unpleasant inheritance of operational infections in surgery. Bibliography: S.D. Mіtrokhin.

Infectious diseases in surgery: antibacterial prophylaxis and therapy. Consilium Medicum 02.2002, 4 / N B.S. Briskin.

Internal infection control and operational acceleration from the position of the surgeon. Consilium Medicum 0 4.200 0.2 / N V.K. Gostishchev. Zagalna surgery. - M., 2004 N.A. Somina, E.T. Kovalova, L.A. Genchik.

Epidemiology and prevention of internal infections. New in the prophylactic hospital infection. - Inform. bull. - M., 1997; 3-9. A.N. Kosinets, Yu.V. Pods.