Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical SurgeryВестник экспериментальной и клинической хирургии2070-478X2409-143XVoronezh State Medical University named after N.N. Burdenko28710.18499/2070-478X-2013-6-4-498-518Review of literatureОбзор литературыUnknownModern Approaches to Сomplex Treatment of Necrotic Tissue DiseasesСовременные подходы к комплексному лечению гнойно-некротических заболеваний мягких тканейШабловскаяТ.А.

applicant, Department of Surgery, A.I. Evdokimov Moscow State University of Medicine and Dentistry

соискатель кафедры хирургии ФПДО Московского государственного медико-стоматологического университета им. А.И. Евдокимова

tamara_doc@mail.ruПанченковД.Н.

MD, PhD, Professor of Surgery, Chief, Department of Surgery and Laboratory of Minimally Invasive Surgery, A.I. Evdokimov Moscow State University of Medicine and Dentistry

д.м.н., проф., зав. кафедрой хирургии ФПДО и лабораторией минимально инвазивной хирургии НИМСИ Московского государственного медико-стоматологического университета им. А.И. Евдокимова

dnpanchenkov@mail.ruMoscow State University of Medicine and Dentistry, 20/1 Delegatskaia Str., Moscow, 127473, Russian FederationМосковский государственный медико-стоматологический университет им. А.И. Евдокимова, Москва, Российская ФедерацияFederal Research and Clinical Center of specialized types of health care and medical technology FMBA of Russia, 28 Orekhovyi Ave., Moscow, 115682, Russian FederationФедеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России, Москва, Российская Федерация24122013644985182804201628042016Copyright ©; 2013, Voronezh N.N. Burdenko State Medical UniversityCopyright ©; 2013, ФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава России2013Voronezh N.N. Burdenko State Medical UniversityФГБОУ ВО ВГМУ им. Н.Н. Бурденко Минздрава Россииhttps://vestnik-surgery.com/journal/about/editorialPolicieshttps://vestnik-surgery.com/journal/article/view/287

This article presents the relevant information on the prevalence, etiology and pathogenesis modification factors, as well as evaluation of modern methods of treatment necrotic soft tissue diseases. Special attention is paid to the actively developing method of physical therapy of necrotic process - the low-frequency ultrasonic (LFUS) cavitation. Presented a detailed assessment of the basic properties of ultrasound treatment on the wound process: mechanical wound cleansing cavitation squirt, acceleration of metabolism at the subcellular and tissue levels, bactericidal and bacteriostatic effect on microorganisms , the potentiation of antibacterial and antiseptic , strengthening of regional blood flow , enhancing the repair processes in the wound. Application LFUS cavitation relevant to the outpatient treatment phase necrotic diseases of soft tissues due to its high-performance, ease of use , and also show the best correlation with program implementation of hospital- substituted technologies in outpatient link of health care. The study of literature shows that few studies use LFUS in outpatient practice do not contain explicit organizational and structural features and algorithms for the treatment of patients with purulent-necrotic diseases of soft tissues LFUS cavitation. Matters relating to the definition of optimum conditions , the multiplicity and duration of exposure to wound, the optimum compositions of acoustic mediums, the optimal method of local anesthesia, when used LFUS in patients with different clinical forms of necrotic soft tissue diseases , there remains little known

В данной статье представлены актуальные сведения о распространенности, модификации этиологических и патогене- тических факторов, а также оценка современных методов лечения гнойно-некротических заболеваний мягких тканей. Особое внимание уделено активно развивающемуся методу физического воздействия на гнойно-некротический процесс – низкочастотной ультразвуковой кавитации (НЧУЗ). Представлена детальная оценка основных свойств ультразвуко- вого воздействия на раневой процесс: механическое очищение раны кавитационной струей, ускорение процесса обмена веществ на внутриклеточном и тканевом уровнях, бактерицидное и бактериостатическое действие на микроорганизмы, усиление действия антибактериальных и антисептических средств, усиление регионарного кровотока, усиление процессов репарации в ране. Применение НЧУЗ актуально на амбулаторно-поликлиническом этапе лечения гнойно-некротических за- болеваний мягких тканей ввиду его высокоэффективности и удобства применения, а также соответствует программе внедрения стационарзамещающих технологий в амбулаторное звено оказания медицинской помощи. Изучение литературы показало, что единичные исследования применения НЧУЗ в амбулаторно-поликлинической практике не содержат четко сформулированных организационно-структурных особенностей и алгоритмов лечения пациентов с гнойно-некротически- ми заболеваниями мягких тканей НЧУЗ кавитацией. Вопросы, связанные с определением оптимальных режимов, кратно- сти и длительности воздействия на рану, оптимальных составов акустических сред, оптимального метода обезболивания при применении НЧУЗ у пациентов с различными нозологическими формами гнойно-некротических заболеваний мягких тканей, остается малоизученным.

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