ostriy gematogenniy osteomielit u detey

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zaporojskiy gosudarstvenniy meditsinskiy universitet. kafedra detskix bolezney fpo ostriy gematogenniy osteomielit u detey opredelenie osteomielit (osteon-kost, myelos- kostniy mozg + -itis) – gnoyno-vospalitelnoe zabolevanie kostnogo mozga, rasprostranyayusheesya na gubchatoe i kompaktnoe veshestvo kosti, nadkostnitsu s vovlecheniem u malenkix detey rostkovoy zoni i epifiza. vozbuditel - naibolee chastim mikroorganizmom pri osteomieliticheskom protsesse yavlyaetsya stafilokokk ( 80 %) i streptokokk; - v poslednee vremya vsyo chashe obnarujivaetsya assotsiatsiya stafilokokka s proteem, sinegnoynoy palochkoy i klebsielloy; - mikroflora v ochage mojet menyatsya s techeniem vremeni; - v redkix sluchayax imeet gribkovuyu mikrofloru. sosudistaya anatomiya kosti do 1 goda starshe 1 goda sosudistaya anatomiya kosti v vozraste starshe 1 goda i do zakritiya zon rosta poslednie predstavlyayut soboy barer, cherez kotorie sosudi ne proxodyat. v metafize u zoni rosta sosudi povorachivayut v vide ostrix petel, posle chego vpadayut v sinusoidalnie veni. zdes formiruetsya medlenniy i turbulentniy krovotok. eto obespechivaet osedanie infektsii v metafize u …

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ey v osnovnom za schyot skopleniya makrofagov, kotorimi bogat krasniy kostniy mozg, i fiziologicheskogo zamedleniya krovotoka v sosudax; sensibilizatsiya organizma rebenka; narusheniya reflektornix vliyaniy, spazm sosudov; provotsiruyushie faktori ( travma, pereoxlajdenie, infektsiya i t.d.). patomorfologiya osteomielita 1-ya faza otyok kostnogo mozga dlitelnostyu 1-2 sutok; 2-ya faza kostno-mozgovaya gipertenziya do 4-5 sutok; 3-ya faza podnadkostnichnoy flegmoni; 4-ya faza flegmona myagkix tkaney 6-7 sutki. dlitelnie troficheskie narusheniya privodyat k formirovaniyu sekvestrov, vokrug kotorix formiruetsya granulyatsionniy val, uplotnyaetsya okrujayushaya kostnaya tkan i formiruetsya «sekvestralnaya korobka», chto yavlyaetsya proyavleniem xronicheskogo osteomielita. puti rasprostraneniya gnoya klassifikatsiya gematogennogo osteomielita v zavisimosti ot virajenosti klinicheskix proyavleniy t.p.krasnobaev razlichal toksicheskuyu, septikopiemicheskuyu i mestnuyu formu ostrogo gematogennogo osteomielita. po klinicheskomu techeniyu ostriy, podostriy, xronicheskiy. po lokalizatsii metaepifizarniy (do 1 goda), metadiafizarniy (deti starshego vozrasta). xronicheskiy osteomielit pervichno-xronicheskiy osteomielit (abstses brodi, skleroziruyushiy osteomielit garre, albuminozniy osteomielit ole, antibioticheskiy osteomielit polikarpova); vtorichno-xronicheskiy osteomielit (rezultat perenesennogo ostrogo gematogennogo osteomielita). mestnaya forma obshee …

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; mestnie simptomi razvivayutsya s pervogo dnya zabolevaniya; mnojestvennie gnoyno-vospalitelnie porajeniya vnutrennix organov: destruktivnaya pnevmoniya, gepatosplenomegaliya s razvitiem jeltuxi, prisoedinyatsya klinika pankardita, mnojestvennix osteomieliticheskix ochagov, gnoynogo nefrita, toksicheskaya gemoliticheskaya anemiya, abstsesov golovnogo mozga i dr. toksicheskaya forma (adinamicheskaya) toksikoz, endotoksicheskiy shok; ostroe nachalo, razvivaetsya gipertermiya, vozbujdenie, galyutsinatsiya, bred, narusheniya soznaniya, sudorogi; rezkaya blednost, akrotsianoz, petexii, taxikardiya, snijenie arterialnogo davleniya, nitevidniy puls; dixanie poverxnostnoe, aritmichnoe, razvivaetsya otek legkix; razvivaetsya «shokovaya pochka» s oliguriey, anuriey; v 70% sluchaev zakanchivaetsya letalnim isxodom v pervie 2-3 sutok. diagnostika oak, oam, proteinogramma, koagulogramma, immunogramma; mikrobakteriologicheskoe issledovanie; rentgenologicheskoe issledovanie; uzi obp, mvs, smejnie sustavi; ekg; rentgenografiya organov grudnoy kletki; obyazatelnaya punktsiya ochaga; konsultatsiya anesteziologa; konsultatsii smejnix spetsialistov pri neobxodimosti. diagnostika rannyaya diagnostika – punktsiya ochaga (opredelenie vnutrikostnogo davleniya, otsenka makroskopicheskogo izmeneniya punktata, bakteriologicheskoe i tsitologicheskoe issledovanie); laboratornie metodi issledovaniya (gemograma, proteinograma, immunograma) svidetelstvuyu o vospalitelnom protsesse, virajenosti intoksikatsii, immunologicheskix narusheniyax; diagnosticheskaya punktsiya rentgendiagnostika rentgenologicheskie priznaki poyavlyayutsya …

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truktivnie ochagi i pyatnistiy osteoporoz differentsialnaya diagnostika travmoy; kostno-sustavnoy formoy tuberkulyoza; ostroy revmaticheskoy lixoradkoy; nagnoivsheysya gematomoy; neosteomieliticheskoy flegmonoy, abstsessom, limfadenitom; kostnimi opuxolyami ( osteogennaya sarkoma, sarkoma yuinga); lechenie po t.p. krasnobaevu: - vliyanie na makroorganizm; - vliyanie na mikroorganizm; - vliyanie na ochag vospaleniya. vliyanie na makroorganizm korrektsiya narusheniy gemodinamiki; korrektsiya narusheniy veb, kshr; dezintoksikatsionnaya terapiya ( infuzionnaya terapiya, plazmaferez, gemodializ); immunoterapiya ( antistafilokkovaya plazma, immunostimulyatori i dr.); desensibiliziruyushaya; oksigenoterapiya; vliyanie na mikroorganizm 1.ratsionalnaya antibiotikoterapiya s uchetom mikroflori i chuvstvitelnosti eyo k antibiotikam; polusinteticheskie penitsillini (oksatsilin); tsefalosporini ( tseporin, tsefaleksin, tsefepim, tseftriakson, tsefotaksim); rifampitsin 8-10 mg/kg; fuzidin 40-80 mg/kg; linkomitsin 30-60 mg/kg; amikatsin 7-10 mg/kg; metronidazol 15-20 mg/kg 2. antiseptiki: dioksidin; xlorofillipt; yodopiron; linkomitsin na 0,5 % novokaine; kanamitsin. vnutriochagovoe drenirovanie po metodu k.p. aleksyuka v osteomieliticheskiy ochag vvodyatsya postoyannie igli spetsialnoy konstruktsii. eto pozvolyaet provodit berejnoe drenirovanie vnutrikostnogo ochaga, a takje obespechivaet vvedenie neposredstvenno v ochag vospaleniya antibiotiki, antiseptiki, …

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mozg. nalajivaetsya postoyannoe protochnoe promivanie rastvorom ringera na protyajenii 7-14 dney do perioda normalizatsii temperaturi, uluchsheniya obshego sostoyaniya, ischeznoveniya lokalnoy simptomatiki. image2.png image3.png image4.png image5.png image6.png image7.png image8.png image9.png image10.png image11.png image12.png

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zaporojskiy gosudarstvenniy meditsinskiy universitet. kafedra detskix bolezney fpo ostriy gematogenniy osteomielit u detey opredelenie osteomielit (osteon-kost, myelos- kostniy mozg + -itis) – gnoyno-vospalitelnoe zabolevanie kostnogo mozga, rasprostranyayusheesya na gubchatoe i kompaktnoe veshestvo kosti, nadkostnitsu s vovlecheniem u malenkix detey rostkovoy zoni i epifiza. vozbuditel - naibolee chastim mikroorganizmom pri osteomieliticheskom protsesse yavlyaetsya stafilokokk ( 80 %) i streptokokk; - v poslednee vremya vsyo chashe obnarujivaetsya assotsiatsiya stafilokokka s proteem, sinegnoynoy palochkoy i klebsielloy; - mikroflora v ochage mojet menyatsya s techeniem vremeni; - v redkix sluchayax imeet gribkovuyu mikrofloru. sosudistaya anatomiya kosti do 1 goda starshe 1 goda sosudist...

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