( )
8 88, 230 80,,,, : (CIP) ISBN 7-81060 - 239 - X /,. :,2002.9............ :. R6 R826 CIP (2002) 040337 () ( 800 : 200433 ) : 787 1092 1/ 16 : 89.25 : 2 : 2 300 2002 9 1 2002 9 1 : 1 4 000 ISBN 7-81060 - 239 - X/ R 184 ( ) : 148.00
21,,,, 80,,,,,,,,,, 2002,
, 8 88 230, 500, ( ) ( ) (:, ;, ;, ;, ;, ;, ;, ;, ), 3 5,,, 80,,,, 2002 6
( ) ( )
( Ge neral Concep t s ) 1 ( In troduction) 1 ( Historical Development of Surgery and War Surgery), 100,,,,,, 50,,,,,,,,,, ( 22 775 ),,,,
2 1 4000 5000 ( 770 ) ;,,,,,,, (142 207 ),,,, ( ),, 2000 1000 ( Vedo), 1500 ( Papyrus ),,, 19, 5 15 5 15,,,,,,,,,,, 1 892,,,,,,,, 16 ( 1540 ), (1745 ) ; 1800 ; 40,,,,,,,,,, : G.B.Morgagni(1682 1771 ),
1 3 A.Von H aller (1708 1777 ),, W.T.G. Morton 19 L.Pasteur ( 1822 1895 ),,,, 20,, X ( CT ) ( MRI),,,,,,,,, (1949 ),,,,,,,,,,,,,,,,,,,,,, ( )20 70,, 1865 (1881 ) 1896 ( ),,,, 1952,,,, 3,
4 1, 1965,,,,, 1978,,,,,,,,,,,,,, 1990,, 2 ( The Relationship of Surgery and War Surgery with Other Subject),, ( ),,,,,,,,,,,,,,, ( ) (injury),,,,, ( trauma),, ( ) (infection ),,,,,,,,,,
1 5 ( ) ( tumor),,,,,,,,,,,,, ( ) ( malformation),,,,,,, ( ) ( dysfunction ),,, ;,, 21,,,,,,,,,,, ( ),,,,,,,,,,,
6 1 ) ; ;,,,,,,,,,,,, 3 ( How to Study Surgery and War Surgery),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
1 7,,,,,,,,,,,,,,,,,,,, ( )
( Surgical Infection) 1 (Introduction ),,,, 1/ 3 1/ 2,,, :,,,,,, ( ),, : (1 ),, (2 ), ;, ( ) ( ),, 3, 2,,,,,,,,,,,
2 9 0 50, 60,,,,,, ( ),, ( T P N) ;,,,,,,,,,,,,,,,,,,, ;,, ( ),,,,,,,,,,, ( ) 1.,,, 2.,,,,,, 3.
10 1 C,,,,, 4. ( ) 1.,,, 2.,,,,,, 3.,, ( ),, ( ),,,,,,,,,,,,, ;,,,, ( ),,,,,,,,, :, ;, ;,,,
2 11 ) 1., (1 ), (2 ), ( BC ) (3 ),,,,, (4 ),,,,, (5 ),,, 2. 20,,, 40, (cefalotin, ) (cefaloridine, ) (cefazolin, ) (cefradine, ) ( cefalexin, ) ( cefuroxine, ) (cefamandole, ) ( ceftazidime, ) (ceftriaxone, ) (cefoperazone, ),, : ; ;, ;,,,,,,, ( ),,,,,, 3.,, ( ),, ;, 1.,,,
12 1. 20%, 25% 50%,,,, 3.,, 4.,,,,,,,,,,,,,,,,,,,,,, 2 ( Acute Pyogenic Infection of Soft Tissue) ( ) ( furuncle), ( 2-1),,,,,,,,,,,,,,,,,,,,,,, ( ),,,, ;,,,,,,,
2 13,,,,, ( ),,,, 75%, ( ) ( ),,,,, -1,,,,,,,, ( ) ( carbuncle ),,,,,,,, ( 2-2) 2-2 ( ),,,,,,,,,,,, ( ),,, ( ) 1.,,,
14 1.,,, +,,, ( 2-3) 3 d,,,,,, 2-3 ( ) ( a- cute cellulitis ),,,,,,,, ( ),,,,,,,,,, ;,,,,,,,,,, ( ),,, ( ),,,,,,,,,,,, 3% ( ) (erysipelas ),, ( ),,
2 15 ),,,,,,,,,,,,,,,,,, ;,,, ( ) 50 %, 3 5 d,,,, ( ) (abscess ),,,,,,,,,,,,,,, ( ),,,,, ; ( 2-4 ),,,,,,,,,,,,,,,,,,,! (DSA),, ( ),,, : ;,, ;,, ;,
16 1-4, ;, ;, ;, ( ) ( acute lymphangitis),,,,,,,, ( ),,,,,,, ( ), ( ),,,,,,, (acute lymphadenitis),,,,,,,,,,, ;, 3 ( Septicaemia and Pyotoxaemia),,,,,,,,
2 17 ( septicaemia),,, ( pyotoxaemia),, ( bacteremia),,,,,, ( toxaemia),,,, ( pyosepticaemia),,, ;,,,, ( ),,,,,,, ( ) 40 41,,,,,, ( ),, ( ) (20 30) 10 9 / L,,,, ( ),,,,
18 1 ),,,, 40 41, 0.5 1,,,,,,,,,,,,,, 2,,, : ; ; ;, ( ),,,,,,,,,,,,,, 24 h,,,,,, ( ),,,
2 19 ),,,, ( ),, 200 ml ; ; ; BC ( ), ( ),,,,,,,,, ( ),,, 3 g, 4 ( Infection of Hand ), ( ),,,,,,,, ( ) (1 ),,,,, (2 ),, ( ) ( ) ( ),,, ; (3 ),,,, (4 ),,,,, (5 ),,
20 1,,, ( ) 1.,,,,, 2. : (1 ),,, (2 ),,, (3 ),,, (4 ),, 3 d 24 h, 48 72 h,,, ( paronychia) ( ),,,,,,,,,,,,,,,,,,, 3 4 d ( felon),,,,,,,,,
2 21,,,,,,,,,,,,,,,, ( 2-5 ),,,,, ( acute pur u- lent tendovaginitis ),, 5 2-5,,,,,,, ( 2-6), 24 h,,,, 2-6,,,,,,,,
22 1,,, ;,,,,,,,,,,,,, ( 2-7 ), 1.5 cm,,,, ( infection of deep thenar space),,,,,,,,,,,, ;,,,,,,, ( ) ( 2-8) 2-7 2-8
2 23 ( Infection of Anaerobic Spor e-bea ring Bacilli) ( tetan us),,,, 20% 40%, 10% ( ),,, 100 30 min,,,,, ;,,,,,,, ( ),,,, ;,,,,, ( ),,,,,,, ( ) 1. 1 2, 24 h,,,, ;,, 12 24 h,, (, ),, ;,,,
24 1, ( 2-9) 2-9,,,,,,,,,,,,,,,,,,, 3 4, 6 2,, 2.,,, ( ),,,,,, 1.,,,,, 2.,,, 3.,,, 4., ( ),,,,,,,, ( TAT ), 1.,
2 25 1 ml, 6 8 1 ml, 3 1 ml: ; ; T AT 3 : 1 0.5 ml, 1 ml, 3 6, 1 1 ml,, 5 1 ml, 10 d, 1 ml 3 7 d, TAT 2. : ; ;, ; ; ( ), TAT TAT,,,, 1,,, 1 4 5, TAT 10 250 500 U,, TAT 1 500 U 12 h,, 2 3 d 1, 0.1 ml TA T 1 ml, 0.1 ml, 0.1 ml 15 min TA T 1 cm,, 1 ml 10, 1 2 3 4 ml, 30 min 1,,, 50 mg 1 mg( ), TAT 3.,,,,, 4., ( ),, 1.,,,,,,,,, 2.,, 3% 1 5 000
26 1., (1 ) 5 U 5% 500 1 000 ml, 5 U 1 2 U,,,,, (2 ) 3 000 6 000 U, 1, 1 000 U (3 ),, 4.,,,,,, (1 ),, 5 mg( ) 10 mg( ) 3 4, 0.1 0.2 g ( ), 10 % 15 ml( ) 20 40 ml( ), 3 (2 ) ( 50 mg 50 mg 100 mg) (20 mg50 mg 100 mg ), 8 12 h 1, 1/ 3 1/ 2, 5% 250 ml (3 ), 0.5 g ( ), 2 4 ml (, ) ;, ( ),,, 5.,,, ( 30 mg 200 400 mg, 1 ),,, 6. ( 10 g, 2 g, 7 ) 1, 3 g, 1, 3 d, ( 10 g, 2 g,,, ) ( ),,,,, ;, ;
2 27 4 d, ;,, 60% ( gas gangrene),,,, ( ),, ( ),,,, 1 h,,,,,,,,,,,,,,,,,,, (),, ;,,,,,,, ( ) 1 4 d, 6 8 h 1,, 1.,,,,,,,,,,,,,, 2.,,, (40 41 ) ( 100 120 / min),,, ( ),
28 1,,, X,,,,,, 3 d,,,,,, ( ), 6 h, 6 h,,,,, 3 % 1 3 000 5 000,,, ( ) 1.,, 2.,, ( ),,,,,, 3% 1 3 000 5 000,,, ;,,,,,,, 3. 3, 15 20,, 3 d 7, 2 h( 1 3, 2 3 2 ), 48 h 5 4.,, ( 1 000 U/ d),,,, 1.5 1.8 g( ),,
2 29 ( Lymphadenitis of TB) ( ),,,,,,,,,,,,,,,,,,, ;,,,,,,,,,,,,,,,, ( ),,, ( ) (,, ), X X ( ),, ( ),,, 1 2 ( ),,,,
30 1, 0.2 0.5 g 2.5 % 5 ml, 2,,,, ( )
( Ulcer Necrosis Gangrene Sinus and Fistula ) 1 ( UIcer), ( ),, ( ) ( ), ( ) ( ) ( ) ( ) (X ) ( ) ( ) ( ) : ( ) ; ( ) ; ( ) ( ),,,,, ( ),,,,, ( ),,,,,, ( ), : ( ) 1/ 3,,
32 1,,,,,,, ( ),,,,,,,,,, ( ),,,,,,,,, ( 3-1),,,, ( ), 3-1 ( ), ( ),,,,,, 2 ( Necrosis and Gangrene),, ( ) ( ) 1. 2. 3. ( ) ( ) 1.
3 33. 3. ( ) ( ) ( ), ( ),,,,,,,, ( ),,,,,,,,,,, ( ),,, ( ),,,, ;,,,,,,,, ( ), 2.5% 75%,,, ( ) 3 (Sinus),,,,
34 1 ),,,, ( ), ( ) ( ),,,,, (,,, ) X,,,, 4 ( Fistula),, ;,,, ( ) ( ) ( ) ( ),,, 4 cm ( ), X ( ),
3 35, ( )
( Water and Elect rolyte and Acid-Base Imbalance ) ; ( ) ( ),,,,,,, 60%, 55%,,,,, 77%, 4,, 1 ( Water and Elect rolyte Imbalance),, ( ) 1. ( dehydration ),,,,,
4 37,,,,, 2.,, ; ;, ( 4-1 ) 4-1 ( % ) 2 4 5 9 10 15,, ( ),,,,,, ( ),,,,,,,,,, 3.,, ;, ;,,,, ( ) 1., ( ),,, ( water overloading ),, (1 ) : : ( < 120 mmol/ L),,
38 1 2 ) :,,, 3% 5%, 400 ml( 20 g ) :,, 2. ( ) (1 ) :, ( ),,,, (2 ) : 1) :,,,,,, 2) :, (3 ) : :,,,,, ( ) ( hyponatraemia),,,, 1.,, : (1 ),, (2 ) 0.25%,,, 1 4 L,,,,, (3 ),,,,, F EN a( )