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ранения огнестрельного в омске","retina":false,"avatarId":"0","isMacOS":false,"brand":"alice-ru","device":{"isIOS":false,"platform":"desktop"},"expFlags":{"isFootnoteDetails":true,"isFootnoteRedesignDivided":true,"futurisMultiqueryFlag":true}},"dialogStoreProps":{"baseUrl":"","orderedPairUUID":["Question"],"requestResponsePairs":{"data":{"Question":{"userMessage":"Ранение огнестрельное: что это?","markdown":"**Огнестрельное ранение** — это совокупность повреждений, возникающих в результате действия снарядов (пуль, шрапнели, картечи, осколков, дроби), выпущенных из огнестрельного оружия [1](https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound)[2](https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf)[4](https://ru.wikipedia.org/wiki/%D0%9E%D0%B3%D0%BD%D0%B5%D1%81%D1%82%D1%80%D0%B5%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D1%80%D0%B0%D0%BD%D0%B5%D0%BD%D0%B8%D0%B5). \n\n**Особенности**: \n- вокруг раневого канала образуется зона омертвевших тканей (первичный некроз) [1](https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound)[4](https://ru.wikipedia.org/wiki/%D0%9E%D0%B3%D0%BD%D0%B5%D1%81%D1%82%D1%80%D0%B5%D0%BB%D1%8C%D0%BD%D0%BE%D0%B5_%D1%80%D0%B0%D0%BD%D0%B5%D0%BD%D0%B8%D0%B5); \n- раневой канал имеет неравномерное направление и протяжённость [1](https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound)[2](https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf); \n- при сквозных ранениях возникает выходное отверстие значительного диаметра [1](https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound)[2](https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf); \n- в ране обнаруживаются инородные частицы, втянутые туда вследствие высокой скорости снаряда [1](https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound)[2](https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf). \n\n**Классификация**: по типу ранящего снаряда (осколочное, пулевое), по особенностям раневого канала (слепое, сквозное, касательное) и другим параметрам [1](https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound)[2](https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf).\n\n\n\n## Причины\nОгнестрельные ранения чаще возникают в военное время, но в мирное время встречаются редко — обычно носят криминальный характер либо возникают в результате несчастного случая с оружием [3](https://ProBolezny.ru/ranenie-ognestrelnoe/). \n\n**Механизм образования**: разрушительное действие снаряда обусловлено двумя компонентами: прямым ударом (непосредственным воздействием на ткани) и боковым ударом (действием ударной волны, которая мгновенно образует зону высокого давления, отбрасывающую ткани в сторону) [1](https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound)[2](https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf).\n\n## Симптомы\n**Местные симптомы**: наличие раны с наружным кровотечением [3](https://ProBolezny.ru/ranenie-ognestrelnoe/). Кровь может выделяться из раны равномерно и неинтенсивно, либо, при повреждении крупных сосудов, бить пульсирующей струёй [3](https://ProBolezny.ru/ranenie-ognestrelnoe/). \n\n**Общие симптомы**: на фоне местных проявлений быстро ухудшается общее состояние [3](https://ProBolezny.ru/ranenie-ognestrelnoe/). В сочетании с повреждением внутренних органов эти проявления складываются в картину травматического шока [3](https://ProBolezny.ru/ranenie-ognestrelnoe/).\n\n## Диагностика\n**Для диагностики огнестрельного ранения используют**: \n* **Визуальное исследование** — осмотр раны невооружённым глазом, с помощью лупы, в инфракрасных и ультрафиолетовых лучах [11](https://www.mediasphera.ru/issues/sudebno-meditsinskaya-ekspertiza/2019/2/1003945212019021055). \n* **Рентгенологическое исследование** — для дифференциальной диагностики входного и выходного отверстий, установления наличия пули и дефектов костной ткани, металлических частиц в области входной раны [11](https://www.mediasphera.ru/issues/sudebno-meditsinskaya-ekspertiza/2019/2/1003945212019021055)[13](https://elib.gsmu.by/bitstream/handle/GomSMU/2963/%D0%A1%D1%83%D0%B4%D0%B5%D0%B1%D0%BD%D0%BE%20-%20%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D1%81%D0%BA%D0%B0%D1%8F%20%D1%8D%D0%BA%D1%81%D0%BF%D0%B5%D1%80%D1%82%D0%B8%D0%B7%D0%B0%20%D0%BE%D0%B3%D0%BD%D0%B5%D1%81%D1%82%D1%80%D0%B5%D0%BB%D1%8C%D0%BD%D0%BE%D0%B9%20%D1%82%D1%80%D0%B0%D0%B2%D0%BC%D1%8B.pdf?sequence=1&isAllowed=y). \n* **Спектральный анализ** — позволяет определить дистанцию выстрела, отличить входное отверстие от выходного [11](https://www.mediasphera.ru/issues/sudebno-meditsinskaya-ekspertiza/2019/2/1003945212019021055)[13](https://elib.gsmu.by/bitstream/handle/GomSMU/2963/%D0%A1%D1%83%D0%B4%D0%B5%D0%B1%D0%BD%D0%BE%20-%20%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D1%81%D0%BA%D0%B0%D1%8F%20%D1%8D%D0%BA%D1%81%D0%BF%D0%B5%D1%80%D1%82%D0%B8%D0%B7%D0%B0%20%D0%BE%D0%B3%D0%BD%D0%B5%D1%81%D1%82%D1%80%D0%B5%D0%BB%D1%8C%D0%BD%D0%BE%D0%B9%20%D1%82%D1%80%D0%B0%D0%B2%D0%BC%D1%8B.pdf?sequence=1&isAllowed=y).\n\n## Лечение\n**Основной метод лечения** — **хирургическая обработка ран** [15](https://medvestnik.by/konspektvracha/boevaya-khirurgicheskaya-travma-v-sovremennykh-realiyakh). Различают первичную и вторичную хирургическую обработку [15](https://medvestnik.by/konspektvracha/boevaya-khirurgicheskaya-travma-v-sovremennykh-realiyakh)[17](https://dzo44.ru/upload/files/%D0%93%D0%9B%D0%90%D0%92%D0%90%209.%20%D0%9E%D0%93%D0%9D%D0%95%D0%A1%D0%A2%D0%A0%D0%95%D0%9B%D0%AC%D0%9D%D0%AB%D0%95%20%D0%A0%D0%90%D0%9D%D0%AB%20%D0%98%20%D0%98%D0%A5.pdf). \n\n**Некоторые принципы лечения**: \n* **Наложение первичной повязки** — защищает рану от неблагоприятного воздействия внешней среды и от вторичного микробного загрязнения [17](https://dzo44.ru/upload/files/%D0%93%D0%9B%D0%90%D0%92%D0%90%209.%20%D0%9E%D0%93%D0%9D%D0%95%D0%A1%D0%A2%D0%A0%D0%95%D0%9B%D0%AC%D0%9D%D0%AB%D0%95%20%D0%A0%D0%90%D0%9D%D0%AB%20%D0%98%20%D0%98%D0%A5.pdf). \n* **При обширных огнестрельных ранениях** необходима иммобилизация повреждённого сегмента, предохраняющая его от вторичной травматизации [17](https://dzo44.ru/upload/files/%D0%93%D0%9B%D0%90%D0%92%D0%90%209.%20%D0%9E%D0%93%D0%9D%D0%95%D0%A1%D0%A2%D0%A0%D0%95%D0%9B%D0%AC%D0%9D%D0%AB%D0%95%20%D0%A0%D0%90%D0%9D%D0%AB%20%D0%98%20%D0%98%D0%A5.pdf). \n* **В послеоперационном периоде** назначают комплексную антибактериальную терапию, инфузионную терапию, лекарственные средства, улучшающие микроциркуляцию [15](https://medvestnik.by/konspektvracha/boevaya-khirurgicheskaya-travma-v-sovremennykh-realiyakh).","linksData":[{"sourceId":1,"url":"https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound","shownUrl":"https://www.KrasotaiMedicina.ru/diseases/traumatology/gunshot-wound","title":"Огнестрельная рана - причины, симптомы, диагностика и лечение","shortUrl":"KrasotaiMedicina.ru","isTranslated":false,"description":"","greenUrl":"KrasotaiMedicina.ru"},{"sourceId":2,"url":"https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf","shownUrl":"https://swsu.ru/sveden/files/aix/MU_LR_Pervaya_medicinskaya_pomoschy_No6.pdf","title":"МИНОБРНАУКИ РОССИИ","shortUrl":"swsu.ru","isTranslated":false,"description":"","greenUrl":"swsu.ru"},{"sourceId":3,"url":"https://ProBolezny.ru/ranenie-ognestrelnoe/","shownUrl":"https://ProBolezny.ru/ranenie-ognestrelnoe/","title":"Ранение огнестрельное: причины, симптомы и лечение в статье ортопеда Николенко В. 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