nbsprotВестник войск РХБ защитыJournal of NBC Protection Corps2587-57283034-279127 Научный центр10.35825/2587-5728-2023-7-4-276-285jeytovnbsprot-322Research ArticleХИМИЧЕСКОЕ И БИОЛОГИЧЕСКОЕ ОРУЖИЕ В ВОЙНАХ И КОНФЛИКТАХCHEMICAL AND BIOLOGICAL WEAPONS IN WARS AND CONFLICTSМедицинские последствия и лечение поражений, вызванных применением боеприпасов с белым фосфоромMedical Consequences and Treatment of Injuries Caused by White Phosphorus Munitionshttps://orcid.org/0000-0002-7088-488XЛакотаЯ.LakotaJ.

Лакота Ян. MD, PhD

Дубравская дорога 9, 841 04, Братислава

ул. Бойцов Сопротивления 10, 841 04, Братислава

Ján Lakota, MD, PhD.

Dúbravská cesta 9, 841 04 Bratislava

Odbojárov 10, 820 05 Bratislava

jan.lakota@savba.skЦентр экспериментальной медицины, Словацкая Академия наук ; Факультет менеджмента Коменского университетаСловакияCentre of Experimental Medicine, SAS ; Faculty of Management Comenius UniversitySlovakia20230801202473276285Copyright © Лакота Я., 20242024Лакота Я.Lakota J.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nbsprot.ru/jour/article/view/322

Белый фосфор (white phosphorus, WP) используется в ручных гранатах, минометных и артиллерийских снарядах, авиационных бомбах с Первой мировой войны. Его применяли в боевых действиях в Ираке, Сирии, Афганистане, Йемене, Нагорном Карабахе и применяют в ходе палестино-израильского конфликта в Газе. Ожоги, вызываемые WP, обычно приводят к смерти или к инвалидности. Цель работы – анализ и обобщение данных научной литературы по медицинским последствиям и лечению поражений, вызванных применением боеприпасов с WP. Материалы и методы. Для анализа использовались доступные научные публикации, описывающие последствия ожогов WP, полученные в ходе боевых действий. Метод анализа – описательный. Решались следующие задачи: изучались свойства WP, как поражающего агента; обобщались материалы по медицинским последствиям поражения WP и методам лечения таких поражений. Обсуждение результатов. WP высоко реакционен, высокотоксичен и воспламеняется на воздухе уже при температуре 35 °С. Тяжесть поражений WP – результат как термического, так и химического воздействия горения. Смертельные случаи среди людей от ожогов WP происходили при участии менее 10 % кожи. Ожоги, вызванные WP, заживают медленнее термических ожогов. WP глубоко проникает через жировую подкожную клетчатку. Поэтому ожоги полнослойные, некротические. Поглощенный WP действует как клеточный яд и вызывает поражение ЦНС, печени, почек, миокарда и других органов. Любые частицы WP, попавшие в рану, могут повторно возгораться. Заключение. На догоспитальном этапе прежде всего необходимо смыть WP прохладной водой и удалить щипцами кусочки WP, попавшие в кожу. Свет от УФ-лампы может визуализировать мелкие частицы WP. Очистка отслоившейся кожи и удаление видимых частиц WP с кожи являются важнейшими методами ограничения тяжести ран и системной абсорбции фосфора. Целесообразны иссечение обожженного участка в период до часа после поражения и повторные оперативные процедуры до тех пор, пока все частицы фосфора не будут удалены; контроль в течение первых 48 ч за содержанием кальция и фосфора в сыворотке крови с соответствующей коррекцией. В дальнейшем целесообразны пересадка кожи и лечение мезенхимальными стволовыми клеткам.

White phosphorus (WP) has been used in hand grenades, mortar and artillery shells, and aerial bombs since World War I. Recently it has been used in combat operations in Iraq, Syria, Afghanistan, Yemen, Nagorno-Karabakh and is used during the Palestinian-Israeli conflict in Gaza. Burns caused by WP usually result in death or disability. The purpose of the work is to analyze and summarize the data of the scientific literature on the medical consequences and treatment of lesions caused using ammunition with WP. Materials and methods. For the analysis, we used available scientific publications describing the consequences of WP burns received during hostilities. The method of analysis is descriptive. The following tasks were solved: the properties of WP as a damaging agent were studied; materials on the medical consequences of WP lesions and methods of treatment of such lesions were summarized. Discussion of the results. WP is highly reactive, highly toxic and ignites in air as early as 35°C. The severity of WP lesions is the result of both the thermal and chemical effects of combustion. Fatalities among humans from WP burns have occurred involving less than 10% of the total body surface area. Burns caused by WP heal more slowly than thermal burns. WP penetrates deeply through the fatty subcutaneous tissue. Therefore, the burns are full-thick, necrotic. The absorbed WP acts as a cellular poison and causes damage to the central nervous system, liver, kidneys, myocardium, and other organs. Any WP particles trapped in the wound may re-ignite. Conclusion. At the pre-hospital stage, the first thing to do is to wash off the wounds with cool water and remove the pieces of WP that have fallen into the skin with forceps. The light from the UV lamp can help to visualize the small particles of WP. Cleaning exfoliated skin and removing visible WP particles from the skin are critical methods for limiting wound severity and systemic WP absorption. It is advisable to excise the burned area within an hour after the lesion and repeat surgical procedures until all phosphorus particles have been removed; to control during the first 48 hours for the content of calcium and phosphorus in the blood serum with appropriate correction. In the future, skin grafting and treatment with allogeneic mesenchymal stem cells are advisable.

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The authors declare that there are no conflicts of interest present.