Objective of the research is to assess the likelihood of complications in the acute and early periods of Traumatic Disease (TD) and primary condition and reserve capability of hemodynamic and homeostasis in patients with polytrauma. Materials and methods. A retrospective study was carried out on 32 patients suffering from polytrauma. The group of the study included patients with the severity of injury according to the Injury Severity Score (ISS) more than 25 points and on a scale APACHE II 10-25 points at the time of admission. The estimated blood loss was 30-40% of blood volume (BV). The individual assessment of blood loss was calculated by Moor. Results. The study of 20 (62.5%) men, 12 (37.5%) women aged 18 to 60 years old (35.22 ± 12.66) were done. The mechanical ventilation was performed for 30 patients (93.75%), and 2 patients (6.25%) required oxygen therapy 5 lit per min for 3 days. The duration of mechanical ventilation was in 10 patients - up to 1 day, 8 patients - up to 3 days and at 12 - more than 3 days. Among 12 patients, who used AMV more than 3 days, 10 patients were tracheostomy in 3d day and 2 patients were extubated on 4th day. Among the patients examined thirty patients (93.7%) had posthemorrhagic anemia during first day of injury. Infectious complications like purulent tracheobronchitis and pneumonia were observed in 14 (43.75%) patients. The local infectious complications (abscesses, festering wounds) occurred in 5 (15.6%) patients and bedsores in 3 (9,375%) patients. The catheterization of the bladder lead to the development of urinary tract infection in 3 patients (9,3%). Conclusion. The most problematic category of victims includes patients with injuries several anatomical regions. Pneumonia, anemia, urinary tract infection and local infectious complications were considered as the most common complications of acute and early periods TD. The factors that influenced the probability of a high degree of complications were AMV, the thoracic component of the injury, more massive blood loss, long-term catheterization of the bladder.
Introduction. The main directions of intensive care in the acute polytrauma period are based on the principles of Damage control surgery, Damage control resusсitation, Damage control orthopedics. The purpose of work was to analyze the results of the diagnosis, treatment, surgical correction stages, deadlines final stabilization of bone fragments. Materials and methods. A retrospective study was carried out on history of 32 patients suffering from polytrauma which was accompanied by massive blood loss (30-40% deficiency of blood volume) and was characterized by combination of injuries. Clinical and laboratory parameters, stages according to Damage сontrol (DC) tactic, results of treatment were analyzed. Results. The results of diagnosis and treatment were analyzed in 20 (62.5%) males and 12 (37.5%) women, whose average age was 35.22 ± 12.7 years. The severity of injuries graded by the ISS scale was 26.84 ± 4.1. The level of consciousness by the GCS was 13,5 ± 0,5 points. In assessing the severity scale for patients with APACHE II was 14,97 ± 2,78 points. The degree of blood loss in the surveyed group corresponded to the III class according to the classification of the American college of surgeons and amounted to 35.21 ± 4.52% of the blood volume. Hemodynamic signs of hypovolemia were registered in all patients, and 25% needed vasopressor support. A total of 140 operations were performed in several stages. Оn the first day were performed 114 operations in order to stop the bleeding and temporary immobilization of the limbs. On the 2-14 days were performed 26 operations due to deferred indicators. Conclusion. this question need to further study of intensive care and development of criteria for the sequence and timing of multistage surgical correction in order to optimize treatment and reduce complications.
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