CONCEPTUAL ANALYSIS OF THE COURSE OF TRAUMATIC DISEASE IN PATIENTS AGAINST POLITRAUMA

Kravchenko S. P., Sukhenko Yu. M.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

In recent decades, despite the significant achievements of surgery, traumatology, anaesthesiology and resuscitation, in Ukraine, as well as almost all over the world, there is a significant increase in the level, severity and mortality under traumatic injuries that has allowed some authors to introduce the concept of an epidemic of injuries. An increased number of injuries to vital organs, the high production and material costs, which are spent on prevention, diagnosis, treatment and rehabilitation of patients with traumatic disease, give this issue aspecial urgency and a great social and medical significance. The primary disorder under all critical conditions is the dysregulation of oxygen exchange between blood and tissues. State of prolonged hypoxia becomes a factor of progressive inhibition of energy-dependent processes responsible for the structural maintenance of intracellular reactions. In patients with polytrauma, acute coagulopathy develops independently of the volume of blood loss. Thus, polytrauma is pathology with corresponding specific changes in all systems of damaged body and development of traumatic disease, which occurs over a long period of time. Half of the lethal cases after traumatic lesions are associated with bleeding, and most of them occur within 6 hours after injury. It is shown that hemorrhagic shock after trauma induces dysfunction of the hemostasis system within a few minutes, and this early trauma-induced coagulopathy can exacerbate bleeding and is associated with a higher mortality and morbidity. To predict the course of the acute period of traumatic illness in patients with polytrauma can be used scales VPH-P, VPH-SP, RTS and TRISS, the medians of which have significant differences in groups of patients with favorable, uncertain and unfavorable course of acute traumatic illness. 120 case histories of patients diagnosed with polytrauma were analyzed. The predominant causes of injuries were road (55.1%) and mechanical (28.5%) injuries. Thus, severe trauma of two or more anatomical areas occurred in 52.2% of patients, severe combined traumatic brain injury occurred in 33.8% of patients, severe combined trauma of the abdomen occurred in 8.2% of patients, severe combined trauma of the chest was place in 2.9% of patients, severe multiple injuries of the limbs and pelvis occurred in 2.4% of patients, severe combined thermomechanical lesions occurred in 0.5% of patients. It was found that a favorable course of the acute period of traumatic illness with stabilization within 48 hours occurs in 55.1% of patients with polytrauma; indefinite course with stabilization of the state after 48 hours – in 26.1%; unfavorable course with no stabilization – in 18.8%. The main factors of the unfavorable course of the acute period of traumatic illness are: extremely severe and critical brain damage, grade III shock and deep coma. Among the scales for assessing the severity of injuries, the VPH-P scale has a greater prognostic value compared to the ISS scale: the VPH-P scale has a range of values for a favorable prognostic range – less than 15 points (AUC=0.86); for adverse – 19 points or more (AUC=0.92); the ISS scale has a value range for a favorable prognostic range of less than 25 points (AUC=0.69); for the unfavorable – 42 points and more = 0.74).

traumatic illness, polytrauma, treatment tactics, prognosis.

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«Bulletin of problems biology and medicine» Issue 4 (162), 2021 year, 130-135 pages, index UDK 616-001-06-07

10.29254/2077-4214-2021-4-162-130-135