СОВЕРШЕНСТВОВАНИЕ ТАКТИКИ ЛЕЧЕНИЯ ТЯЖЁЛОЙ СОЧЕТАННОЙ ЧЕРЕПНО-МОЗГОВОЙ ТРАВМЫ С УЧЁТОМ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ СИНДРОМА ЖИРОВОЙ ЭМБОЛИИ

Abstract

Objective: The reduction the lethality in the acute period of severe combined craniocerebral injury (SCCI) by improving the treatment tactics, in terms of the clinical manifestations of fat embolism syndrome (FES). Methods: The results of treatment of 393 patients with SCCI at the age of 14 to 68 years are analyzed. Patients were divided into three groups: I group (traditional treatment) – 144 (36.7%); group II (optimized tactics) – 194 (49.3%); group III – children and adolescents aged 14-18 years – 55 (14.0%). In turn, patients of the II group are divided into the following subgroups: IIA (FES) – 33 (8.4%); IIB (SCCI) – 99 (25.6%); IIC (FES + SCCI) – 62 (15.7%). Results: The implementation of optimized treatment tactics in combination with the identification and pathogenetic treatment of FES contributed to a reduction in deaths compared to traditional approaches. Overall mortality was 31.0%; 40.3% in group I; 12.2% in group IIA; 23.2% in group IIB; 40.3% in group IIB, and group IIIB – 21.8%. In a differentiated analysis, postoperative lethality as a whole was 26.5%; in group I – 34.1%; in group IIA – 5.3%; in group IIB – 20.8%; in group IIB – 33.9%, and in III group – 14.3%. Mortality after conservative treatment was 55.7%; in group I – 83.3%; in group IIA – 21.4%; in group IIB – 100.0%; in group IIB – 100.0%, and in group III – 35.0%. Conclusion: The suggested approaches in the treatment of SCCI by improving tactics, properly the clinical manifestations of FES refer to effective ways to reduce the lethality in the acute period of traumatic illness. Keywords: Severe combined craniocerebral injury, fat globulemia, fat embolism syndrome, optimized treatment tactics, lethality.