Аналіз результатів різних видів периопераційної аналгезії та інтраопераційної анестезіологічної підтримки при хірургічних втручаннях у постраждалих з бойовою травмою грудної клітки

Abstract

SummaryIntroduction. The actual problem of up-to-date military surgery is to determine theplace and role of various methods of anesthesia in the care of victims with combat chesttrauma. We have clarified and improved the indications and contraindications for theuse of methods of anesthesia and intraoperative support in providing care to thiscategory of wounded and injured.Aim of the work: improving the results of treatment of wounded in the chest due tomultimodal anesthetic support and differentiated use of videothoracoscopic technologiesfor providing medical care based on the analysis of the results of treatment of 103victims with combat chest trauma received in the area of antiterrorist operation (ATO) /environmental protection at the II-IV levels of medical care in the period from 2014 to2019.Results. The proportion of chest injuries in the general structure of combat surgicaltrauma is 7.5–11.7%. fragmentation wounds prevail (48.2%) by the mechanism ofoccurrence, non-penetrating wounds prevail (38.9%) by the nature of the injury, chestinjuries - by the type of injury (40.3%), according to the severity of injury – mild injuries(42.7%) and moderate ones (37.9%).A multimodal approach to anesthetic management and differentiated use ofvideothoracoscopic techniques in patients with combat wounds and chest trauma wasdeveloped and implemented. This made it possible to carry out selective ventilation in53 (81.6%) cases without complications, to differentiate the type and volume of surgicalintervention, which allows us to achieve reliable hemostasis of wounds, aerostasis of thelungs, removal of foreign bodies from the chest organs, thorough debridement of thepleural cavity and prevent the development of early and late postoperative complications associated with anesthesia and ventilation of the lungs.Conclusions.1. The proportion of chest injuries in the general structure of combat surgicaltrauma is 7.5–-11.7%. fragmentation wounds prevail (48.2%) by the mechanism ofoccurrence, non-penetrating wounds prevail (38.9%) by the nature of the injury, chestinjuries – by the type of injury (40.3%), according to the severity of injury – mildinjuries (42.7%) and moderate ones (37.9%).2. Selective ventilation of the lungs in treatment of the patients with combat woundsand chest injuries is indicated when there is a threat of transbronchial ingress ofpathological contents (blood, pus, necrotic masses, foreign bodies, etc.) into thecontralateral lung, the presence of bronchial air leakage due to trauma of a largebronchus or a pulmonary defect tissue, the need for selective lavage of the lungs withthe threat or occurrence of recurrent pulmonary hemorrhage.3. Absolute contraindications to selective ventilation of the lungs in combat woundsand chest trauma are the discrepancy between the lumen of the main bronchi and thediameter of the endotracheal tube and pathological processes of the airways revealedduring intubation or bronchoscopy, accompanied by their stenosis or occlusion (tumors,cicatricial stenosis, exogenous deformation, bifurcation etc.). It is advisable to referoperations from the posterior thoracotomy access to relative contraindications (due tothe possible displacement of the mediastinum and rotational occlusion of theendotracheal tube when the victim is turned to the pronation position).4. Transfer of an injured person with a combat wound or chest trauma fromselective ventilation to two-lung ventilation is indicated in case of a progressivedecrease in the perfusion index and / or arterial oxygen saturation, which cannot becorrected or instability of the patient’s hemodynamic parameters