Венозний тромбоемболізм у травмованих із тяжкою поєднаною травмою живота

Abstract

Introduction. According to the modern data, in the structure of peacetime injuries, the part of severe combined abdominal trauma (SCAT) occupies 5-20%, leading to disability in 25.2% of cases. Venous thromboembolism is a frequent complication of SCAT. Despite of progress in diagnostics, treatment and prevention, number of randomized multicenter studies on venous thromboembolism in the injured is insufficient, world standards and prevention recommendations remain sometimes controversial.The aim of the study. To improve the outcomes of the treatment of patients with SCAT by differentiated prophylaxis of venous thromboembolism.Materials and methods. One hundred and five patients with SCAT (ISS score result 16-35 (18.4±7.4) points), who underwent inpatient treatment at the Lviv city emergency clinical hospital, were comprehensively examined. Twenty-seven (25.7%) had deep vein thrombosis, which were operated for SCAT in 2012-2016.Results and discussion. Twenty-seven (25.7%) cases of thrombosis were verified in the basin of the lower vena cava, 10 (37.0%) of which were manifested clinically, namely by limb edema, pastosity and pain. The remaining (17-63%) cases were asymptomatic and were verified by ultrasonic compression angioscanning of the veins of the lower extremities. Thrombosis of tibial veins and the sural sinuses was asymptomatic and was verified in 7 (25.9%) cases, thrombosis of the popliteal vein was seen in 4 (14.8%), of superficial femoral vein in 5 (18.5%) and the common femoral vein was diagnosed in 8 (29.6%) patients. The cause of thrombosis of deep veins in the injured with SCAT is a combination of factors in preoperative (age over 50, time from injury to hospitalization for more than 6 hours, body mass index over 28, history of venous thrombosis and embolism) and postoperative (duration of operation over 160 minutes, ISS score result over 21 points, postoperative immobilization over 48 hours) periods, vascular damage, massive blood loss, use of hemostatic drugs, traumatic shock.Conclusions. In the absence of prevention, the incidence of deep vein thrombosis in patients with SCAT reaches 25.7%. The method of ultrasonic compression angioscanning of the veins of the lower extremities had revealed a predominance of the proximal nature of thrombosis; risk of fragmentation and potential thromboembolism of the pulmonary artery were detected in 13.7% of the injured. There are 18 significant (p<0,05) parameters associated with the development of postoperative venous thrombosis and embolism in patients with SCAT, of which 4 are independent risk factors of deep vein thrombosis in the preoperative period (age over 50, time from injury to hospitalization over 6 hours, body mass index over 28, history of venous thrombosis and embolism) and 3 in the postoperative period (duration of operation over 160 minutes, ISS score result over 21 points, postoperative immobilization over 48 hours).