Course Of Traumatic Disease Research Articles

Prognostic Significance of Markers of Endothelial Dysfunction in Case of Severe Combined Blunt Abdominal Trauma

INTRODUCTION. In case of polytrauma, an imbalance occurs between substances produced by the endothelium, the rheological properties of the blood are disrupted, the content of procoagulants increases, the permeability of the vascular wall increases, which contributes to thrombus formation and increased tissue hypoxia, and subsequently to the development of multiple organ failure, and, of course, affects the course of traumatic disease, the development of complications and mortality. However, specific markers of endothelial dysfunction and their levels, by which it is possible to reliably predict the course of traumatic disease in severe combined closed abdominal trauma for the appropriate pathogenetic treatment have not yet been determined.AIM OF THE STUDY. To determine the significance of some markers of endothelial dysfunction (C-reactive protein, von Willebrand factor, the number of desquamated endothelial cells in the blood) in combined blunt abdominal trauma to predict the likelihood of complications and adverse outcomes.MATERIAL AND METHODS. The main group consisted of 31 patients with severe combined blunt abdominal trauma, the comparison group consisted of 5 patients operated on for large ventral hernias. All patients underwent blood tests for C-reactive protein, von Willebrand factor, the number of desquamated endothelial cells.RESULTS. The level of all three considered markers of endothelial dysfunction in severe abdominal trauma significantly differs from that in operated non-traumatized patients, which allows differential diagnostics to be made between abdominal wall contusion and damage to internal organs; extremely high values suggest an unfavorable course of traumatic disease and a high probability of a fatal outcome.CONCLUSION. Taking into account that the development of traumatic disease is based on damage to the vascular endothelium, it is necessary to consider as prognostic indicators changes in the level of activity of C-reactive protein, von Willebrand factor, desquamated endothelial cells in patients with severe combined blunt abdominal trauma.

CHARACTER AND FREQUENCY OF COMPLICATIONS IN PATIENTS WITH POLYTRAUMA AND CHRONIC ALCOHOL INTOXICATION

Purpose. Identify patterns of traumatic disease and characterize complications in patients with polytrauma (PT) and chronic alcohol intoxication (CAI).
 Materials and methods. Case histories of 39 victims with PT and alcohol history at age 19-60 years who were undergoing treatment at the Prof. Meshchaninov Kharkov City Clinical Emergency Hospital in 2016. Patient inclusion criteria: age 19-60, damage of two or more anatomical functional areas, severity of traumatic injury on the ISS scale 9-25 points, Glasgow coma scores ≥14 at the time of admission, absence of craniocerebral trauma, the absence of general anesthesia.
 Results. The average age of patients was 37.4 ± 9.4 years. Among these groups of patients were 29 men (74%), which is 2.9 times the number of women 10 (26%). Attention is drawn to the fact that the most important part of the victims (28.2%) was precisely the patients of the young able-bodied age. Infectious complications that developed in the early and late period of traumatic disease in victims with CAI are the main causes of death in PT - patients and induce a negative prognosis for survival. During analyzing the timing of the development of purulent-septic complications in this group of patients, we came to the conclusion that they occur on average at 7.2 ± 2.4 days. Among the infectious complications of PT in patients with CAI were pneumonia (28.2%), sepsis (7.6%), peritonitis (7.6%), pleural empyema (5.1%), osteomyelitis (5.1%). Non-infectious complications, in contrast to infectious, manifested from the first hours of injury and reached maximum development during the period by 2.3 ± 0.8 days, they were the main trigger for the development of severe infectious complications in the early period of traumatic disease. Noninfectious complications were consisted by delirium - in 29 patients, which increased the patients duration at intensive care unit on 39,6 ± 5 3 hours. These complications significantly increased the severity of the PT patients with CAI. With a higher incidence, it occurred in hyperactive, (62%) patients with delirium, and mixed (38%) form. Attention is drawn to the fact that patients with fatal outcome (29 cases), delirium was observed significantly more frequently (χ2 to include Yeats = 3.641, p <0.05) was found in 25 patients. Less frequently in patients occurred thrombosis 5(12.8%) and fat embolism syndrom 2 (5.1%).
 Conclusions. Most often, multiple injuries with history of alcohol use are obtained by young working aged men. The cause of injury in more than 60% of cases is accidents. 82% of the victims were in the state of alcohol intoxication during their hospitalization. On average, the terms of stay of patients with ICU are 64.9 ± 23.7 hours, although with the development of complications, these terms increase to 103.2 ± 14.2 hours. In patients with CAI there is a complicated course of traumatic disease. Among the infectious complications that develop at 7.2 ± 2.4 days, pneumonia, sepsis and peritonitis predominate. The most common non-infectious complications were delirium, thrombophlebitis thrombosis, fat embolism. Risk of fatal outcome in patients with delirium in 6.25 times higher than in patients without acute encephalopathy. Thus, the treatment of patients with a history of with polytrauma and chronic alcohol intoxication is an extremely important medical problem that needs further study and improvement.

Predictors of polytrauma outcomes in the early period in children

BACKGROUND: The problem of anti-shock measures and stabilization of the general condition of the affected children with polytrauma at the stage of intensive care is an extremely urgent issue in pediatric traumatology. Various aspects, such as determining the most sensitive prognostic scale for assessing the severity of polytrauma, clinical and laboratory predictors of changes in the vector of development of the course of traumatic disease in the direction of thanatogenic orientation, remain actively discussed among clinicians.
 АIM: The aim of the study is to analyse the dynamics of changes in the indicators of internal homeostasis in children with polytrauma, indicating a favorable or thanatogenic direction of the course of the traumatic disease.
 MATERIALS AND METHODS: A retrospective analysis of the medical records of 49 patients diagnosed with polytrauma was performed. All patients were divided into two groups: the survivors group comprised 41 patients, and the deceased group consisted of 8 patients.
 All patients were examined for total blood count (Er, Tr, Ht, Hb, le, ESR), acid-base state (pH, SBC, BE), blood biochemical parameters (creatinine, urea, ALT, AST, K, Na, Ca), and C-reactive protein. The tests were performed daily during the first 10 days of the acute phase of the injury. The severity of the injury was determined by the NISS and pediatric trauma score scales, and in the case of a traumatic brain injury, the Glasgow coma scale was used.
 A logistic step-by-step regression analysis was performed to identify predictors of polytrauma outcomes. The statical significance was considered at p 0.05.
 RESULTS: The step-by-step logistic regression revealed significant predictors that determined the unfavorable outcome of polytrauma (death), already on the second day. They were the NISS score, the level of CRP, Hb, Er, Na, and creatinine. At the same time, the statistical significance in the dynamics of changes in red blood parameters (Er, Hb), blood ionic composition (Na, K), humoral activity (Le, ESR, CRP) remained up to 10 days, i.e., during the period of possible complications of the traumatic disease. Our data offered the possibility to derive an equation for calculating the risk of failure of compensatory mechanisms in polytrauma.
 CONCLUSIONS: The course of traumatic disease in children with polytrauma is characterized by morpho-functional changes in many organ systems. Predictors of failure of compensatory-adaptive mechanisms in response to polytrauma can be determined already in the early post-shock period.

Catalase activity as signal of antioxydant system affection under influence of limb ischemia-reperfusion

The use of hemostatic tourniquet is a proved means of primary care. However, systemic disorders, as well as ultrastructural, in the area of compression can significantly worsen the condition of the injured organism.
 The aim. Estimation of catalase level in rats’ liver on the background of modifications of ischemic-reperfusion syndrome to know the severest pathogenic combination for organism.
 Materials and methods. 260 white adult male rats were divided into 5 groups: control (KG), EG1 – simulation of isolated ischemia-reperfusion syndrome (IRS) of the limb, EG2 – simulation of isolated volumetric blood loss, EG3 – combination of IRS of the limb with blood loss, EG4 – simulation of isolated mechanical injury of the thigh, EG5 – combination of IRS of the limb and mechanical injury. The variability of catalase level in liver was analyzed.
 Results. It was found that each of the experimental interventions has led to changes of catalase activity in the liver. The most expressed pathological expressions were observed on the 3rd after interventions, when the studied index in EG3 was lower than in EG1 and EG2 in 6,2 times and by 33,1 %. On the 7th day catalase activity in EG3 was in 9,4 times and by 44,5 % times lower than in EG1 and in EG2 data concordantly. The combination of limb ischemia-reperfusion with blood loss in EG3 led to exhausting of liver antioxydant enzyme catalase in the most critical posttraumatic period (day 3). The same, but less significant effect was registered in the group of combination of mechanical trauma with ischemia-reperfusion in EG5. This proved the role of the tourniquet as a factor that complicated the course of traumatic disease due to ischemic reperfusion.
 Conclusions. In this experiment, founded risk factors of combination of ischemia-reperfusion with heavy blood loss emphasized the importance and particular attention on such widespread method of bleeding tratment, as the imposition of a tourniquet, as in our experiment it triggered risk factors of ischemia-reperfusion. It was shown katalase activity depression respectively to the periods of increasing of lipid peroxydation. There was peculiarity, that on the base of isolated IRS catalase activity was increased in 2,5 times comparely to control group, whereas the hardest depression of it was found on the background of IRS, combined with blood loss – catalase activity was lower, comparely to KG – in 2,5 times. The importance of understanding the suppression of hepatocytes’ antyoxydants is great, as it might help in prevention the development of liver failure or hepatorenal syndrome on the background of limb ischemia-reperfusion.

Effects of the influence of copper and zinc on living organisms (literature review)

Introduction. Scientists from Horbachevsky Ternopil National Medical University, Ternopil, and various countries, including state laboratories, have thoroughly studied the biological significance of copper and zinc ions in the body for many years. Nevertheless, the value of the shortage or excess of these metals and their compounds in the body remains mostly underestimated for health. Purpose of work: to study the pathogenesis of traumatic disease occurring due to an imbalance of copper and zinc in the body. Methods. Bibliosemantic and analytical methods were used. A literature search was conducted for the following queries as zinc, copper, heavy metals, negative impact. The investigation was performed with PubMed, Scopus, Web of Science, and Google Scholar for various articles. All publications have been analyzed and included in this review. The importance of these metals’ lack or excess and their compounds in the body remains mostly underestimated. Features of the pathogenesis of many diseases occurring due to imbalance of copper and zinc in the body have also been unexplored. The traumatic disorder was no exception, as this was not considered in experimental and clinical medicine. Conclusion. From the analysis of the available scientific literature, no messages were found about the features of the course of traumatic disease in conditions of excessive intake of copper and zinc ions in the body. We can only assume that a violation of the functional ability of the liver, lungs, brain and other organs that occurs against the background of heavy metal ion damage creates an unfavorable background for the occurrence of a serious injury.

DYNAMICS C-REACTIVE PROTEIN AND CERULOPLASMIN IN THE BLOOD OF PATIENTS WITH COMBINED THORACIC TRAUMA AS A PROGNOSTIC CRITERION OF TRAUMATIC DISEASE

Purpose: to assess the informativeness of the level of "acute phase" proteins in the blood and their changes in the acute and early period of traumatic disease in patients with combined thoracic trauma with polytrauma as a marker of disease severity and the impact of proposed modifications of intensive care algorithm on treatment results. Material and methods. The basis of this study is a statistical analysis of the results of a comprehensive examination of 92 patients with thoracic trauma. Control points were 1st, 2nd, 3rd, 5th,7th and 12th day of treatment. The severity of the injury was determined according to the ISS scale, the condition of patients at the time of admission according to the ARASNE II scale, the level of C-reactive protein and ceruloplasmin in the blood. 3 groups of patients were identified. Group I - standard IT protocol, group II - standard IT protocol with the addition of ceruloplasmin, group III - standard IT protocol with the addition of a solution of D-fructose-1,6-diphosphate sodium salt of hydrate. Parametric statistics methods were used to process the obtained data. Results. In patients with combined thoracic trauma, it is important when planning the patient's management tactics to diagnose the content of CRP and CP in the blood during the entire period of stay in the intensive care unit. The level of CP in the blood of patients with combined thoracic trauma is a highly informative diagnostic marker of the impact of hypoxia of mixed genesis on the course of traumatic disease in general. The leading mechanism for the development of acute lung injury syndrome in patients with combined thoracic trauma is oxidative stress, so the appointment of ceruloplasmin as an adjunct to the standard protocol of intensive care is pathogenetically justified. Conclusions. In patients with combined thoracic trauma, it is important when planning patient management tactics to diagnose the content of C-reactive protein and ceruloplasmin in the blood during the entire period of stay in the intensive care unit. The level C-reactive protein and ceruloplasmin in the blood of patients with combined thoracic trauma is a highly informative diagnostic marker of the prognosis. There is oxidative stress, so the appointment of ceruloplasmin as an adjunct to the standard protocol of intensive care is pathogenetically justified.

The role of metabolic adaptation of the functional state of circulating erythron in determining the course of traumatic disease in patients with massive blood loss in polytrauma

Annotation. Metabolic adaptation of the functional state of circulating erythron is an important criterion for predicting the course of traumatic disease in patients with polytrauma, which is accompanied by heavy blood loss. The aim of the study was to increase the effectiveness of treatment of patients with polytrauma with hemorrhagic shock by developing and implementing a differentiated approach to infusion and transfusion therapy, based on elucidation of the mechanisms of systemic oxygen transport in the postoperative period. The index of erythrocyte transformation index, oxygen delivery index as a leading indicator of oxygen transport system in patients of group I who received intensive therapy according to the classical algorithm, in patients of group II who were additionally prescribed ceruloplasmin solution, in patients of group III who were additionally prescribed a solution of D-fructose-1,6-diphosphate sodium salt hydrate. To determine the functional state of erythrocytes and their ability to deform, we used the method of scanning electron microscopy. Statistical data processing was performed using Student’s t-test (for n<100) at a given level of reliability p=0.95. The statistical analysis of the obtained data revealed a probable reduction in the number of doses of heterogeneous erythrocytes received by patients with high blood loss in polytrauma in patients of group II on the background of maximum ability of erythrocytes to transform while maintaining the oxygen delivery index at a satisfactory level. In the future it is planned to study the morphofunctional parameters of erythrocytes in this group of patients.

The role of diagnosis of respiratory dysfunction in patients with thoracic trauma with polytrauma

Annotation. Combined thoracic trauma is one of the most unfavorable in determining the prognosis in patients with polytrauma. The aim of the study was to evaluate the informativeness of the spirography method in patients with concomitant thoracic trauma as a prognostic criterion for the severity of the course of traumatic disease and the effect of the proposed modifications of the intensive care algorithm on treatment results. A study of the state of indicators of the function of external respiration was carried out using the method of spirography in 92 patients with concomitant thoracic trauma. The patients were divided into 3 groups depending on the foreseen leading pathogenetic mechanism of respiratory failure in all periods of traumatic illness. The effect of additional administration of ceruloplasmin solution, solution of D-fructose-1,6-diphosphate sodium salt hydrate solution was compared with the classical algorithm of intensive therapy. The effect of the proposed treatment was assessed 30 days after receiving polytrauma and the parameters of the external respiration function were compared with the data obtained in conditionally healthy volunteers. It was determined that the addition of a solution of ceruloplasmin to the algorithm of intensive therapy, the leading mechanism of action of which is the effect on oxidative stress, is the most pathogenetically determined in patients with concomitant thoracic trauma in polytrauma, which is confirmed by the most restored indicators of the function of external respiration in them, determined using spirography on the 30th day of observation. The data obtained are important in determining the prognosis of the course of traumatic illness and planning a rehabilitation program in patients with concomitant thoracic trauma.

ОСОБЕННОСТИ ФУНКЦИОНАЛЬНОГО СОСТОЯНИЯ ЭРИТРОЦИТОВ В УСЛОВИЯХ ГИПОКСИИ СМЕШАННОГО ГЕНЕЗА ПРИ ПОЛИТРАВМЕ

Остается открытым и актуальным вопрос изменений маркеров метаболизма эритроцитов исходя из патогенетических особенностей течения травматической болезни при политравме. Целью данного исследования явилось изучение функционального состояния эритроцитов в условиях развития гипоксии смешанного генеза у больных травматической болезнью. Для этого было проведено проспективное рандомизированное контролируемое клиническое исследование 120 пациентов на базе отделения политравмы. В крови определяли основные маркеры функционального состояния эритроцитов – лактат, пируват, 2,3-ДФГ, АТФ спектрофотометрическим. Выявлено то, что течение острого и раннего периодов травматической болезни сопровождается изменениями функционального состояния эритроцитов, о чем свидетельствуют снижение уровня АТФ и увеличение уровней лактата, 2,3-ДФГ, индекса лактат/пируват в остром периоде. Установлена связь между маркерами функционального состояния эритроцитов в момент поступления и развитием инфекционно-воспалительных осложнений, постгеморрагической анемии, посттравматической нефропатии.

Why the lungs became a target organ due to ischemic-reperfusion syndrome of the limb, caused by the use of haemostatic tourniquet

Much attention has been paid to the ambiguous effects of the tourniquets and hemostatic bandages - namely the local and systemic consequences of planned operations, as well as the changes that occur after the cessation of bleeding from a wounded limb on the battlefield. However, there is still no consensus on the ischemic-reperfusion syndrome (IRS). Aim. Detect changes in the activity of lipid peroxidation in lung tissue on the background of experimental modifications of IRS. For this goal 260 male white rats aged 5-5.5 months were divided into 5 experimental groups: 1) EG1 - imposition of the tourniquet on the thigh for 2 h; 2) EG2 - modeling of venous blood loss in the amount of 40% of the volume of circulating blood; 3) EG3 - a combination of hemostatic tourniquet and blood loss 4) EG4 - mechanical injury to the thigh bone 5) a combination of hemostatic tourniquet and mechanical trauma. The biochemical study in 10 % lung homogenate was performed by reacting of peroxidation derivatives with thiobarbituric acid. Conclusions. It was found that each of these types of intervention caused the activation of lipid peroxidation in the lungs. The peculiarities of the reaction were such increase of this rate, which was the highest on the background of blood loss combined with the use of a tourniquet. However, the concentration of malonic dialdehyde was higher in the group where the imposition of the tourniquet was combined with mechanical trauma, compared with isolated mechanical trauma of the thigh. This has shown the role of the tourniquet as a factor that complicated the course of traumatic disease due to ischemic reperfusion.

Стан проблеми атипового перебігу травматичної хвороби у хворих з тяжким станом на момент надходження

Стан проблеми атипового перебігу травматичної хвороби у хворих з тяжким станом на момент надходження

ИСХОДНЫЕ УРОВНИ IL-17А У ВОЕННОСЛУЖАЩИХ С ОСЛОЖНЕННЫМ ТЕЧЕНИЕМ ТРАВМАТИЧЕСКОЙ БОЛЕЗНИ ПРИ РАНЕНИЯХ НИЖНИХ КОНЕЧНОСТЕЙ

Иммунная дисфункция у военнослужащих при боевых ранениях является ключевым фактором, определяющим скорость заживления ран, риск развития инфекционных осложнений, сепсиса, синдрома полиорганной недостаточности и летального исхода. Поэтому иммуномодулирующая терапия является жизненно важной в лечении пациентов с боевыми травмами. Для совершенствования методов коррекции иммунной системы при травме необходимы исследования, направленные на поиск новых патогенетически важных цитокинов и расшифровку их роли в развитии системного воспалительного ответа как предикторов осложненного течения травматической болезни. Цель работы – исследовать ассоциации исходных уровней интерлейкина-17A (IL-17А) у военнослужащих с последующим развитием осложненного течения ранений нижних конечностей с повреждениями костей. Материал и методы. Обследовано 32 военнослужащих мужчин с ранениями нижних конечностей с переломами костей. Возраст их составил от 19 до 40 лет (30,5±4,3 лет). Контрольными данными служили результаты обследования 19 здоровых военнослужащих мужского пола, средний возраст которых составил 28,0±4,9 лет. Концентрацию IL-17А исследовали у раненных лиц через 3 дня после операции методом иммуноферментного анализа.Результаты. Через 3 дня после ранения у военнослужащих с огнестрельными ранениями костей нижних конечностей установлено достоверное (p<0,001) увеличение сывороточных концентраций IL-17А (26,8 [16,1-58,2] пг/мл против 2,2 [0,0-5,7] пг/мл в контроле). Степень увеличение уровней IL-17А в ранние сроки после ранения имеет ассоциацию с особенностями течения травматической болезни в последующем. У раненых с благоприятным течением травматической болезни исходные показатели IL-17А были увеличены в 10,0 раза (до 21,9 [14,5-49,2] пг/мл; p<0,01), а при осложненной травме – в 17,9 раза (до 39,3 [20,4-74,0] пг/мл; p<0,001). Развитию осложнений предшествуют значительно более высокие концентрации IL-17А, чем при благоприятном течении травматической болезни (p<0,05). Заключение. Полученные результаты необходимо учитывать для прогноза развития осложнений при огнестрельных ранениях костей нижних конечностей и при проведении лечебно-профилактических мероприятий.

Systemic disorders of brain functions in distant period of explosive closed brain injury: clinical case

The paper presents of clinical case of brain traumatic disease course after explosive injury. It was included about forming systemic disorders of brain in distant period based on of patient complaints, anamnesis of disease, data of neurological status as well as results neurophysiological and neuropsychological examinations. This pathology is manifested as functional impairment of non-specific system of brain on all levels of organization with domination of mediobasal temporal area dysfunction with involvement of parietal-temporal section of cortex. Case presented points to necessity of durable neurological observation of patients with this pathology for timely diagnosis and treatment of complications as well as for providing of patients psychical and social adaptation. Keywords: explosive closed brain injury, distant eff ects, systemic disorders of brain

Traumatic disease peculiarities course, its diagnostics and treatment at polytrauma in suffer obese patients

Introduction. It’s known that the issue of polytrauma is one of the most urgent problems of surgery, and among injured patients a special approach is required for patients with overweight and obesity of varying degrees.
 Purpose of the study. To study prognostic features of traumatic disease course and to improve the results of diagnostics and surgical treatment of patients with polytrauma suffer obesity.
 Materials and methods. Clinical material was made up of 106 patients with combined body trauma, which were divided into three groups according to body mass index.
 Results. The results of the research showed a significant difference in the course of traumatic disease in patients with normal body weight and obesity. In particular, in the process of diagnostics of blunt chest and abdominal trauma the frequency of application of interventional methods of diagnostics was directly proportional to the increase of body mass index. The course of traumatic disease in the obese patients had a number of characteristic features that formed the basis for the development of diagnostics and differential program of treatment.
 Conclusions. The results of the research showed that the course of traumatic disease in combined injury obese patients is directly proportional to the body mass index and has certain features that differentiate them from patients with normal body weight.

Удосконалена система хірургічного лікування постраждалих з пошкодженнями таза та тазових органів при політравмі

Мета. Оцінити ефективність удосконаленої системи хірургічного лікування постраждалих з пошкодженнями таза та тазових органів при політравмі. Матеріали і методи. В основу дослідження покладено клінічні спостереження 406 постраждалих з нестабільними пошкодженнями таза (НПТ) при політравмі (оцінка тяжкості за шкалою ISS 17 балів і вище). НПТ у 98 (24,1%) постраждалих з політравмою були поєднані з пошкодженнями тазових органів. Сформовано дві клінічні групи: основну – 137 (33,7%) постраждалих, із них у 37 (27,0%) НПТ були поєднані з пошкодженнями тазових органів, і контрольну – 269 (66,3%) постраждалих, із них у 61 (22,7%) постраждалого НПТ були поєднані з пошкодженнями тазових органів. У постраждалих основної групи застосована диференційована хірургічна тактика лікування, яка базувалась на оцінці тяжкості травми, прогнозі перебігу травматичної хвороби (ТХ) у залежності від її періодів, а також запропонованих сучасних методах діагностики і лікування пошкоджень таза й інших анатомічних ділянок (АД). Для лікування пацієнтів контрольної групи застосовували хірургічну тактику згідно з тимчасовими галузевими уніфікованими стандартами медичних технологій діагностично-лікувального процесу стаціонарної допомоги дорослому населенню в лікувально-профілактичних закладах України, затвердженими наказом МОЗ України №226 від 27 липня 1998 р. Результати. При травмі сечового міхура у 47 (83,9%) постраждалих зашили розрив стінки міхура з епіцистостомією і катетеризацією міхура катетером Фолея. При травмі уретри епіцистостомію поєднували з шинуванням уретри катетером у 27 (81,8%) хворих. У 3 пацієнтів основної групи використали первинний шов уретри в гострому періоді ТХ. У всіх пацієнтів з пошкодженнями прямої кишки накладали дводульну сигмостому. Операції на внутрішніх статевих органах виконані 3 (3,2%) постраждалим. Усього на тазових органах у гострому періоді ТХ виконано 94 оперативних втручання різної складності. Висновки. При політравмі переломи кісток таза були поєднані з травмою тазових органів у 24,1% постраждалих. Поєднане пошкодження тазових органів (за винятком пошкоджень прямої кишки) не є протипоказанням до виконання внутрішнього або комбінованого металоостеосинтезу нестабільного тазового кільця у постраждалих з політравмою в ранньому та пізньому періодах ТХ.

ANALYSIS OF CHANGES IN HOMOCYSTEIN USED AS A MARKER OF METABOLIC SYNDROME IN PATIENTS WITH INCREASED BODY MASS INDEX WHO HAVE MULTIPLE TRAUMA

In recent years, the concept of "metabolic syndrome" has become more spreading, and in parallel with disorders of carbohydrate and lipid metabolism, endothelial dysfunction is no less significant. The aim of our work was to analyze changes in homocysteine (HC) as a marker of metabolic syndrome in patients with an increased body mass index (IBMI) in polytrauma. The study involved 224 patients with polytrauma, who had different initial values of body mass index (BMI) and were treated at the polytrauma department and the intensive care unit for patients with combined injuries for a period from 1 day to 1 year since the moment of injury. All the patients were subjected to identifying the level of serum HC. The patients had the same severity according to the APACHE II scale, 14 ± 5.8, at the admission to the hospital, and were divided into 3 stratified clinical groups depending on the initial values of anthropometric parameters and BMI. The study was conducted on the 1, 3, 7, 14, 30 and 360 days from the date of polytrauma. Assessment of blood serum HC was performed by ELISA. It was found that the overweight patients with BMI ≤ 29.9 demonstrated an increase in the mean values of blood HC on the 7th and 14th days of the treatment, with a further decrease on the 15th day since the date of injury. For the patients with BMI within the range of 30.0 - 39.9, the persistence of the HC index during the first month of the treatment at baseline with an increase on the 360th day was found out. The patients with BMI ˃ 40.0 showed an increase in the level of blood HC through the year since the date of polytrauma. It was revealed that the level of HС directly affects the course of traumatic disease in patients with increased BMI, its severity in terms of uniformity of injuries received and the same range of severity according to the APACHE II scale depends on BMI at the admission to the hospital.

Using of tranexamic acid as component of trauma induced coagulopathy treatment

The aim of the study was to determine the effectiveness of tranexamic acid in patients with multiple skeletal trauma for reducing blood loss and correction of hemostatic disorders. Materials and methods . The initial state of the hemostasis system was studied in 104 patients with multiple trauma. All patients was in class II (15-30 % of blood loss) according to ATLS protocol, and NISS – 28,34±2,06. Was provided complex evaluation of patients state, including continuous monitoring of temperature and lactates level, the hemostasis system was evaluated using laboratory tests and low-frequency pyezoelectric thromboelastography (LPTEG). Patients in Group I (n = 33) did not receive tranexamic acid, Patients in Group II received tranexamic acid 15 mg / kg every 6 hours for 3 days. Results . In patients who received tranexamic acid, there was a positive dynamics of hemoglobin, creatinine phosphokinase, lactate, less need for transfusion of blood products and duration of treatment in ICU. Conclusions . The use of antifibrinolytic drugs positively influences the course of traumatic disease in patients with polytrauma, by correcting coagulopathy and reducing blood loss.

Вплив антифібринолітичної терапії на індуковану травмою коагулопатію та перебіг травматичної хвороби

Мета. Визначити ефективність раннього призначення транексамової кислоти хворим з травматичними ураженнями.
 Матеріали і методи. Досліджено систему гемостазу та перебіг травматичної хвороби впродовж 72 год у 108 хворих з множинними травматичними ураженнями. Хворих розподілили на дві групи в залежності від методу профілактики та комплексної корекції: 1-ша група - 54 пацієнти, які не отримували антифібринолітичних засобів, 2-га група - 54 пацієнти, яким вводили транексамову кислоту 1000 мг внутрішньовенно болюсно під час госпіталізації та 15 мг/кг кожні 6 год протягом трьох діб. Усім хворим проводили інструментальні, лабораторні дослідження, оцінювали загальний стан та здійснювали постійний моніторинг показників вітальних функцій, величини діурезу, динаміки рівня загальної креатинфосфокінази (КФК), рівня гемоглобіну крові, потреби у гемотрансфузії та ретроспективно аналізували тривалість лікування у відділенні інтенсивної терапії (ВІТ). На момент госпіталізації до ВІТ стан хворих за шкалою NISS (New Injury Severity Score - Оновлена шкала тяжкості пошкоджень) був оцінений у (28,34 ± 2,06) бала.
 Результати. Під час госпіталізації до ВІТ у пацієнтів з травматичними ураженнями діагностували підвищення агрегації тромбоцитів з активацією судинно-тромбоцитарного гемостазу, гіпокоагуляцію та значно активований фібриноліз. За даними моніторингу показників гемодинаміки у всіх пацієнтів констатували зниження систолічного артеріального тиску (САТ), середнього артеріального тиску (СрАТ) та підвищення шокового індексу (ШІ) і частоти серцевих скорочень (ЧСС), що є ознаками травматичного шоку, активації симпатоадреналової системи та централізації кровообігу. У пацієнтів 2-ї групи динаміка зниження рівня загальної КФК була більш виражена, рівень гемоглобіну стабільно вищий, а отже, вони потребували гемотрансфузії еритроцитарної маси у значно меншому об’ємі в порівнянні з пацієнтами 1-ї групи, що можна пов'язати з раннім призначенням терапії індукованої травмою коагулопатії та зменшенням крововтрати.
 Висновки. Виявлені зміни свідчать про те, що введення препаратів з групи інгібіторів фібринолізу хворим з травматичними ураженнями позитивно впливає на показники фібринолітичної системи, перебіг травматичної хвороби, нормалізує кровообіг, сприяє виходу пацієнтів із стану травматичного шоку, знижує потребу у гемотрансфузії.

PROGNOSIS OF THE ACUTE PHASE COURSE OF TRAUMATIC DISEASE AND TRANSPORTABILITY IN POLYTRAUMA PATIENTS

OBJECTIVE. The aim of the study was to substantiate the criteria for predicting of the acute phase course of traumatic disease and transportability in polytrauma patients. MATERIAL AND METHODS. The course of traumatic disease was studied in 233 patients. The prognostic value of the ISS, RTS, TRISS scores and Russian VPH-P, VPH-SP and Tsybin scores was studied using the method of binary logistic regression, Roc analysis and correlation analysis. RESULTS. RTS (AUC=0.93), TRISS (AUC=0.86) and Russian VPH-P (AUC=0.74) scores have the highest prognostic value. There is a strong correlation between the RTS and TRISS scores (r =+0.90). CONCLUSION. It is advisable to use the RTS score and Russian VPH-P score to predict the acute phase course of traumatic disease and transportability in polytrauma patients.

ТЯЖЕЛАЯ СОЧЕТАННАЯ ЗАКРЫТАЯ ТРАВМА ЖИВОТА: ОСОБЕННОСТИ ТЕЧЕНИЯ ТРАВМАТИЧЕСКОЙ БОЛЕЗНИ (СООБЩЕНИЕ ПЕРВОЕ)

The objective : to detect specific features of traumatic disease in those with severe concurrent trauma with a major injury of abdomen organs. Subjects. 326 patients with severe concurrent traumas; the median severity of injury made 4.6 ± 0.1 scores according to Military Field Surgery Score (20.4 ± 0.2 scores as per ISS). 111 patients had severe concurrent abdomen injury (in 52 patients, the severity of abdomen injury prevail over injuries in the other anatomical regions). Results. When analyzing the distribution of variants of the traumatic disease course in 111 patients with a severe concurrent abdomen injury, variant I was observed in 22.5% of patients, variant II – in 47.7%. and variant III – in 29.8%. Among 215 patients with no abdomen injury, variant I was observed in 25.1%, variant II – 46.0%, and variant III – in 28.9%. Thus the distribution of variants of the traumatic disease course among those included into the study was approximately the same. The difference in mortality rates during the first period of the traumatic disease in those injured was not associated with specific features of traumatic disease with abdomen injuries, but for presence or absence of severe brain injury. There were no differences in frequency or duration of the second period of the traumatic disease. In those with severe concurrent trauma and prevailing abdomen injuries, on the average, the time of maximum chances to develop complications is longer with a higher mortality level. Conclusions. In those with severe concurrent trauma and prevailing blunt abdomen injuries, the third period of traumatic disease (time of maximum chances to develop complications) is longer, has a higher statistically significant mortality rate due to a higher frequency of severe sepsis versus patients with same severity of concurrent trauma but with no abdomen injury.