Experience in the surgical tactics of complex treatment of victims with severe combined trauma

Abstract

Relevance. Currently, there is an increase in combined injuries worldwide, with more than a third of the victims of this category dying from various complications in the post-traumatic period.Objective: To determine the possibility of performing optimal surgical interventions in patients with multiple and combined trauma, including anti-shock, with shock of varying duration against the background of intensive therapy.Research material. The paper analyzes the surgical tactics of complex treatment of 150 victims with severe combined trauma. In the course of the study, we divided them into five clinical groups with various shock phenomena. Prediction and determination of the expected duration of shock against the background of intensive therapy was carried out using the table "Score assessment of shockogenicity of trauma" and nomograms developed at the I.I. Janelidze. Research Institute of Emergency Medicine.The results of the work. For clinical and prognostic groups, we noted a correlative relationship between the predicted duration of shock and the time of possible recovery operations, as a result, the coefficient of multiplicity of recovery was revealed. Dividing the average bed-day in hours by the duration of the shock in the forecast groups, we calculated the coefficient of multiplicity "K", which averaged 11 days. K= (144:12 + 184:18 +224:25) : 3 ≈ 11 ( days).Conclusions. Predicting the duration of shock allowed us to develop in an experiment and propose for implementation into clinical practice sparing surgical interventions that are of the nature of anti-shock, as well as to determine the most optimal time for performing reconstructive operations on the principle of simultaneous polysegmental osteosynthesis: 1. Operations for damage to the organs of the upper and lower floors of the abdominal cavity and pelvis. 2. Primary stabilization of fractures of the pelvic bones by an external fixation device in our modification. 3. Fixation of floating rib plastrons by the external fixation device of our modification. 4. Simultaneous polysegmental osteosynthesis.

Keywords

• combined trauma
• surgical tactics
• shock