Great experience with treatment and a comprehensive investigation of the severe combined trauma allowed the authors to choose six basic principles to be followed in diagnosing and treatment of this surgical pathology whose peculiarity is the phenomenon of mutual aggravation of the injuries. Following these principles, especially at surgical hospitals, promotes complete diagnosing, choice of the rational treatment policy in order to avoid medical errors and severe posttraumatic and postshock complications and to improve the outcomes. The authors prove expediency of organization of the multifield specialized centers for treatment of patients with the severe combined traumas.
Acute insufficiency of the gastrointestinal tract (GIT) in patients with severe gunshot injuries is an important link of pathogenesis of the polyorganic insufficiency syndrome. The character of the wound, the numerical score objective assessment of the injury severity and severity of the patient's state are considered to be criteria of early diagnosis of a risk of the development of acute insufficiency of GIT. The specific feature of "general" intensive therapy of acute insufficiency of GIT in severe gunshot traumas is the necessary application of regional anesthesia, sympatholytics, anticholinesterase agents and H2-blockers. Intensive "enteral" therapy of acute insufficiency of GIT in severe gunshot wounds includes the measures resulting in improvement of microcirculation, tissue respiration in organs of GIT, decompression of the stomach, local defense of mucosa, detoxication and early enteral balanced nutrition. The described method of treatment of wounded to the stomach used at specialized medical institutions resulted in 6.2 less lethality among this category of patients.
The authors discuss problems of terminology and definition of terms associated with surgery of injuries, polytrauma and a conception of wound dystrophy. Great statistical material (about 5000 casualties with polytrauma) was used to show the structure and frequency of infectious complications of severe associated injuries systematized according to the original classification of this pathology. The classification is based on a universal pathophysiological process developing in response to any extraordinary influence--a systemic inflammatory response. The mechanisms of the appearance of infectious complications of severe injuries are described. The authors propose new organizational and epidemiological accesses to prophylactics of infectious complications of polytraumas.
The authors describe the aims and content of anesthesiologic and reanimatologic care of the medical reinforcement group in the medical institution of the 1st echelon of specialized care. Basing on the experience of treatment of 825 casualties with gunshot injuries the rational methods of anesthesia and intensive care are shown including the prolonged controlled ventilation, infusion-transfusion therapy, early enteral nutrition. The main causes of lethal outcomes are analyzed. The conclusion was made that during counter-terrorist operations it is reasonable to include anesthesiologists and reanimatologists into the medical reinforcement group.
The results of rendering the intensive care to 2244 patients with severe wounds and traumas were analyzed, which made it possible to define the most topical problems needed to be resolved, i.e. treatment schemes for patients with vegetative state (similar to coma) and with asthenic syndrome, perfection of intensive care for the elderly and absolutization of some intensive care techniques. Perspective solutions are suggested to cope with the above issues, which comprise a bigger quantity of rehabilitation centers, an elaboration of pathogenetic tactics of intensive care for the elderly patients and revising the feasibility of a long-term use of the intensive care methods with respect to the regulation and integration suppressed by such methods.