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Treatment of patients with polytrauma is a difficult problem for surgeons and physicians of intensive care units due to the fact that a multiple and complex lesion often serves as a trigger for the development of a number of life-threatening complications, such as pulmonary embolism (PE). Despite the existing methods of prevention and treatment of pulmonary embolism, the development of this complication in patients with polytrauma accompanied by massive hemorrhageisstill remains an unsolved problem. This article presents a clinical case of the development of isolated PE during performing osteosynthesis of the patient with polytrauma and in stable condition achieved after the intensive therapy within the week. The analize of studies considering the problem of thrombus formation in various parts of the vascular bed and considering of pathophysioliogycal mechanisms of the systemicinflammatory response has been performed. Riskfactors forpulmonary embolism and methods of prophylaxis are studied. Taking into consideration the currently available research data dedicated to this issue, the idea about the generalized nature of the pathological process which can be manifested as deep vein thrombosis such as PE or their combination has been expressed. In respect the insufficient effectiveness of thromboprophylaxis, the need to work out the other or additional laboratory and diagnostic methods of blood coagulation system assessment and responsively therapeutic methods is being considered.

The question of the changes in red blood cells metabolism markers based on the pathogenetic features the course of traumatic disease in polytrauma remains open and relevant. Objective of this study was to evaluate changes in the functional state of red blood cells during hypoxia in patients with traumatic disease. A prospective randomized controlled clinical trial was carried out on 120 patients on the basis of the Polytrauma department. The main markers of the functional state of red blood cells (lactate, pyruvate, 2.3-diphosphoglyceric acid, ATP) were determined by spectrophotometric method. We have revealed that the course of the acute and early periods of traumatic disease is accompanied by changes in the functional state of red blood cells. This is evidenced by a decrease in ATP level and an increase in the levels of lactate, 2,3-DFH and lactate/pyruvate index. We have established a relationship between the markers of the functional state of red blood cells at the time of admission and the development of infectious complications, posthemorrhagic anemia, posttraumatic nephropathy.

Modern treatment of burns has led to a significant reduction in mortality in patients with burns whose injuries were fatal several years ago. However, along with improved survival, new problems arose in the treatment of burn patients. Systemic inflammatory response, capillary leak, sepsis top the list of the most common problems in both adults and children with severe thermal injury. Currently, new strategies are being developed and studied in the treatment of this category of patients. One of the ways to improve the results of treatment of patients with severe burn injury is to prescribe corticosteroids, both in the stage of burn shock and in the development of septic complications. Do corticosteroids reduce mortality and improve recovery in burn patients? The discussion about this has been going on for many years, but the opinion about their effectiveness remains controversial. An analysis of the literature shows that corticosteroids can play a significant role in the treatment of patients with severe burn injury and can be successfully used at any stage of a burn disease. The effect of reducing capillary leakage, increasing myocardial contractility, antiemetic, membrane-stabilizing effect of corticosteroids will be useful in the stage of burn shock. The anti-inflammatory, immunomodulatory effect of corticosteroids will play a role in any stage of a burn disease. With the aim of preventing and treating sepsis, corticosteroids may be useful in the stage of toxemia, septicotoxemia. It is also necessary to remember about adrenal insufficiency, which develops in burn patients. The article analyzes the literature, substantiates the use of corticosteroids in patients with severe burn injury in different periods of a burn disease.

Резюме. Зростання активності перекисного окислення ліпідів (ПОЛ) є найважливішим механізмом клітинних ушкоджень при хірургічному стресі, провокує відхилення метаболічних процесів, що порушує їх нормальне функціонування і стає причиною ускладненого перебігу післяопераційного періоду. Метою дослідження було вивчення динаміки активності процесів ПОЛ залежно від складу інтенсивної терапії (ІТ) у хворих на травматичну хворобу (ТХ) при політравмі, яким проведено багатоетапну оперативну корекцію (БОК). Матеріали та методи. У 64 хворих на ТХ при політравмі (середній вік 36,5±12,6 років, у тому числі 46 чоловіків та 18 жінок) вивчена динаміка процесу ліпопероксидації за рівнем накопичення первинних та вторинних продуктів ПОЛ на різних термінах ІТ при проведенні етапних оперативних втручань та імовірність ускладнень в гострому та ранньому періоді ТХ. При цьому пацієнти були розділені на дві групи по 32 постраждалих в кожній. Пацієнти ІІ-ої групи додатково до стандартного комплексу ІТ одержували церулоплазмін. Результати дослідження. Загалом динаміка змін рівня ДК та МДА виявилася подібною в обох групах. При цьому відзначалися достовірні відмінності (р

Objective of the research is to assess the likelihood of complications in the acute and early periods of Traumatic Disease (TD) and primary condition and reserve capability of hemodynamic and homeostasis in patients with polytrauma. Materials and methods. A retrospective study was carried out on 32 patients suffering from polytrauma. The group of the study included patients with the severity of injury according to the Injury Severity Score (ISS) more than 25 points and on a scale APACHE II 10-25 points at the time of admission. The estimated blood loss was 30-40% of blood volume (BV). The individual assessment of blood loss was calculated by Moor. Results. The study of 20 (62.5%) men, 12 (37.5%) women aged 18 to 60 years old (35.22 ± 12.66) were done. The mechanical ventilation was performed for 30 patients (93.75%), and 2 patients (6.25%) required oxygen therapy 5 lit per min for 3 days. The duration of mechanical ventilation was in 10 patients - up to 1 day, 8 patients - up to 3 days and at 12 - more than 3 days. Among 12 patients, who used AMV more than 3 days, 10 patients were tracheostomy in 3d day and 2 patients were extubated on 4th day. Among the patients examined thirty patients (93.7%) had posthemorrhagic anemia during first day of injury. Infectious complications like purulent tracheobronchitis and pneumonia were observed in 14 (43.75%) patients. The local infectious complications (abscesses, festering wounds) occurred in 5 (15.6%) patients and bedsores in 3 (9,375%) patients. The catheterization of the bladder lead to the development of urinary tract infection in 3 patients (9,3%). Conclusion. The most problematic category of victims includes patients with injuries several anatomical regions. Pneumonia, anemia, urinary tract infection and local infectious complications were considered as the most common complications of acute and early periods TD. The factors that influenced the probability of a high degree of complications were AMV, the thoracic component of the injury, more massive blood loss, long-term catheterization of the bladder.

The measurement of RBC indices is of particular importance as an indirect intermediate component of the recovery process after exposure to hypoxia, ischemia, hypothermia in patients with traumatic disease due to polytrauma. The aimof this study was to evaluate the parameters of the morphologic state of red blood cells as a reaction of patients with traumatic disease. Materials and methods.A prospective study was carried out evaluation of 120 patients suffering from polytrauma. The patients were divided into 3 groups according to the principle of using additional substances as a part of IC. The parameters of morphologic state of red blood cells were studied. Results and discussion.The course of acute and early periods of traumatic disease has accompanied variability morphological forms of red blood cells, as evidenced by a decrease in MCV and RDW increased levels of the 3rd to 5th day. The optimized therapy used in the treatment of patients, has a positive effect on the parameters of red blood cells, contributes to a better recovery of red blood cells after hypoxia resulting multiple trauma. Conclusion.The study has demonstrated variations in the morphologic properties of red blood cells in the acute and early period of traumatic disease, as confirmed by pathological changes of the erythrocyte indices. The administration of the proposed therapy with the use of D-fructose-1.6-diphosphate sodium salt of hydrate has a positive effect on the parameters of red blood cells, contributes to a better recovery after hypoxia resulting multiple trauma. Given this, the calculations of the red blood cell indices may carry additional diagnostic information, which allows identify trends for not obvious pathological changes and quality of treatment.

Introduction. The main directions of intensive care in the acute polytrauma period are based on the principles of Damage control surgery, Damage control resusсitation, Damage control orthopedics. The purpose of work was to analyze the results of the diagnosis, treatment, surgical correction stages, deadlines final stabilization of bone fragments. Materials and methods. A retrospective study was carried out on history of 32 patients suffering from polytrauma which was accompanied by massive blood loss (30-40% deficiency of blood volume) and was characterized by combination of injuries. Clinical and laboratory parameters, stages according to Damage сontrol (DC) tactic, results of treatment were analyzed. Results. The results of diagnosis and treatment were analyzed in 20 (62.5%) males and 12 (37.5%) women, whose average age was 35.22 ± 12.7 years. The severity of injuries graded by the ISS scale was 26.84 ± 4.1. The level of consciousness by the GCS was 13,5 ± 0,5 points. In assessing the severity scale for patients with APACHE II was 14,97 ± 2,78 points. The degree of blood loss in the surveyed group corresponded to the III class according to the classification of the American college of surgeons and amounted to 35.21 ± 4.52% of the blood volume. Hemodynamic signs of hypovolemia were registered in all patients, and 25% needed vasopressor support. A total of 140 operations were performed in several stages. Оn the first day were performed 114 operations in order to stop the bleeding and temporary immobilization of the limbs. On the 2-14 days were performed 26 operations due to deferred indicators. Conclusion. this question need to further study of intensive care and development of criteria for the sequence and timing of multistage surgical correction in order to optimize treatment and reduce complications.