Muryzina O. Influence of analgesia on course of posttraumatic period under severe combined chest trauma

On the basis of profound study of О2 exchange disorders, pulmonary ventilation and breathing biomechanics in 108 patients with severe combined chest trauma, insufficiency of systemic analgesia in acute and at the beginning of early periods of traumatic disease for providing of pulmonary ventilation reserves restoration were proven. Morphinum (to 72 hours) and Methamizolum systemic analgesia decrased pain step by step, and during first 2 days after a trauma did not influence on severety of hypoxemia, that began to decrease after 3 days of trauma. Deminishing of the stenoventilatory pattern of breathing began after 5 day and correlated with the improvement of bronchial passage. The considerable increase of reserves of pulmonary ventilation began after 7 days after trauma, however ventilator functional reserve didn't restore fully till 18-21 days of trauma. Shortage of duration of Morphinum administration till 24 hours or replacement it for NSAID or Tramadolum didn't influence on the dynamics of posttraumatic period. The use of system analgesia complicated of posttraumatic period with pneumonia (in 27-38 %) and with pleurisy (in 33-55 %), that in 16% accompanied with a fatal outcome, and also increased the terms of treatment in department up to 21 bad-days. There were shown influence of thoracic paravertebral blockade (ТPVB) on speed-up О2 exchange renewal, improvement of gases exchange through pulmonary membrane and shunt decreasing. ТPVB improved both ventilation in general and bronchial passage, increased functional breathing reserves and ventilating of small bronchiole tubes. Instability of the regulator systems with the decreaasing of spectrum power in all frequency domens at all variants of system analgesia lasted up to 14 days after trauma. ТPVB provided strengthening of the vegetative regulation with maintenance of sympatho-vagal balance, diсreasing mortality rate till 3,5%, prevented posttraumatic pneumonia (till 3,5%) and pleuritis (till 24%), decreasing the terms till 18 bad-days.