Makovetsky P. Diagnosis and treatment of inflammatory complications in the early period of craniocerebral trauma

In the dissertation practical summary and new approaches to the solution of current scientific applied problem of Neurosurgery - studying the prevalence, disease course's peculiarities, and the influence of risk factors of unfavourable course of inflammatory complications and development of methods of improvement of the results of treatment of patients with inflammatory complications in early period of craniocerebral trauma were proposed. The results of clinical and instrumental examination, treatment of 134 patients with isolated craniocerebral trauma with inflammatory complications in the early period - intracranial inflammatory complications (ICIC), nosocomial pneumonia (NP), catheter-associated urinary tract infections (CAUTI), who were treated in the Neurosurgical department of Kyiv City Clinical Hospital of Emergency Care were analyzed. The influence of risk factors (RF) on the development and severity of the course of intracranial inflammatory complications (ICIC), nosocomial pneumonia (NP), catheter-associated urinary tract infections (CAUTI) has been studied. The risk factors included factors associated with the physical status, trauma, intraoperative features. Based on the research data, there are some RF which contribute to the unfavourable course of nosocomial meningitis: consciousness impairment determined as 8 or less points according to Glasgow scale and delayed of specialized care for more than 24 hours. Consciousness impairment determined as 8 or less points according to Glasgow scale and state of physiological immunodeficiency (patient's age over 60 years) contribute to the unfavourable course of NP. It has been demonstrated that in patients with aspiration or at risks of its occurrence, the use of protected aminopenicillins is effective. Based on the analysis of treatment of patients with inflammatory complications, timing of their occurrence according to the data of bacteriological studies the choice of antibacterial drugs was provided.