Malysh I. Analgosedation and early nutritive provision as methods of intensive therapy of multiply-injured patients.

The thesis devoted to improvement the results of treatment of multiply-injured patients by using analgosedation and early nutritive provision. The prospective analysis of 270 multiply-injured patients was performed. It was found, that severe injury is accompanied by development of MOF in 70% cases (the control group). The development of MOF is characterized by constantly high plasma levels of proinflammatory cytokines and progressive increase of anti-inflammatory meditors, exhaustion of spontaneous and stimulated production of proinflammatory cytokines by immunocytes. The development of MOF is characterized by increasement of relatively and absolute neutrophil count, decrease of phagocytosis activity, phagocytosis count, phagocytosis completion, failure of regulation influence of cytokines on nonspecific immunity. The development of MOF is characterized by lymphopenia, decrease of T-cells, especially of T-helpers, constantly low levels of B-cells, decreasement of immunoglobulin levels, failure ofregulation influence of cytokines on cellular and humoral immunity. In control group the nosocomial pneumonia developed in 68%; the nosocomial infection of urogenital tract- in 71%; the wound infection - in 37%; the catheter sepsis in 10%, MOF developed in 70%, and level of mortality of multiply-injured patients was 50%.The use of analgosedation and early nutritive provision limits the elevation of proinflammatory cytokines in plasma, promotes the preservation of balance among pro and antiinflammatory cytokines, preserves the spontaneous and stimulated production of proinflammatory cytokines by immunocytes, promotes the balanced cytokine response. The use of analgosedation and early nutritive provision limits the hyperleukocytosis, preserves the amount of normally reacting leukocytes, phagocytic function, limits the lymphopenia, prevents the decreasement of T-helpers, promotes the B-cells proliferation, the immunoglobulines production, the regulatory influence of cytokines on cellular and humoral immunity.The correction of immune response by use of analgosedation and early nutritive provision promotes the decrease of nosocomial infections: the nosocomial pneumonia developed in 2,64 times; the nosocomial infection of urogenital tract in 1,98; the wound infection - in 2,26; the catheter sepsis in 3,5 times rarely than in control group. The use of analgosedation and early nutritive provision led to decreasment of MOF-development (from 70 to 32,8%), and level of mortality of multiply-injured patients (from 50 to 30%).