Krut'ko Y. Optimization of preventive measures and methods of intensive therapy of multiple organ dysfunction in patients with severe multiple trauma.

The thesis is theoretically grounded and presents a new solution of the issues of prevention and intensive care of patients with polytrauma severe by implementing the methods of treatment that are aimed at reducing the number of complications and mortality. Based on the study of clinical and pathogenetic aspects of the syndrome of multiple organ dysfunction found that the weight at admission to the clinic is 92%, in the structure of polytrauma. When severe polytrauma complicated by development of multiple organ dysfunction syndrome, post-traumatic complications were detected in 92.8% of the victims. The most effective methods of anesthesia in this category of victims is TBA with AVL combined with regional methods of anesthesia, therefore, which better ensure the stability of hemodynamics in 2.5 times. Hyperglycemia decreased by 1.2 times, the level lactate reduced by 17%. The condition of severity APACHE III decreased by 6.6%. In the postoperative period multilevel analgesia is most effective because it reduces pain by 1.2 points scale), in the first 10 - 12 hours after surgery and is 3.8 points. In 1 day by 1.8 points.The use of a ventilator in protective mode enabled to reduce the peak pressure of 35 cm H2O up to 26 cm H2O, frequency of pneumonia decreased from 84% to%. Duration of respiratory support decreased B1,2 times, the degree of lung injury on a scale LIS decreased from 2.5 points to 0.5 points. Mortality of victims decreased from 20.5% to 17.9%, which is 1.2 times. The use of the method of hemofiltration and hepatotropic therapy using the drug ornithine and aspartate effectively in patients with severe polytrauma therefore, possible to reduce the level of toxemia from 38.8% to 33.5%. Integrated use and implementation of the proposed methods of prevention and intensive therapy in patients with severe polytrauma complicated by multiple organ dysfunction syndrome, has reduced the mortality rate by 1.9 times, and the likelihood of development of multiple organ dysfunction syndrome - 1.7 times.