The dissertation presents a theoretical generalization and a new solution of the actual scientific problem, which is related to the clarification of the mechanisms of formation of blood circulation disorders, metabolic processes, hemostasis, immune and endocrine systems in patients with polytrauma on the background of an increased body mass index specific response to injury. The basis of this study is the analysis of the results of a comprehensive clinical and instrumental and laboratory dynamic study of hemodynamic, biochemical, endocrine, hemostatic, immune parameters, as well as markers of SIR in 268 patients with IBMI with polytrauma for the period from 1 day to 1 year from the moment of injury. An evaluation of the effectiveness of the proposed methods of treatment in the process of cohort prospective randomized simple open clinical study in 120 patients with traumatic diseases with IBMI 30.0 - 39.9 (Obesity II-III degree) was evaluated. A total of 268 patients were examined, but 23 of them were excluded due to the refusal of outpatient visits, and 21 - at a lethal end during the year from the moment of injury. The control group consisted of 60 volunteers who were initially divided into 3 groups: with BMI up to 29.9, with BMI 30.0 - 39.9 and with BMI > 40.0. Patients who were selected to study the clinical and pathogenetic aspects of the traumatic illness were of the same severity at the time of their arrival on the AHACHE II scale of 10-15 points and were divided into 3 stratified clinical groups, depending on the starting figures of anthropometric indicators and BMI. Thus, in group І, 88 patients (54 men, 34 women) with BMI at the time of receipt reached 29,9 (26,1 ± 3,1), in the II group - 84 patients (48 men, 36 women) with BMI at the time Income to 30.0 - 39.9 (35.2 ± 3.8), in the III group - 52 patients (32 men, 20 women) with BMI at the time of receipt up to> 40.0 (46.2 ± 5.8 ). For the implementation of a prospective, randomized, simple open clinical study and the study of the effect of an elongated medical complex on the consequences of traumatic disease in patients with IBMI, the level of disability and mortality, 82 patients were evaluated in addition to the assessment on the AРACHE II scale 10-15 points, with BMI 30,0-39.9, which were divided into 2 groups. Thus, in the clinical study, 3 groups of patients participated: group 1 is a group II, 84 patients (48 men, 36 women) with an assessment on the scale of the AРACHE II at the time of receipt of 13,7 ± 5,1 points, with the BMI at the time of receipt to 30,0 - 39,9 ( 35.2 ± 3.8); group 2 - 36 people (24 men, 12 women), with an assessment on the AРACHE II scale at the time of receipt of 14,8 ± 6,3 points, with BMI at the time of receipt up to 30,0 - 39,9 (36, 2 ± 3,2), which was assigned an additional treatment complex; group 3 - 34 persons (20 men, 14 women), with the BMI at the time of receipt up to 30.0 - 39.9 (35.8 ± 3.8) with an assessment on the scale of AРACHE II at the time of receipt of 13.9 ± 6,1 points, which was assigned an additional medical complex 2. In this way, 294 victims were traumatized with polytrauma with IBMI. The study was conducted on 1, 3, 7, 14, 30, 90 and 360 days from the moment of injury. For the first time on the basis of a comprehensive prospective clinical and laboratory research and modern methodological approach - mathematical modeling - The classification of clinical forms of pathogenic disorders occurring in patients with polytrauma IBMI in traumatic disease. In accordance with its proposed differential-diagnostic program algorithms to predict the disease, the potential cardiac, infectious, immunopathological, trombohemorahichnyh complications and consequences of traumatic disease that are adapted to its terms and consist of an optimal set of diagnostic tests. Based on the received data on the mechanisms of development of complications of traumatic illness in patients with IBMI therapeutic complexes were developed as an addition to the protocol for the treatment of patients with polytrauma. Its use helped to reduce the overall percentage of hemodynamic complications by 3.4 times, thrombohemorrhagic - by 4 times, immuno-inflammatory - by 3.5 times.
