Ukhach Y. ANESTHETIC SUPPORT FOR PATIENTS WITH GUNSHOT WOUNDS OF THE HEAD DURING AIROMEDICAL EVACUATION

The dissertation presents the theoretical justification of the results of clinical scientific research and practical recommendations for solving the modern problem of military anesthesiology, namely, predicting the optimal anesthetic support in order to prevent the occurrence of potential risks and complications in victims with penetrating head injuries during aeromedical evacuation. According to the results of the study, it was established that at the stage of hospitalization, 17.5% of the victims of the PCI group, 16.7% of the victims of the PCI+MBI group, and 23.1% of the MBI group victims needed vasopressor support. No significant difference in the need for vasopressors was found between the studied groups of victims (p>0.05). The need for ventilation at the stage of hospitalization was 85% in the victims of the PCI group, 96.7% in the PCI+MBI group, and 53.8% in the MBI group. In the group of victims with combined penetrating craniocerebral and thoraco-abdominal injuries, there was a significantly higher need for mechanical ventilation (96.7%). Also, according to the results of the conducted research, it was established that there was a significant need for medical sedation in the studied groups of victims. Victims from the PCI group had a higher mean hemoglobin level compared to victims from the PCI+MBI and MBI group. The difference in hemoglobin level was statistically significant between the PCI and PCI+MBI groups, as well as between the PCI and MBI groups. The index of AI in victims with the PCI group was 0.7 (range 0.60–0.80), in the PCI+MBI group – 0.8 (range 0.73–0.91), and in the MBI group – 0.885 (range 0.72–1.12). A statistically significant difference was found between the PCI and MBI groups (p<0.05), as well as between the PCI and PCI+MBI groups (p<0.05). The results of the study indicate a smaller volume of blood loss in the injured group of PCI, as well as a significantly lower need for transfusion therapy at the stage of stabilization. A higher volume of blood loss in victims of the PCI+MBI group may be an additional complicating factor in the course of TBI. It was found that as a result of the measures taken to stabilize victims with penetrating head injuries, it was possible to improve MBP indicators in the PCI group by an average of 8.3% (95% CI 4.2% - 12.5%), in the PCI+MBI group by 6.6% (95% CI 3.0% - 11.4%) and 8% (95% CI 3.7% – 12.3%) of the initial median level in the MBI group. a decrease in AI (p<0.001) was found in the PCI group by an average of 17.0% (95% CI 11.1% – 24.4%), in the victims of the PCI+MBI group by 25.4% (95% CI 21.3% – 34.6%) and by 28.8 % (95% CI 20.3% – 39.0%) in the MBI group from the initial median level. When constructing a scale diagram in the affected study groups at the stages of the study, we also observed a decrease in the scale of the values of MBP and AI indicators due to their denser grouping at the stage of preparation for AME. During the comparison of the hemodynamic indicators at the stages of AME, a statistically significant increase in the values of heart rate indicators, as well as a decrease in SBP, DBP, and MBP were found at the 2nd stage of the study (takeoff), which were statistically significantly different from the values of these indicators at the ground stage of evacuation (1st stage). In victims with combined penetrating craniocerebral injuries and thoraco-abdominal injuries (PCI+MBI ), MBP indicators were characterized by more pronounced variability during the first 40 minutes. AME relative to the ground stage of the research. As a result of the IT measures carried out on board the transport vessel after 40 minutes of flight and before landing on the helipad, it was possible to achieve SAT indicators that did not differ statistically from the ground stage of evacuation. The obtained research results should be taken into account when predicting the development of hemodynamic changes in victims with similar types of combat wounds. The constructed aeromedical evacuation (AME) safety assessment scale based on collected information about past evacuation cases at the stage of victim stabilization and decision-making about evacuation at higher levels of medical support allows identifying potential risks and problems that may arise. This makes it possible to identify shortcomings in the assessment of the condition of victims with a combat injury and to improve the process of their stabilization before conducting AME, ensuring the maximum level of safety for patients. This approach can contribute to improving the quality of medical care and reducing possible risks during air evacuations of injured servicemen with penetrating head injuries.