Журнал «Травма» Том 15, №5, 2014

Introduction Among the different types of injuries a special place because of the prevalence, pronounced upward trend, and the severity of the impact, primarily on the number of deaths took concomitant injury. This is especially true for the Donetsk region, where 10 % of the Ukrainian population and occurs most technological accidents and disasters, traffic accidents. Donetsk Institute of Traumatology and Orthopedics, Regional Trauma Hospital have many years of experience in the treatment of this category of injured, which is based on the concept of traumatic disease (TD).

Purpose - to show clinical benefit of the concept of traumatic disease in relation to the injured with associated trauma.

Materials and methods. The analysis of medical records of 309 patients with concomitant trauma, which in 2010-2013 in the acute and early periods of TD were treated at the intensive care unit of our institution. Among the injured men was 252 (81.6 %), women - 57 (18.4 %) aged 14 to 83 years. The average age of injured was 40 years. Depending on the nature of injuries suffered were divided into 4 groups:

The first group - suffered from a traumatic brain injury and injuries of musculoskeletal system - 114;

The second group - the injured with chest injuries and injuries of musculoskeletal system - 21;

The third group - the injured with trauma of the abdomen and the injuries of musculoskeletal system - 19;

The fourth group - with the injury of two or more cavities and injuries of musculoskeletal system - 155.

Results. Applying the concept of allowing prioritize treatments to prevent a number of iatrogenic complications and served as the basis for us to implement a number of new principles of treatment of patients with polytrauma:

• Restoring and maintaining hemodynamic normovolemia at acceptable hypotension "and AP levels (90 mm Hg.Art.) Under the control of diuresis minute;

• «limitation strategy transfusion" - Restores the number of circulating erythrocytes to a level ensuring a minimally adequate delivery and consumption of oxygen to the tissues (er. - 2.8 t / L, HB - 90 g / l) under the control of lactate;

• operative stabilization of fractures in acute trauma in volume, regulated nature of the damage and the severity of the victim with bringing up the total scheme of osteosynthesis in the late period of the injury;

• treatment endotoxik syndrome caused resorption products lysis massive hematoma by applying multifunctional infusion-transfusion therapy and modern means of detoxification;

• “surgical peace” in the treatment of injuries and injuries of musculoskeletal system maximum possible watchdog tactics of the patients in the early period of injury (3-14 days);

• reduction in the body's energy needs through adequate multimodal analgesia and protective inhibition of the brain;

• Early enteral and parenteral nutritional support;

• de-escalation principle of prevention of infectious complications.

Clinical efficacy below concepts analyzed the results of treatment. Mortality in the acute and early periods TD groups was observed at: co-head injury and the injuries of musculoskeletal system - 12.3%; associated injury of the chest and the injuries of musculoskeletal system - 4.8 %; associated injury of the abdominal cavity and the injuries of musculoskeletal system -5.3%; associated injury of 2 or more cavities and injuries of musculoskeletal system - 15.5 %.