Pelvic injury and acute respiratory distress syndrome in the patients, suffering severe combined trauma
Objective. Lowering of mortality in the patients, suffering severe combined pelvic injuries and acute respiratory distress-syndrome (ARDS), using a new tactics of treatment.
Маterials and methods. We conducted retrospective and prospective analysis of the treatment results in 1033 patients, suffering severe combined trauma in 2009 - 2015 yrs in the Municipal Clinical Hospital №3 of Baku. For the comparative analysis conduction for the treatment results the patients were divided into two groups: a comparative one - the patients, who were treated in 2009 - 2010 yrs, and the main - the patients, who were treated in 2011 - 2015 yrs. The procedure for the comparative group patients’ treatment did not differ essentially from the standard one. The injuries of the main group were estimated, basing on the AIS (Abbreviated Injury Scale) and ISS (Injury Severity Scale) scales. The development rate for ARDS have constituted 41.2% in the main group (68 of 165 patients with pelvic injury) and 43.6% - in the comparative one (17 of 39 patients). The help for the patients, suffering nonstable pelvic injuries, who were classified in accordance to АО-Tile (fractures of the types В and С) and ARDS was delivered in accordance to the principle of a «damage control».
Results. Lethality among the patients of the main group have constituted 17.6%, while in a comparative one - 23.5%.
Conclusion. In compensated form of ARDS on the stage of the vital functions stabilization it is possible to perform the indicated surgical interventions, owing a small risk. In a subcompensated form of ARDS and presence of fractures of the long bones, nonstable pelvic fractures for conduction of effective treatment of the hollow organs, the surgical fixation of the fractures fragments is needed first of all. Before the surgical intervention in the patients, suffering decompensated form of ARDS, on the first order a durable (minimally 24 h) correction of vital functions and the main parameters of homeostasis is needed, аs well as the conduction of measures, aimed on the patient’s savage and survival.
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