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A M UA R T YL O P 4/2012 POLYTRAUMA Scientically-practical reviewed journal Editorial board ...

ISSN 1819-1495

-

A M UA R T YL O P

4/2012

POLYTRAUMA

Scientically-practical reviewed journal

Editorial board

Editor in chief

..., . .. V. V. Agadzhanyan . Deputy editor in chief . ..., . .. Moscow V. A. Sokolov . - ..., . .. Leninsk-Kuznetsky I. M. Ustyantseva . ..., . .. Novosibirsk M. A. Sadovoy .

Science editors 12-0644 . - Leninsk-Kuznetsky 15 2005 .

... .. ... .. A.H. Agalaryan L. M. Afanas`ev ... .. ... .. S. A. Kravtsov A. V. Novokshonov

:

... .. ... .. A. A. Pronskikh A. V. Shatalin . Novokuznetsk ... .. ..., . ..

   

!

2012

   

, , Objective to assess the incidence rate, prevalence, nature and pat () , tern of pediatric polytrauma in a major city and to outline the steps for . reduction .

. - Materials and methods. The study of pediatric polytrauma charac 11 , 2001 2011 . - teristics in the major city was performed for the period of 11 years be - tween 2001 and 2011. The results of the treatment of surgical patients . and medicolegal autopsy data from the cases of fatal polytrauma were . 2001 2011 . analyzed .

Results and discussion. 617 children with polytrauma were brought 617 , 381 (61,8 %), 236 (38,2 %). -- in and hospitalized from 2001 to 2011 including 381 males (61,8 %) and 399 (64,7 %), - 236 females (38,2 %). The most common reasons of polytrauma cases in 98 (15,9 %), 65 (10,5 %), - children were motor vehicle incidents (399; 64,7 %), falling from height 27 (4,4 %), 19 (3 %), 7 (1,1 %), above ones own size (98; 15,9 %), home accidents (65; 10,5 %), criminal

1 (0,2 %), 1 (0,2 %). injuries (27; 4,4 %), street injuries (19; 3 %), sport injuries (7; 1,1 %), - () 586 (94,2 %), school injuries (1; 0.2 %), industrial injuries (1; 0,2 %). Most of the - 508 (82,3 %), - patients had injuries of locomotion system (586; 94,2 %). The cranio 160 (25,9 %). . T cerebral injuries were noted in 508 patients (82,3 %), internal injuries , , 1/5 . in 160 (25,9 %). Minor injuries prevailed most of the times. Major 20 , 68. life threatening injuries were observed in approximately 1/5 of children .





. 12,8 %, 20 hospitalized patients died, 68 children died before admission. Lethal 100000 . - ity in pediatric polytrauma, therefore, amounted to 12,8 % in Barnaul, . death rate: 1,3-1.4 per 100000 population per year .

. Conclusions. The treatment of polytrauma in children should be per . formed in specialized multiple injury and polytrauma departments. The seasonality of injures in school children calls for increased precautionary . , measures during summer season. Immediate transportation of victims , from the scene to hospital is required due to a major state of shock and substantial blood loss. Frequent injuries of locomotion system in child . - polytrauma require a much wider application of modern osteosynthesis - methods in order to shorten treatment duration .

, .

: ; ; - Key words: multiple injuries; fractures in children; polytrauma; con; . comitant injury .

() - [2] .

.,

   

[9]., -, 4, -.,

   

THE PROBLEMS OF PATENT ACTIVITY ORGANIZATION IN HEALTH CARE AND SOLUTIONS

   

- The article reviews the issues of patent activity organization which are - actual for the modern stage of development of the domestic health care . and medical science .

- Objective to reveal the problems of the organization of patent activity . in health care and to suggest the ways of decision .

. , - Materials and methods. The methods of literary, statistical and eco , , , - nomic analysis, questioning, expert assessment and organizational mod . eling were applied .

. - Results and discussion. The methods of the scientific analysis revealed some problems in the patent activity organization in the sphere of medical science and helped to define the ways of its optimization in realization of . an innovative cycle in health care .

. - Conclusion. The developed scientific approaches to the organization of , patent activity, registration and protection of the rights for intellectual , - property promote increase in quantity of planned scientific works, the growth of number of patents and the other results of intellectual activity . as a whole .

: ; ; ; - Key words: patent; patent activity; innovations; innovative cycle; results ; . of intellectual activity in the health sector .

-

   

   

: Information about authors:

.., ..., , -- Totskaya E.G., candidate of medical sciences, senior researcher, , laboratory experimental department, Novosibirsk Scientific Research In - stitute of Traumatology and Orthopedics, Novosibirsk, Russia .

, . , .

.., , Kazakov R.A., postgraduate, chair of healthcare organization , and public health, Novosibirsk State Medical University, Novosibirsk, Russia .

, . , .

.., , Kan V.V., postgraduate, chair of healthcare organization and , public health, Novosibirsk State Medical University, Novosibirsk, Russia .

, . , .

   

( ), Objective to analyze the underlying causes (risk factors) leading to , - the formation of femur pseudoarthrosis and to determine their signifi . cance .

. Materials and methods. Based on the retrospective analysis of medi 74 cal histories and X-ray pictures of 74 patients the probable risk factors 3 of femur pseudoarthrosis were identified in 3 groups of patients with , , localization in the diaphysis, proximal and distal femur .

.

. (p 0,05) Conclusion. The statistically significant (p 0.05) differences were : . found between the groups of the patients: for the group I inadequate , , - chosen method of treatment or fixation technique, unstable fixation, ( ); . violation of rehabilitation (early loading); for the group II high energy , , 2 ; trauma, comminuted fracture, more than 2 stages of treatment; for the . , group III inadequate chosen method of treatment or osteosynthesis, . - opened fracture. Identifying the causes of pseudoarthrosis will improve treatment outcomes and prevent its occurrence .

.

: ; . Key words: pseudoarthrosis; risk factors .

13,3 %

-,

   

: Information about authors:

.., ..., , - , - Gayko G.V., MD, PhD, professor, corresponding member, director, In, stitute of Traumatology and Orthopedics by National Academy of Medical , Sciences of Ukraine, Kyiv, Ukraine .

. , .

.., -, Kozak R.A., traumatologist-orthopedist, Institute of Traumatology - and Orthopedics by National Academy of Medical Sciences of Ukraine, , . , . Kyiv, Ukraine .

   

- Objective to evaluate results of treatment of hemorrhagic stroke in de , pendence upon initial patient condition, time from onset of brain catastro, . phe and type of operative intervention .

. 211 Materials and methods. The prospective clinical study included 211 pa : 97 (1 ) tients with hemorrhagic stroke, 97 patients (group I) with ruptured arte 114 (2 ) - rial aneurysms and 114 patients (group II) with hypertensive intercerebral () hematoma (HIH) in acutest and acute periods of hemorrhage. The group I . had two types of operative interventions: craniotomy with clipping of an: (69 ) - eurysm (69 patients) and endovascular occlusion of aneurysm with micro (28 - spirals (28 patients).The group II had craniotomy with removal of hema); ; - toma and punctional aspiration with local fibrinolysis (Purolaza 200 IU) .

Results. In the group I up to 3 days 33 patients (34 %) were oper ( 200 ) .

. 33 (34 %) ated upon open approach 19 patients (58,6 %), and endovascular one : 19 (57,6 %) 14 (42,4 %); 14 (42,4 %). Lethality was 4 patients (21 %) and 3 (21,4 %). In the 4 (21 %) 3 (21,4 %). period of more than 3 days 64 patients (66 %) were operated: 50 64 (66 %): 50 14 - open approach and 14 endovascular one. Lethality was 10 (20 %) and ; 10 (20 %) 5 (35,7 %). 5 (35,7 %). In the group II (up to 3 days) craniotomy with hematoma re - moval was performed for 56 patients (75,6 %). Lethality was 19 patients 56 (75,6 %); 19 (33,9 %). (33,9 %). The mean GCS in died patients was 8. After 3 days 18 patients () (24,4 %) were operated. Lethality was 3 (16,6 %). The mean GCS was 12 .

8 . 18 (24,4 %), Total lethality was 22 patients (29,7 %). With using punction aspiration 3 (16,6 %), 12 . with local fibrinolysis in the group of 27 patients operated up to 3 days 22 (29,7 %). - 6 patients (22,2 %) died, and in the group of 13 patients operated after 27 (67,5 %), 3 days 2 patients (15,4 %) died. According to GCS the consciousness level , 6 (22,2 %), 13 , upon admission in died patients was 14. Total lethality after punction , 2 (15,4 %). aspiration was 8 patients (20 %) .

Conclusion. In the acutest and acute periods of arterial aneurysm rup 14 .

8 (20 %). ture lethality does not depend upon a type of operative intervention .

. - Considering little invasiveness, endovascular method is preferable. During . - the removal of HIH the choice of a method of the operative interven , . tion depends upon the volume, location of the hematoma, extent of the dislocation of middle structures of the brain and heaviness of patient , , - condition .

Key words: hemorrhagic stroke; arterial aneurysms; hypertensive intra .

: ; ; cerebral hematoma .

.

(), -,

- -,

   

-

   

TREATMENT OF LEG FALSE JOINTS BY MEANS OF TRANSOSSEOUS FIXATION WITH REMOTE STIMULATION

OF REGENERATIVE PROCESS

   

- Objective to improve outcomes of treatment of patients with false joints - of long bones by means of complex minimally invasive surgical intervention - on pseudoarthrosis with the use of additional bone formation areas .

Materials and methods. 57 patients with leg pseudoarthrosis were ana .

.

57 - lyzed. In 25 cases the closed controlled combined transosseous osteosyn . 25 thesis was carried out. In 32 cases the remote stimulation of regenerative (), 32 - process was used additionally. The outcomes of regenerative process of false joints were detected by clinical and radiological investigation and by measur. - ing of the density along the whole shinbone. The severity of the pathology - and the restoration process were assessed according to the standardized . assessment of treatment of locomotorium fractures and their consequences - (SAO-1) .

Results. Union of false joints by closed controlled combined transosseous (-1) .

. osteosynthesis method approached approximately on 115,2 3,9 days, and 115,2 3,9 , - with the use of remote stimulation of regenerative process the period of 90,2 fixation in the apparatus decreased up to 90,2 3,8 days. The outcomes of 3,8 . -1 I - rehabilitation according to SAO-1 attained 78,2 3,6 % in the group I by the 78,2 3,6 % , II 92,1 1,8 %. termination of treatment, in the group II 92,1 1,8 % .

. Conclusion. The new technology reduces the period of union of pseudoar - throsis by means of involvement additional foci of proteins, salts and miner, . als into the reparative process .

: ; , - Key words: long bones; transosseous, compression osteosynthesis; pseu; ; . doarthrosis; stimulation of osteoregeneration .

(),

-, 15-50,6 % [1],

   

1. , .. 6. , .. (- ): . .... /.. // IV . - . /.. . , 2005. 24 c. -. , 1984. . 167-169 .

2. ( , ) 7. , .. /.. .. [ .]. : - . . , .. . .: , 1974. 248 .

-, 2010. 130 . 8. , .. .. /.. [ .]. /.. // .

: . -, 2006. 116 . 2011. 1. . 26-31 .

4. 9. , .. /.. [ .] /.. , .. VII - : . . 2 . . : , 1998. 187 .

, 2002. . 2. . 336-337. 10. , .. , .. - - /.. , .. , .. (-1) /.. , .. , .. // - . ., . , 2009. . 3. . 28-42. 2008. . 24-26 .

   

USING OF CRYO-POOR PLASMA IN COMPLEX TREATMENT OF PATIENTS WITH WIDESPREAD PERITONITIS

   

- Objective to compare the complex treatment of widespread peritonitis - using cryo-poor plasma and fresh frozen plasma .

.

. Materials and methods. The comparative study was conducted including - the results of complex treatment of widespread peritonitis in 88 patients us 88 - ing cryo-poor plasma and in 104 patients using fresh frozen plasma .

104 .

. - Results. The better positive dynamics of some laboratory values of hemo , , - stasis, reduction of thrombosis development risk, lower lethality and better outcomes of diseases with using cryo-poor plasma were observed .

.

. Conclusion. Cryo-poor plasma can be used instead of fresh frozen plasma - for complex treatment of patients with widespread peritonitis and concur -. rent DIC .

: ; Key words: widespread peritonitis; fresh frozen plasma; cryo-poor plasma;

; ; . treatment .

   

: : * 0,05; ** p 0,01; *** p 0,001 .

0 c . c .

   

   

1. , .. , .. [ .] // . 2002 .

/.. , .. , 1. . 56-58 .

.. [ .] //. 2002. 4. . 69-74. 5. , .. /.. , .. . .: , 2001. 286 .

/.. , .. - 6. , .. . , .. [ .] //Consilium medicum. 2000. .

9. . 374-379. // , .. /.. , .. , . 1997. 1. . 26-29 .

.. . .: , 2006. 206 . 7. , ..

4. - - /.. . :

/.. , -, 2010. 832 .

   

DIAGNOSTICS AND TREATMENT OF URINARY SYSTEM INJURIES IN PATIENTS WITH POLYTRAUMA

   

Objective to define the surgical tactics and the optimal terms for ini tiation of intermittent renal placement therapy in the complex of intensive - therapy of multiple organ dysfunction in urinary system injuries in patients . with polytrauma .

. 177 Materials and methods. The study is based on the experience of treatment , - of 177 patients with urinary system injuries with polytrauma who received ػ. the treatment in Federal Scientific Clinical Center of Miners Health Protec . (n = 119) tion. The patients were divided into 2 groups. The first group (n = 119) . (n = included the patients with urinary system injuries in polytrauma. The second 58) - group (n = 58) consisted of the patients with secondary renal injury because ; 2 : - of severe decompensate shock, which were additionally divided into 2 sub (n = 28) (n = 30). groups: the experimental group (n = 28) and the controls (n = 30). The . control subgroup analysis was retrospective .

. - Results. The patients of the first group received diagnostic and curative , measures in relation with assessment of state severity that allowed to con 28 fine with conservative treatment in 28 patients. For 4 patients the surgical , 4 treatment was performed in emergent order after stabilization of their state .

. - This differentiated approach allowed to optimize the surgical treatment of urinary system injuries. The second subgroup of 28 patients with secondary . 28 renal injury received renal replacement therapy in the early terms consider - ing the additional criteria. In this group it allowed to reduce the number of . sessions of renal replacement therapy and the terms of treatment in the intensive care unit .

.

. Conclusion. The treatment of urinary system injuries in polytrauma based , , - on evaluation of state severity of patients, as well as using of additional polytrauma criteria for renal replacement therapy allows improving surgery - outcomes, decreasing the frequency of multiple organ dysfunction and de , creasing lethality by more than 8,6 % .

8,6 % .

: ; ; - Key words: polytrauma; urinary system injury; multiple organ dysfunction;

; . extracorporeal detoxication techniques .

-,

   

: Information about authors:

.., ..., , , - Agalaryan A.K., candidate of medical sciences, head of surgery de - partment, Scientific Clinical Center of Miners Health Protection, Leninsk - - Kuznetsky, Russia .

, . -, .

.., ..., , Shatalin A.V., candidate of medical sciences, head of department of , - resuscitation and intensive therapy, Federal Scientific Clinical Center of - - Miners Health Protection, Leninsk-Kuznetsky, Russia .

, . -, .

   

SIGNIFICANCE OF DUPLEX SCAN OF VERTEBRAL ARTERIES IN CERVICAL SPINE TRAUMA

   

- Subject to identify the indicators of blood flow in vertebral arteries in - cervical spine trauma with using color duplex scanning .

.

Objective to study hemodynamics in vertebral arteries in cervical spine . trauma .

. 42 - Materials and methods. The complex examination of 42 patients was , , , - performed. It included neurological investigation, X-ray radiography, spiral - computer and magnetic resonance tomography of spine and spinal cord, , , - color duplex scan, magnetic resonance angiography and spiral computer an . - giography of cervical vessels. Men dominated among the examined patients 35 (83,3 %). (n = 35; 83,3 %). The mean age was 38 6 .

38 6 .

. - - Results. The causes of injuries were road traffic incidents (76,2 %), shallow (76,2 %), (16,7 %) water dive (16,7 %) and fall from height (7,1 %). Deformations of vertebral (7,1 %). 73,8 % , artery course were identified in 73,8 % of cases, ultrasound signs of extra 31 % - vascular compression of vertebral artery in 31 %, angiospasm in 16,7 % .

, 16,7 % . Vertebral artery dissection and thrombosis were in 2,4 % of patients. The 2,4 % . - calculation of the ratio of blood flow in V3-segment to V1-segment allowed V3- V1- - to define the degree of compensation of extravascular influence on artery:

: , 0,7-1,0, with the ratio 0,7-1,0 the blood flow was considered as subcompensated, , 1,0 - 1,0 and more as compensated, 0,7 as decompensated. Total blood , 0,7 . flow in vertebral arteries in 8 patients (19 %) was below the standard val 8 (19 %) ues. 28 patients (66,7 %) received surgical interventions. There were good . 28 (66,7 %) - (47,6 %) and satisfactory (38,1 %) restoration, absence of hemodynamics . (47,6 %) (9,5 %) and lethal outcome (4,8 %). Duplex scanning allows to define the (38,1 %) , (9,5 %) indications for surgical management and its volume, as well as to assess (4,8 %). - results of conservative therapy and surgical treatment .

, .

: ; - Key words: cervical spine injury; vertebral artery; duplex scanning; extra; ; . vascular compression .

-

- 14 60 % [5]. :

10 36,8 % [1, 2]. -, (),

   

: Information about authors:

.., ..., , Sebelev K.I., MD, PhD, docent, head of X-ray department, Polenov , Russian Scientific Research Neurosurgery Institute, St. Petersburg, Ru - - ssia .

. . .. , . -, .

.., ..., -, - Zakhmatova T.V., candidate of medical science, Polenov Russian -- Scientific Research Neurosurgery Institute, St. Petersburg, Russia .

. . .. , . -, .

.., ..., -, - Zuev I.V., candidate of medical science, PhD candidate, Polenov Rus -- sian Scientific Research Neurosurgery Institute, St. Petersburg, Russia .

. . .. , . -, .

.., ..., -, - Anikeev N.V., candidate of medical science, PhD candidate, Pole -- nov Russian Scientific Research Neurosurgery Institute, St. Petersburg, . . .. , Russia .

. -, .

.., ..., , , - Shchedrenok V.V., MD, PhD, professor, Honored Doctor of Russian , Federation, chief research worker, Polenov Russian Scientific Research - - Neurosurgery Institute, St. Petersburg, Russia .

. . .. , . -, .

.., ..., , Moguchaya O.V., PhD, professor, head of quality sector of medical , aid, Polenov Russian Scientific Research Neurosurgery Institute, St. Pe - - tersburg, Russia .

. . .. , . -, .

   

ALGORITHM OF ULTRASOUND EXAMINATION OF LOWER LIMB VEINS IN PATIENTS WITH FRACTURES

OF PELVIS AND LOWER EXTREMITIES IN POLYTRAUMA

   

, Asymptomatic thrombosis in the inferior vena cava system requires active 45-91 % , detection and surveillance, because it may result in complications of the . acute phase of polytrauma in 45-91 % of cases .

- Objective to define the optimal terms of dynamic ultrasound control at . the different stages of treatment .

. 1686 - Methods. The analysis was performed including 1686 ultrasound exami 496 . 388 - nations of lower limb veins in 496 patients with polytrauma. 388 patients , received surgical management, 108 conservative treatment .

108 .

. Results. The acute period of the concomitant injury was complicated by 39 % . venous thrombosis in 39 % of the patients. It was found the dependence - between the frequency of thromboembolic complications, total amount of . bone damage and the treatment methods. Thrombosis was detected sig - nificantly more often with multiple broken bones of lower extremities and (48 % ), - pelvis (48 %) than with isolated fractures (33,3 %). The smallest number (33,3 %). (20 %) of thrombotic cases (20 %) took place after reconstructive emergency , surgery compared with delayed operations (45,5 %). 60 % of thrombosis , (45,5 %). in the surgical treatment was observed within first week after the opera 60 % tion .

. The deep vein thrombosis was found in 41,7 % of the patients in case of 41,7 % , - the conservative treatment. Most of thrombosis (63 %) took place within (63 %) - second-third week of the injury. It was defined here as splint thrombosis, . , - which is a result of prolonged skeletal traction .

.

. , - Conclusion. We have found that the risk of thrombotic complications de creased in the surgical treatment of fractures within three days from the time . of injury and increased in case of delayed operations. We have offered the algorithm of dynamic ultrasonic studies considering the terms of formation - of thrombotic events and methods of patients treatment .

.

: ; ; Key words: polytrauma; ultrasonic studies; deep venous thrombosis; low ; . extremities .

, 45-91 % [1-3]. :

-,

   

O

GENERAL PATTERNS OF MICROCIRCULATION IN MINERS WITH SEVERE CONCOMITANT INJURY

   

Objective to study the general patterns of microcirculatory disorders in - miners with severe concomitant injury, with the aim of subsequent develop . ment of differential intensive care violations .

. 72 - Material and methods. A total of 72 patients with severe concomitant , 2 : (24 - injuries, which were divided into 2 groups: the main group (24 persons) ) 10 , underground miners with work experience more than 10 years, and the (48 ) , . comparison group (48 persons) victims who are not employed in hazard , - ous working conditions. Both groups were comparable in age, the nature of , , - traumatic injury, severity, volume of blood loss and ongoing complex inten , sive care, but differed in the time of transport to the hospital. Functional as. - sessment of the microcirculation of the skin was performed by laser Doppler flowmetry using the laser analyzer of capillary blood (LACK-02). The term of (-02). - the follow-up was 7 days .

7 .

. - Results. In both groups with severe concomitant trauma the disorders of microcirculation were identified in the view of decrease in the index of micro . circulatory disorders and the mechanisms of regulation. In the second group , , of the employees without underground length of service microhemodynam , ics improved more rapidly on the background of the complex of intensive . therapy due to activation of mechanisms aimed at stabilizing perfusion. The , miners showed the same index of reduced microcirculation, since the factors . modulating microhemodynamics was not involved enough .

. 10 Conclusion. In severe traumatic injury the expressed disorders of micro - circulation develop in the miners with underground work length of 10 years , and more that can be conditioned by both decrease of spare capacities of - - cardiovascular diseases because of poor work conditions, and long transport , - of patients .

.

: ; ; ; Key words: microcirculation; severe concomitant injury; miner; tissue per . fusion .

-,,

-

   

: (p 0,05); (p 0,05); * 1- (p 0,05) .

   

- [12, 14] .

, - The present clinical surveillance of sepsis progression in the patient with a () heavy concomitant injury and lower urinary tract damage proves a great role - of existence of persistent infection focus of the patient .

.

Objective to evaluate the chronic infection during inflammatory complica . tion progression in the patients with severe concomitant injury and lower . ; ( urinary tract damage .

Methods. Clinical surveillance, laboratory monitoring (including blood and , ); : (), - , urine bacteriological tests, immunogram), radiology, ultrasound examination (). (US), cystography, urethrography, computed tomography (CT) .

. ( ) Results. The progression of sepsis and systemic inflammatory response on - the background of chronic urinary tract infection in the patient with concomi - tant injury and phagocytic deficiency signs in early posttraumatic period .

Conclusions. Detailed history taking, appropriate diagnosis and treatment

.

. , - methods, polycomponent therapy with prescription of immunoglobulin and , - reserve group antibiotics in curative dose, all that has a great significance for detection, prophylaxis and treatment of septic conditions on the background , - of possible chronic disease exacerbation in the patients who suffered seri ous injuries .

, .

: - ; Key words: purulent septic complications; concomitant injury; lower uri; ; . nary tract damage; chronic infection; phagocytic deficiency .

(, - .

, -, ),. .

-, - [9], 11,1 %

-, (). -,, 85 % [1]. - 8,8 % 6,7 %, -, .

- - 50 % 2 :, - 2-3, 24, -

   

- ( ), -.

   

Objective to evaluate the functional outcome of complex treatment . of a child with complicated course of severe spinal cord injury .

. - Material and methods. The case of the staged complex treatment of ., 5 , the patient U. (age of 5, female) with complicated course of severe spi. ػ nal cord injury is presented. The patient was admitted to the neurosur 4 . - gery center of Clinical Center of Miners Health Protection in 4 months after the motor vehicle accident. Using microsurgical technique the , - circular plastics of dural sac with administration of artificial dura was . performed, with following ventriculoperitoneal shunting. In the early . postsurgical period the restorative treatment was initiated .

. - Results. As result of performed surgical procedures and early initia tion of restorative treatment the favorable functional outcome of the . patients treatment was achieved .

: ; ; - Key words: trauma; pediatric spinal cord injury; surgical treatment;

; . rehabilitation .

- 4,9-5,3 % [4] .

, - .

-, -

   

, - 3 30-45. (. 6). - : Information about authors:

.., ..., -, Yakushin O.A., MD, traumotologist-orthopedist, neurosurgery de 2, - partment N 2, Federal Stat Budget Medical Prophylactic Institution - Scientific Clinical Center of the Miners Health Protection, Leninsk , . -, . Kuznetsky, Russia .

.., ..., , Novokshonov A.V., PhD, head of neurosurgery center, Federal Stat -- Budget Medical Prophylactic Institution Scientific Clinical Center of the - - Miners Health Protection, Leninsk-Kuznetsky, Russia .

, . -, .

.., - , - Krasheninnikova L.P., instruction coordinator of exercise therapy, , restorative treatment department, Federal Staty Budget Medical Prophy - -- lactic Institution Scientific Clinical Center of the Miners Health Protec , . -, tion, Leninsk-Kuznetsky, Russia .

.

.., -, - Kubetsky Y.E., neurosurgeon, neurosurgery department N 2, Federal 2, -- Stat Budget Medical Prophylactic Institution Scientific Clinical Center of - - the Miners Health Protection, Leninsk-Kuznetsky, Russia .

, . -, .

.., -, Glebov P.G., neurosurgeon, neurosurgery department N 2, Federal 2, -- Stat Budget Medical Prophylactic Institution Scientific Clinical Center of - the Miners Health Protection, Leninsk-Kuznetsky, Russia .

, . -, .

.-., -, - Kitiev I.B-G., neurosurgeon, neurosurgery department N 2, Federal 2, -- Stat Budget Medical Prophylactic Institution Scientific Clinical Center of - - the Miners Health Protection, Leninsk-Kuznetsky, Russia .

, . -, .

: Address for correspondence:

.., 7- , 9, Yakushin O.A., 7th district, 9, Leninsk-Kuznetsky, Kemerovo region, - -- Russia, 652509 , . -, Federal Scientific Clinical Center of Miners Health Protection , , 652509 : 8 (384-56) 9-53-59; 8 (384-56) 2-33-78; +7-905-075-5373 Tel: 8 (384-56) 9-53-59; 8 (384-56) 2-33-78; +7-905-075-5373 E-mail: yakushin-gnkc@rambler.ru E-mail: yakushin-gnkc@rambler.ru

   

Objective on the basis of the review of modern references on the problem , - of polytrauma to give the characteristic of traumatic disease, its most used . definitions and diagnostics methods .

. - Methods. The review of the major publications in the domestic and foreign - literature on a problem of a heavy mechanical trauma in critical medicine, , . anesthesiology and resuscitation .

. - Results. The contradiction between existing representations about trau ( matic illness as about a consequence polytrauma (combined or a multiple ) - trauma) and its development meeting in practice after some isolated injuries . is revealed .

. Conclusions. Diagnostics of traumatic illness is most expedient from posi tions of pressure regulatory mechanisms and functional failure of mecha . nisms of adaptation .

: ; ; ; Key words: polytrauma; traumatic illness; diagnostics; functional sys . tems .

   

: Information about authors:

.., ..., , -- Samusenko D.V., candidate of medical science, senior researcher, , - scientific research laboratory of traumatology, Russian Ilizarov Sci - entific Centre Restorative Traumatology and Orthopedics, Kurgan, . . .. Russia .

, . , .

.., ..., , , - Erokhin A.N., MD, PhD, docent, leading research worker, laboratory c, - of functional researches, Russian Ilizarov Scientific Centre Restorative - Traumatology and Orthopedics, Kurgan, Russia .

. . ..

, . , .

.., ..., , - - Martel I.I., MD, PhD, chief of scientific clinical laboratory of trauma , tology, Russian Ilizarov Scientific Centre Restorative Traumatology and - Orthopedics, Kurgan, Russia .

. . .. , . , .

   

C

SYSTEMIC INFLAMMATORI RESPONS SYNDROME AND MULTIPLE ORGAN DYSFUNCTION IN CHILDREN

WITH POLYTRAUMA

   

() Multiple organ dysfunction syndrome (MODS) is one of the most severe com , - plications of critical states in children which define the outcome of disease , , . and patients quality of life both in early and long term period. The state severity in children in critical cases is conditioned not only with results of , - promoting traumatic factors, but also with the characteristics of child body .

. The infections following disorders in immune defense mechanisms are the basic reason of late mortality in children. At the present time the conception . of the septic process relies on the particularities of development of systemic inflammatory reaction (SIRS) .

(SIRS) .

Objective to present the literary data review of the mechanisms of devel . opment of MODS and sepsis in children .

. Conclusion. The physiologic and metabolic features in children predeter SIRS . mine the early development and progression of SIRS and MODS .

The perceptions about the molecular mechanisms of MODS dysfunction are - mainly based on the experimental data and the results of examination of , - adult patients that require the further investigation and refinement .

. Understanding of the mechanisms of the cellular changes in SIRS develop SIRS - ment is necessary for development of the therapeutic strategies for manage . ment of MODS .

- The priority question is the actuality of early accurate diagnostics of sepsis , and MODS. The solution of this question will give a chance of survival to . thousands of ill persons .

The problem of terminology and identification of pediatric sepsis require the , - further improvement, conduction of cases of evidential studies and it will be . discussed in the medical society .

: (SIRS); Key words: systemic inflammatory response syndrome (SIRS); multiple or () ; ; . gan dysfunction syndrome (MODS) in children; cytokines; polytrauma .

-. [9, (), 10, 52] .

-,,,

- -,

   

: Information about authors:

.., ..., , , - Agadzhanyan V.V., MD, PhD, professor, director, Federal Scien - tific Clinical Center of Miners Health Protection, Leninsk-Kuznetsky, - , - Russia .

, . -, .

.., ..., , Ustyantseva I.M., Doctor of Biological Sciences, professor, , - deputy director of clinical laboratory diagnostics, Federal Scien - - tific Clinical Center of Miners Health Protection, Leninsk-Kuznetsky, - , Russia .

, . -, .

.., ..., - Khokhlova O.I., MD, PhD, physician of clinical laboratory diagnostics, , -- Federal Scientific Clinical Center of Miners Health Protection, Leninsk - Kuznetsky, Russia .

, , . -, .

   

, .

50 %. Outcome in polytraumatized patients with and without brain injury /T. Gross, M. Schepp, C. Attenberger [et al.] //Acta Anaesthesiol. Scand .

2012. Vol. 56, N 9. P. 1163-1174 .

   

: Iwashyna, T.J. The incomplete infrastructure for interhospital patient transfer /T.J. Iwashyna //Crit. Care Med. 2012. Vol. 40, N 8. P .

2470-2478 .

.

   

: Single versus multiple doses of antibiotic prophylaxis in limb fracture surgery /S. Morrison, N. White, S. Asadollahi, J. Lade //ANZ J. Surg. 2012. Oct. 11. : http://onlinelibrary.wiley .

com/doi/10.1111/j.1445-2197.2012.06143.x/

Abstract

( :

15.10.2012)

   

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. -]. ., 2011. 18 .

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2. /.. , .. , .. , .. // . 2012. 2. . 22-26 .

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4. /.. , .. , .. [ .] // . 2012. 3. . 51-56 .

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6. /.. , .. , .. [ .] // . 2012. 2. . 80-83 .

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8. , .. - /.. , .. , .. // . 2012. . 93, 3. .

434-438 .

9. /.. , .. , .. [ .] // . 2012. 3. . 66-69 .

10. A prospective study of thrombophilia in trauma patients with pulmonary embolism = /J.L. Gary, R.C. Barber, C.M. Reinert, A.J. Starr //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 1 .

P. 247-250 .

11. Acute kidney injury and posttrauma multiple organ failure: The canary in the coal mine = /M.V. Wohlauer, A. Sauaia, E.E. Moore [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 2. P .

373-380 .

12. Avdimiretz, N. Focus on pediatric intentional trauma = /N. Avdimiretz, L. Phillips, I. Bratu //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 1031-1034 .

13. Base deficit as a marker of survival after traumatic injury: Consistent across changing patient populations and resuscitation paradigms = : /E.I. Hodgman, B.C. Morse, C.J. Dente [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 844-851 .

14. Coagulation management of bleeding trauma patients is changing in German trauma centers: An analysis from the trauma registry of the German Society for Trauma Surgery = /A. Wafaisade, R. Lefering, M. Maegele [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 936-942 .

15. Continuously recorded oxygen saturation and heart rate during prehospital transport outperform initial measurement in prediction of mortality after trauma = /M.R. Woodford, C.F. Mackenzie, J. DuBose [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 1006-1012 .

16. Factor IX complex for the correction of traumatic coagulopathy = IX /B. Joseph, A. Amini, R.S. Friese [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 828-834 .

17. Geriatric trauma service: A one-year experience = : /A.J. Mangram, C.D. Mitchell, V.K. Shifflette [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 1. P. 119-122 .

18. Is contrast exposure safe among the highest risk trauma patients? = /D.Y. Kim, L. Kobayashi, T.W. Costantini [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 1. P. 61-67 .

19. Moving from optimal resources to optimal care at trauma centers = /S. Shafi, N. Rayan, S. Barnes [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P .

870-877 .

20. Pain and satisfaction in hospitalized trauma patients: The importance of self-efficacy and psychological distress = , . /K.R. Archer, R.C. Castillo, S.T. Wegener [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 1068-1077 .

21. Physical effects of trauma and the psychological consequences of preexisting diseases account for a significant portion of the health-related quality of life patterns of former trauma patients = , , /L. Orwelius, M. Bergkvist, A. Nordlund [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 2. P. 504-512 .

22. Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients = /F. X.Guyette, H. Gomez, B. Suffoletto [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 930-935 .

23. Radiation exposure has increased in trauma patients over time = /K. Ahmadinia, J.B. Smucker, C.L. Nash, H.A. Vallier //Journal of Trauma and Acute Care Surgery. - 2012. Vol. 72, N 2. P. 410-415 .

24. Single-drug sedation with fentanyl for prehospital postintubation sedation in trauma patients = /C.P. Michetti, J.F. Maguire, A. Kaushik [et al.] //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 924-929 .

25. Trauma center volume and quality improvement programs = /H.T. Stelfox, F. Khandwala, A.W. Kirkpatrick, M.J. Santana //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 4. P. 962-968 .

26. Vachon, C.M. Readmission of trauma patients in a nonacademic Level II trauma center = /C.M. Vachon, M. Aaland, T.H. Zhu //Journal of Trauma and Acute Care Surgery. 2012. Vol. 72, N 2. P .

531-536 .

   

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