Factorii prognostici de deces în traumatismul, complicat cu hemoragie retroperitoneală

Abstract

Introducere: Prezența unei leziuni retroperitoneale, complicată cu hemoragia retroperitoneală (HRP) este un factor problematic în diagnostic, tratament, agravând prognosticul favorabil traumatizaților. Scopul: Analiza factorilor de deces în traumatismul, complicat cu hemoragie retroperitoneală. Material si metode: Studiul include 195 victime cu traumatism, complicat cu HRP. Mortalitatea a constituit 36,92%(72). Cauzele traumatismului: accidente rutiere-109(55,89%), сatatrauma-59(30,25%), strivire-11(5,64%), lovituri directe-8(4,1%), alte cauze-8(4,1%). Algoritmul de conduită medicochirurgicală a depins de stabilitatea hemodinamică. Pentru a evalua gravitatea traumatismului a fost folosită valoarea medie a grilei: GCS(Glasgow), AIS, ISS; indicele de şoc Algover (SIA), datele expertizei medico-legale, cu metode complexe morfopatologice. Rezultate: S-a depistat: traumatism cranio- cerebral la 131(67,17%), cu coma cerebrală sub 9 Glasgow - 33pacienți; numărul de organelor lezate: I organ - 57cazuri, II-39, III-34, IV-13, V-25, VI organe-1caz; fracturi ale bazinulu i- 152(77,94%); etc. Media severității lezărilor traumatismului la spitalizare: GCS=11,25±3,26; AIS=10,58±3,78; ISS=36,78±16,99; SI Algover=1,3±0,63. S-a efectuat: laparoscopia- 15; laparotomie de urgență la 51 de pacienți. Cauzele decesului: şoc ireversibil(28), insuficiența poliorganică(29), insuficiența cardio-vasculară(8), complicații septice(3), traumatism cranio-cerebral grav(3), CID(1). Concluzii: Factorii prognostici de deces în traumatismul, complicat cu HRP sunt: caracterul şi gravitatea traumatismului; şocul hemoragic sever; lezări multiple ale organelor interne; hemoragia retroperitoneală masivă; timpul trauma-spitalizare-operație; starea generală; acutizarea maladiilor concomitente şi dezvoltarea complicațiilor în perioada posttraumatică.

Introduction: The presence of retroperitoneal lesions, complicated by retroperitoneal hemorrhage (HRP) is a problematic factor in the diagnosis, treatment, worsening the favorable prognosis of traumatized. Aim: Analysis of the death factors in trauma, complicated by retroperitoneal hemorrhage. Material and methods: The study includes 195 victims with trauma, complicated by HRP. The mortality was 36,92%(72). Causes of the injury: car accidents - 109(55,89%), katatraumas - 59(30,25%), compression-11(5,64%), direct blows - 8(4,1%), other causes - 8(4,1%).The algorithm of medic-surgical behavior depended on hemodynamic stability. The average value of the scale was used to evaluate the gravity of the trauma: GCS(Glasgow), AIS, ISS, shock index Algover(SIA), complete forensic results with the complex morph- pathological methods. Results: It was traced out: skull-cerebral trauma in 131(67,17%), with cerebral coma <9 Glasgow- 33patients, inner abdominal organ damage: I organ-57 cases, II-39, III-34, IV-13, V-25, VI organs- 1 case, the pelvis fracture- 152(77,94%), etc. The severity average of the injury at the admission: GCS=11,25±3,26; AIS=10,58±3,78; ISS=36,78±16,99; SI Algover=1,3±0,63. It has been made: laparoscopy-15, emergency laparotomy to 51 patients. Causes of death: irreversible shock (28), MODS (29), cardio-vascular failure (8), septic complications (3), severe skull-cerebral trauma (3), CID (1). Conclusions: The prognostic factors of death in trauma, complicated by HRP are: the character and severity of trauma; severe shock; multiple injury of internal organs; massive retroperitoneal hemorrhage; time during trauma-admission-surgery; general state; aggravation of the concomitant diseases and the development of complications during the posttraumatic period.