NEW APPROACHES TO REDUCING MORTALITY IN SEVERE COMBINED CRANIOCEREBRAL INJURY

Abstract

Objective: The decline of the lethality in severe combined craniocerebral injury (SCCI) by implementing a program of diagnosis and treatment of fat embolic syndrome (FES) identification methods. Methods: Analyzed data on 338 patients with SCCI at the age of 18 to 68 years, which depending on the diagnosis and treatment tactics distributed to the control group (42.6%) and the main group (57.4%). Treatment of patients of the control group carried out traditionally, and in the main group – taking into account the results of identification of fat globulemia and neuroimaging data. Results: Common to both groups of patients were signs arising from the overlap of symptoms of FES and craniocerebral trauma – and other impaired consciousness, hypoxia, etc. In the main group, FES diagnosed in 33 (17.0%) patients, in 99 (51.0 %) – craniocerebral trauma and in 62 (32.0%) – their combination. In general, in the main group, clinical manifestations of FES detected in 95 (49.0%) patients, including 12 (12.6%) in the classical, 9 (9.5%) – clinical, 31 (32.6%) – subclinical form, and 43 (45.3%) patients had no clinical manifestations of fat globulemia. Mortality in the control and main groups was 40.3% and 26.8%, respectively Conclusion: The introduction to the system of diagnostic considered lesions of FES identification methods and neuroimaging data, as well as differentiated treatment tactics, contributed to a 13.5% decrease in mortality rate. Keywords: Combined trauma, craniocerebral trauma, fat globulemia, fat embolic syndrome, lethality.