[Pathogenetical features of the first period of trauma disease with acute respiratory insufficiency].

The pathogenetical features of acute respiratory insufficiency (ARI) were studied as a clinical form of the first period of the trauma disease (TD)--the period of acute impairments of the important for life functions (the first 8-12 h after trauma). In 17 casualties with a severe combined trauma the severity of the first period of the disease depended on the ARI caused by a serious injury of the chest not accompanied by a direct injury of the heart. It was shown that ARI is an independent clinical form of the first period of TD. The indices of the systemic hemodynamics in ARI are within the limits of the normal values. ARI resulting from the "primary" injury of the lungs results in a decreased delivery of oxygen to the tissues and of its consumption. When ARI takes place during the first period of TD the metabolic function of the lungs is sharply suppressed and pronounced endotoxemia is observed.

[Pathogenetical peculiarities of the first period of trauma disease in acute heart failure].

Under observation there were 29 casualties with severe combined trauma complicated by acute heart failure (AGF) caused by a direct injury of the heart, without severely disturbed consciousness and valuable blood loss. In 65% of the patients the trauma was severe, in 35%--extremely severe. Higher ST wave was registered in ECG of 40% of the patients in standard leads, in 30% there was no wave R in chest leads. Disturbed rhythm was noted 2-2.5 times more often than in other kinds of injuries. Ventricular extrasystoles, paroxysmal ciliary arrhythmia, atrioventricular and ideoventricular rhythm were determined since the first day after trauma. The results of the investigation have shown that the primary injury of the myocardium was followed by a decreased heart work. Circulatory insufficiency of blood circulation was developed. The impaired systemic hemodynamics led to inadequate delivery of oxygen to the tissues and of oxygen consumption, to the development of tissue hypoxia and respiratory disorders closely connected with it. The circulation disturbances caused also a suppression of detoxication mechanisms of organism, the development of disseminated intravascular coagulation and endotoxicosis.

[Pathogenetical features of the acute period of traumatic disease. Traumatic shock as a special manifestation of the acute period]. / Patogeneticheskie osobennosti ostrogo perioda travmaticheskoi bolezni. Travmaticheskii shok -- chastnoe proiavlenie ostrogo perioda.

Clinico-pathogenetical features of the acute period of trauma disease due to a severe combined injury were studied in 644 patients. An analysis of clinical indices was made in 428 of them, clinico-laboratory indices--in 216 patients. The results have shown that the main form of the acute period of the trauma disease are traumatic shock (62.8%), traumatic coma (18.3%), acute respiratory insufficiency (5.7%). Dramatically decreased delivery and consumption of oxygen lower than the metabolic requirements of the tissues accompany the traumatic shock which results in the suppression of tissue metabolism. Pronounced endotoxicosis developing along with the traumatic shock results not from the degree of injured tissues only, but from the centralization of blood circulation. It is also supported by the insufficient detoxicating function of the kidneys. A severe degree of the traumatic shock causes disseminated intravascular coagulation (DIC) of the II-III degree. After helping out from shock the patient has normocoagulation or the I degree DIC. Traumatic shock with marked hypotension and metabolic acidosis is a significant factor of high risk of the development of acute lesion of the lungs.

[The pathogenetic correction of disorders of blood oxygen transport in the postshock period of traumatic disease]. / Patogeneticheskaia korrektsiia narushenii transporta kisloroda krov'iu v postshokovom periode travmaticheskoi bolezne.

The state of the gas exchange system was analyzed in 79 patients with a severe combined trauma (SCT) at the postshock period. It allowed detection of specific features of disturbances of the oxygen transport by blood in different kinds of injuries. The SCT with a critical injury of the brain is more often accompanied by hyperdynamia of circulation within the first two days after trauma, while the 3rd-4th days are characterized by a sharp drop of the heart index to (2,17 +/- 0,21) l/min.m2, oxygen transport to (261,9 +/- 37,2) ml/min.m2, oxygen consumption to (99,9 +/- 8,3) ml/min.m2. If the SCT was accompanied by a contusion of the heart the changes of central hemodynamics were especially pronounced and prolonged having a hypocirculatory character with a decreased cardiac and stroke index from the first hours of stay at the hospital (20,4 +/- 1,5) ml/m2 and (2,10 +/- 0,14) ml/min.m2 correspondingly. It led to a substantial decrease of indicators of the transport and consumption of oxygen correspondingly: (266,5 +/- 25,1) ml/min.m2 and (112,6 +/- 8,2) ml/min.m2. For the pathogenetically substantiated therapy of disturbances of the oxygen transport by blood the following measures are considered: isovolemic hemodilution, moderate sympathetic blockade, the use of membrane stabilizers, glucocorticoids, adrenolytics, solcoseryl. The state of the organism system of respiration and subsystem of the oxygen transport must be taken into consideration when choosing the optimum time for performing the postponed operative interventions at the postshock period.

[The development of a prognostic model of trauma outcomes]. / Razrabotka modeli prognozirovaniia iskhodov travmy.

Mathematical models of prognosing outcomes of trauma was developed on the basis of an analysis of treatment of 1485 patients. The probability of correct prognosis was 86%.

[Clinico-pathophysiological aspects of post-traumatic disease]. / Kliniko-patofiziologicheskie obosnovaniia travmaticheskoi bolezni.

On the basis of the many-years clinico-physiological investigations the authors substantiate the idea of the trauma disease, its forms and periods of its development.

[Cerebral evoked potentials in comatose states of various etiology]. / Vyzvannye potentsialy golovnogo mozga pri komatoznykh sostoianiiakh razlichnoi étiologii.

The authors studied the evoked potentials (EPs) of the brain cortex in patients in comatose states of various etiology as well as the EPs of the brain cortical and subcortical structures of the animals during simulation of the conditions studied in clinical practice. A sharp drop in the amplitude of early waves and an increase in the amplitude and latency of late EP waves in all the cerebral structures irrespective of the coma genesis were disclosed. The changes were of a simultaneous and generalized character with a greater similarity between the EPs of the cortical zones but an increase of their difference from the subcortical structures. These facts are explained by the deprivation of the nonspecific systems of both cortical and local inhibitory influence which leads to the late activation of the brain specific systems. It is assumed that the space-time dissociation in the action of various cerebral systems is, regardless of the coma genesis, one of the principal mechanisms giving rise to disorders of information perception, analysis and processing.