Problems of intrapelvic bleeding arrest in unstable fractures of the pelvic bones

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Abstract

The results of treatment of 349 patients with unstable injuries of the pelvic ring and signs of intrapelvic bleeding were analyzed. The assessment of the clinical effectiveness of the developed algorithm for the timely diagnosis of intrapelvic bleeding and its final stop using open and endovascular methods of surgical hemostasis was carried out. In the comparison group (170 people), mechanical stabilization of the pelvic ring was performed, and bleeding was expected to stop due to the effect of biological tamponade. In the main group (179 people), after mechanical stabilization of the pelvic ring, pelvic tamponade, or resuscitation endovascular balloon aortic occlusion, angioembolization was used. The choice of the method of surgical hemostasis depended on the hemodynamic parameters, the source of intrapelvic bleeding, the presence of life - threatening injuries to other areas of the body, the severity of the victim’s condition, the effectiveness of the previously used method for stopping intrapelvic bleeding. The implementation of this algorithm made it possible to reduce the overall mortality by 1.8, the daily mortality by 2.7 times, and also to reduce the duration and volume of blood transfusion replacement therapy by 1.8 times.

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About the authors

I. V Kazhanov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation; The I.I.Dzhanelidze St. Petersburg Research Institute of Emergency Medicine of the Ministry of Health of the Russian Federation

Email: carta400@rambler.ru
St. Petersburg, Russia

M. B Borisov

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

St. Petersburg, Russia

S. I Mikityuk

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation; The I.I.Dzhanelidze St. Petersburg Research Institute of Emergency Medicine of the Ministry of Health of the Russian Federation

St. Petersburg, Russia

Ya. V Gavrishchuk

The I.I.Dzhanelidze St. Petersburg Research Institute of Emergency Medicine of the Ministry of Health of the Russian Federation

St. Petersburg, Russia

V. V Denisenko

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

St. Petersburg, Russia

A. R Grebnev

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

St. Petersburg, Russia

E. V Ganin

The S.M.Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation

St. Petersburg, Russia

E. A Kolchanov

The I.I.Dzhanelidze St. Petersburg Research Institute of Emergency Medicine of the Ministry of Health of the Russian Federation

St. Petersburg, Russia

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