Method of determining tactics of treating patients with closed abdominal trauma

FIELD: medicine. SUBSTANCE: invention relates to medicine, namely to abdominal surgery, and can be used in case if it is necessary to determine tactics of treatment of said category of patients. For this purpose anamnestic and clinical-instrumental criteria are determined: a) time from the moment of trauma; b) possibility of contact with patient; c) state of hemodynamics; d) presence of free gas in abdominal cavity, e) growth of volume of appearance of free liquid in abdominal cavity within an hour; f) US or CT-signs of injury of parenchymatous organs; g) increase of small intestine diameter. Assessment of obtained data is carried out in points in the following way: tome from the moment of trauma: 0 points - less than 2 hours, 1 point - 2-6 hours, 2 points - 7-12 hours, 3 points - 13-24 hours, 4 points - more than 24 hours; possibility of contact with patient: 0 points - possibility of communication, 1 point - confused speech, 2 points - inadequate speech, 3 points - inarticulate sounds, 4 points - no contact; state of hemodynamics: 0 points - stable, 4 points - unstable; presence of free gas in abdominal cavity: 0 points - absent, 1 point - present; separation of peritoneum layers: 0 points - absent, 1 point - less than 1 cm, 2 points - 1-2 cm, 3 points - 2.1-3 cm, 4 points - 3.1-4 cm; growth of volume or appearance of free liquid in abdominal cavity within an hour: 0 points - absent, 1 point - to 200 ml, 2 points - 200-500 ml, 3 points - more than 500 ml; US or CT - signs of injury of parenchymatous organs: 0 points - no; 1 point - isolated tear of capsule, 2 points - rupture of capsule and parenchyma, 3 points - fragmentation of organ; increase of small intestine diameter: 0 points - no, 1 point - to 3 cm, 2 points - 3-4 cm, 3 points - 4.1-6 cm, 4 points - more than 6 cm. Obtained points are summed up. If the sum of points is from 0 to 6 including, conservative treatment with dynamic clinical and instrumental control is carried out. If the total quantity of points is from 7 to 14 including, laparoscopic operation is performed. If the total quantity of points is from 15 to 27, laparotomy is carried out. EFFECT: method makes it possible to ensure optimisation of selection of medical assistance type due to consideration of individual changes of diagnostically significant totality of indices. 1 tbl, 1 ex