EUROMEDICA  Hanover 1-2  Juni 2007	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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As the consequence of WOH findings, traumatism is reported to take the third place in general structure of mortality. The level of combined trauma is 26-80% in all non-outpatients cases. Nowadays it is the tendency, that polytrauma is increasing in connection with mechanical injures (road traumatism, industrial traumatism, trauma after falls and after different catastrophes and extraordinary accidents).

Between 2002 and 2005 at Municipal Clinical Hospital №33 named after professor A.A. Ostroumov in the surgical resuscitation department patients with different mechanical injures have been treated. The general quantity of those was 5997, included 1032 (17,2 %) patients with severe combined trauma, 198 (3,3 %) patients had died. The structure of combined trauma consisted of thoracic cage injures with contusion of heart and lungs (50 %), skull injure (56-70 %), injure of the vertebral column (3031 %). The combination of disorders of different systems and organs was noted. The severity of general state was assessed with using results of physical examination, laboratory investigations, electrocardiogram findings, X-rays studies of skeleton, immunofermental method. Prognosis and severity of general state was obtained with using Revised Trauma Score – classification, Injure Severity Score, Apache II and with data of the level of proinflammatory cytokines (TNF, IL-1beta, IL-6, IL-10) in blood. This research is performing in conformity with award program of support of young scientists by Russian President. Our findings of the level of proinflammatory cytokines in blood and the stages of traumatic disease in 518 patients have shown that there were marked characteristic changes of the level of proinflammatory cytokines in it. Those were depended on the general state of the patient. In the first stage (primary effect) usually the increase of the level of cytokines of this group was not significant or it was normal. Then in conformity of progress of traumatic shock it was change for the worse of the general state of the patient and increase of the level of cytokines in blood. In the hypercatabolism phase we have revealed prolongation of the increase of the level of cytokines (change for the worse) or the level was still high, but had not been enlarged (change for the better). In the phase of resorbtion the level of proinflammatory cytokines was increased again or was high (the negative tendency). If the level had been decreased, it was the evidence of the positive effect of the treatment. In case of polyorganic disorders we have noted the constant increase of the level of cytokines (the negative tendency). In this situation either there were mortal changes and death, or it was septic condition. If the level of cytokines had been decreased, it was the evidence of positive tendency.

Our findings and results of other studies have shown, that the analysis of the level of cytokines in blood is the possible way to prognosis and to change the treatment of traumatic shock in time in patients with polytrauma.