DISTURBANCE OF HOMEOSTASIS AFTER TRAUMA S URGERY OF VARYING SEVERITY

The objective of this study was to evaluate and compare the derangemen t of body homeostatis and the inflammatory response after different ty pes of traumatological operations in patients with multiple injuries. These were determined in a total of 60 operations. The procedures comp rised osteosynthesis of the femur (n = 28), the pelvic girdle (n = 11) the spine (n = 8), and facial and basal skull reconstructions (n = 13 ). Specific and unspecific parameters of the inflammatory response wer e determined on the morning of the operation, immediately after the pr ocedure, every 6 h on the 1st day and 48 h after the end of surgery. A fter all types of operations (pelvis, femur, spine, face/basal skull) significant alterations were observed for neutrophil elastase, C-react ive protein, interleukin 6, interleukin 8, antithrombin III, partial t hromboplastin time and other parameters. The degree of postoperative c hanges differed significantly (Kruskal-Wallis test, P<0.05) among the four types of operations for lactate, heart rate, PO2/FiO(2) ratio and nitrogen excretion and showed a strong discriminating tendency for ne utrophil elastase and C-reactive protein. The changes were most pronou nced after operations on the pelvic girdle, followed by procedures in the femoral, spinal, and facial/basal skull regions. We conclude that a considerable inflammatory response and pronounced disturbance of bod y homeostasis follow traumatological operative procedures, varying in severity with the type of surgery. Several parameters allow quantitati on of the surgical trauma and differentiation between different operat ions/regions. Further research should focus on the interrelationship b etween pre-existing preoperative inflammation and the additional traum a inflicted by surgery in patients with severe injuries. If indicators and mediators of the inflammatory response were determined this might allow integration of these two influencing factors into one concept f or study of the perioperative course in trauma patients.