HEALTH CARE OUTCOMES IN THE CIVILIAN POPULATION WITH GUNSHOT WOUNDS OF THE NECK IN THE CONDITIONS OF THE LOCAL MILITARY CONFLICT

• Main Authors: Владимир Владимирович Масляков, Виталий Геннадьевич Барсуков, Алексей Вячеславович Усков
• Format: Article
• Language: Russian
• Published: The Publishing House Medicine and Enlightenment 2016-12-01
• Series: Medicina v Kuzbasse
• Subjects: ранения шеи; послеоперационный период; гражданское население
• Online Access: http://mednauki.ru/index.php/MK/article/view/22

The research is base don’t he analysis of 129 cases of gunshot wounds of the neck. The age of the wounded varied from 18 to 65 years. All patients were treated in the Surgical Unit of the City Hospital N 9 of the city of Grozny of the Chechen Republic. All wounds have been got during local military operations in the Chechen Republic during the period from 1991 to 2000. Objective – to improve the arrangement of health care delivery to the civilian population with gunshot wounds of the neck provided by the medical personnel of civil health care in the conditions of the local military conflicts. Methods. We used medical and diagnostic methods, their application depended on the staff structure and the medical institutions facilities. In the diagnostic purposes clinical, laboratory and special methods of research were applied. The studied medical documentation included primary medical cards, emergency care team reports, case histories, clinical records and protocols of forensic medical examinations. Results. The analysis showed that in patients with gunshot wounds of the neck the early postoperative period was severely complicated in 51,9 % cases, the purulent and septic complications being the common ones in 21,7 % cases in the studied group. The high rate of purulent and septic complications development can be associated with several factors. The patients admitted to the in-patient setting had not been given a proper pre-hospital care. In extreme conditions the hospitals providing health care for the patients with severe wounds lacked the facilities necessary for edaquate diagnosis that often resulted in diagnostic mistakes. The severity of the wounds should be considered. The mortality rate was 32,5 %. The common cause of the lethal outcome in patients with gunshot wounds of the neck was hemorrhagic shock – 13,1 %. Conclusions. For the civilian population with gunshot wounds of the neck at the pre-hospital stage the following medical procedures were performed: bandaging the wound – 45 (34,8 %); anesthesia by not narcotic analgesics 12 (9,3  anesthesia by narcotic analgesics – 2 (1,5 %); a hemostasis – 6 (4,6 %); no medical procedures performed – 64 (49,6 %). In the early postoperative period 51,9 % patients with gunshot wounds of the neck developed complications, purulent and septic complications having been registered in 21,7 % cases. The mortality rate was 32,5 %. The common causes of the lethal outcome in patients with gunshot wounds of the neck were hemorrhagic shock – 13,1 %; traumatic shock – 6,2 %; thromboses and embolisms – 3,1 %; purulent and septic complications – 10 %.