[The arteriovenous difference in osmotic and hemostatic indices as a criterion for the early diagnosis of pulmonary complications in severe combined trauma].

The arteriovenous difference in the values of plasma and its main ingredients' osmolality and hemostasis were examined in patients with grave combined injuries complicated with the adult respiratory distress syndrome (RDS) in the posttraumatic period. The findings showed a changed trend of arteriovenous difference in the osmotic homeostasis parameters in comparison with those during on uneventful course of combined injury: a-v Dosm. in stage IV RDS is (-)22.9 +/- 13.5 mosm/kg H2O versus 3.36 +/- 3.51 mosm/kg H2O in an uncomplicated course (p < 0.001). The arteriovenous difference for plasma COD was 8.1 +/- 3.0 mm Hg and (-)0.5 +/- 0.7 mm Hg in an uncomplicated course (p < 0.001). These changes permit a conclusion about the impaired osmolality regulating function of the lungs in RDS. Analysis of the arteriovenous difference of hemostasis once again confirms the presence of disorders in the hemostasis regulating function of the lungs: the arteriovenous difference of the structural and chronometric values of thromboelastogram is inverted, which indicates an increase of the coagulation potential of arterial blood: the a-v is equal to difference of blood clotting time 48 h after the injury and is (-)0.1 +/- 0.04 min, in contrast to the uneventful course: 2.5 +/- 0.27 min (p < 0.01): the a-v equal to the coagulation index difference was 2.26 +/- 0.49 arb. U, in contrast to (-)2.0 +/- 0.13 arb. U in an uncomplicated course of heating. Disorders in the other than respiratory functions of the lungs develop 11 h earlier than clear-cut x-ray signs of RDS appear, which gives us grounds to consider these changes as the earliest diagnostic criterion of RDS.