Diaphragmatic damage is a potentially life-threatening condition for the victim, and delay in diagnosis and treatment significantly increases the mortality rate from this type of injury. Diaphragmatic damage is a diagnostic and curative challenge for any surgeon. The purpose of the study was to determine the effectiveness of the advanced diagnostic and treatment methods for victims of firearms wounded by the diaphragm delivered from the Armed Conflict in the East of Ukraine / Operation of the United Forces zone by assessing the structure of the morpho-functional index relationships using factor analysis. Material and methods. During 2014-2018, 1005 victims from the Armed Conflict in the East of Ukraine / Operation of the United Forces zone were delivered to the surgical clinic with penetrating firearms wounds in the chest and abdomen. The final analysis included 92 wounded with simultaneous penetrated the wounded projectile into the chest and abdominal cavity and damage to the diaphragm. The average age of the wounded comparison group was Me = 33.5 (26; 43) years; the main group had Me = 32 (25; 37) years. To evaluate the treatment efficacy of the diaphragm affected by firearms, the following parameters were analyzed: the age of the affected area, the size of the diaphragm wound, the severity of the pain syndrome for the visual-analog scale, the index of combined wounds of the chest and abdomen, the scope of the diaphragm excursion in the postoperative period with the help of X-ray and ultrasound, the results of the vital capacity of the lungs according to the standard methods of conducting spirography. To investigate the relationship between the indicators of the wounded, factor analysis was used. Results and discussion. During the analysis, the initial information was presented as a matrix. In order to take into account the peculiarities of the somatic state of the victims, appropriate indexes of damage to the chest and abdomen were introduced. To construct the final analytical solution in the analysis of data, a clusterization was conducted. After the clusterization, the average values of all the studied parameters were calculated. Comparison of the indicators of the studied groups showed a significant difference in the parameters of the diaphragm excursion, the results of functional tests. It can be noted that the wounded comparison group is generally worse than the wounded main group.The correlation between the improvement of respiratory functions on the background of reducing the size of the diaphragm wound, the number of wounded organs and the corresponding pain syndrome, is consistent with contemporary notions of the role of wounding the diaphragm and internal organs on the respiratory function.Video-endoscopic diagnostics of all available damages of the chest organs, surgical correction of the wound to reduce the effect of pain sensations on the diaphragm excursion promotes early restoration of respiratory function and prevents the development of postoperative complications. Conclusions. The proposed tactics for the examination and treatment of the main group with wounded injuries with the use of videothoracoscopy, laser imaging of wounds, fluorescence diagnostics with the definition of nonviable tissues, magnetodetection, surgical treatment and wound suturing according to the indications taking into account the morpho-functional features of the diaphragm is effective, which is confirmed analysis of the structure of connections of morpho-functional parameters using factor analysis.
Keywords: firearms wound of the diaphragm, excursion of the diaphragm, pain syndrome in visual-analog scale, index of injury of the chest, index of injury of the abdominal cavity, lung capacity
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