FEATURES OF PROXIMAL AND DISTAL TRANSPORT OF SODIUM IN ACUTE BLOOD LOSS, COMPLICATED BY ISCHEMIA-REPERFUSION OF EXTREMITY, AND THEIR CORRECTION IN THE EXPERIMENT
Introduction. The most effective way to stop massive external bleeding is the application of a tourniquet. Complete bleeding of the limb within 2 hours can cause damage to nerves and blood vessels under the tourniquet, myonecrosis, rhabdomyolysis, deep vein thrombosis. However, the role of limb ischemia-reperfusion in the pathogenesis of impaired renal function in acute blood loss has not been adequately studied. There is no data on the effectiveness of their correction with carbacetam.
The aim of the study – to find out the features of the renal transport of sodium ions in the early period after applying a skeletal injury of varying severity, complicated by blood loss and the effectiveness of the correction of the revealed violations with carbacetam.
Research Methods. The experiments were performed on 108 non-linear male rats weighing 160–180 g. In the research group 1, two-hour limb ischemia was simulated followed by reperfusion, in group 2 – acute blood loss in the amount of 20–22 % of the circulating blood volume, in group 3 – these injuries were combined, in group 4 – animals with acute blood loss and limb ischemia-reperfusion was administered intraperitoneally at a dose of 5 mg/kg. After 1 and 2 hours, as well as after 1, 7 and 14 days in rats of the research groups, the functional state of the kidneys was determined by the method of water loading. The animals of the control group were injected with anesthesia and taken for research after 1 hours. The urine output and concentration of sodium ions in urine and blood serum were determined. The proximal and distal sodium transport was calculated.
Results and Discussion. Reperfusion after two-hour limb ischemia in white rats was accompanied by a significant decrease in proximal and distal sodium transport with a maximum of disturbances after 1 day and normalization after 14 days. Acute blood loss significantly exacerbated the violation of the proximal and distal sodium transport processes. The combination of acute blood loss and limb ischemia-reperfusion was accompanied by a large decrease of indicators. The use of carbacetam led to an improvement in the studied parameters after 7 and 14 days of use, which did not reach the level of the control group.
Conclusions. The complication of acute blood loss by two-hour ischemia and reperfusion of the limb causes a greater decrease in the proximal and distal sodium transport compared to other research groups. The use of carbacetam under these conditions is accompanied by a nephroprotective effect.
Christensen, M.C., Parr, M., Tortella, B.J., Malmgren, J., Morris, S., Rice, T., & Holcomb, J.B. (2010). Global differences in causes, management, and survival after severe trauma: the recombinant activated factor VII phase 3 trauma trial. Journal of Trauma, 69 (2), 344-352.
Carter, J.W., Falco, M.H., Chopko, M.S., Flynn, W.J.Jr., Wiles Iii, C.E., & Guo, W.A. (2015). Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury, 46 (5), 817-821.
Efficacy of prehospital application of tourniquets and hemostatic dressings to control traumatic external hemorrhage. Retrieved from: https://www.ems.gov/pdf/research/Studies-and-Reports.pdf
Clasper, J.C., Brown, K.V., & Hill, P. (2009). Limb complications following pre-hospital tourniquet use. J R Army Med. Corps., 155 (3), 200-202.
Televiak, A.T. (2018). Dynamika pokaznykiv perekysnoho okyslennia lipidiv ta antyoksydantnoho zakhystu v miazovii tkanyni zadnikh kintsivok shchuriv pry rozvytku ishemichno-reperfuziinoho syndromu (eksperymentalne doslidzhennia) [Dynamics of lipid peroxidation and antioxidant protection in rat muscle of the hind limbs in the development of ischemic-reperfusion syndrome (experimental study)]. Zdobutky klinichnoi i eksperymentalnoi medytsyny – Achievements of Clinical and Experimental Medicine, 3 (35), 132-139 [in Ukrainian].
Volotovska, N.V., Nhokwara, T.C., & Zhulkevych, I.V. (2019). Changes in the glutathione system’s activity of internal organs in the first hours of experimental limb ischemia-reperfusion syndrome, combined with blood loss and mechanical injury. Zdobutky klinichnoi i eksperymentalnoi medytsyny – Achievements of Clinical and Experimental Medicine, 1, 23-27. DOI 10.11603/1811-2471.2019.v0.i1.10043
Wright, G., Mcdonald, V.S., & Smith, V.G. (2015). Would civilian pre-hospital emergency care provision include tourniquets for the management of uncontrolled traumatic haemorrhage? Australasian Journal of Paramedicine, 12 (4), 1-5.
Kuzminskyi, I.V. (2018). Osoblyvosti zhovchovydilnoi funktsii pechinky v umovakh ishemichno-reperfuziinoho syndromu kintsivok, zakrytoi travmy orhaniv cherevnoi porozhnyny, uskladnenoi masyvnoiu krovovtratoiu [Features of biliary function of the liver in conditions of ischemic-reperfusion syndrome of the extremities, closed trauma of the abdominal organs, complicated by massive blood loss]. Aktualni problemy transportnoi medytsyny – Actual Problems of Transport Medicine, 4 (54), 148-158 [in Ukrainian].
Tsymbaliuk, H.Yu. (2018). Stan dobovoho diurezu nyrok v umovakh ishemichno-reperfuziinoho syndromu kintsivok. Travmy orhaniv cherevnoi porozhnyny, uskladnenoi hipovolemichnym shokom, ta yikh poiednannia u rannomu periodi travmatychnoi khvoroby [Condition of diurnal diuresis of the kidneys in conditions of ischemic-reperfusion limb syndrome. Injuries of abdominal organs complicated by hypovolemic shock and their combination in the early period of traumatic disease]. Zdobutky klinichnoi i eksperymentalnoi medytsyny – Achievements of Clinical and Experimental Medicine, 3 (35), 163-169 [in Ukrainian].
Kozak, D.V. (2014). Vplyv karbatsetamu na antyoksydantnyi-prooksydantnyi balans tkanyny sertsia, lehen i pechinky v dynamitsi politravmy [Influence of carbacetam on antioxidant-prooxidant balance of tissue of heart, lungs and liver in the dynamics of polytrauma]. Shpytalna khirurhiia – Hospital Surgery, 1 (65), 40-42 [in Ukrainian].
Rohovyi, Yu.Ye. (2012). Patofiziolohiia hepatorenalnoho syndromu na poliurychnii stadii sulemovoi nefropatii [Pathophysiology of hepatorenal syndrome at the polyuric stage of sulemic nephropathy]. Chernivtsi: Misto [in Ukrainian].
Kovalov, V.V., & Popovych, D.V. (2018). Dynamika funktsionalnoho stanu nyrok u rannii period pislia nanesennia skeletnoii travmy riznoi tiazhkosti, uskladnenoi krovovtratoiu [Dynamics of functional condition of kidneys in the early period after skeletal injury of different severe complicated by blood loss]. Visnyk naukovykh doslidzhen – Bulletin Scientific Research, 4, 184-189 [in Ukrainian].