INFLUENCE OF LOWER LIMBS REPERFUSION ON THE DYNAMICS OF CHANGES IN THE INDICATORS OF ENDOGENIC INTOXICATION IN CONDITIONS OF COMBINED ABDOMINAL INJURY AND MASSIVE BLOOD LOOS
DOI:
https://doi.org/10.11603/mcch.2410-681X.2019.v.i4.10826Keywords:
combined trauma, endogenous intoxication, reperfusion, massive blood loss, experiment, lungsAbstract
Introduction. The article presents the results of an experimental study that investigated the effect of lower extremity reperfusion on the development of endogenous intoxication with closed trauma of the abdominal organs and massive external blood loss. It is known that endogenous intoxication is a complex multicomponent process, caused by pathological biological activity of endogenous products or dysfunction of natural detoxification systems. The results of the study showed that reperfusion of the lower extremities enhances the development of endogenous intoxication with combined trauma in the experiment.
The aim of the study – to learn the effect of lower extremity reperfusion on changes in endogenous intoxication in a model of combined injury of abdominal organs against the background of massive blood loss.
Materials and Methods. An experiment was conducted on 80 non-linear male rats weighing 190–220 grams. In the experimental groups, reperfusion of the lower extremities in combination with closed trauma of the abdominal organs was simulated against the background of massive blood loss and the content of markers of endogenous intoxication (molecules of the average mass of fractions determined at 254 and 280 nm) and erythrocytic intoxication index were analyzed. The likelihood of differences between the control group and the study group was evaluated using the non-parametric Mann-Whitney test.
Results and Discussion. The imposition of hemostatic strap on the two lower extremities caused a significant increase in endogenous intoxication index in all study groups. The maximum increase in the endogenous intoxication index was in the group where the tourniquet was combined with trauma to the abdominal cavity and massive blood loss. This proved the potentiating effect of reperfusion syndrome on the development of systemic changes in combined trauma. It is also proved that the manifestation of endogenous intoxication during the first 24 hours after the imposition of hemostatic straps is similar to that resulting from the combined injury of the abdominal organs against the background of massive external bleeding.
Conclusion. The imposition of hemostatic bundles on the two lower extremities, within two hours, increases the development of endogenous intoxication in the model of combined injury of the abdominal organs against the background of massive blood loss, which is confirmed by a significant increase in the endogenous intoxication index and dementia molecules.
References
Location-dependent effects of trauma on oxidative stress in humans / L. Servia, J. C. E. Serrano, R. Pamplona [et al.] // PLoS One. – 2018. – 13 (10). – P. 103–111.
Turgay Ş. Response to trauma and metabolic changes: posttraumatic metabolism / Ş. Turgay, U. Ş. Hayal, Z. C. Nuh // Ulus Cerrahi Derg. – 2014. – 30 (3). – P. 153–159. DOI: https://doi.org/10.5152/UCD.2014.2653
The systemic immune response to trauma: an overview of pathophysiology and treatment / J. M. Lord, M. J. Midwinter, Y.-F. Chen [et al.] // Lancet. – 2014. – 384 (9952). – P. 1455–1465.
Jenne C. N. Platelets: bridging hemostasis, inflammation, and immunity / C. N. Jenne, R. Urrutia, P. Kubes // Int. J. Lab. Hematol. – 2013. – 35 (3). – P. 254–261.
Updated concepts on the pathophysiology and the clinical management of trauma hemorrhage and coagulopathy / M. Maegele, Gu Z.-T., Q.-B. Huang, H. Yang // Chin. J Traumatol. – 2017. – 20 (3). – P. 125–132.
Khan S. Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage / S. Khan, R. Davenport, I. Raza // Intensive Care Med. – 2015. – No. 41. – Р. 239–247.
Volotovska N. V. 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 / N. V. Volotovska, T. Cliff Nhokwara, I. V. Zhulkevych // Здобутки клінічної і експериментальної медицини. – 2019. – № 1. – С. 23–27. https://doi.org/10.11603/1811-2471.2019.v0.i1.10043
Козак Д. В. Динаміка синдрому ендогенної інтоксикації в умовах політравми та його корекція карбацетамом / Д. В. Козак // Здобутки клініч. і експерим. медицини. – 2015. – № 2–3. – C. 58–60. DOI: https://doi.org/10.11603/1811-2471.2015.v23.i2-3.5238
The systemic immune response to trauma: an overview of pathophysiology and treatment / J. M. Lord, M. J. Midwinter, Y.-F. Chen [et al.] // The Lancet. – 2017. – 384 (9952). – P. 1455–1465.
Systemic inflammation and multiple organ injury in traumatic hemorrhagic shock / H. Liu, X. Xiao, C. Sun [et al.] // Front Biosci (Landmark Ed). – 2015. – No. 20. – P. 927–33.
Застосування препарату Ентеросгель для профілактики оксидативного стресу при гострій крововтраті / В. Г. Ніколаєв, І. М. Кліщ, І. В. Жулкевич [та ін.] // Вісн. наук. дослідж. – 2009. – № 1. – С. 72–74.
Del Rio D. A review of recent studies on malondialdehyde as toxic molecule and biological marker of oxidative stress / D. Del Rio, A. J. Stewart, N. Pellegrini // Nutr. Metab. Cardiovasc. Dis. – 2005. – 15. – P. 316–328.
REFERENCES
Servia, L., Serrano, J.C.E., Pamplona, R., Badia, M., Montserrat, N., Portero-Otin, M., & Trujillano, J. (2018). Location-dependent effects of trauma on oxidative stress in humans. PLoS One, 13 (10), 103-111. DOI: https://doi.org/10.1371/journal.pone.0205519
Turgay, Ş., Hayal, U.Ş., & Nuh, Z.C. (2014). Response to trauma and metabolic changes: posttraumatic metabolism. Ulus Cerrahi Derg., 30 (3), 153-159.
Lord, J.M., Midwinter, M.J., Chen, Y.F., Belli, A., Brohi, K., Kovacs, E.J., …, & Lilford, R.J. (2014). The systemic immune response to trauma: an overview of pathophysiology and treatment. Lancet, 384 (9952), 1455-1465.
Jenne, C.N., Urrutia, R., & Kubes, P. (2013). Platelets: bridging hemostasis, inflammation, and immunity. Int. J. Lab. Hematol., 35 (3), 254-261. DOI: https://doi.org/10.1111/ijlh.12084
Maegele, M., Gu, Z.-T., Huang, Q.-B., & Yang, H. (2017). Updated concepts on the pathophysiology and the clinical management of trauma hemorrhage and coagulopathy. Chin. J. Traumatol., 20 (3), 125-132. DOI: https://doi.org/10.1016/j.cjtee.2017.03.004
Khan, S., Davenport, R., & Raza, I. (2015). Damage control resuscitation using blood component therapy in standard doses has a limited effect on coagulopathy during trauma hemorrhage. Intensive Care Med., 41, 239-247. DOI: https://doi.org/10.1007/s00134-014-3584-1
Volotovska, N.V., Cliff Nhokwara, T., & Zhulkevych, I.V. (2019). Zminy aktyvnosti hlutationovoi systemy vnutrishnikh orhaniv u pershi hodyny eksperymentalnoho ishemichno-reperfuziinoho syndromu kintsivky, poiednanoho z krovovtratoiu ta mekhanichnoiu travmoiu [Changes in the glutathione systems 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 [in Ukrainian]. Retrieved from: https://doi.org/10.11603/1811-2471.2019.v0.i1.10043 DOI: https://doi.org/10.11603/1811-2471.2019.v0.i1.10043
Kozak, D.V. (2015). Dynamika syndromu endohennoi intoksykatsii v umovakh politravmy ta yoho korektsiia karbatsetamom [Dynamics of endogenous intoxication syndrome in the conditions of polytrauma and its correction with carbacetam]. Zdobutky klinichnoi i eksperymentalnoi medytsyny – Achievements of Clinical and Experimental Medicine, 2-3, 58-60 [in Ukrainian].
Lord, J.M., Midwinter, M.J., Chen, Y.-F., Belli, A., Brohi, K., Kovacs, E.J., …., & Lilford, R.J. (2017). The systemic immune response to trauma: an overview of pathophysiology and treatment. The Lancet, 384 (9952), 1455-1465.
Liu, H., Xiao, X., Sun, C., Sun, D., Li, Y., & Yang, M. (2015). Systemic inflammation and multiple organ injury in traumatic hemorrhagic shock. Front Biosci. (Landmark Ed), – 20, 927-933. DOI: https://doi.org/10.2741/4347
Nikolaiev, V.H., Klishch, I.M., Zhulkevych, I.V., Oleshchuk, O.M., Nikolaieva, V.V., & Shevchuk. O.O. (2009). Zastosuvannia preparatu Enteroshel dlia profilaktyky oksydatyvnoho stresu pry hostrii krovovtrati [The use of Enterosgel for the prevention of oxidative stress in acute blood loss]. Visnyk naukovykh doslidzhen – Bulletin of Scientific Research, 1, 72-74 [in Ukrainian].
Del Rio, D., Stewart, A.J., & Pellegrini, N. (2005). A review of recent studies on malondialdehyde as toxic molecule and biological marker of oxidative stress. Nutr. Metab. Cardiovasc. Dis., 15, 316-328. DOI: https://doi.org/10.1016/j.numecd.2005.05.003
