THE DYNAMICS OF CYTOLYSIS MARKERS UNDER CONDITIONS OF ACUTE BLOOD LOSS COMPLICATED BY LIMB ISCHEMIA-REPERFUSION AND THEIR CORRECTION BY CARBACETAM
DOI:
https://doi.org/10.11603/mcch.2410-681X.2020.v.i2.11354Keywords:
acute blood loss, limb ischemia-reperfusion, cytolytic syndrome, carbacetamAbstract
Introduction. The main means of saving the wounded on the battlefield in conditions of massive blood loss from the limbs is the use of a hemostatic tourniquet. It is known that complete bleeding of the extremity for 2 hours during the reperfusion period is accompanied by activation of lipid peroxidation processes, which increases with acute blood loss, is accompanied by degradation of cell membranes and causes the development of cytolysis syndrome.
The aim of the study – to determine the dynamics of cytolysis markers in the presence of acute blood loss complicated by limb ischemia-reperfusion and the efficacy of their correction by carbacetam.
Research Methods. In experiments on nonlinear white male rats under thiopental sodium anesthesia, two-hour limb ischemia was simulated followed by reperfusion, acute blood loss (20 % of the circulating blood volume), and these injuries were combined. In a separate study group in conditions of acute blood loss and limb ischemia-reperfusion, rats were injected intraperitoneally with a dose of 5 mg/kg of animal weight for rats with a corrective purpose. In the control group, rats were anesthetized. After 1 and 2 hours, and also after 1, 7 and 14 days under thiopental sodium anesthesia, experimental animals were removed from the experiment by the method of total bloodletting from the heart. The content of cytolysis markers in the blood serum was determined: the activity of alanine and aspartate aminotransferases (AlAT, AsAT).
Results and Discussion. Modeling of limb ischemia-reperfusion was accompanied by a pronounced cytolytic syndrome, which, in comparison with the control, was manifested by a significant increase in serum activity of AlAT and AsAT after 3 hours and 1 day of observation. Starting from 7 days, the indicators returned to normal. Modeling of acute blood loss deepened the activity of cytolysis processes. The studied parameters were greater than the control level at all observation periods with a maximum after 1 day of the experiment and significantly exceeded the parameters of the research group, in which only limb ischemia-reperfusion was modeled. In conditions of acute blood loss complicated by ischemia-reperfusion of the limb, the disorders were more significant. The studied parameters significantly exceeded the control and other research groups during all observation periods: AlAT activity – after 1–14 days of observation, AsAT – after 2 hours – 7 days. The use for the correction of carbacetam in rats with acute blood loss complicated by limb ischemia-reperfusion showed that after 7–14 days of its use, the activity of AlAT and AsAT in blood serum decreased significantly compared to animals without correction, but did not reach the control level.
Conclusions. The results obtained indicate a significant role of cytolysis processes in the pathogenesis of acute blood loss complicated by limb ischemia-reperfusion, as well as the prospect of using carbacetam as a comprehensive tool to reduce the manifestations of limb ischemia-reperfusion in acute blood loss.
References
Shlaifer, A., Yitzhak, A., Baruch, E.N., Shina, A., Satanovsky, A., Shovali, A., Almog, O., & Glassberg, E. (2017). Point of injury tourniquet application during Operation Protective Edge-What do we learn? J. Trauma Acute Care Surg., 83, 2, 278-283. DOI: https://doi.org/10.1097/TA.0000000000001403
Volotovska, N.V., Nhokwara, T.C., & Zhulkevych, I.V. (2019). 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. 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
Maksymiv, R.V., Hudyma, A.A., & Sydorenko, V.M. (2017). Dynamika balansu antyoksydantno-prooksydantnykh mekhanizmiv u vnutrishnikh orhanakh pid vplyvom arterialnoho dzhhuta i reperfuzii kintsivky [Dynamics of balance of antioxidant-prooxidant mechanisms in internal organs under the influence of arterial tourniquet and limb reperfusion]. Shpytalna khirurhiia. Zhurnal imeni L. Ya. Kovalchuka – Hospital Surgery. Journal named after L. Ya. Kovalchuk, 1, 37-44 [in Ukrainian].
Shatsky, V.V., Hudyma, A.A., & Fedoniuk, L.Ya. (2019). Dynamika antyoksydantno-prooksydantnoho balansu kirkovoho i mozkovoho shariv nyrky pislia hostroi krovovtraty, uskladnenoi ishemiieiu-reperfuziieiu kintsivky, ta yoho korektsiia karbatsetamom [Dynamics of antioxidant-prooxidant balance of renal cort ex and medulla after acute blood loss complicated by ischemia-reperfusion of the extremity, and its correction with carbacetam]. Zdobutky klinichnoi i eksperymentalnoi medytsyny – Achievements of Clinical and Experimental Medicine, 4, 144-153 [in Ukrainian].
Kuzminskyi, I.V. (2018). Vplyv ishemichno-reperfuziinoho syndromu na aktyvatsiiu systemy perekysnoho okysnennia lipidiv u tkanyni pechinky [The effect of ischemic-reperfusion syndrome on the activation of the lipid peroxidation system in liver tissue]. Klinichna ta eksperymentalna patolohiia – Clinical and Experimental Pathology, 4 (66), 53-59 [in Ukrainian].
Tsymbalyuk, H.Yu. (2018). Stan systemy peroksydnoho okysnennia lipidiv u tkanyni nyrky na foni travmy orhaniv cherevnoi porozhnyny ta reperfuzii kintsivok [The state of the lipid peroxidation system in the kidney tissue against the background of trauma to the abdominal organs and reperfusion of the extremities]. Ekstrena medytsyna: vid nauky do praktyky – Emergency Medicine: From Science to Practice, 3 (29), 23-32 [in Ukrainian].
Kozak, D.V., & Hudyma, A.A. (2013). Vplyv politravmy na dynamiku piznoho apoptozu tkanynnykh limfotsytiv [Influence of polytrauma on the dynamics of late apoptosis of tissue lymphocytes]. Klinichna khirurhiia – Clinical Surgery, 9 (848), 70-72 [in Ukrainian].
Hudyma, A.A., Kashchak, T.V., & Shepitko, K.V. (2019). Antyoksydantno-prooksydantnyi ta tsytokinovyi balans u piznii period kombinovanoi travmy v eksperymenti [Antioxidant-prooxidant and cytokine balance in the late period of combined trauma in the experiment]. Svit medytsyny ta biolohii – World of Medicine and Biology, 1 (67), 42-47 [in Ukrasinian].
Kozak, D.V. (2012). Dynamika pokaznykiv tsytolizu v umovakh politravmy [Dynamics of cytolysis in conditions of polytrauma]. Shpytalna khirurhiia – Hospital Surgery, 2 (58), 50-52 [in Ukrainian].
Kozak, D.V., & Volkov, K.S. (2014). Strukturni zminy deiakykh vnutrishnikh orhaniv tvaryn iz modelovanoiu politravmoiu za umov korektsii karbatsetamom [Structural changes of of some internal organs by animals with simulated polytrauma and correction with carbacetam]. Naukovyy visnyk UzhNU Seriia: “Medytsyna” – Scientific Bulletin of UzhNU Series: “Medicine”, 2 (50), 3-6 [in Ukrainian].
Maksymiv, R., Horban, I., & Strelbytska, I. (2018). Dynamika lipidnoi peroksydatsii v pechintsi pid vplyvom arterialnoho dzhhuta i reperfuzii kintsivky [Dynamics of lipid peroxidation in the liver under the influence of arterial tourniquet and limb reperfusion]. XXII Mizhnarodnyi medychnyi konhres studentiv ta molodykh vchenykh: materialy (23-25 kvit. 2018 r.) – XXII International Medical Congress of Students and Young Scientists: Materials (April 23-25, 2018). Ternopil: Ukrmedknyha [in Ukrainian].
Kuzminskyi, I.V. (2018). Vplyv ishemichno-reperfuziinoho syndromu kintsivok na vidkhylennia pokaznykiv tsytolitychnoho syndromu [Influence of ischemic-reperfusion syndrome of extremities for cytolytic syndrome]. Zdobutky klinichnoi i eksperymentalnoi medytsyny – Achievements of Clinical and Experimental Medicine, 3 (35), 176-181 [in Ukrainian].
