Results of the stress reactions study in patients with combined injuries of the midface area after using of complex postoperative rehabilitation
DOI:
https://doi.org/10.11603/2311-9624.2020.2.11399Keywords:
midface bone damage, stress reactions, hypothalamic-pituitary system, transcranial electrical stimulation, β-endorphins, Harkavi stress index, adreno-corticotropic hormone, cortisolAbstract
Summary. The frequency of the midface bone demages area occupy the second place among the all maxillo-facial fractures. In all cases, these injuries are accompanied by multiple, often multi-fragmented fractures of zygomatic-orbital complex. The most frequent complication of the cranial-brain trauma is disorder or hypofunction of hypothalamic-pituitary system, which not only complicates the disease, but also slows down the recovery of patients and in some cases requires correction. The frequency of hypothalamic-pituitary system dysfunction due to the cranial-brain trauma ranges from 15 to 68 %.
Recently, considerable attention of scientists have been paid to transcranial electrotherapy application. It has been found that this method is able to activate the opioid structures of the brain and the structures of the hypothalamic-pituitary area.
The aim of the study – to learn the effectiveness of transcranial electrical stimulation on the regulation of hypothalamic-pituitary system function in the rehabilitation of patients with traumatic injuries of zygomatic-orbital complex.
Materials and Methods. 47 patients were under our observation at Lviv City Municipal Clinical Emergency Hospital during the period from 2014 to 2018. These patients underwent mild brain injury and severe trauma to the maxillofacial area. Patients, depending on the methods of treatment at the stage of postoperative rehabilitation, were divided into control (22 patients) and the main group (25 patients). Patients of the control group underwent traditional methods of conservative treatment, and management of the main group patients was supplemented by a course of transcranial electrotherapy. Determination of general nonspecific adaptation reaction type was performed using the adaptation index of Garkavi L. H. Biochemical markers of stress – adrenocorticotropic hormone (ACTH), cortisol and antistress systems – β-endorphins were identified in peripheral venous blood.
Results and Discussion. On the 7th day β-endorphin content was higher than normal in the control (12.73±1.6) pg/ml and the main groups (15.4±1.8) pg/ml. On the 14th day, the growth of β-endorphins was stopped in both clinical groups. The obtained data clearly indicate on a positive therapeutic effect of dynamic electroneurostimulation on the stress-limiting endogenous opiate system.
In patients with mild cranial-brain trauma and severe zygomatic-orbital complex injury content of ACTH (35.67±3.42) pg/ml and cortisol (309.9±12.3) nmol/L on the 14th day was significantly lower in the main group than in the control group (ACTH – (44.62±4.37) pg/ ml; cortisol – (364.4±16.3) nmol/l). Such results can be explained by the severity of the injuries, which caused disturbances in the work of the hypothalamic-pituitary system.
During the evaluation of the stress index, it was found that on the 7th day after the surgery, the indicators were less than 0.3 conventional units (c.u.). This indicates that the majority of patients with combined trauma develop a stress response to the trauma. Examination on day 14 showed that stress reactions had stopped and turned into a training response in both clinical groups with slightly higher rates in the main group (control group – (0.41±0.05) c.u.; main group – 0.44±0.040) c.u.).
Conclusions. It can be concluded that the application of transcranial electrical stimulation contributed to the normalization of the anti-stress mechanisms tone, stimulated endodorphic structures of the brain, provided regulation of the stress-releasing hormones in blood and reducing of the stress level and anxiety of patients in the postoperative period.
References
Suyunova, D.D. (2014). Kliniko-diagnosticheskiye i terapevticheskiye osobennosti sochetannoy cherepno-litsevoy travmy [Clinical diagnostic and therapeutic features of combined craniofacial injury]. Candidate’s thesis. Moscow [in Russian].
Malanchuk, V.O., Lohvynenko, I.P., Timoshchenko, N.M., & Chepurnyi, Yu.V. (2012). Kharakterystyka perelomiv vylytsevoho kompleksu za arkhivnymy danymy 2006–2010 rr. porivniano z poperednimy rokamy [Characteristics of fractures of the cheekbone complex according to archival data of 2006-2010 compared to previous years]. Novyny stomatolohii – Dentistry News, 4, 46-51 [in Ukrainian].
Klenk, G., & Kovacs, A. (2003). Etiology and patterns of facial fractures in the United Arab Emirates. The Journal of Craniofacial Surgery, 14, 1, 78-84. DOI: https://doi.org/10.1097/00001665-200301000-00014
Kharitonov, D.Yu. (2008). Sochetannyye kranio-fatsialnyye povrezhdeniya u detey: organizatsionnyye i metodologicheskiye podkhody k diagnostike, lecheniyu i reabilitatsii (klinicheskoye issledovaniye) [Combined craniofacial lesions in children: organizational and methodological approaches to diagnosis, treatment and rehabilitation (clinical study)]. Extended abstract of Candidate’s thesis. Voronezh [in Russian].
Golovko, K.P. (2016). Sovremennyy podkhod k kompleksnomu lecheniyu sochetannykh povrezhdeniy chelyustno-litsevoy oblasti [A modern approach to the complex treatment of combined injuries of the maxillofacial region]. Doctor’s thesis. Saint-Petersburg [in Russian].
Azarchenko, K.Ya. (2007). Diagnostika perelomov skuloorbitalnogo kompleksa [Diagnosis of fractures of the zygomatic orbital complex]. Sbornik tezisov dokladov V Mezhdunarodnoy konferentsii chelyustno-litsevykh khirurgov i stomatologov – Abstracts of the Reports of the V International Conference of Maxillofacial Surgeons and Dentists. Saint-Petersburg [in Russian].
Vlasov, A.M. (2005). Diagnostika i lecheniye sochetannoy cherepno-mozgovoy i chelyustno-litsevoy travmy [Diagnostics and treatment of combined craniocerebral and maxillofacial trauma]. Extended abstract of Candidate’s thesis. Moscow [in Russian].
Boymuradov, S.H. (2009). Sravnitelnyy analiz rezultatov lecheniya bolnykh s sochetannymi travmami kostey nosa i povrezhdeniyami golovnogo mozga [Comparative analysis of the results of treatment of patients with combined injuries of the nasal bones and brain injuries]. Rossiyskaya otorinolaringologiya – Russian Otorhinolaryngology, 3, 31-33 [in Russian].
Belevitin, A.B., Golovko, K.P., & Maday, D.Yu. (2009). Sovremennyye tekhnologii uluchsheniya rezultatov lecheniya postradavshykh s kranio-fatsialnymi povrezhdeniyami [Modern technologies for improving the results of treatment of victims with craniofacial injuries]. Vestnik Rossiyskoy voyenno-meditsinskoy akademii – Bulletin of the Russian Military Medical Academy, 1, 963-964 [in Russian].
Khristoforando, D.Yu. (2012). Osobennosti patogeneza i lecheniya sochetannoy cherepno-litsevoy travmy [Features of the pathogenesis and treatment of combined craniofacial injury]. Doctor’s thesis. Stavropol [in Russian].
Kawakami, M., Liu, M., Otsuka, T., Wada, A., Uchikawa, K., Aoki, A., & Otaka, Y. (2013). Asymmetric skull deformity in children with cerebral palsy: frequency and correlation with postural abnormalities and deformities. The Journal of Rehabilitation Medicine, 45, 2, 149-153. DOI: https://doi.org/10.2340/16501977-1081
Gofman, V.R., Golovko, K.P., Samokhvalov, I.M., & Kozadayev, Yu.Yu. (2010). Lechebnaya taktika pri povrezhdenii okolonosovykh pazukh u postradavshikh s tyazheloy sochetannoy travmoy [Therapeutic tactics for damage to the paranasal sinuses in patients with severe combined trauma]. Rossiyskaya otorinolaringologiya – Russian Otorhinolaryngology, 3, 52-63 [in Russian].
Afanasyev, Ye.V., Galkin, A.N., & Kostrigina, Ye.D. (2017). Fizioterapevticheskiye metody lecheniya, primenyayemyye pri travmakh chelyustno-litsevoy oblasti. Ikh znacheniye v periode reabilitatsii bolnykh s travmami litsa i chelyustey [Physiotherapeutic methods of treatment used for injuries of the maxillofacial region. Their significance in the period of rehabilitation of patients with injuries of the face and jaw]. Sbornik nauchnykh trudov po materialam Mezhdunarodnoy nauchno-prakticheskoy konferentsii “Integratsionnyye protsessy mirovogo nauchno-tekhnologicheskogo razvitiya – Collection of Scientific Papers on the Materials of the International Scientific and Practical Conference “Integration Processes of World Scientific and Technological Development. (29.11. 2017), Belgorod [in Russian].
Modabber, A., Rana, M., Ghassemi, A., Gerressen, M., Gellrich, N.C., Hölzle, F., & Rana, M. (2013). Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study. Trials, 14 (238), 10. DOI: https://doi.org/10.1186/1745-6215-14-238
Gurlenya, A.M., Bagel, G.Ye., & Smychek, V.B. (2008). Fizioterapiya v nevrologii [Physiotherapy in neurology]. Moscow: Med. lit. [in Russian].
Schneider, H.J., Kreitschmann-Andermahr, I., Ghigo, E., Stalla, G.K., & Agha, A. (2007). Hypothalamopituitary disfunction following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a systematic review. The Journal of the American Medical Association, 298, 1429-1438. DOI: https://doi.org/10.1001/jama.298.12.1429
Lebedev, V.P., Melikhova, M.V., & Kolbasov, S.Ye. (2000). Vliyaniye transkranialnoy elektrostimulyatsii endorfinnykh struktur mozga krys na funktsionalnuyu aktivnost gepatotsitov pri ikh toksicheskom povrezhdenii [The effect of transcranial electrostimulation of rat endorphin brain structures on the functional activity of hepatocytes during their toxic damage]. Rossiyskiy fiziologicheskiy zhurnal imeni I.M. Sechenova – I. Sechenov Russian Physiological Journal, 86, 11, 1449-1457 [in Russian].
Antipova, O.A. (2005). Transkranialnaya elektrostimulyatsiya v kompleksnom lechenii bolnykh parodontitom [Transcranial electrical stimulation in the complex treatment of patients with periodontitis]. Candidate’s thesis. Volgograd [in Russian].
Barkova, S.V. (2007). Effektivnost primeneniya transkranialnoy elektrostimulyatsii v kompleksnom lechenii bolnykh krasnym ploskim lishayem slizistoy obolochki polosti rta [The effectiveness of transcranial electrical stimulation in the complex treatment of patients with lichen planus of the oral mucosa]. Candidate’s thesis. Volgograd [in Russian].
Rogova, N.V. (2008). Transkranialnaya elektrostimulyatsiya endorfinergicheskikh struktur mozga (TES-terapiya) – novyy metod lecheniya bolnykh sakharnym diabetom [Transcranial electrical stimulation of endorphinergic brain structures (TES-therapy) – a new method of treating patients with diabetes mellitus]. Vestnik Volgogradskogo gosudarstvennogo meditsinskogo universiteta – Bulletin of the Volgograd State Medical University, 2 (26), 53-55 [in Russian].
