The influence of combined mechanical and thermal injury on the biliary function of the liver in the period of late manifestations of traumatic disease

Abstract

The aim of the work: to study the effect of combined mechanical and thermal trauma on the biliary function of the liver in the period of late manifestations of traumatic disease.

Materials and Methods. In the experiments, 60 non-linear white rats weighing 180–200 g were used in the experiments. In the conditions of thiopental-sodium anaesthesia (40 mg/kg-1), a skeletal injury was simulated in the first experimental group by applying a metered impact to each thigh, which caused their closed fracture. In the second experimental group simulated skin burns III A-B degree 10–11 % of the surface of the body – to the depilated surface of the back for 10 seconds was applied a copper plate of 28 cm², pre-immersed in boiling water for 3–5 minutes. In the study group III, the two injuries were combined. The control group was a group of intact animals. After 14, 21, and 28 days after injury in thiopental-sodium (60 mg · kg-1 mass) conditions, in 6 animals of each experimental group the biliary function of the liver by catheterization of the common bile duct and bile intake for 1 hour was studied. In the obtained bile we determined the concentration of total bile, total and direct bilirubin. The rate of bile excretion and the rate of excretion of the studied components of bile for 1 hour were calculated. From the experiment, the animals were removed after the collection of bile by the method of total bloodletting from the heart.

Results and Discussion. Under the conditions of simulated traumas, the vast majority of the investigated indicators of biliary function of the liver were significantly lower in all investigated periods of the period of late manifestations of traumatic disease than in the control. The peculiarity of the dynamics of bile excretory function after modeling of skeletal trauma was the decrease of the studied parameters from 14 to 21 days, which was statistically significant for the rate of excretion of total bile acids, with a subsequent significant increase up to 28 days. During this time, the rate of bile excretion and the rate of excretion of total bilirubin reached the level of the control group. Other indicators continued to be significantly lower. After modeling of thermal burns of the skin, the studied parameters statistically increased from 14 to 28 days, but remained significantly lower than in the control. Under these experimental conditions, the magnitudes of the biliary function of the liver after 14 and 28 days were significantly smaller than after the skeletal injury. A characteristic feature of the dynamics of the studied parameters after the simulation of the combined trauma was the tendency to decrease from 14 to 21 days, and in terms of the rate of excretion of total bile acids differences were statistically significant. After 28 days the indicators increased, became significantly higher than after 14 and 21 days, but did not reach the control level. Compared to the skeletal trauma, the magnitudes of the studied indices under the conditions of combined trauma were statistically significantly smaller in all observation periods. Compared with the thermal burns of the skin after 14 days, no significant differences were observed, however, after 21 and 28 days, the values ​​of the studied parameters also became significantly smaller. The exception was the rate of bile excretion, which after 28 days under the conditions of thermal burns of the skin and combined trauma was almost the same. Therefore, modeled traumas in the period of late manifestations of traumatic disease are characterized by a significant impairment of biliary function, which increases from skeletal to burn and combined trauma and is a manifestation of multiple organ dysfunction, which should be taken into account when developing corrective measures.

Conclusions. 1. Modeling of skeletal trauma, thermal burns of the skin and combined trauma during the late manifestations of traumatic disease is accompanied by a significant decrease in the rate of bile excretion and excretion of total bile acids, total and conjugated bilirubin. Indicators up to 28 days increase, but only in the case of skeletal injury, the rate of bile excretion and excretion of total bilirubin reaches the level of control.

1. The greatest violations of the investigated parameters occur in the conditions of combined trauma compared with the skeletal at all terms of observation, compared with thermal burns of the skin – after 21 and 28 days. An exception is the rate of bile excretion, which after 28 days, against the background of burns and combined trauma, is not statistically significantly different.