INFLUENCE OF ISCHEMIC-REPERFUSION SYNDROME OF EXTREMITIES FOR CYTOLYTIC SYNDROME

Abstract

Introduction. In recent years in Ukraine, as in the whole world, the number of emergencies, both natural and man-made, has increased. A special place among emergencies is occupied by terrorist acts, the deliberate and unintentional use of explosive devices in everyday life. The features of such situations are the emergence of high-energy injuries, which are accompanied by massive bleeding, damage to a large array of soft tissues. For clinicians, such cases require special attention, because the adverse factors in such patients are added ischemic-reperfusion syndrome of the extremities due to overlaying hemostatic harnesses. His action has not been actually studied in conjunction with a trauma.

The aim of the work – to study the effect of ischemic-reperfusion syndrome on the indicators of the cytolytic syndrome in the trauma of the abdominal cavity complicated by hypovolemic shock in the early post-traumatic period.

Material and Methods. In the experiment, 80 sexually mature white male rats, Wistar weighing 190–220 g, were found on a standard vivarium diet.

Animals were divided into control and 3 experimental groups (8 animals per group). In the animals of the first experimental group under the thiopental-sodium enzymes (40 mg · kg-1) proximal to the lower paws imposed a hemostatic tourniquet for 120 minutes, which caused the development of ischemic-reperfusion syndrome. In the second experimental group, they simulated a closed trauma of the abdominal cavity by applying two dose injections to the region of the abdominal cavity; Hypovolemic shock was modeled in a group by crossing the femoral vessels and bloodletting from 20 to 22 % of the volume of circulating blood. In the third group of studies, the damage was combined with the first two groups. Animals of the control group were injected into the anesthesia without any injury.

In order to determine the changes in the cytolytic syndrome, the activity of the enzymes markers of the cytolytic syndrome ALT and AST was determined by a unified method.

Animals of experimental groups were extracted from the experiment under conditions of thiopental sodium anesthesia by the method of total blood-flow from the heart.

Results and Discussion. Our studies have found that in the conditions of simulated injuries, despite their type, develop cytolytic processes that are systemic in nature. So, after 1 day of post-traumatic period the activity of ALT and AST increases, which is clearly marked not only in RG-2 and RG-3, but also in RG-1. In the future, before 3 days, the process of destruction of cell membranes deepens, which manifests a significant increase in the activity of ALT and AST serum and continues to deepen to 7 days. The tendency to decrease the levels of ALT and AST is observed only for 7 days in RG-1. The comparison in the time interval of RG-2 and RG-3 gives an understanding that the imposition of two-legged harness in animals with closed abdominal trauma and massive bleeding deepens the cytolytic processes, which affects the activity of ALT and AST.

Conclussions. 1. In the study groups simulated traumas were accompanied by the development of cytolytic processes that tended to develop during the early manifestations of traumatic illness.

2.Ischemic-reperfusion syndrome of the extremities potentiates the development of systemic changes in the trauma of the abdominal cavity and hypovolemic shock, which was revealed by a significant increase in AlAt and AsAT in GD-3, which after 7 days of observation exceeded controls by 118.2 % (p<0.001) and by 150.6 % (p<0.001).