Surgical tactics in patients with skeletal and abdominal trauma according to immunological status
DOI:
https://doi.org/10.11603/2414-4533.2018.3.9442Keywords:
skeletal-abdominal trauma, cytokines, immunological statusAbstract
The aim of the work: reduction of lethality and surgical complications of patients with skeletal and abdominal trauma by optimization of medical diagnostic tactics taking into account immunological status.
Materials and Methods. Concentration in blood serum of cytokines, interleukin 2 (IL-2), interleukin 10 (IL-10), tumor necrosis factor alpha (FNP-α) and interferon gamma (IFN-γ) was determined by immunoassay test systems. Investigation of the immunological status was carried out at the victims at admission to the hospital and on 7th and 14th days.
Results and Discussion. At admission to the hospital of patients with skeletal-abdominal trauma, the concentration of proinflammatory cytokines, FNP-α and IFN-γ, increased respectively in 4.5 and 2.2 times. At the same time, we observe a drop in anti-inflammatory intracellular messengers IL-2 in 4.1, and IL-10 - in 9.5 times. At 7th day there is still an increasing of FNP-α by 16.7%. The content of anti-inflammatory protective cytokines IL-2 and IL-10 increased by 79.8% and 147.6% on 7th days. At day 14, the concentration of TNF-α remained at 96.3% higher compared to the onset day. The content of IFN-γ was 51.9 % different from the data on the day of admission. IL-2 concentration at day 14 was higher by 163.9 % compared with the primary data and by 46.8 % compared to the patients on 7th day. The content of IL-10 grew by 159.0% compared to the 7th day and then by 541.3 % (in 5.4 times) higher than the indicators at the time of admission. The analysis of immunological status shows that a patient with a skeletal and abdominal trauma has a greater chance to die as a result of intraoperative metabolic disorders during prolonged surgical interventions than as a result of a purposeful reduction of the operation time.
Conclusion. The level of cytokines and the balance between humoral and cellular immune responses stabilize in 2 weeks after a skeletal-abdominal injury. Within one hour after the trauma, the victim should be restored to vital functions, the surgery should only control of the bleeding and contamination. After 2 weeks from admission according to the immunological status, radical and reconstructive operations can be performed.
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