Observations of 153 patients admitted to the rehabilitation toxicological department of the Sklifosovsky Research Institute for Emergency Medicine after severe poisoning with psychopharmacological agents (36), cauterizing fluids (67) and neurotoxicants (drugs of the opium group, ethanol and psychopharmacological agents) (50) were summarized. To assess the systemic response of the body to a chemical injury of varying severity and the treatment used, the factor analysis method was used. For all of the estimated pathological conditions, high hemorrheological abnormalities are of high informational importance, especially during poisoning with psychopharmacological agents. The factor of endotoxicosis also has a noticeable effect, to the greatest extent during poisoning with psychopharmacological agents and cauterizing fluids. During the development of encephalopathy, the importance of blood viscosity, apoptosis and immune status is of informative significance. Factor analysis makes it possible to obtain new information on the pathogenesis of the studied poisonings. The data on the information value of the indicators used, obtained by the factor analysis, is in accordance with positive clinical results (shortening the hospitalization of patients), and therefore are recommended for practical use.
The objective of the present study was to compare the results of the treatment and changes in the measurements of the laboratory characteristics in the patients suffering from severe poisoning with the scolding liquids under effect of the combined treatment including the application of extremely high frequency electromagnetic radiation (EHF therapy). The study included ten patients given a course of EHF therapy and 10 ones treated without it. The patients of the two groups developed the oppositely directed alterations in the rheological properties of blood and hemostasis including the elevation of the hemorheological viscoelastic constituent, erythrocyte and platelet aggregation, the increase in blood viscosity at a high shear velocity and, conversely, its decrease at the low and moderate shear velocities and hematocrit. Moderate leukocytosis was observed during this period along with the 3-4 rise in the concentration of lymphocytes involved in the apoptotic process and the substantial increase (1,4 - 8,1 times) in the values of parameters of endotoxicosis (the leukocytic index of intoxication and the erythrocyte sedimentation rate). The use of EHF therapy for the management of this category of the patients at the stage of their medical rehabilitation produced a modulating hemorheological effect manifested as the reduction of the elevated hemorheological characteristics, with the especially pronounced increase in the parameters below the respective normal values. In the group comprising the control patients, the undesirable changes occurred more frequently than in the previous one; specifically, deviations of the parameters of interest from their normal values were more pronounced. EHF therapy resulted in the reduction of the concentration of dead leukocytes in blood and a two-fold decrease in the amount of lymphocytes at the later stages of apoptosis whereas the concentration of the lymphocytes just entering apoptosis was elevated; this situation reflected the process of sanogenesis. In contrast, this parameter decreased in the patients of the group of comparison. The reduction in the level of endogenous intoxication under effect of EHF therapy manifested itself as a more significant decrease of leukocytic index of intoxication and erythrocyte sedimentation rate in the patients of the main group in comparison with those of the group of comparison. It is concluded that the inclusion of EHF therapy in the combined treatment of severe poisoning with the scolding liquids reduces the time of epithelization of gastrointestinal mucosa by 4.7 days on the average. Accordingly, the duration of the hospital stay can be decreased by 3.8 days.
Многие острые и хронические патологические состояния сопровождаются активацией свободно ра дикальных окислительных процессов [1-3]. По мне нию ряда авторов, они способствуют адаптации орга низма к экстремальным условиям [1, 4]. С другой стороны, свободно радикальные процессы рассмат риваются, как основное патогенетическое звено мно гих заболеваний [1], оказывая отрицательное влия ние на различные органы и системы организма. В на стоящее время отсутствуют сведения о влиянии окислительного стресса на гемореологические пока затели у больных с острыми отравлениями, измене ния которых являются одним из важных факторов, ведущих к нарушениям кровотока на уровне микро циркуляции [3]. Возможно, что немалая роль в этих изменениях принадлежит интенсификации свобод норадикальных процессов. Цель исследования-оценить влияние интенсив ности окислительного стресса на показатели геморео логии при острых отравлениях психофармакологичес кими средствами.
We have undertaken the comparison of the results of the treatment and the changes in the laboratory characteristics of 25 patients that suffered a viper bite and were given the combined treatment either with the application of wave biomechanical therapy (WBMT) (10 patients comprising the study group), and without it (15 patients making up the control group). During the rehabilitation period, all the patients exhibited the common symptoms of intoxication including fever, shortness of breath, dizziness, nausea, dilated pupils, and rapid heartbeat as well as the local changes (burning sensation, redness of the skin at the site of the bite, decreased skin sensitivity, swelling, bruising, and blisters); other pathological conditions documented in the association with the snake bite included lymphangitis, lymphadenitis of the regional lymph nodes, and extensive swelling of the extremities with severe pain which were collectively responsible for the significant prolongation of the duration of hospitalization and required an additional treatment. The laboratory studies have demonstrated the multidirectional disorders of the hemorheologic patterns and of the cellular component of toxemia, such as deviations from the normal values of practically all hemorheological characteristics, mostly in the upward direction, moderate leukocytosis, and the increase in the amount of the dead white blood cells, as well as the significant enhancement of the indicators of endotoxemia including the leukocyte index of intoxication, and the coefficient of endogenous intoxication (a 1.8-5.7 times elevation, respectively). The application of the WBMT technology gave rise to positive clinical and laboratory dynamics (more pronounced in the patients of the study group than in those of the group of comparison) in the form of the reverse development of the general manifestations of intoxication and, especially, such local changes as reduced swelling, skin redness, bleeding, feelings of pain, normalization of body temperature and heart rate, restoration of skin sensitivity. The use of WBMT was accompanied by a full and pronounced correction of hemorheological disorders (viscosity and aggregation), and the 1.5-fold higher frequency of their effective correction in the treatment group compared with that in the control patients. There was an apparent tendency towards the normalization of endogenous intoxication and higher overall contents of the blood fractions of medium molecular weight peptides (MMP) (with the 1.2 and 1.4 times reduction in the levels of the MMP254 and MMP280 fractions, respectively) while leukocyte index of intoxication showed a statistically significant fall by a factor of 3.5 in comparison with its initial value. It is concluded that the introduction of WBMT in the combined therapeutic modality makes it possible to decrease the duration of hospitalization of the patients by 1.5 times (33%) on the average.
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