Остается открытым и актуальным вопрос изменений маркеров метаболизма эритроцитов исходя из патогенетических особенностей течения травматической болезни при политравме. Целью данного исследования явилось изучение функционального состояния эритроцитов в условиях развития гипоксии смешанного генеза у больных травматической болезнью. Для этого было проведено проспективное рандомизированное контролируемое клиническое исследование 120 пациентов на базе отделения политравмы. В крови определяли основные маркеры функционального состояния эритроцитов – лактат, пируват, 2,3-ДФГ, АТФ спектрофотометрическим. Выявлено то, что течение острого и раннего периодов травматической болезни сопровождается изменениями функционального состояния эритроцитов, о чем свидетельствуют снижение уровня АТФ и увеличение уровней лактата, 2,3-ДФГ, индекса лактат/пируват в остром периоде. Установлена связь между маркерами функционального состояния эритроцитов в момент поступления и развитием инфекционно-воспалительных осложнений, постгеморрагической анемии, посттравматической нефропатии.
Стаття присвячена методам прогнозування та контролю інтенсивної терапії недостатності кровообігу на основі оцінки енергетичних показників кровообігу. Мета. Розробка прогностичних критеріїв перебігу недостатності кровообігу. Методи. Застосовано електродинамічне моделювання роботи системи кровообігу, в результаті якого введено ряд нових параметрів системи кровообігу, визначених у здорових осіб, при серцевій, судинній і гіповолемічній недостатності. Результати. Інтегральний енергетичний показник кровообігу-циркуляторний резерв (ЦР)-у здорових осіб становить 617±145 мВт/м 2 , при серцевій недостатності-від 184±58 до 367±86 мВт/м 2 , при судинній недостатності-від 202±65 до 384±77 мВт/м 2 , при крововтраті 40% ОЦК і більше-менше 50 мВт/м 2. Висновки. Енергетичні параметри системи кровообігу дозволяють прогнозувати результат інтенсивної терапії недостатності кровообігу. Рівень ЦР нижче 100 мВт/м 2 є небезпечним і з високою ймовірністю пророкує несприятливий результат недостатності кровообігу. Ключові слова: енергетика кровообігу, серцева недостатність, судинна недостатність, гіповолемія.
The measurement of RBC indices is of particular importance as an indirect intermediate component of the recovery process after exposure to hypoxia, ischemia, hypothermia in patients with traumatic disease due to polytrauma. The aim of this study was to evaluate the parameters of the morphologic state of red blood cells as a reaction of patients with traumatic disease. Materials and methods.A prospective study was carried out evaluation of 120 patients suffering from polytrauma. The patients were divided into 3 groups according to the principle of using additional substances as a part of IC. The parameters of morphologic state of red blood cells were studied. Results and discussion. The course of acute and early periods of traumatic disease has accompanied variability morphological forms of red blood cells, as evidenced by a decrease in MCV and RDW increased levels of the 3rd to 5th day. The optimized therapy used in the treatment of patients, has a positive effect on the parameters of red blood cells, contributes to a better recovery of red blood cells after hypoxia resulting multiple trauma. Conclusion. The study has demonstrated variations in the morphologic properties of red blood cells in the acute and early period of traumatic disease, as confirmed by pathological changes of the erythrocyte indices. The administration of the proposed therapy with the use of D-fructose-1.6-diphosphate sodium salt of hydrate has a positive effect on the parameters of red blood cells, contributes to a better recovery after hypoxia resulting multiple trauma. Given this, the calculations of the red blood cell indices may carry additional diagnostic information, which allows identify trends for not obvious pathological changes and quality of treatment.
The review article presents data on the modern possibilities of intensive care for patients with thoracic trauma in case of polytrauma. It should be noted that over the past 5 years, the number of patients with thoracic injuries in polytrauma who require intensive care in the intensive care unit has increased by 10 times. For their treatment, advanced intensive care methods are used, but, despite this, the mortality rate of this category of patients remains one of the highest, reaching 80%. Moreover, it is combined thoracic trauma that plays a leading role in thanatogenesis. Studying the clinical manifestations of thoracic trauma in patients with polytrauma will help to improve the quality of medical care and the results of treatment of such patients. One of the reasons for the high mortality and disability of patients with thoracic trauma during polytrauma is the lack of a single integrated pathogenetic approach to assessing the severity of the condition of patients and the tactics of intensive care. The values of direct damage to internal organs, the main vessels of the chest and mediastinum in the development of a number of formidable complications are not fully defined, and it is not clearly stated in which cases support for vital functions is needed or their replacement. In the practice of conducting intensive care with thoracic trauma on the background of software in different institutions, often opposite methods and approaches to tactics of conducting intensive care are used. This indicates that the problem of intensive care patients of this contingent is far from being solved and is of certain scientific and practical interest. The role of primary and secondary injuries in combined thoracic trauma has not been studied, the boundaries of compensatory and adaptive reactions have not been determined. Moreover, there is no single concept for intensive care patients with thoracic trauma during polytrauma. This type of damage is accompanied by deep disorders of homeostasis systems, which determine the severity of the clinical course and cause a high level of complications and disability. Unsatisfactory results of intensive care are often associated with insufficient ideas about the pathogenesis of the early post-traumatic period in patients with polytrauma, which leads to errors in determining the volume, timing, feasibility and sequence of intensive care. Conclusion. We believe that the improvement of treatment outcomes for this category of patients can be achieved only with a comprehensive, objectively substantiated approach to the choice of intensive care tactics, focused on the clinical features of thoracic trauma on the background of polytrauma
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