Severe combined trauma is characterized by high mortality both among young people (above 20 %) and among the older age group (about 45 %). Correction of metabolic disorders is the most difficult task, especially in the first hours after injury.Objective. To demonstrate the effectiveness of early initiation of veno-venous hemodiafiltration on the example of successful treatment of a patient with severe combined trauma (ISS is 57 points).Clinical observation. Patient A., 19 years old, was taken to the surgical intensive care unit by an ambulance team with a directional diagnosis of ‘severe combined injury’ as a result of falling from a height of the 6th floor in a state of alcoholic intoxication. Considering the impossibility of correcting waterelectrolyte and metabolic disorders by conservative methods, it was decided to start extracorporeal treatment early in the volume of prolonged venovenous hemodiafiltration with citrate-calcium anticoagulation (Ci-Ca CVVHD). In addition, the patient received therapy within the framework of the current recommendations for the treatment of severe combined trauma. Against the background of the ongoing treatment, there was a distinct positive trend. Vasopressor support was discontinued on day 3, and on day 15 the patient was transferred to independent breathing. In total, one CVVHD session was conducted, with a total duration of 62 hours. The patient’s stay in the intensive care unit was 29 days, in the profile distance – 4 days with subsequent discharge.Conclusions. The use of the CVVHD method in a patient with severe combined trauma in the early period without the phenomena of acute kidney injury contributed to the relief of metabolic disorders with the stabilization of the homeostasis system. However, in order to form conclusions and expand indications for the use of extracorporeal detoxification methods in patients with severe combined trauma, further study of this issue is necessary.
The relevance of the problem of ischemic stroke is difficult to overvalue in modern terms. The data on the frequency of occurrence and outcomes, especially among young people, force us to look for new strategies to minimize its consequences. Recent experimental studies have shown pronounced neurocardio-nephroprotective properties of lithium salts.Aim of study. To evaluate the effect of lithium chloride on the lethality and severity of cognitive and neurological deficits in the modeling of ischemic stroke in rats.Materials and methods. The study used mongrel male rats weighing 312±12.5 g. The model of Longa’s focal ischemia was used as a basis. The animals were divided into 5 groups: false-operated, control (model of ischemic stroke with the introduction of 0.9% NaCl) and three groups with the introduction of lithium chloride in various concentrations (4.2 mg/kg, 21 mg/kg and 63 mg/kg). The drug was administered daily for 14 days with a parallel assessment of neurological deficits.Results. According to the results of the experiment, the following data were obtained with respect to lethality in the studied groups: false — operated 0 out of 8, control group — 13 out of 22 (lethality 59%), group 3 (LiCl 4.2 mg/kg) — 8 out of 14 (lethality 57%), p>0.05 with respect to control, group 4 (LiCl 21 mg/kg) — 6 out of 15 (lethality 40%) p>0.05 with respect to control and in group 5 (LiCl 63 mg/kg) — 4 out of 15 animals died (lethality 27%) p=0.0317. Lithium chloride at doses of 21 mg/kg and 63 mg/kg resulted in a decrease in the severity of neurological deficits on the second day of the experiment. On the 15th day of the experiment, there were no differences in the severity of neurological disorders. Also, the dosage of 63 mg/kg contributed to better memory retention during the assessment of cognitive functions.Conclusion. Lithium chloride at a dosage of 63 mg/kg significantly (p=0.037) reduced the mortality and severity of neurological deficits in the simulation of experimental ischemic stroke in rats compared to the control group.
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