Andryeyev S. Structural changes in lungs caused by severe craniocerebral injury (clinic-experimental research)

Thesis is dedicated to research of lungs structural changes peculiarities caused by severe craniocerebral injury on experimental (white rat) and autopsy material. In the course of research it is shown that time history of structural changes in lungs is represented by successive change process of blood circulation disturbance and pulmonary ventilation in form of atelectasis, emphysema and inflammation with maximum intensity after 5 days of hospital stay. In the same time, in the thesis attention is accentuated on complicacy of delimitation in lungs changes related to intensive therapy from lungs pathology caused by injury itself because these changes identification on basis of morphological picture among died people is obviously impossible. Experiment allowed to evaluate regularity and dynamics of lungs changes development caused by severe craniocerebral injury, excluding influence of age, chronic somatic pathology, remedial measure structure and possible postmortem changes on lungs morphological picture. According to research results experimental severe craniocerebral injury is accompanied by development of structural changes in rats lungs, prevailing among which are microcirculation disorders, development of atelectasis and acute emphysema, lungs obstruction. Subsequently it is accompanied by capillary permeability increase, alveoli haemorrhage, interstitial and interalveole oedema, vessels thrombosis of microcirculation channel, system inflammatory reaction. Thus, lungs morphology while severe craniocerebral injury is characterized by significant specific weight of lungs acute injury syndrome morphological characters, while noted changes development in experiment can be regarded as pattern of lungs structural changes caused by central nervous system traumatic injury. Severe craniocerebral injury with background of alcoholic intoxication is characterized by development desequencing of vascular response (p<0,001), which is mediated by rapid (first day) development of interstitial and interalveole oedema, multiple irreversible atelectasis formation, fibrinogen exudation and hyaline membrane formation. In case of patients death by the reason on severe craniocerebral injury with traumatic damage of mesencephalic bulbar brainstem parts during first days after injury persistent capillary spasm of lungs respiratory part is dominating; in case of diencephalic level of injury - abrupt hyperemia of capillary and lesser circulation venous link, acute emphysema and atelectasis, alveolar septum abundant leukocyte infiltration. Early bronchopneumonia is more frequently developed among non operated patients, whereas late bronchopneumonia as well as early and late pleuropneumonia among operated patients. Lungs microscopically picture which is characterized by confluent pneumonia complicated by an abscess in aggregate with fibrinopurulent pleuritis is more effusive among operated patients who stayed in hospital less than 4 days.