The study is devoted to investigation of the effects, justification of the metabolic drugs administrution as a component of intensive care (IC) at polytrauma. The special significance of acute massive blood loss in the pathogenesis of traumatic disease is currently considered indisputable. Hypoxia, hypoperfusion, ischemia quickly lead to the activation of protective and adaptive reactions and subsequently to secondary tissue damage. There is very limited information about the development, the severity of adaptive reactions in severe combined trauma on the background of operative stress when it is necessary to conduct a series of staged surgical interventions. In this regard, it seems important to study and implement new treatment algorithms using effective metabolic means of pharmacological correction.
The purpose of this study was to increase the effectiveness of treatment the patients with traumatic disease requiring multistage surgical correction with waiting periods at polytrauma, by improving methods of prevention of postoperative complications during IC in the perioperative period.
The study included 88 patients aged 18-60 years with polytrauma. To achieve this goal and perform tasks, patients (n = 88) were divided into 2 groups, by fixed simple randomization. Patients in group I (n = 32) received standard IC according to the local protocol. Group II (n = 56) included patients who, in addition were treated with infusion of D-fructose-1.6-diphosphate sodium hydrate.
A comprehensive assessment of the effectiveness of this therapy in the acute and early period of traumatic disease, the assessment of complications that occurred in the early and late periods and the factors that contributed to their development were conducted. The parameters of cellular metabolism, oxygen status and lipid peroxidation were determined according to the dynamics of ATP, 2.3-diphosphoglyceric acid (2,3-DFG), lactate, puruate, oxygen delivery and consumption indices, oxygen extraction coefficient, malondialdehyde and diene conjugates. Laboratory findings were studied using standardized methods. The results of the study were processed using Student's t-test or non-parametric Wilcoxon W-test. The frequency indices were compared using the Pearson’s xi2 test.
It was found thе application of the optimized intensive care provided faster stabilization of hemodynamics, reliably better indicators of contractile ability and productivity of the heart, improvement of delivery and oxygen consumption. This conclusion is based on the results obtained at the second and third stages of the study.
The low cardiac output caused a decrease in iDО2. The analysis of the results the level of iVO2 at the second and third stages of the study showed a multidirectional nature of changes in the studied groups. At the third stage of the study, iVO2 was significantly higher in patients in group with optimized IC and was 134.1 ± 25.5 ml / min / m2, whereas in the traditional IC group iVO2 was 107.3 ± 15.9 ml / min./ m2 (t = 5.37, p˂0.001). At the same time, KEO2 reached 29.4 ± 4.5% in the first group and 29.8 ± 6.3% in the second group.
The expediency of using optimized IC is that in comparison with traditional IC it provides faster recovery of morphometric parameters of erythrocytes: МСН, МСНС and RDW-CV. Optimized therapy used in the treatment of patients in group II, has a positive effect on the antioxidant protection and reduces level of lipid peroxidation products - intermediate and final.
The optimization of intensive care led to a faster restoration of the balance between aerobic and anaerobic metabolic processes, to an increase in the level of ATP and 2,3-DFG in erythrocytes. Which in turn increases the functional potential of erythrocytes, promotes full oxygen supply to the cells, supports cellular respiration and prevents development tissue damage.
It was found that optimized IC provides a significantly lower level of complications, less need to continued use of norepinephrine (group I - 40%, group II - 20%, χ2 = 0.034, p <0.05) and shorter period of stay in the ICU (group I - 21.1 ± 9.9 days, II - 16.9 ± 7.8 days, p = 0.03). The study has revealed a significant decrease in the incidence of renal dysfunction (group I - 56%, II - 25, χ2 = 8,594, p = 0,004), thrombohemorrhagic (group I - 40%, group II - 16%, χ2 = 6,548, p p < 0.05) and infectious-inflammatory complications (group I - 72%, group II - 29%, χ2 = 14.972, p <0.001) in the group of patients who received modified IC.
