Horban I. The role of mandibular fracture in the development of systemic disorders under conditions of multiple trauma and their correction (clinical and experimental study)

The thesis work focuses on theoretical generalization and new solution to the actual scientific task, which deals with establishing the role of mandibular fracture in the manifestations of hepatic dysfunction of the wounded with a gunshot-induced soft tissue injury of the thigh, massive haemorrhage and limb ischemia-reperfusion injury, as well as in the impairment of functional and morphological state of the liver in the dynamics of experimental multiple trauma model, and highlighting the efficacy of the carbacetam in the correction of identified abnormalities. It has been evidenced that the wounded, who have sustained an isolated gunshot-induced soft tissue injury of the thigh with a massive external haemorrhage, exhibit a greater hepatic functional impairment with its maximum manifestations after 6-7 days of hospital treatment compared to the wounded without mandibular fracture. It is identified by significantly increased activity of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), a higher concentration of direct bilirubin and a lower level of total protein in serum. It has been demonstrated that the length of stay in an inpatient service for patients undergoing additional mandibular fracture is 2.62 times longer than for patients without additional fracture of the lower jaw. It has been established that an additional mandibular fracture model in the background of acute blood loss and limb-ischemia reperfusion injury leads to a significant increase in the intensity of lipid peroxidation processes in the liver, decrease in the values of indicators of enzymatic antioxidant defense system, more pronounced cytolytic syndrome along with the shift in pro-oxidant/antioxidant balance towards the dominance of the pro-oxidant mechanisms compared to the group of animals subjected to acute blood loss complicated by limb ischemia-reperfusion injury. It has been first-time established that the maximum decrease in the values of the studied parameters up to the 1st day of the experiment with the subsequent increase up to the 14th day that has not reached the control level is a common pattern of the identified abnormalities. It was found that an additional mandibular fracture model in the background of acute blood loss and limb-ischemia reperfusion injury is accompanied by the impairment of functional and morphological state of the liver, which is manifested by a decrease in the bile-forming, bile excretion, and glycogen synthesis functions along with an increase in the indicators of absorptive-excretory function. Hepatic structural disorders considerably aggravate under conditions of multiple trauma compared to the group of animals with acute blood loss complicated by ischemia-reperfusion injury. The administration of carbacetam under an experimental mandibular fracture model in the presence of acute blood loss and limb ischemia-reperfusion injury contributes to the improvement in the biochemical, functional, and structural state of the liver compared to the animals without correction.