The dissertation provides a theoretical justification and solution to the current
problem, which consists in increasing the effectiveness of treatment of burn patients by
developing and implementing schemes for transfusion correction of endothelial
dysfunction and indicators of inflammation during surgical treatment of burn wounds.
The study included the results of the examination and treatment of 71 patients with
burn lesions ranging from 10 to 60% of the total body surface area (TBSA), aged from
24 to 65 years. All patients were divided into two groups - the main group and the
comparison group. The main group included 49 patients with thermal burns with TBSA
from 10 to 60%, who, in addition to the standard scheme of transfusion therapy and
surgical treatment, were treated with endotheliotropic, antiproteolytic and antioxidant
drugs. Depending on the additional drug used in transfusion therapy schemes, the patients
of the main group were divided into three subgroups. Subgroup 1 included 23 patients
who were treated with an endotheliotropic drug – L-carnitine and arginine hydrochloride
in the transfusion therapy scheme during surgical treatment, subgroup 2 - 12 patients who
were treated with a proteinase inhibitor drug - ulinastatin, and subgroup 3 - 14 patients
who were treated with an antioxidant drug - ethylmethylhydroxypyridine succinate. The
comparison group included 22 patients who underwent a standard generally accepted
scheme of transfusion therapy and surgical treatment without additional drugs.
The results of endotheliotropic, antiproteolytic and antioxidant drugs usage were
studied according to the dynamics of changes indicators of endothelial dysfunction,
indicators of pro- and anti-inflammatory cytokines, proteolytic activity indicators and
cells phagocytic activity in peripheral blood and capillary blood of the thermal injury zone
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in patients of each subgroup of the main group and in patients of the comparison group.
Morphological and immunohistochemical confirmation was conducted based on markers
of angiogenesis activation, epidermization, and epithelialization. Clinical success criteria
for surgical treatment included: reduction in the area of excisions and wound closure, the
timing of the first autodermoplasty, the timing of complete final wound closure, the
number of surgical interventions, the frequency of infectious and inflammatory
complications, and the duration of the patient's hospital stay.
It was observed that on the 2nd to 3rd day after burn trauma, there was an increase
in the levels of markers of endothelial dysfunction, namely endothelin-1 (ET-1) and
homocysteine, in the capillary blood of the wound and peripheral blood. The levels of
ET-1 in the blood from the burn wound exceeded those in peripheral blood, indicating a
prevalence of local vasoconstriction in the burn area, which significantly affected the
development of the wound healing process and the timing of surgical treatment. When
studying the dynamics of changes in nitric oxide (NO) indicators in the capillary blood
of the burn wound, it was found that in both groups on the 2nd to 3rd day after the burn,
the levels of NO metabolites exceeded reference values. However, on the 7th to 8th day,
in the capillary blood of the wound in patients from the comparison group, the NO level
was 3.48±0.2 µmol/L, significantly lower than both the initial levels (8.68±0.08 µmol/L)
and reference values (4.69±0.42 µmol/L) (p<0.05). This indicated a decrease in NO
bioavailability, its inactivation by active oxygen species, insufficient substrate for eNOS,
leading to the exacerbation of endothelial dysfunction and a prevalence of vasospasm in
the burn wound area.
It was determined that the application of the elaborated transfusion therapy
regimens in the early period of burn disease led to a significant reduction in the levels of
the vasoconstrictor factor ET-1 in the blood and a significant decrease in homocysteine
levels, especially in the capillary blood of the burn wound. This indicated a reduction in
cytotoxic effects on the endothelium. The use of the proposed transfusion therapy allowed
maintaining NO levels on the 7th to 8th day at twice the level of the comparison group,
both through the provision of NO substrate and through the use of S-nitrothiols for NO
synthesis.
