ЗВ’ЯЗОК ОБ’ЄКТИВНИХ КРИТЕРІЇВ ТЯЖКОСТІ ТРАВМИ З ПОКАЗНИКАМИ ОКСИДАТИВНОГО ПОШКОДЖЕННЯ БІЛКІВ ТА ЛІПІДІВ У ПАЦІЄНТІВ З ПОЄДНАНОЮ ТОРАКАЛЬНОЮ ТРАВМОЮ

Abstract

The aim of the study was to investigate the relationships between the trauma severity objective criteria and the proteins’ and lipids’ oxidative damage markers in patients with the severe combined thoracic trauma during early posttraumatic period. Study was performed on 73 male patients aged from 20 to 68. Patients with the severe blunt combined thoracic trauma with pneumothoraxes and hemothoraxes, lung contusions, heart contusions and multiply (≥3) rib fractures were included in this study. Plasmatic concentration of malonic dialdehyde was determined according to TBA-activity of deproteined plasma. The proteins’ carbonyl groups level was determined with the help of dinitrophenylhydrazine reaction with plasma proteins extracted from blood. Blood sampling was performed in three stages: the 1-st – the 1-2-d day; the 2-d – the 3-4-th day and the 3-d – 5-6-th day after trauma. The decrease of both malondialdehyde and carbonyl groups levels were observed in patients’ plasma on 1-2-d day after trauma in comparison to control group with stepwise growth up to 5-6-th day. Negative relationships between malondialdehyde concentration and total infusion volume, volume of colloid solutions that were infused before examination were observed on 1-2-d day of treatment. Negative relationships between carbonyl groups level and both volumes of total infusion and colloid solutions were obtained on 1-2-d day after trauma too. Negative reliable Spearman correlation coefficients of both malondialdehyde and carbonyl groups level with shock degree, ISS, PTS, ВПХ-МТ, AIS head and AIS abdomen scores and positive relationships with RTS score and TRISS probability on the 1-2-d day after trauma were found too. These data indicate great influence of hemodilution on concentrations of both oxidative damage markers. The divisions of malondialdehyde and carbonyl groups concentrations into the total protein concentration were decided for the adjustment of oxidative stress markers. Positive reliable correlation coefficients of malondialdehyde relative concentration with ISS and ВПХ-МТ scores and negative relationships with RTS score and TRISS probability on the 5-6-th day after trauma were found. Positive reliable correlation coefficients of carbonyl groups relative concentration with ISS, ВПХ-МТ, AIS head scores and negative relationships with RTS score and TRISS probability on the 5-6-th day after trauma were obtained. On the 3-4-th day weakly reliable and small number (in case of malondialdehyde relative concentration – absence) of correlation coefficients were found. These data allow us to make next conclusions. Pathophysiological processes that start during tissue damage in patients with the severe combined thoracic trauma in early posttraumatic period influence the clinical course of wound dystrophy up to 5-6-th day after trauma. Decrease of the oxidative stress markers concentrations in plasma from patients with the severe combined thoracic trauma on 1-2-d day is the result of hemodilution due to massive infusion-transfusion therapy. On 3-4-th day of posttraumatic period failure of the regulatory mechanisms, bounding oxidative processes and pathogenetic links, involved in the mechanisms of the response to extreme traumatic causes occur, as the result of the urgent adaptation mechanisms exhaustion.