Role of surfactant protein SP-D in the diagnosis of pulmonary complications in patients with combined thoracic injury

Abstract

The aim: to evaluate the informativeness of the content of SP-D in the blood of patients with combined thoracic trauma as a marker of the severity of traumatic illness and the impact of the proposed modifications of the intensive care algorithm on treatment outcomes.Material and methods. The basis of this study is a statistical analysis of the results of a comprehensive examination of 92 patients with thoracic trauma. Control points were 1st, 3rd, 7th and 12th day of treatment. The severity of the injury was determined according to the ISS scale, the condition of patients at the time of admission according to the ARASNE II scale, the level of SP-D in the blood, the degree of pulmonary hypertension, the number of bed-days in the intensive care unit (IC). 3 groups of patients were identified. Group I - standard IC protocol, group II - standard IC protocol with the addition of ceruloplasmin, group III - standard IC protocol with the addition of a solution of D-fructose-1,6-diphosphate sodium salt of hydrate. Parametric statistics methods were used to process the obtained data.Results. In patients of group I, the maximum numbers of SP-D in the blood were determined, which had a positive strong correlation during the entire observation period with the frequency of pulmonary complications and the duration of treatment in the IC department. In group II, the administration of ceruloplasmin neutralized the negative effect of oxidative stress on the surfactant, so the average SP-D in the blood only on the 3rd day exceeded the reference values by 20 %, which affected the lack of correlations between pulmonary parenchyma and duration of treatment. In group III, the addition of a solution of D-fructose-1,6-diphosphate sodium salt hydrate had a positive effect on the general condition of patients as a whole, but throughout the study period SP-D figures in the blood exceeded the starting and reference, which affected the presence of strong and medium positive correlation between them, the degree of pulmonary hypertension and the length of stay in the IC department.Conclusions. In patients with combined thoracic trauma, it is important when planning patient management tactics to diagnose the content of surfactant protein SP-D in the blood during the entire period of stay in the intensive care unit. The level of SP-D in the blood of patients with combined thoracic trauma is a highly informative diagnostic marker of the functional state of the lung parenchyma (surfactant). An increase in its numbers three times indicates the beginning of the development of acute lung injury syndrome (exudative phase). Reduction of its figures in the course of respiratory distress syndrome by half the values in the exudative phase indicates the beginning of the proliferative phase and improvement of patients. The leading mechanism for the development of acute lung injury syndrome in patients with combined thoracic trauma. There is oxidative stress, so the appointment of ceruloplasmin as an adjunct to the standard protocol of intensive care is pathogenetically justified