Abstract
The purpose of the investigation was to study the effect of the ethylmethylhydroxypyridine succinate (EMHPS) infusion on the dynamics of cerebral blood flow patterns in patients during the acute phase of severe concomitant traumatic brain injury. Materials and methods. The study involved two groups of patients, each of 25 persons aged 41.5 (29; 51) years on average, with a severe concomitant traumatic brain injury. The patients of the 1 st (control) group were cured with a standard intensive care while in the 2 nd (study) group the EMHPS infusion was added to the said standard treatment in a dose of 100 mg per hour through an infusion pump within 10 days. By transcranial dopplerography (TDG) testing the following cerebral macrocirculation parameters (CMP) were studied: systolic blood flow velocity (V max ), diastolic blood flow velocity (Vmin), pulsation index (PI) and resistance index (RI). Results. The most frequent type of the cerebral blood flow (CBF) disorder noted in the both groups during the initial examination was a hindered perfusion pattern noticed in 15 and 16 patients from 1st and 2 nd groups, respectively. Mild vasospasm was recorded in four patients in the 1st group and in three cases in the 2 nd group. Signs of gross vasospasm were noted in two patients from each group. In two patients of each group patterns of hypoperfusion and hyperperfusion were noted. In the patients of the 1 st group the CMP normalization was observed in six cases on the third day, in eight cases on the fifth day, in 12 cases on the seventh day, in 18 cases on the 10th day, while in the patients of the 2nd group the CMP normalization was observed on the 3 rd day in 12 cases, on the 5 th day in 15 cases, on the 7 th day in 16 cases and on the 10 th day in 20 cases. Conclusion. The most common patterns identified during the initial examination included hindered perfusion and vasospasm, which were transformed into a normoperfusion pattern through the hyperperfusion stage (reactive hyperemia). The EMHPS infusion in a dose of 100 mg per hour usually aids to normalize parameters within 3—5 days.
Highlights
Изучение механизмов защиты головного моз га при его повреждениях различного генеза являет ся актуальной проблемой реаниматологии [1, 2]
The study involved 50 patients with severe concomitant trau matic brain injury combined with head, long bones and abdominal organs injuries
The said patients were admitted to the Inpatient Department directly from road traffic accident (RTA) sites or transferred from central district hospitals (CDH) of the Nizhny Novgorod region
Summary
Изучение механизмов защиты головного моз га при его повреждениях различного генеза являет ся актуальной проблемой реаниматологии [1, 2]. Актуальность вопросов, связанных с лечением по страдавших с черепно мозговой травмой (ЧМТ) не сомненна [3, 4]. Одним из важнейших направлений интенсивной терапии пострадавших с ЧМТ являет ся профилактика вторичного ишемического по вреждения головного мозга [5, 6]. При нормализации кровотока в этой зоне вос станавливается церебральный метаболизм с вос становлением утраченных церебральных функ ций. В противном случае происходит дальнейшее снижение мозгового кровотока, и возникают нео братимые морфологические изменения мозговой ткани с развитием инфаркта мозга [9, 10]
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