STUDY OF THE PROCESSES OF LIPID PEROXIDATION, THE STATE OF THE ANTIOXIDANT SYSTEM IN PATIENTS WITH POLYTRAUMA AND ALCOHOL ANAMNESIS.

The effectiveness of management of patients with severe combined trauma and alcohol withdrawal syndrome, complicated alcoholic delirium remains relevant and modern in intensive care. Sedation is the mainstay of treatment in patients with alcohol withdrawal complicated by alcohol delirium. Choosing the optimal scheme of treatment tactics, considering sedation, in victims with polytrauma becomes a difficult task due to a diverse combination of injuries and a lack of time for tactical decisions of patient management. Given the fact that polytrauma is characterized by pronounced oxidative stress, the development of hypoxia, especially when combined with chronic alcoholism, the expressiveness of biochemical disorders deepens significantly, the study of the course of biochemical processes and their mutual influence and the formation of current tactics of intensive therapy for these diseases is promising. Purpose - study of lipid peroxidation processes and the state of the antioxidant system in patients with polytrauma and alcohol withdrawal syndrome complicated by alcoholic delirium. The study was conducted on the basis of the Department of Anesthesiology and Intensive Care with 12 beds for patients with combined trauma of the communal non-profit enterprise "Kharkiv City Clinical Hospital of Rapid and Emergency Medical Care named after Professor O.I. Meschaninov". To achieve the goal of the study, 40 patients with polytrauma were examined (thoracic and/or abdominal trauma: rib fractures, hemothorax, pneumothorax, hematomas of the liver or spleen, fractures of the waist and/or upper and/or lower limbs, pelvic fractures), medium severity. During the study, to achieve the goal, the main indicators of the oxidant-antioxidant system in patients were determined. We determined the content of the main indicators of the oxidant system: active products of thiobarbituric acid, diene conjugates, 8-isoprostane to assess the intensity of lipid peroxidation. The state of the antioxidant system was assessed by the content of superoxide dismutase, catalase, and glutathione peroxidase. The study was conducted on the 1st and 7th day of hospitalization of the patients. The main indicators of the intensity of lipid peroxidation in the human body are diene conjugates and active products of thiobarbituric acid. This provides an autocatalytic self-accelerating character. The obtained results indicate that in patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium against the background of chronic alcoholism due to the generation of reactive oxygen species, which is evidenced by an increase in the content of active products of thiobarbituric acid, diene conjugates, 8-isoprostane, against the background of insufficient antioxidant the system can develop oxidative stress, which is accompanied by damage to biological molecules: lipids, proteins, nucleic acids. Thus, the obtained results indicate an increase in the intensity of free radical reactions and processes of lipid peroxidation. Changes in the content of lipid peroxidation parameters in the blood of patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium, indicate more pronounced violations of the integral redox state. Activation of lipid peroxidation processes leads to a violation of the elasticity and mechanical integrity of cell membranes, a decrease in the activity of lipid-dependent membrane-bound enzymes. In a complex analysis of the content of biochemical markers of lipid peroxidation, namely active products of thiobarbituric acid, diene conjugates and 8-isoprostane in the blood of patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium, it was found that distinct processes are observed upon admission to the intensive care unit lipid peroxidation and free radical processes. Against the background of increased activity of the oxidant system, a decrease in antioxidant resources was observed as a decrease in the content of superoxide dismutase, catalase, and glutathione peroxidase. The work revealed the dynamics of the indicators of the antioxidant system in patients and is related, on the one hand, to the exhaustion of the body's compensatory capabilities under the conditions of the development of strong oxidative stress, and on the other hand, it was probably a consequence of the negative impact of the products of chronic endogenous intoxication, alcohol, acetaldehyde on hepatocytes, where detoxification processes occur in the body of patients with chronic alcoholism and alcohol withdrawal syndrome. During the study, a significant suppression of the activity of all studied enzymes was found in patients with polytrauma, complicated by alcoholic delirium during admission to the intensive care unit, and on the seventh day after the therapy. Superoxide dismutase is part of the first link of antioxidant protection. This enzyme forms hydrogen peroxide from superoxide anions, which is further transformed into oxygen and water under the action of catalase. Considering the leading role of the activation of pro-oxidant processes in chronic alcoholism, indicators of the antioxidant-pro-oxidant status can be used to predict the course of this pathology, as well as the effectiveness of the selected treatment tactics for patients in this category.

DYNAMICS OF CHANGES IN 2,3 DIPHOSPHOGLYCERATE AND COGNITIVE DYSFUNCTION IN THE POSTOPERATIVE PERIOD IN PATIENTS WITH ABDOMINAL NEOPLASMS.

The problem of analysis of clinical - diagnostic and biochemical criteria of postoperative cognitive dysfunction in abdominal oncosurgery, depending on the degree and structure of disorders, remains unresolved, which determines its relevance. The role of 2, 3-diphosphoglycerate is essential, because its increase in the concentration of red blood cells in hypoxic conditions is one of the adaptive mechanisms that improve oxygen transport to tissues. Purpose. The influence of the dynamics of 2,3 diphosphoglycerate content, as the main indicator of hypoxia, on the occurrence of cognitive dysfunction in the postoperative period in patients with neoplasms of the abdominal cavity. The study was conducted on the basis of departments for patients of the surgical profile of the municipal institution "Kharkiv City Clinical Hospital of Ambulance and Emergency Care named after Professor OI Meshchaninov ". To achieve this goal, we examined 80 patients with abdominal neoplasms who underwent surgery under general anesthesia using propofol and fentanyl. All patients were divided into 2 groups depending on the age of patients on the WHO scale, who underwent surgery using general anesthesia: Group 1 (n = 39) - middle-aged patients (50-59 years); Group 2 (n = 41) - elderly and senile patients (60-80 years). The control points of the examination were the day before the operation and the 1st, 7th, 30th day from the moment of the operation. The state of cognitive function in these patients was determined by conducting neuropsychological tests. To assess the state of cognitive function of patients, neuropsychological tests were used: MMSE scale (Mini-Mental State Examination, MMSE), the method of memorizing 10 words AR Luria, frontal dysfunction battery (FAB), Schulte technique. To assess the state of energy metabolism in patients, the level of erythrocytes and hemoglobin in the blood analysis was determined by well-known methods, the level of 2,3 diphosphoglycerate in erythrocytes and its ratio to hemoglobin. Anemia in the first week after surgery in patients of group 1 contributes to the development of a hypoxic state, in erythrocytes there is an increase in the content of 2,3 41 diphosphoglycerate, which promotes the transport of oxygen to tissues. During the week there is an increase in the intensity of the formation of 2,3 diphosphoglycerate, as evidenced by the ratio of 2,3 diphosphoglycerate to hemoglobin. In patients of group 2, the changes are more pronounced: anemia with a significant decrease in erythrocytes and hemoglobin in the blood, a decrease in 2.3 diphosphoglycerate in erythrocytes, reflects changes in erythrocyte metabolism, namely a decrease in biosynthesis of important organophosphorus compounds, in particular 2,3 diphosphogly by reducing the basic enzymes of glycolysis. Decreased energy metabolism in the elderly contributes to impaired cell function. With age, the content of adenosine triphosphate, 2,3 diphosphoglycerate decreases, thus increasing the affinity of hemoglobin for oxygen, impaired transport of oxygen to tissues, which leads to the development of hypoxia. According to the results of neuropsychological tests, we found postoperative cognitive dysfunction in patients with neoplasms of the abdominal cavity. Disruption of energy metabolism and changes in the activity of glycolysis enzymes in erythrocytes contributes to a decrease in the concentration of 2, 3 diphosphoglycerate, increase the affinity of hemoglobin for oxygen and the development of tissue hypoxia. The obtained results indicate the interdependence of these processes and allow continuing research in this direction with the development of appropriate clinical and diagnostic measures and areas of intensive care to improve the condition of patients with abdominal tumors and their quality of life after surgery.