[The severe combined cerebro-cranial trauma. Pathobiochemical characterization]. / Tiazhelaia sochetannaia cherepno-mozgovaia travma. Patobiokhimicheskaia kharakteristika.

ABSTRACT

The indices of the endocrine system, systemic transport and consumption of oxygen, metabolism, hemostasis in the femoral artery, central and internal jugular veins were investigated in 144 patients with severe combined cerebro-cranial traumas (CCT) during the first 7 days after trauma. In 15 of them liquor was investigated. The results of the investigation have shown that in not severe CCT (FS-II 0.50+/-0.25 scores) the ACTH level in blood was 1.9 times higher and cortisol 5.6 times higher than normal. In the cerebral tissue aerobic oxygenation of glucose prevailed (aerobic index 90+/-2%) metabolic disorders were caused by extracranial injuries--the content of lactate, malon dialdehyde (MDA), middle molecular peptides (MCM238-302) was higher in the central vein than in the jugular vein. In patients with the superior truncal form of severe contusion of the brain (Field Surgery-II 11.8+/-0.2 scores) in the cerebral tissue there was prevalence of anaerobic glycolysis (aerobic index 60.1+/-3.5%), lactate oxygen index grew to 0.160+/-0.018. The inferior truncal form of brain contusion (FS-II 18.8+/-0.2 scores) had sharply decreased both aerobic and anaerobic oxidation of glucose in the cerebral tissue. In cases of severe and extremely severe CCT there was a suppression of central regulatory mechanisms--in response to the trauma the elevation of the level of ACTH and cortisol in blood was insignificant. Thrombinemia and prevailing endotoxemia were noted in the jugular vein. Great concentrations of lactate, MDA, MCM were determined in the liquor. So, liquor sorption is thought to be expedient. Lower index of oxygenation (1.9+/-0.3), higher respiratory index (1.5+/-0.1) and alveolar dead space (37.7+/-7.2%) evidenced secondary injury of the lungs in cases of severe and extremely severe combined CCT.