OXIDATIVE STRESS IN PATIENTS WITH TRAUMATIC DISEASE IN POLYTRAUMA AFTER MULTI-STAGE SURGICAL CORRECTION

Severe combined trauma is characterized by a wide range of reactions of the body to the harmful stimuli, with the participation of all body systems, leading to marked changes prooxidant-antioxidant balance. Increased degree of oxidative stress is the most important mechanism of cellular damage in surgical stress. It provoks abnormal metabolic processes in different organ systems, that violates their normal functioning and causes complicated postoperative course. The aim of the study was to evaluate oxidative stress in patients with traumatic disease. In case, they were operated according to multi-stage surgical correction strategy and use different variants of intensive care. Materials and methods. The dynamic of the level of oxidative stress in 64 patients (mean age 36,5±12,6 years, 36 men and 18 women) with traumatic disease was investigated. For this, we studied the level of accumulation the primary and secondary lipid peroxida-tion products (diene conjugates (DC) and malondialde-hyde (MDA)) at the time of admission, 24 hours later, on the 3rd, 5th and 14th days of intensive care during the stage-by-stage surgery. All of patients were divided into 2 groups. The first group included 32 victims receiving standard complex of intensive care according to the local protocol. The second group included 32 victims who received ceruloplasmin in addition to the standard thera-py complex. The likelihood of complications in acute and early periods of traumatic disease was assessed. Results. The increase of the content level of primary and secondary lipid peroxidation products in plasma all of patients was found at the time of admission to the operating room. In general, the dynamics of changes in DC and MDA levels were similar for both of groups. Significant differences (p <0.05) were observed between the mean values of DC and MDA in the same periods of the study in the compared groups. In addition, the comparison showed a tendency to decrease complications in the second group. Post-traumatic nephropathy and thrombohemorrhagic complications were diagnosed in 22% and 9% of cases more frequently in the first group than in the second. The rate of infectious complications was on 1.35 times higher also in patients of the first group, which did not apply the proposed scheme optimized intensive care. In our opinion, an increased level of DC and MDA to the fifth day shows a high level of lipid peroxidation. Firstly, it is due to the development of traumatic disease. Secondly, it is response of the organism to the output of lipid peroxidation products from the area of injury at the stage of additional surgery (at 4.7±1.3 days in patients of first group, and 4.6±1.1 days in patients of second group). Conclusion. The changes in laboratory parame-ters are objective indexes of the presence of significant differences in patients of compared groups. Optimized therapy used in the treatment of patients in group II, has a positive effect on the antioxidant protection and reduces level of lipid peroxidation products - intermediate (DC) and final (MDA). Surgical trauma at every stage of traumatic disease additionally stimulates excessive activation of lipid peroxidation. This affects the compensatory capacity of antioxidant protection, leads to a decrease in body resistance and, as a consequence, the development of complications. The indicator of the quality of treatment is a lower complication rate in the second group than the first group.