Patologìâ (Dec 2013)
THE PATHOGENIC SIGNIFICANCE OF IMMUNOLOGICAL DISORDERS IN COMBINED TRAUMATIC BRAIN INJURY AND TOURNIQUET TOXEMIA
Abstract
INTRODUCTION. The most frequent trauma in modern conditions is a craniocereberal one (brain injury). Especially hard brain injury proceeds in combination with syndrome of position compression, or with the syndrome of long crush (SLC) of soft tissues. Disorders of immune system functional activity in the combined brain injury pathogenesis against traumatic intoxication always lead to development of pyo-inflammatory complications. AIM OF INVESTIGATION. To define the pathogenetic importance of immunological disorders at the initial stage of the brain injury proceeding against traumatic intoxication, depending on individual organism reactivity. MATERIALS AND METHODS. Experiments were executed on 106 white not purebred male rats that were distributed into 4 series: isolated brain injury – 24 rats, tourniquet – 24, combined trauma (brain injury + tourniquet) – 50, control – 8. The brain injury was modeled by one blow of spring mechanism. Force of blow to the skull was 1325 N/cm2, the lethality in the sharp period (till 1 day) was 40 %. Life expectancy of animals was in the wide interval of values – from 12 to 75 hours, on the average 34,5±3,3 hours. For the identification of the role of individual reactivity an original technique was applied – measurement of electroskin resistance on which three main types of post-traumatic reaction were differentiated. The first type of reactions (rats who were lost on the third day) is called by us "excitable", the second type of reactions (rats who were lost on the second day) – "intermediate", the third type of reactions (rats who were lost within the first days) – "inhibitive". Squeezing of soft tissues was modeled by tourniquet applying on hips area for 4 hours. Standard immunological methods (quantity of leukocytes, a leukocyte formula, the phagocyte activity, blood concentration of immunoglobulins of the main classes: A, G, M), enzyme-linked immunosorbent assay (blood concentration of interleukins (IL): IL-1β, IL-2, IL-4, IL-6, IL-8 and tumor necrotic factor α) and statistical methods are used. RESULTS AND DISCUSSION. The brain injury combined with hip tourniquet applying reflects adequately the main pathogenetic links of one of the types of frequent trauma (moderate severity of brain injury and traumatic intoxication). Removal of tourniquet from rats’ hips led to gradual restoration of blood stream in extremities and to washing away of toxins from them. The same intoxication mechanism takes place during release of victims from under blockages. In brain injury there was an expressed immunological reaction. This reaction had the inflammatory nature and was expressed in leukocytosis, left shift of a leukocyte formula, in oppression of macrophages phagocyte activity, in hypercytokinemia and minor immunoglobulins’ concentration changes. Expressiveness of immunological reaction in tourniquet, isolated and combined brain injury depended on the character of a trauma, on animals’ individual reactivity, and in the turnstile trauma and the combined trauma – on decompression time. Expressiveness of immunological reactions in the excitable type of brain injury had moderate character, strong – in intermediate and excessive – in inhibitive types. The decompression at initial (30 minute) stage didn't change the immune response significantly, and at the late (60 minute) stage – activated it sharply. Such a character of the immunological response reflected the process of blood accumulation of the ischemic tissues toxic substances. Immunological disorders in the combined trauma reflect the character of syndrome of mutual burdening of the damages, typical for brain injury and tourniquet. Maximal immunological disorders occur in the late decompression period of “inhibitive” type of post-traumatic reaction in the rats with the combined trauma. The revealed violations are the basis for carrying out the intensive immunomodulating therapy in the initial stage of the trauma.
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