International Medical Journal, Vol. 23., Iss. 4, 2017, P. 79−82.
BLOOD BIOCHEMICAL STRESS MARKERS IN PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY
Kharkiv National Medical University
Prof. O. I. Meschaninov Kharkiv City Clinical Hospital of Emergency Medical Care, Ukraine
According to the WHO, 10 million people in the world receive traumatic brain injury annually, of them 250−300 die. In Europe traumatic brain injury is the main cause of death among people under 35. During the acute period of traumatic brain injury, numerous mediators of systemic inflammatory response, which are both causative factors of the systemic inflammatory response and its markers, are formed in the organism. To study the biochemical markers of stress in the blood of patients with severe traumatic brain injury we investigated 40 patients with isolated severe traumatic brain injury on days 1, 3, 5 and 7 after the surgery. At these stages, the levels of insulin, cortisol, glucose in serum were studied, the HOMA index was calculated, and the period of recovery of consciousness and duration of artificial ventilation of the lungs was determined. On day 1 after the operation, the highest tension in stress reactions in patients was observed. It was confirmed by the maximum level of all stress markers. On day 3 stress reactions weakened, only glycemia did not have significant differences during the study, but a significantly higher level of insulin showed a high tension in the regulation of carbohydrate metabolism. Only day 7 of the study there was a significant decrease in these stress markers. In patients, the average duration of artificial ventilation of the lungs was 6,6±1,9 days, and consciousness during the study recovered by 3,7 points. Correlation analysis between the initial levels of stress markers and the duration of artificial ventilation of the lungs demonstrated that the initial tension of stress reactions affected the duration of artificial ventilation of the lungs and, consequently, the rate of recovery of consciousness. The level of cortisol had the greatest effect in this regard. The tension of stress reactions in patients with severe traumatic brain injury causes a significant increase of biochemical stress markers (cortisol, insulin, glucose} in the organism of patients, and their significant decrease occurs only on day 7. The initial tension of stress reactions affects the duration of artificial ventilation of the lungs, therefore, there is a further need for the use of drugs that could faster decrease the tension of stress reactions and shorten the duration of artificial ventilation of the lungs.
Key words: severe traumatic brain injury, stress markers, artificial ventilation of the lungs, consciousness restoration.