International Medical Journal, Vol. 24., Iss. 1, 2018, P. 85−88.
THE ROLE OF ENDOTHELIOPROTECTION IN TREATMENT OF TRAUMATIC DISEASE IN PATIENTS WITH ELEVATED BODY MASS INDEX
Kharkiv National Medical University, Ukraine
One of the main factors, producing a direct effect on the long−term outcome of the critical condition in patients with an elevated body mass index (BMI) at polytrauma, is the functional state of the vascular endothelium. To improve the effectiveness of critical state treatment in patients with elevated BMI and improve their quality of life after discharge a long−term complex clinical, instrumental and laboratory dynamic study of markers of endothelial dysfunction and apoptosis was conducted in 134 patients with elevated BMI with polytrauma with different ratings on the АРАСНЕ II scale at the time of admission within the time frame from 1 day to 180 days from the time of the injury. The effectiveness of the proposed intensive care complexes was evaluated in a prospective, randomized, open, cohort and comparative clinical trial in these patients. In patients with elevated BMI with polytrauma, endothelial dysfunction was prolonged to six months or more from the time of the injury; had a regular and unidirectional character, had periods of decline and rise in activity. The degree of damage, the consistency of compensatory capabilities and the ability to restore endothelial function in patients with elevated BMI with polytrauma depended on the type of infusion component of the intensive care complex. Infusion component of intensive therapy HES 200/0.5 6 % had the most pronounced endothelioprotective effect in monoadministration during the entire period of intensive care. To maintain endothelial function at the active level and slow the implementation of the apoptotic cascade, it is necessary to use a stepwise approach in the form of endothelioprotective agents when transferring a patient from an intensive care unit and later for a year after the injury.
Key words: traumatic disease, body mass index, multiple trauma, quality of life, endothelioprotectors.