Georgian Med News. 2023 Apr;(337):118-124.

ABSTRACT

The effectiveness of management of patients with severe combined trauma and alcohol withdrawal syndrome, complicated alcoholic delirium remains relevant and modern in intensive care. Sedation is the mainstay of treatment in patients with alcohol withdrawal complicated by alcohol delirium. Choosing the optimal scheme of treatment tactics, considering sedation, in victims with polytrauma becomes a difficult task due to a diverse combination of injuries and a lack of time for tactical decisions of patient management. Given the fact that polytrauma is characterized by pronounced oxidative stress, the development of hypoxia, especially when combined with chronic alcoholism, the expressiveness of biochemical disorders deepens significantly, the study of the course of biochemical processes and their mutual influence and the formation of current tactics of intensive therapy for these diseases is promising. Purpose – study of lipid peroxidation processes and the state of the antioxidant system in patients with polytrauma and alcohol withdrawal syndrome complicated by alcoholic delirium. The study was conducted on the basis of the Department of Anesthesiology and Intensive Care with 12 beds for patients with combined trauma of the communal non-profit enterprise “Kharkiv City Clinical Hospital of Rapid and Emergency Medical Care named after Professor O.I. Meschaninov”. To achieve the goal of the study, 40 patients with polytrauma were examined (thoracic and/or abdominal trauma: rib fractures, hemothorax, pneumothorax, hematomas of the liver or spleen, fractures of the waist and/or upper and/or lower limbs, pelvic fractures), medium severity. During the study, to achieve the goal, the main indicators of the oxidant-antioxidant system in patients were determined. We determined the content of the main indicators of the oxidant system: active products of thiobarbituric acid, diene conjugates, 8-isoprostane to assess the intensity of lipid peroxidation. The state of the antioxidant system was assessed by the content of superoxide dismutase, catalase, and glutathione peroxidase. The study was conducted on the 1st and 7th day of hospitalization of the patients. The main indicators of the intensity of lipid peroxidation in the human body are diene conjugates and active products of thiobarbituric acid. This provides an autocatalytic self-accelerating character. The obtained results indicate that in patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium against the background of chronic alcoholism due to the generation of reactive oxygen species, which is evidenced by an increase in the content of active products of thiobarbituric acid, diene conjugates, 8-isoprostane, against the background of insufficient antioxidant the system can develop oxidative stress, which is accompanied by damage to biological molecules: lipids, proteins, nucleic acids. Thus, the obtained results indicate an increase in the intensity of free radical reactions and processes of lipid peroxidation. Changes in the content of lipid peroxidation parameters in the blood of patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium, indicate more pronounced violations of the integral redox state. Activation of lipid peroxidation processes leads to a violation of the elasticity and mechanical integrity of cell membranes, a decrease in the activity of lipid-dependent membrane-bound enzymes. In a complex analysis of the content of biochemical markers of lipid peroxidation, namely active products of thiobarbituric acid, diene conjugates and 8-isoprostane in the blood of patients with polytrauma and alcohol withdrawal syndrome, complicated by alcoholic delirium, it was found that distinct processes are observed upon admission to the intensive care unit lipid peroxidation and free radical processes. Against the background of increased activity of the oxidant system, a decrease in antioxidant resources was observed as a decrease in the content of superoxide dismutase, catalase, and glutathione peroxidase. The work revealed the dynamics of the indicators of the antioxidant system in patients and is related, on the one hand, to the exhaustion of the body’s compensatory capabilities under the conditions of the development of strong oxidative stress, and on the other hand, it was probably a consequence of the negative impact of the products of chronic endogenous intoxication, alcohol, acetaldehyde on hepatocytes, where detoxification processes occur in the body of patients with chronic alcoholism and alcohol withdrawal syndrome. During the study, a significant suppression of the activity of all studied enzymes was found in patients with polytrauma, complicated by alcoholic delirium during admission to the intensive care unit, and on the seventh day after the therapy. Superoxide dismutase is part of the first link of antioxidant protection. This enzyme forms hydrogen peroxide from superoxide anions, which is further transformed into oxygen and water under the action of catalase. Considering the leading role of the activation of pro-oxidant processes in chronic alcoholism, indicators of the antioxidant-pro-oxidant status can be used to predict the course of this pathology, as well as the effectiveness of the selected treatment tactics for patients in this category.

PMID:37354684