Morphological rearrangement of large joints of the lower extremities under the conditions of a combination of abdominal and orthopedic trauma complicated by ischemia-reperfusion of the extremity

Abstract

Introduction. Injuries are among the pressing problems of modern urban society. The structure of injuries is dominated by multiple and combined injuries, which are characterized by significant severity and high mortality and lead to multiple organ dysfunction and insufficiency. In recent years, studies of the functional state of the liver have been widely used as a model for the development of multiple organ dysfunction in conditions of severe experimental trauma.

The objective is to determine the nature of disorders of biliary function of the liver in conditions of combined trauma to the abdomen and chest of rats in the early period of traumatic disease and to evaluate the effectiveness of their correction with thiotriazoline.

Research materials and their discussion. The experiments were performed on 86 nonlinear white male rats weighing 200-220 g. All animals were divided into five groups i.e. one control group and four experimental ones. Injuries were performed under thiopental-sodium anesthesia. The control group included intact animals that had just been anesthetized. In the first experimental group, the animals were simulated chest trauma. In the second experimental group, a blunt trauma was simulated. In the third experimental group, these injuries were combined. In the fourth experimental group, animals with combined trauma were injected intraperitoneally with thiotriazoline at a dose of 9.1 mg-kg^-1. 1, 3 and 7 days after injury under thiopentalone sodium anesthesia in animals, the common bile duct was catheterized and bile was collected for 60 min. It was set the rate of bile excretion. The concentration of total bile acids and conjugated bilirubin was determined in bile, and the rate of their excretion was calculated.

Research results and their discussion. Under conditions of isolated trauma of the chest, abdomen and their combination, there is a significant violation of biliary function of the liver, which is primarily manifested by a decrease in the rate of bile secretion and excretion of its main components - cholates and conjugated bilirubin. According to the severity of hepatic dysfunction, they can be divided as follows: isolated chest injury ← isolated abdominal injury ← combined injury. Under conditions of isolated chest trauma, the studied parameters in comparison with the control reach a minimum level of up to 3 days and normalize up to 7 days. After applying an isolated abdominal injury, the rate of bile secretion and the rate of excretion of total bile acids are reduced after 1 day. However, all the studied indicators reach a minimum value after 3 days and remain at the same level until 7 days. After a combined injury, the rates gradually decrease to 7 days and in each subsequent period become significantly lower than in the previous one. The use for the correction of detected disorders of thiotriazoline in the group of animals with combined trauma compared with animals without correction contributed to a significant increase in the rate of bile excretion, excretion of total bile acids and conjugated bilirubin. Although up to 7 days the indicators did not reach the level of the control group, it can be argued that thiotriazoline has a positive effect on biliary function of the liver.

Conclusion. Combined trauma to the abdomen and chest contributes to a greater decrease in liver function, compared with isolated lesions. They are based on the suppression of the rate of bile secretion and excretion of total bile acids and conjugated bilirubin. The use of thiotriazoline at a dose of 9.1 mgkg-1 in animals with combined abdominal trauma is accompanied by a significant decrease in biliary dysfunction.