Shatskiy V. V., Hudyma A. A., Shepitko K. V.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

In the case of massive external bleeding, an effective means of saving life is the imposition of a hemostatic harness of up to two hours. There is evidence that limb reperfusion after two hours of ischemia is capable of stimulating the development of multiple organ dysfunction. A sensitive marker of kidney dysfunction is the clearance of sodium free water. Purpose. To find out the concentration of the kidneys by the amount of clearance of sodium-free water after modeling of acute blood loss complicated by ischemia-reperfusion of the limb, and to establish the effectiveness of carbacetam in the correction of the detected disorders in the experiment. Object and methods. The experiments were performed on 108 non-linear male rats weighing 160-180 g. All animals were divided into five groups: control and four experimental (6 rats in each group). The first experimental group included animals that under thiopentalosodium anesthesia modeled a two-hour limb ischemia followed by reperfusion. In the second experimental group, animals were treated with acute blood loss in the amount of 20- 22% by volume of circulating blood by intersection of the femoral vein in conditions of indigestion. In the third experimental group, these injuries were combined. In the fourth experimental group animals with acute blood loss, complicated by limb ischemia-reperfusion, were intraperitoneally administered carbacetam at a dose of 5 mg per kilogram of animal weight. In the control group, the animals were anesthetized using an equivalent dose of sodium thiopental, administered a bundle for 2 h without stopping the blood flow, and subsequently taken for research after 1 h. After 1 and 2 hours, as well as after 1, 7 and 14 days in experimental animals, the functional state of the kidneys was determined by the method of water loading. Urine was collected for 2 h and urine output was determined. After urine sampling under thiopental-sodium anesthesia, rats were removed from the experiment by total bloodletting from the heart. The concentration of sodium ions was determined in the urine and serum. The clearance of sodium water was calculated. Results and discussion. Limb reperfusion after two hours of ischemia is accompanied by inhibition of sodium transport in the distal nephron, which is a significant decrease in clearance of sodium-free water compared with control after 4 h, 1 and 7 days of the reperfusion period. The admission of toxins from the ischemic limb after its reperfusion deepens the ischemic injury of the kidney under conditions of acute blood loss in all terms of the reperfusion period, which leads to the transition of the prerenal form of acute renal injury to the real one. Introduction to animals with acute blood loss complicated by ischemia-reperfusion of the limb of carbacetam after 7 days is accompanied by a statistically significant increase in clearance of sodium-free water compared with animals with blood loss without ischemia-reperfusion. Positive effect is observed after 14 days of the drug. Conclusion. The complication of acute ischemia-reperfusion of the limb is accompanied by greater damage to the distal epithelium, which is manifested by a significantly lower clearance of sodium water at all times of the reperfusion period compared with animals with acute blood loss. The use of carbacetam after 7 days causes a decrease in the damage of the epithelium of the distal nephron, which is manifested by a significant increase in clearance of sodium water.

blood loss, limb ischemia-reperfusion, kidney, clearance of sodium-free water.

1. Elster EA, Frank KB, Todd ER. Implications of Combat Casualty Care for Mass Casualty Events. JAMA. 2013;310(5):475-6.
2. Efficacy of Prehospital Application of Tourniquets and Hemostatic Dressings To Control Traumatic External Hemorrhage. Available from: https://www.ems.gov/pdf/research/Studies-and-Reports.pdf
3. Kolesnikova TI. Osmoticheskiy gomeostaz u bolnyih v kriticheskih sostoyaniyah razlichnogo geneza. Pytannia eksperymentalnoi ta klinichnoi medytsyny. 2008;12(2):22-5. [in Russian].
4. Tsymbaliuk HYu. Zminy funktsionalnoho stanu nyrok u modeli poiednanoi travmy, hipovolemichnoho shoku ta ishemichno-reperfuziinoho syndromu kintsivky. Hostri ta nevidkladni stany u praktytsi likaria: materialy desiatoho brytano-ukrainskoho sympoziumu z anesteziolohii ta intensyvnoi terapii, m. Kyiv, 18–21 kvitnia 2018 r. Kyiv, 2018. s. 101-2. [in Ukrainian].
5. Sheiman DA. Patofyzyolohyia pochky. SPb.: Bynom; 2017. 208 s. [in Russian].
6. Shatskyi VV, Stakhiv OV, Maksymiv RV, Strelbytska IV. Dynamika funktsionalnoho stanu nyrok za umov ishemii-reperfuzii kintsivky, hostroi krovovtraty ta yikh korektsii. Ekstrena medychna dopomoha v nadzvychainykh umovakh: vseukr. nuak.-prakt. konf., 20-24 liutoho 2019 r. Ternopil: Ukrmedknyha; 2019. s. 40-1. [in Ukrainian].
7. Cherniy VI, Kolesnikova TI, Gorodnik GA. Klirens svobodnoy vodyi kak kriteriy ranney diagnostiki porazheniya vyidelitelnoy funktsii pochek u neyroreanimatsionnyih bolnyih s ugrozoy razvitiya ostroy pochechnoy nedostatochnosti. Ukrainskyi zhurnal ekstremalnoi medytsyny imeni H. O. Mozhaieva. 2008;4:31-5. [in Russian].
8. Kozak DV. Vplyv karbatsetamu na antyoksydantnyi-prooksydantnyi balans tkanyny sertsia, lehen i pechinky v dynamitsi politravmy. Shpytalna khirurhiia. 2014;1(65):40-2. [in Ukrainian].
9. Rohovyi YuYe. Patofiziolohiia hepatorenalnoho syndromu na poliurychnii stadii sulemovoi nefropatii. Chernivtsi: «Misto»; 2012. 200 s. [in Ukrainian].
10. Blaisdell FW. The pathophysiology of skeletal muscle ischemia аnd the reperfusion syndrome: a review. Cardiovasc Surg. 2002;10(6):620-30.
11. Morsey H, Aslam M, Standfield N. Patients with critical ischemia of the lower limbareat risk of developing kidney dysfunction. Am J Surg. 2003;185:360-3.
12. Stoffels F, Lohöfener F, Beisenhirtz М. Concentration decrease nitric oxide in the post ischemic muscle is not only caused by degeneration of O2-. Microsurgery. 2007;27(6):565-8.
13. Lu S, Wang Х, Wen L. Effect of super oxide dismutase on adhesion molecules expression in skeletal muscle ischemia/reperfusion injury in rats. Zhonghua Yi Xue Za Zhi. 2002;82(12):840-3.
14. Su QS, Zhang JG, Dong R. Comparison of changes in markers of muscle damage induced by eccentric exercise and ischemia/reperfusion. Scand J Med Sci Sports. 2010;20(5):748-56.

«Bulletin of problems biology and medicine» Issue 4 Part 2 (154), 2019 year, 251-254 pages, index UDK 612.46-02:616.137.8-005.4/-007.271-085]-092.9

10.29254/2077-4214-2019-4-2-154-251-254