[Metabolic bases of the pathogenesis of severe multiple trauma]

Under analysis there were data of hormonal activity of the hypothalamo-hypohysis-adrenocortical system and the incretory apparatus of the pancreas, metabolism (of proteins, lipids, carbohydrates) and concentration of microelements (iron, zinc), lipid peroxidation (content of malonic dialdehyde and diene conjugates, on the one hand, and total oxidative activity of blood, superoxide dismutase (SOD), ceruloplasmin, catalase, SH-group, on the other hand) and results of its therapeutic correction (with superoxide dismutase, ionole, extracorporeal laser irradiation and laser irradiation of the wounds), content of the inflammatory reaction markers (tumor necrosis factor and IL-1) in patients with a severe combined trauma in the dynamics of traumatic disease. The results obtained and literature data allow a conclusion to be made that the basis of metabolic changes in severe combined traumas are formed by a developing adaptation reaction of organism immediately after trauma integrated with the systemic aseptic inflammatory response caused by vast necrosis of tissues, hypo- and reperfusion processes. The intensity of these reactions depends on severity of the trauma, determines its clinical course and outcome. The therapeutic correction of higher activity of the lipid peroxidation system (caused by a systemic inflammatory response) ionol, extracorporeal laser irradiation of blood, laser therapy of the wounds increase the antioxidative volume of blood and decrease the production of lipid peroxidation. Early intrabronchial instillation of homogenic SOD increases the total antioxidative activity, the level of SOD and catalase, decreases the content of malonic dialdehyde in the sediment of broncho-alveolar lavage and in blood.