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[The severe combined cerebro-cranial trauma. Pathobiochemical characterization]
Vestnik Khirurgii Imeni I. I. Grekova
|August 20, 2004
Summary
Severe traumatic brain injury disrupts endocrine and metabolic functions, impacting oxygen use and leading to secondary lung injury. Early trauma severity correlates with specific metabolic and hormonal changes, suggesting potential interventions like liquor sorption.
Area of Science:
- Neurotraumatology
- Endocrinology
- Metabolic Medicine
Background:
- Combined cerebro-cranial trauma (CCT) presents complex physiological challenges.
- Understanding early post-trauma systemic responses is crucial for patient management.
Purpose of the Study:
- To investigate endocrine, oxygen metabolism, and hemostasis changes in severe CCT patients within 7 days post-trauma.
- To correlate injury severity with specific physiological and biochemical markers.
Main Methods:
- Analysis of endocrine markers (ACTH, cortisol), oxygen consumption indices, and metabolic products (lactate, MDA, MCM) in blood and cerebrospinal fluid (liquor).
- Inclusion of 144 patients with varying CCT severity, with liquor analysis in 15.
- Assessment of systemic transport, oxygenation, and hemostasis parameters.
Main Results:
- Mild CCT showed elevated ACTH and cortisol, with aerobic glucose metabolism. Extracranial injuries contributed to metabolic derangements.
- Severe CCT (superior form) exhibited anaerobic glycolysis. Inferior form showed significantly reduced glucose oxidation.
- Very severe CCT indicated suppressed central regulatory mechanisms, with thrombinemia, endotoxemia, and elevated lactate, MDA, and MCM in liquor. Secondary lung injury was evident.
Conclusions:
- Cerebral metabolic pathways shift based on CCT severity, from aerobic to anaerobic glycolysis and impaired oxidation.
- Endocrine responses are blunted in extremely severe CCT.
- Liquor sorption may be beneficial given high toxin concentrations. Secondary lung injury requires attention in severe CCT.