Introduction. Traumatic brain injury (TBI) is the main cause of death among the working population. Patients who have suffered this type of injury, in addition to high mortality, have problems with existing neurological deficits and the terms of further rehabilitation and socialization. This pathology often leads to disability. Worldwide, annual statistics indicate 10 million patients hospitalized for TBI. The fatality rate for severe traumatic brain injury reaches more than 80%, and among those who survive, about 75% remain with severe neurological deficits. It is estimated that in the United States, traumatic brain injury occurs with a frequency of 363 cases per 100,000 population per year. In Germany, the annual incidence of TBI is approximately 340 per 100,000 population per year. In Western Europe, as well as in the USA, it has decreased somewhat in recent years due to the wider use of modern safety systems in cars. But, despite this, in the world in general, due to local armed conflicts (in particular, the war between Ukraine and the Russian Federation), the number of penetrating gunshot wounds to the brain is increasing. TBI is most common in young people between the ages of 15 and 24. According to statistics, men receive this type of injury two to three times more often than women in all age groups [1].
The analysis of literary sources indicates that when the brain is damaged, hyperproduction of reactive oxygen species by brain tissues is registered, which activates the development in its structures of processes of oxidative and nitrosative stress of proteins, lipids and nucleic acids of neurons, disrupts the affinity and specificity of receptors, the generation of action potentials and nerve impulse conduction [2]. Therefore, an important step in the intensive therapy of patients with TBI is the use of pharmacotherapeutic agents with antioxidant properties [3]. Blockade of NMDA receptors is considered one of the main links of neuroprotection [4].
The purpose of the study is to compare the results of treatment of patients with a diagnosis of brain injury who received standard therapy and patients with a diagnosis of brain injury who were additionally prescribed intravenous L-lysine escinate to standard therapy.
Materials and methods. During the study, patients were divided into 2 groups. In the first group, 69 patients received standard complex therapy, in the second group, 51 patients were additionally prescribed intravenous L-lysine escinate. The level of consciousness disturbance in patients during therapy was determined according to the Glasgow coma scale. Plasma levels of AST, ALT, and glucose were determined in patients. The duration of treatment and the outcome of the disease were studied. In the first group of patients, the distribution: men – 74.1%, women – 25.9%, the average age was 60.6±18.4 years. In the second group of patients, the ratio of men and women was 73 and 27%, respectively. The average age was 62±12.5 years. The age and gender of the patients did not differ statistically significantly. Statistical processing of the obtained material, estimation of distribution parameters was carried out using the program STATISTICA for Windows (Version 10.0).
The results. The level of consciousness of the patients upon admission to the clinic was determined according to the Glasgow coma scale: in group 1 - 9, group 2 - 9 [5]. In statistical analysis, the groups did not differ significantly (p>0.05). After the course of treatment, the level of consciousness was also calculated according to the SHCG of groups 1 - 12, group 2 - 13 (р<0.05). When evaluating the time of stay in the hospital, an increase in the time of stay in the group of 2 - 20 days is noted in comparison with the group of 1 - 16 days (р<0.05). An increase in the duration of treatment is associated with greater mortality in group 1 in the early stages of therapy.
When using L-lysine escinate, the proportion of surviving patients (group 2) was 85.3%, group 1 – 70.8% (p<0.05). The appointment of L-lysine escinate led to an increase in overall survival by 14.5% (p<0.05). When analyzing depending on the level of consciousness according to the SHKG, in patients with a level of suppression of consciousness at the time of admission up to 4-5 points according to the SHKG, survival increased by 31.3% when using L-lysine escinate (p<0.05); with 6-7 points on the SHKG, survival increased by 17.3% (p<0.05); with 8-9 points on the SHKG, an increase in the share of those who survived was noted by 14.0% (p<0.05). The introduction of L-lysine escinate into complex therapy of traumatic brain injury is associated with a lower risk of death – 14.7% versus 29.2% (group 1) (p<0.05).
Conclusions. Various pharmacological treatments can influence the pathophysiology of TBI. Appropriate treatment can reduce the detrimental impact of traumatic brain injury in the acute and post-acute period and improve the overall prognosis. In our paper, we have summarized the drugs based on clinical data and their use, although more clinical studies should be conducted for potential pharmacological therapy. A change in the tactics of intensive care of brain injury with the introduction of L-lysine escinate into clinical practice led to a significant increase in survival in brain injury.
References
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2. Semenenko, A. I, Kobeliatsky, Yu. Yu., & Kondratsky, B. O. (2015). Changes in oxidative-antioxidant balance on the background of infusion therapy in ischemia-reperfusion of the brain. Emergency medicine, 2(65), 116-119. doi: 10.22141/2224-0586.2.65.2015.79485.
3. Long, B., & Koyfman, A. (2018). Secondary Gains: Advances in Neurotrauma Management. Emerg Med Clin. North Am., 36(1), 107-133. doi: 10.1016/j.emc.2017.08.007.
4. Olloquequi, J., Cornejo-Cordova, E., Verdaguer, E., Soriano, F. X., Binvignat, O., Auladell, C., & Camins, A. (2018). Excitotoxicity in the pathogenesis of neurological and psychiatric disorders: Therapeutic implications. J Psychopharmacol., 32(3), 265-275. doi: 10.1177/0269881118754680.
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