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Khirurgii

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Year 2023 Vol. 31 No 2

SCIENTIFIC PUBLICATIONS

A.A. KINZERSKIY 1, 2, M.S. KORZHUK 3, 4, V.T. DOLGIKH 5, T.S. SOLOV’YOVA 6, R.V. ESELEVICH 4, O.V. BALURA 4, I.I. KOTOV 2

EFFECT OF PATHOGENETIC THERAPY ON COAGULOPATHY AFTER SEVERE LIVER INJURY

Omsk City Emergency Hospital N1 1,
Omsk STATE MEDICAL UNIVERsity 2, Omsk,
NMRC of Oncology named after N.N.Petrov of MoH of Russia,
St. Petersburg, The Russian Federation 3,
Military Medical Academy named after S.M.Kirov, of MoD of Russia 4,
Federal Scientific Center of Reanimatology and Rehabilitology of Russian Academy of Science 5,
St. Petersburg clinic hospital of Russian Academy of Science 6, St. Petersburg,
Russian Federation

Objective. Effect of pathogenetic therapy (PGT) and the methods of administration of its components on developing coagulopathy in the author’s model of severe closed liver injury has been studied..
Methods. Male Wistar rats (n=100) weighing 379±23 g were randomized into 3 groups: I – control (n=42), II – experimental (n=34), III - donors (n=24). The injury was modeled according to the author’s technique. The experimental group at the 60th minute after injury was randomized into 3 subgroups: II-I (n=12) – injection of PGT into the femoral vein, II-II (n=12) – injection of PGT into the portal vein, II-III (n= 10) – without PGT. PGT components: tranexamic acid solution 100 mg/kg (0.8 ml), native plasma (2 ml) and platelet rich plasma (2 ml). The rate of introduction of the mixture is 0.5 ml/min. The general and biochemical blood tests, coagulogram, parameters of low-frequency piezothromboelastography and piezoaggregatometry were studied.
Results. PGT suppresses hyperfibrinolysis at the 10th (p=0.012), 30th minute (p=0.032) after reaching the maximum thrombus density, stabilizes the levels of: protein C (p=0.14), antithrombin-III (p=1), constants of anticoagulant activity (p=0.29), fibrinogen (p=0.1), coagulation drive intensity (p=0.25), thrombin activity (p=0.65), platelet count (p=0.38), their retractions (p=1) and aggregations (p=0.058), APTT (p=0.29), despite the progression of multiple organ failure and traumatic shock (need for infusion, increase in lactate (p=0.00000036) up to the 140th minute). The effects of PGT on coagulopathy when injected into the portal vein and into the femoral vein do not differ (p=0.7). The hepatoprotective effect of PGT was found: the levels of AST (p=0.58) and ALT (p=1), bilirubin (p=1), total protein are stable (p=1), with increasing renal failure: creatinine (p=0.0042 ) and urea (p=0.049).
Conclusion. PGT, including a solution of tranexamic acid, native plasma and platelet-rich plasma, suppresses coagulopathy after severe closed liver injury in the experiment, both with the introduction of components into the femoral vein and into the portal vein, and has a hepatoprotective effect

Keywords: liver trauma, blood plasma, Wistar rats, coagulopathy, low-frequency piezothromboelastography, low-frequency piezoaggregatometry
p. 98-116 of the original issue
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Address for correspondence:
644074, Russian Federation,
Omsk, Komarova avenue, 17/3, 96, City Clinical Emergency Hospital No1,
tel.: +7-913-151-39-89,
e-mail: kinzerskij@mail.ru,
Kinzersky Alexander A.
Information about the authors:
Kinzersky A.A., Surgeon of the Surgical Department of the City Clinical Emergency Hospital No. 1, Assistant of the Department of Hospital Surgery named after A.I. N.S. Makokhi Federal State Budgetary Institution of Higher Education “Omsk State Medical University” of the Ministry of Health of Russia of the Russian Federation.
http://orcid.org/0000-0001-5749-1873
Korzhuk M.S., MD, Professor, Lecturer at the Department of Naval Surgery, Federal State Budgetary Educational Institution of Higher Education “Military Medical Academy named after A.I. CM. Kirov” of the Ministry of Defense of the Russian Federation, Researcher of the Scientific Laboratory of cancer Chemoprevention and Oncopharmacology of the Federal State Budgetary Institution “N.N. N.N. Petrov” of the Ministry of Health of Russia of the Russian Federation. Omsk, Russian Federation.
http://orcid.org/0000-0002-4579-2027
Dolgikh V.T., MD, Professor, Honored Scientist of the Russian Federation, Chief Researcher of the Research Institute of General Resuscitation named after V.I. V.A. Negovsky FGBNU “Federal Scientific and Clinical Center for Resuscitation and Rehabilitology”.
http://orcid.org/0000-0001-9034-4912
Solovieva T.S., Pathologist of the Federal State Budgetary Institution of Health “St. Petersburg Clinical Hospital of the Russian Academy of Sciences”.
http://orcid.org/0009-0005-2672-276X
Eselevich R.N., PhD, Major of the Medical Service, Head of the Oncology Department of the Clinic of the Department of Naval Surgery CM. Kirov” Ministry of Defense of the Russian Federation.
http://orcid.org/0000-0003-3249-233X
Balura O.V., PhD, Major of the Medical Service, Senior Lecturer of the Department of Naval Surgery CM. Kirov” Ministry of Defense of the Russian Federation.
http://orcid.org/0000-0001-7826-8056
Kotov I.I., MD, Associate Professor, Professor of the Department of Hospital Surgery. N.S. Makokhi Federal State Budgetary Institution of Higher Education “Omsk State Medical University” of the Ministry of Health of Russia of the Russian Federation, Omsk, Russian Federation.
http://orcid.org/0000-0002-9712-2391
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