Year 2014 Vol. 22 No 6

SCIENTIFIC PUBLICATIONS
EXPERIMENTAL SURGERY

A.P. TRUKHAN

THE ASSESSMENT OF EFFICIENCY OF TOURNIQUET APPLICATION AS AN ELEMENT OF FIRST AID IN CRUSH SYNDROME. REPORT 2: SOME MORPHOLOGICAL CHANGES

EE "Belarusian State Medical University"
The Republic of Belarus

Objectives. To assess the effectiveness of tourniquet application as a component of the first aid in crush syndrome on the basis of morphological changes in the tissues.
Methods. The work is based on the experimental modeling of crush syndrome of moderate severity in rabbits by the method developed by the author (compression 25 kg/cm2 on the area of 6 cm2 on the pelvic limb within 5 hours). In the main group, in contrast to the comparison group, after the elimination of compression a tourniquet was applied for 1,5 hours on the injured limb. To assess the influence of tourniquet application on local and system changes on the third day after the elimination of compression, corresponded to the end of the early postcompression period, the samples of tissues (muscles of the damaged limb, kidneys, and lungs) for morphological examination have been taken. The results were evaluated using specially developed indices of morphological changes.
Results. It has been established the tourniquet application as an element of the first aid in the crush syndrome leads to more severe muscular destructive changes of an affected limb (p=0,0357). This is due to the prolongation of the ischemic time of limbs, and additional traumatic effect of tourniquet application on tissues. Furthermore the tourniquet application leads to more significant kidney (p=0,0104) and lung (p=0,0341) damage, associated with greater severity of traumatic shock, as well as more severe syndrome of reperfusion-recirculation (the gradual entering of a large number of products of muscular destruction and changed by hypoxia metabolism, inflammatory mediators to the systemic circulation).
Conclusion. The application of the tourniquet as part of the first aid for crush syndrome leads to more expressed local and visceral morphological changes.

Keywords: crush syndrome treatment, tourniquet, morphological changes, experimental surgery
p. 649-653 of the original issue
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Address for correspondence:
220034, Respublika Belarus,
g. Minsk, ul. Azgura, d. 4,
Voenno-meditsinskiy fakultet v
UO Belorusskiy gosudarstvennyiy meditsinskiy universitet,
kafedra voenno-polevoy khirurgii,
tel. mob.: 8-044-7331058, aleksdoc@yandex.ru,
Trukhan Aleksey Petrovich
Information about the authors:
Trukhan A.P. PhD, an associate professor of the military field surgery chair of the military medical faculty of EE "Belarusian State Medical University", lieutenant colonel of medical service.
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