FEATURES OF INTENSIVE CARE OF SPINAL CORD INJURY

Salkov M. M., Ovcharenko D. V., Tsarev O. V., Yovenko I. A., Dubina V. M.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

The work is based on observations of 200 patients with spinal injury aged 17 to 73 years, operated at different times after injury. For the purpose of the study, all patients with spinal injury were divided into 4 clinical groups depending on the timing of surgery: the first day (Group 2a), on 2 and 3 day (group 2b), 4-6 day (group 2c) and more than 6 days (group 1). Statistics show the highest mortality in group 2b, which is due to increase in complications such as pulmonary embolism and brainstem embolism. All patients underwent examination of the severity of their condition, functions of the cardiovascular system, respiratory system and visceral organs. Patients were examined by the related specialists (anesthesiologist, surgeon, traumatologist) for the purpose of the exclusion of combined pathology. The ASІА Neurological Impairment Scale proposed by the Amerіcan Spіnal Іnjury Assocіatіon (ASІА) has been taken as a basis for classification of patients with spinal cord injury. We conducted morphological examinations of the basilar artery and brainstem, which explain the mechanism of development of secondary spinal cord injuries and ischemic changes in the brainstem. It is our opinion that the primary endothelial injury of the vertebral artery, Lazorthes artery or anterior spinal artery is one of the leading mechanisms of formation of the vascular catastrophe, i.e. edema and ischemia of the brainstem and development of secondary stroke. According to Virchow’s triad, the extended thrombus formation occurs at the site of an endothelial injury. Ascending edema of the spinal cord shall be considered as the main cause of death of patients with cervical cord injury at an early stage without complications (thromboembolism of the pulmonary artery, infectious complications etc.). However, we conducted an examination of the basilar artery and brainstem, which demonstrated the presence of thromboembolic in the basilar artery and the development of ischemia in the brainstem, which caused the death of the patients. Microscopic studies – colouring all micro-slides with Ehrlich hematoxylin – eosin x7 was conducted. Conclusions. According to the study mortality prevailed in group 2b (2-3 days) 25%. Thrombosis and thromboembolism vertebral artery is the cause of ischemia in the brainstem. The key role of intensive care is a correction of cardiopulmonary dysfunction and venous thromboembolism.

spinal cord injury, secondary trauma of spinal cord, intensive care, ischemia, edema

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«Bulletin of problems biology and medicine» Issue 3 (145), 2018 year, 172-176 pages, index UDK 612-08-092.9:615.225

10.29254/2077-4214-2018-3-1-145-167-172