rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2014-5-18-26rmt-1417Research ArticleТРАВМА. КРОВОПОТЕРЯINJURY. BLOOD LOSSДИНАМИКА ЛИПОПОЛИСАХАРИДСВЯЗЫВАЮЩЕГО ПРОТЕИНА И ЛАКТАТА В КРОВИ ПАЦИЕНТОВ С ПОЛИТРАВМОЙTime Course of Changes in LipopolysaccharideBinding Protein and Lactate in the Blood of Patients with PolytraumaУстьянцеваИ. М.UstyantsevaI. M.

652509, Кемеровская область, г. ЛенинскКузнецкий, 7й Микрорайон, д. 9, Россия

9, Seventh Microdistrict, LeninskKuznetsky, Kemerovo Region 652509, Russia

irmaust@gnkc.kuzbass.netХохловаО. И.KhokhlovaO. I.

652509, Кемеровская область, г. ЛенинскКузнецкий, 7й Микрорайон, д. 9, Россия

9, Seventh Microdistrict, LeninskKuznetsky, Kemerovo Region 652509, Russia

ПетуховаО. В.PetukhovaO. V.

652509, Кемеровская область, г. ЛенинскКузнецкий, 7й Микрорайон, д. 9, Россия

9, Seventh Microdistrict, LeninskKuznetsky, Kemerovo Region 652509, Russia

ЖевлаковаЮ. А.ZhevlakovaYu. A.

652509, Кемеровская область, г. ЛенинскКузнецкий, 7й Микрорайон, д. 9, Россия

9, Seventh Microdistrict, LeninskKuznetsky, Kemerovo Region 652509, Russia

Научно-клинический центр охраны здоровья шахтеров, ЛенинскКузнецкий, РоссияРоссияResearch and Clinical Center for Miners' Health Care, LeninskKuznetsky, RussiaRussian Federation2014211020141051826Copyright © Устьянцева И.М., Хохлова О.И., Петухова О.В., Жевлакова Ю.А., 20142014Устьянцева И.М., Хохлова О.И., Петухова О.В., Жевлакова Ю.А.Ustyantseva I.M., Khokhlova O.I., Petukhova O.V., Zhevlakova Y.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/1417

Цель исследования — оценить клиническую и прогностическую значимость уровней липополисахаридсвязывающего протеина (ЛПССП) и лактата в крови пациентов с политравмой в критическом состоянии.

Материал и методы

Материал и методы. Проведен анализ результатов обследования пострадавших с политравмой в критическом состоянии, которые ретроспективно были классифицированы в соответствии с критериями ACCP/SCCM (1992 г.): SIRS (n=18), локальная инфекция (n=36), сепсис (n=27), тяжелый сепсис (n=12) и септический шок (n=6). Случай считали инфекцией при установлении источника инфекции и его микробиологическом подтверждении. Содержание ЛПССП в сыворотке крови определяли на иммунохемилюминесцентном анализаторе «IMMULITE ONE» (США), лактата в цельной венозной крови — на анализаторе «Roche Omni S» (Германия).

Результаты

Результаты. У 81% пациентов с политравмой к 5—7 суткам отмечается развитие инфекционных осложнений; у 45% к 8—10 суткам диагностируется сепсис, тяжелое течение которого характеризуется присоединением полирезистентной грамотрицательной микрофлоры. Установлено раннее увеличение концентрации и частоты встречаемости диагностических уровней липополисахаридсвязывающего протеина (ЛПССП) в сыворотке крови у пациентов с политравмой до микробиологического подтверждения инфицирования. Показана сильная прямая корреляционная связь между уровнями лактата и ЛПССП.

Заключение

Заключение. Полученные данные свидетельствуют о диагностической и прогностической значимости ЛПССП и лактата и о возможности использования этих показателей в качестве ранних маркеров гнойносептических осложнений.

Objective

Objective: to estimate the clinical and prognostic value of the blood levels of lipopolysaharidebinding protein (LPSBP) and lactate in critically ill polytrauma patients.

Subjects and methods

Subjects and methods. An analysis was made of the results of an examination in critical ly ill polytrauma victims who were retrospectively classified in accordance with the 1992 ACCP/SCCM criteria: systemic inflammatory response syndrome (n=18), local infection (n=36), sepsis (n=27), severe sepsis (n=12), and septic shock (n=6). A case was regarded as infection when the source of the latter was established and it was microbiologically verified. The investigators determined serum LPSBP levels by an immunochemiluminescence analyzer (IMMULITE ONE, USA) and venous whole blood lactate concentrations by a Roche Omni S analyzer (Germany).

Results

Results. The development of infectious complications was notedin 81% of the polytrauma patients by days 5—7; by days 8—10, 45% were diagnosed as having sepsis whose severe course was characterized by the addition of polyresistant gramnegative microorganisms. An early increase in the concentration and frequency of diagnostic levels of serum LPSBP was ascertained in the polytrauma patients before infection was microbiologically verified. There was a strong direct correlation between lactate and LPSBP levels.

Conclusion

Conclusion. The findings suggest that LPS BP and lactate are of diagnostic and prognostic value and may be used as early markers of pyoseptic complications.

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The authors declare that there are no conflicts of interest present.