The Effect of Ethylmethylhydroxypyridine Succinate on the Dynamics of Cerebral Blood Flow Patterns in Patients with Acute Concomitant Traumatic Brain Injury

The purpose of the investigation was to study the effect of the ethylmethylhydroxypyridine succinate (EMHPS) infusion on the dynamics of cerebral blood flow patterns in patients during the acute phase of severe concomitant traumatic brain injury. Materials and methods. The study involved two groups of patients, each of 25 persons aged 41.5 (29; 51) years on average, with a severe concomitant traumatic brain injury. The patients of the 1^st (control) group were cured with a standard intensive care while in the 2^nd (study) group the EMHPS infusion was added to the said standard treatment in a dose of 100 mg per hour through an infusion pump within 10 days. By transcranial dopplerography (TDG) testing the following cerebral macrocirculation parameters (CMP) were studied: systolic blood flow velocity (V_max), diastolic blood flow velocity (Vmin), pulsation index (PI) and resistance index (RI). Results. The most frequent type of the cerebral blood flow (CBF) disorder noted in the both groups during the initial examination was a hindered perfusion pattern noticed in 15 and 16 patients from 1st and 2^nd groups, respectively. Mild vasospasm was recorded in four patients in the 1st group and in three cases in the 2^nd group. Signs of gross vasospasm were noted in two patients from each group. In two patients of each group patterns of hypoperfusion and hyperperfusion were noted. In the patients of the 1^st group the CMP normalization was observed in six cases on the third day, in eight cases on the fifth day, in 12 cases on the seventh day, in 18 cases on the 10th day, while in the patients of the 2nd group the CMP normalization was observed on the 3^rd day in 12 cases, on the 5^th day in 15 cases, on the 7^th day in 16 cases and on the 10^th day in 20 cases. Conclusion. The most common patterns identified during the initial examination included hindered perfusion and vasospasm, which were transformed into a normoperfusion pattern through the hyperperfusion stage (reactive hyperemia). The EMHPS infusion in a dose of 100 mg per hour usually aids to normalize parameters within 3—5 days.

1. Sergeev A.V., Stepanov S.S., Akulinin V.A., Mytsik A.V. Natural defense mechanisms of the human brain against chronic ischemia. Obshchaya Reanimatologiya = General Reanimatology. 2015; 11 (1): 22–32. http://dx.doi.org/10.15360/1813-9779-2015-1-22-32. [In Russ., In Engl.]

2. Boyarinov G.A., Boyarinova L.V., Deryugina A.V., Solov’eva O.D., Zaytsev R.R., Voyennov O.V., Moshnina E.V., Shumilova A.V. Role of secondary brain damage factors in activation of vascular platelet hemostasis in traumatic brain injury. Obshchaya Reanimatologiya = General Reanimatology. 2016; 12 (5): 42–51. http://dx.doi.org/10.15360/1813-9779-2016-5-42-51. [In Russ., In Engl.]

3. Potapov A.A., Konovalov A.N., Korniyenko V.N., Kravchuk A.D., Likhterman L.B., Pronin I.N., Zakharova N.Ye., Gavrilov A.G., Okhlopkov V.A., Yeolchiyan S.A., Zaytsev O.S., Yakovlev S.B., Gorkov K.M., Oshorov A.V., Shurkhay V.A. The target scientific and technical program — strategic way of solution of social and medical problems related to craniocerebral trauma. Rossiiskie Meditsinskie Vesti. 2010; 15 (3): 92–96. [In Russ.]

4. Midori I.M., Bersnev V.P., Ryabukha N.P. Syndrome of brain compression in cranio-cerebral trauma. Vestnik Khirurgii Imeni I.I.Grekova. 2012; 171 (6): 66–68. PMID: 23488267. [In Russ.]

5. Ryabov G.A. Syndromes of critical states. Moscow: Meditsina Publishers; 1994: 386. [In Russ.]

6. Moroz V.V., Churlyaev Yu.A. Secondary brain damage in severe traumatic brain injury. Moscow; 2006: 403. [In Russ.]

7. Shmakov A.N., Danchenko S.V. Investigation into 'golden hour' in severe craniocerebral injury. Meditsinsky Alfavit. 2011; 1 (3): 38–40. [In Russ.]

8. Talypov A.E., Petrikov S.S., Puras Yu.V., Solodov A.A., Titova Yu.V. Current treatments for brain contusions. Nevrologiya, Neiropsikhiatriya, Psikhosomatika. 2011; 1: 8–15. https://doi.org/10. 14412/2074-2711- 2011-127. [In Russ.]

9. Kosovskikh A.A., Churlyaev Yu.A., Kan S.L., Lyzlov A.N., Kirsanov T.V., Vartanyan A.R. Central hemodynamics and microcirculation in critical conditions. Obshchaya Reanimatologiya = General Reanimatology. 2013; 9 (1): 18. http://dx.doi.org/10.15360/1813-9779-2013-1-18. [In Russ., In Engl.]

10. Odinak M.M., Voznyuk I.A., Yanishchevsky S.N. Ischemia of the brain. Neuroprotective therapy. Differentiated approach. Sankt-Peterburg: VMA; 2002: 77. [In Russ.]

11. Glazman L.Yu., Potapov A.A., Tomas D. Hemispheric cerebral blood flow in various types of brain injuries. Voprosy Neirokhirurgii Imeni N.N.Burdenko. 1988; 4: 39–43. PMID: 3218429. [In Russ.]

12. Gaidar B.V., Semernya V.M., Vainshtein G.B. Relation of the level of blood flow and reactivity of cerebral vessels to the functional state of brain tissue. Fiziologichesky Zhurnal SSSR Imeni I.M.Sechenova. 1986; 72 (5): 603–611. PMID: 3721004. [In Russ.]

13. Aaslid R., Markwalder T.M., Nornes H. Noninvasive transcranial Doppler ultarasound recoding of flow velosities in basal cerebral arteries. J. Neurosurg. 1982; 57 (6): 769–774. http://dx.doi.org/10.3171/ jns.1982.57.6.0769. PMID: 7143059

14. Okovityi S.V. Clinical pharmacology of antioxidants. FARMindeks Praktik. 2003; 5: 85–111. [In Russ.]

15. Skoromets A.A., Dyakonova M.M. Neuroprotection of acute and chron" ic cerebrovascular insufficiency. Sankt"Peterburg: Nauka; 2007: 200. [In Russ.]

16. Suslina Z.A., Maksimova M.Yu., Fedorova T.N. Oxidative stress and the main directions of neuroprotection in cerebral circulatory disorders. Nevrologichesky Zhurnal. 2007; 12 (4): 3–7. [In Russ.]

17. Marklund N., Bakshi A., Castelbuono D.J., Conte V., McIntosh T.K. Evaluation of farmacological treatment strategies in traumatic brain injury. Curr. Pharm. Des. 2006; 12 (13): 1645–1680. http://dx.doi.org/ 10.2174/138161206776843340. PMID: 16729876

18. Shimko P.D., Vlasov M.P. Statistics. Moscow: Feniks; 2003: 448. [In Russ.]

19. Lakina G.F. Biometrics. Moscow: Vysshaya Shkola; 1990: 352. [In Russ.]