Cerebral Circulation and Metabolism of Patients with Cerebral Injury

The purpose of the study was to asses changes in cerebral macrocirculation and metabolism parameters in patients with concomitant cerebral injury during infusions of ethylmethylhydroxypyridine succinate at a dose of 12.5 to 100 mg/h depending on a source pattern of the cerebral blood flow.

Materials and methods. The study included 25 patients with severe concomitant cerebral injury who administered ethylmethylhydroxypyridine succinate (EMHPS) intravenously in addition to the standard therapy at a dose of 12.5 mg/h for 1 hour, then the dose was increased up to 25 mg/h within 1 hour, then up to 50 mg/h within 1 hour followed by an infusion at a dose of 100 mg/h for 1 hour. Cerebral macrocirculation parameters were analyzed every hour before each dose increase. Transcranial dopplerography (TDG) was used to assess the following linear blood flow velocity (LBFV) parameters: systolic (Vmax), diastolic (Vmin), medium (Vm) LBFV, pulsation index (PI) and resistance index (RI), as well as glucose and lactate levels, lactate dehydrogenase (LDH) activity and the pH level in venous blood from a jugular vein.

Results. Positive changes of LBFV parameters in the form of cerebral perfusion increase were recorded in patients with hindered perfusion and hypoperfusion patterns after EMHPS infusions at a dose of 12.5 to 100 mg/h. Patients with a mild vasospasm pattern presented favorable changes in LBFV parameters including a decrease in velocity parameters, normalization of the pulsation index and the resistance index which confirmed normalization of the vascular tone and vasospasm elimination. Positive changes in LBFV parameters in patients with a hyperperfusion pattern were noticed in the form of the reduction of hyperemia manifestations and normalization of the vascular tone. Patients with a severe vasospasm pattern presented normalization of the vascular tone. Normalization of LBFV parameters was accompanied by normalization of the lactate level, lactate dehydrogenase activity and the pH level in venous blood. Optimal values were found in infusions at a dose of 50—100 mg/h.

Conclusion. Infusions of EMHPS at a dose of 12.5—100 mg/h to patients with concomitant cerebral trauma resulted in normalization of LBFV and metabolism parameters in patients with all kinds of CBF patterns. 

1. Kondakov E.N., Krivetsky V.V. Craniocerebral injury. Sankt Peterburg: SpetsLit; 2002: 271. [In Russ.]

2. Potapov A.A., Konovalov A.N., Kornienko V.N., Kravchuk A.D., Likhterman L.B., Pronin I.N., Zakharova I.E., Gavrilova A.G., Okhlopkov V.A., Eoniyan S.A., Zaitsev O.S., Yakovlev S.B., Gorkov N.M., Oshorov A.B., Shukhrai 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.]

3. Midori I.M., Bersenev 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.]

4. Pervukhin S.A., Lebedeva M.N., Elistratov A.A., Palmash A.V., Statsenko I.A. Respiratory disorders in complicated cervical spine injury. Obshchaya Reanimatologiya = General Reanimatology. 2016; 12 (2): 30-42. DOI: 10.15360/1813-9779-2016-2-30-42. [In Russ., In Engl.]

5. Boyarinov G.A., Boyarinova L.V., Deryugina A.V., Solovyeva O.D., Zaytsev R.R., Voennov 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. DOI: 10.15360/1813-9779-2016-5-42-51. [In Russ., In Engl.]

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. [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): 18-22. DOI: 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. Marklund N., Bakshi A., Castelbuono D.J., Conte V., McIntosh T.K. Evolution of farmacological treatment strategies in traumatic brain injury. Curr. Pharm. Des. 2006; 12 (13): 1645-1680. PMID: 16729876

12. Skoromets A.A., Dyakonova M.M. Neuroprotection of acute and chronic cerebrovascular insufficiency. Sankt Peterburg: Nauka; 2007: 200. [In Russ.]

13. Suslina Z.A., Maksimova M.Yu., Fedorova T.N. Oxidative stress and the principal directions of neuroprotection in patients with stroke. Nevrologichesky Zhurnal. 2007; 12 (4): 3-7. [In Russ.]

14. 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. DOI: 10.3171/jns.1982.57.6.0769. PMID: 7143059

15. 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.]

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

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

18. Gnezdilova A.V., Lebedeva M.A., Ganshina T.S., Mirzoyan R.S. Effect of mexidol on combined vascular pathology of brain and heart. Eksperimentalnaya i Klinicheskaya Farmakologiya. 2011; 74 (6): 20-23. PMID: 21870770. [In Russ.]

19. Verizhnikova E.V., Sholomov I.I., Doroshenko L.M. The use of «Mexidol» in the intensive care of patients with multiorgan insufficiency. Byulleten Eksperimentalnoi Biologii i Meditsiny. 2006; Suppl 1: 104. [In Russ.]