Изменения иммуно-биохимического статуса у критических больных с геморрагическим инсультом при проведении интенсивной терапии

Abstract

статті представлені результати клінічного, неврологічного і імуно-біохімічного обстеження 16-ти критичних хворих з геморагічним інсультом. Встановлено, що зменшення рівня нейронспецифічної енолази характеризує ефективність інтенсивної терапії, за умови зупиненої внутрішньомозкової кровотечі, у хворих з геморагічним інсультом на тлі неврологічного дефіциту, який зберігається. Abstract. In the structure of a cerebral stroke hemorrhagic stroke is the most destructive type of stroke leading to death and severe disability of patients. Mortality due to hemorrhagic stroke varies from 25% in persons who do not need artificial ventilation of lungs to 70-80% in persons who are on artificial ventilation. For the prediction of the disease development it is very important to determine the size of the hematoma in the acute period. However, the severity of the neurological deficit does not always correspond to the size of the outbreak. The use of visualized head techniques, for a variety of reasons, is not always available for patients with hemorrhagic stroke. One of the methods that allow us to assess quickly the extent of damage to the brain tissue is the study of neuron-specific enolase (NSE). Materials and methods. A retrospective, nonrandomized study of 16 critical patients with hemorrhagic stroke (mean age 67,5 ± 2,4 years) was conducted. 7 male patients (43,75 %) of average age 69,9 ± 2,8 years and 9 female (56,25 %) – the average age is 69,1 ± 2.8 years were examined. With intensive care four patients died before 3 days after their hospitalization (3 men and 1 woman). The diagnosis was established in accordance with the existing criteria for clinical-neurological examination and computer tomography. The severity of hemorrhagic stroke was assessed according to the National Institutes of Health Stroke Scale (NIHSS) scale. The level of NSE was determined by an enzyme immunoassay using the CanAg NSE EIA reagent kit (Sweden). Results. The severity of hemorrhagic stroke, assessed by the severity of the neurological deficit, according to the NIHSS scale, corresponded to severe cerebral stroke at all stages of the study: day 1 – 15,7 ± 1.1 points; day 2 – 15,6 ± 1.2 points; day 3 – 16,4 ± 0.5 points. At the same time, on the third day of patients' stay in the hospital, the severity of the neurological deficit was exacerbated, which was explained by the final formation of the focus and the stabilization of the dislocation of the brain during intensive therapy. Concentration of NSE, at all stages of the study was below the norm, but exceeded the level of the values of the control group by almost 2 times. This is due to the fact that in the group of patients with hemorrhagic stroke, there was no further development of the dislocation syndrome followed by cerebral ischemia, which did not require neurosurgical correction. However, due to the intensive therapy, there was a decrease in the concentration of NSE, which indicates the leveling of the dislocation of the brain and the stabilization of the hematoma foci. Conclusions. Intensive therapy (IT) in patients with hemorrhagic stroke (HS) can be considered effective if the NSE level is marked down against the background of the continuing neurological deficiency on the NIHSS scale, under the condition of confirmed stopped intracerebral hemorrhage. Determining the level of NSE is one of the main methods that allow an objective assessment of the extent of brain tissue damage in patients with HS, in a complex of standard diagnostic measures. During the implementation of diagnostic measures and IT, mortality in patients with hemorrhagic stroke was 25%.