ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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JMBS 2018, 3(2): 60–65
https://doi.org/10.26693/jmbs03.02.060
Clinical Medicine

Influence of Various Postoperative Analgesia Regimens on the Level of Markers of the Systemic Inflammatory Response and System of Regulating the Aggregate State of Blood in Geriatric Patients with Polytrauma

Dolzhenko M. O.
Abstract

The aim of the study was to compare the effect of various postoperative analgesia regimens on the level of the markers of the systemic inflammatory response and the system parameters of regulating the blood aggregate state in geriatric patients with polytrauma. Materials and methods. All patients were divided into 3 groups. In group 1, they received morphine 10 mg, in the 2nd group – nalbuphine 10 mg, in the 3rd group – combination of the central inhibitor cyclooxygenase infulgan with rheumoxicam. The study was conducted on the 1st, 3rd, 5th and 7th days after surgery. The concentration of mediators of systemic inflammatory response and indicators of the system of regulating the blood aggregate state was studied. Results and discussion. In group 3, with the cyclooxygenase inhibitor therapy, the interleukins level was significantly lower than in the groups of patients receiving opioids (p<0.02). On the 1st day after the operation, the endothelin - 1 level significantly decreased in patients of group 3, whereas there were no significant changes in its concentration (when group 3 was compared with groups 1 and 2 p<0.015) in groups 1 and 2. Only on the 5th day the tendency for hypercoagulability in groups 1 and 2 began to decrease. It was fixed in group 2 to a greater extent, so that there were no statistically significant differences observed between groups 2 and 3, whereas between groups 1 and 3 they were stored. We also checked the level of markers of the systemic inflammatory response in the postoperative period in geriatric patients with polytrauma in the application of the studied anesthetic regimens. Concentration of interleukins on the 1st day after operation was naturally elevated in patients of the 1st and the 2nd groups without any significant differences between them. In group 3, with the cyclooxygenase inhibitor therapy, IL levels were already significantly lower than in opiate groups (p<0.02). Conclusions. The revealed correlation dependences illustrate the etiological significance of the severity of the inflammatory response reactions in the development of the pain syndrome and confirm the expediency of suppressing these reactions during its treatment.

Keywords: analgesia, geriatric patients, polytrauma, systemic inflammatory response, system of regulating the aggregate state of the blood

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References
  1. Chekman IS. Maksymchuk OO, Horchakova IO. Pokhidni yantarnoyi kysloty yak likars'ki zasoby: herontolohichnyy aspekt. Ratsional'na farmakoterapiya v heriatriyi: materialy nauk-prakt konf. 13 zhovtnya, 2009. K, 2009. p 65. [Ukrainian]
  2. Chepkiy LP, Usenko LV. Heriatrychna anesteziolohiya ta reanimatsiya. K: Zdorov’ya, 1994. 256 р. [Ukrainian]
  3. Volikov. I.A. Sravnitelnaya otsenka razlichnykh variantov uprezhdayushchey analgezii pri operatsiyakh u gerontologicheskikh bolnykh. Bіl znebolyuvannya і іntensivna terapіya. 2008; 1: 48-53. [Russian]
  4. Viktorov AP, Maltsev VI, Matveyeva EV, Logvina IA. Pobochnyye deystviya lekarstv v pozhilom i starcheskom vozraste. Ratsionalnaya farmakoterapiya. 2007; 3 (04): 42-55. [Russian]
  5. Chepkiy LP, Usenko LV. Heriatrychna anesteziolohiya ta reanimatsiya. K: Zdorov’ya, 1994. 256 р. [Ukrainian]
  6. Korkushko OV, Lishnevskaya VYu, Duzhak GV, Pisaruk AV, Asanov EO, Chebotarev ND, Chizhova VP. Vozrastnyye izmeneniya reologicheskikh svoystv krovi i funktsionalnogo sostoyaniya endoteliya pod vliyaniyem normobaricheskoy gipoksii. Zhurn AMN Ukraїni. 2009; 15 (3): 488-99. [Russian]
  7. Korkushko OV. Vozrastnyye izmeneniya serdechno-sosudistoy sistemy pri starenii: materіali Kh Nats. kongresu kardіologіv Ukraїni (Kiїv. 23-25 veresnya. 2009). Ukr kardіol zhurnal. 2009; 1: 233-7. [Russian]
  8. Puntmann VO. Taylor PC, Mayr M. Coupling Vascular and Myocardial Inflammatory Injury into a Common Phenotype of Cardiovascular Dysfunction: Systemic Inflammation and Aging – A Mini-Review. Gerontology. 2011; 57 (4): 295-303. https://www.ncbi.nlm.nih.gov/pubmed/20551624. https://doi.org/10.1159/000316577
  9. Camici GG, Shi Y, Cosentino F, Francia P, Lüscher TF. Anti-Aging Medicine: Molecular Basis for Endothelial Cell-Targeted Strategies – A Mini-Review. Gerontology. 2011; 57 (2): 101-8. https://www.ncbi.nlm.nih.gov/pubmed/20431281. https://doi.org/10.1159/000314227
  10. Zara S, Rapino M, Centurione L, di Giacomo V, Petruccelli G, Cataldi A. Apoptotic Pathway in Hypoxic and Aged Rat Hearts. Gerontology. 2010; 56 (6): 544-52. https://www.ncbi.nlm.nih.gov/pubmed/20299780. https://doi.org/10.1159/000299105
  11. Weskler ME. Handbook on Immunosenescence: Basic Understanding and Clinical Applications. Gerontology. 2010; 56 (3): 359-60. https://doi.org/10.1159/000295788
  12. Christy RM, Baskurt OK, Gass GC, Gray AB, Marshall-Gradisnik SM. Erythrocyte Aggregation and Neutrophil Function in an Aging Population. Gerontology. 2010; 56 (2): 175-80. https://www.ncbi.nlm.nih.gov/pubmed/19776557. https://doi.org/10.1159/000242461