抗氧化剂和高压氧对严重热损伤的影响:一项前瞻性研究

K. Belyaeva, N.V. Didenko, V. I. Zagrekov, A. S. Pushkin, Alexander A. Yeremenko, A. Soloveva
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摘要

简介:严重热损伤(STI)的特点之一是缺氧和氧化应激(OS)。严重热损伤(STI)的特点包括缺氧和氧化应激(OS)。有人提出通过使用抗氧化剂来维持抗氧化系统的可能性,但其有效性和持续时间是值得商榷的问题。另一方面,通过高压氧治疗(HBO)纠正 STI 时的氧化应激反应理论上是可行的,但需要评估其收益风险比。研究目的研究抗氧化剂和高压氧治疗对严重热损伤时氧化应激过程的影响。材料和方法:本研究涉及条件健康者(n = 25)和 STI 患者(n = 31),随机分为 3 组:标准方法(n = 11)、补充抗氧化剂(14 天内每天注射 250 克维生素 C、1.494 克 "Cernevit "和 10 毫升 "Addamel N",n = 11)或高压氧疗程(在 1.3 阿塔的 "低剂量 "压力舱 BLKS-30 和 BLKS-307/1 中进行 50-60 分钟的高压氧疗程,n = 9)。对血浆和红细胞的自由基氧化(FPO)和总抗氧化活性、丙二醛(MDA)浓度、超氧化物歧化酶(SOD)活性、过氧化氢酶和谷胱甘肽还原酶进行了评估。结果与讨论在使用抗氧化剂的第二天,发现 SOD 活性增加了 11 %(p 0.01),第 9 天 FROer 降低了 13 %(p = 0.012),第 6 天 MDAer 降低了 13 %(p = 0.036)。在 HBO 组中,SOD 活性在第一个疗程后增加了 9%(p = 0.038),谷胱甘肽还原酶活性在第 9 天增加了 15%(p = 0.028)。因此,可以预先限制使用抗氧化剂和 HBO 的潜在有利时期,这有助于达到最大的治疗效果。在这项研究中,尚未发现使用抗氧化剂或 HBO 造成的不良后果。结论。在 STI 中使用抗氧化剂有助于提高红细胞的抗氧化保护能力。使用 HBO 可改善细胞呼吸和抗氧化酶的活性,但不会导致 OS 的加深。抗氧化剂的最佳处方时间为治疗开始后的前 6-8 天,HBO 为 9-11 天。
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The Effects of Antioxidants and Hyperbaric Oxygenation at Severe Thermal Injury: a Prospective Study
INTRODUCTION. Severe thermal injury (STI) characterized, among others, by hypoxia and oxidative stress (OS). The possibility of maintaining the antioxidant system through the antioxidants usage is proposed, but their effectiveness and duration are debatable issues. On the other hand, correction of OS at STI is theoretically possible by hyperbaric oxygenation (HBO) sessions, but there is a need to assess the benefit-risk ratio. AIM. Investigate the effect of antioxidants and hyperbaric oxygenation sessions on the course of oxidative stress at severe thermal injury. MATERIALS AND METHODS. This study involved conditionally healthy individuals (n = 25), and patients with STI (n = 31), randomized into 3 groups: standard methods (n = 11), supplemented with antioxidants (daily injecting of 250 g vitamin C, 1.494 g “Cernevit” and 10 ml “Addamel N” during 14 days, n = 11) or HBO sessions (50–60 minutes in pressure chambers BLKS-30, BLKS-307/1 in the “low dose” at 1.3 Ata, n = 9). Plasma and erythrocytes were evaluated for free radical oxidation (FPO) and total antioxidant activity, malonic dialdehyde (MDA) concentration, activity of superoxide dismutase (SOD), catalase, and glutathione reductase. RESULTS AND DISCUSSION. At the antioxidant usage was found SOD activity increase by 11 % (p 0.01) on the second day, a decrease in FROer by 13 % (p = 0.012) on the 9th day, and MDAer by 13 % (p = 0.036) on the 6th day. In the HBO group, there was 9 % increase in SOD activity (p = 0.038) after the first session, an increase in glutathione reductase activity by 15 % (p = 0.028) by the 9th day. Thus, it is possible to pre-limit the period of potentially favorable use of antioxidants and HBO, which contributes to the maximum therapeutic effect. The negative consequences caused by the use of antioxidants or HBO have not been identified in this work. CONCLUSION. The antioxidant usage at STI contributes to the growth of the antioxidant protection of erythrocytes. The HBO usage leads to an improvement in cellular respiration and antioxidant enzymes activity and does not cause a deepening of OS. The optimal duration of prescribing antioxidants is the first 6–8 days, HBO — 9–11 days from the beginning of therapy.
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