Clinical Dopplerographic Correlates of a Continuous Long-Term Ethylmethylhydroxypyridine Succinate Infusion in Acute Concomitant Traumatic Brain Injury

The aim of the investigation was to assess the efficiency of a long-term ethylmethylhydroxypyridine succinate (EMHPS) infusion in patients with severe concomitant traumatic brain injury (TBI) by the dynamics of cerebral macrocirculation, consciousness level and state severity index.

Materials and Methods. We examined two groups of patients, 25 patients in each group, with severe concomitant TBI. The 1^st group (control) patients underwent standard intensive therapy. The 2^nd group patients, in addition to standard treatment, had EMHPS infusion in a dose 100 mg/h through an infusion pump for 10 days. Using transcranial dopplerography we studied linear blood flow rate (LBFR): systolic blood velocity, diastolic blood velocity, mean blood velocity, pulsation index and resistance index, and assessed the consciousness level dynamics using Glasgow coma scale and the severity of patients' state according to APACHE II.

Results. In the 1^st group patients LBFR normalized in 24, 32, 48 and 72% cases on day 3, 5 7 and 10, respectively, while in the 2^nd group patients, LBFR values normalized in 48, 60, 64 and 80% cases within the same period. When using EMHPS, the quicker consciousness recovery was reported: in 60 and 24% patients, respectively, in groups 2 and 1 by day 5; in 80 and 60% patients by day 10. In the 2^nd group patients by day 10 the severity index values according to APACHE II were 2 times less than in group 1.

Conclusion. Long-term (within 10 days) EMHPS infusion in a dose of 100 mg/h in patients with severe TBI contributes to more rapid normalization of LBFR parameters, consciousness recovery and the decrease of severity according to APACHE II.

1. 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. Rossiyskie meditsinskie vesti 2010; 15(3): 92–96.
2. Langlois J.A., Rutland-Brown W., Wald M.M. The epidemiology and impact of traumatic brain injury: a brief owerwiew. J Head Trauma Rehabil 2006; 21(5): 375–378, https://doi.org/10.1097/00001199-200609000-00001.
3. Midori I.M., Bersnev V.P., Ryabukha N.P. Syndrome of brain compression in cranio-cerebral trauma. Vestnik khirurgii im. I.I. Grekova 2012; 171(6): 66–68.
4. Moroz V.V., Karmen N.B., Mayevsky E.I. Mechanisms of secondary neuronal damage in severe brain injury (part 2). Obshchaya reanimatologiya 2011; 7(5): 44–47.
5. Shmakov A.N., Danchenko S.V. The study of “a golden hour” in severe traumatic brain injury. Meditsinskiy alfavit 2011; 1(3): 38–40.
6. Talypov A.E., Petrikov S.S., Puras Yu.V., Solodov A.A., Titova Yu.V. Current treatments for brain contusions. Nevrologiya, neyropsikhiatriya, psikho­somatika 2011; 1: 8–15.
7. Marklund N., Bakshi A., Castelbuono D., Conte V., McIntosh T. Evaluation of pharmacological treatment strategies in traumatic brain injury. Curr Pharm Des 2006; 12(13): 1645–1680, https://doi.org/10.2174/138161206776843340.
8. Maas A.I. Neuroprotective agents in traumatic brain injury. Expert Opin Investig Drugs 2001; 10(4): 753–767, https://doi.org/10 .1517/13543784.10.4.753.
9. Faden A.I. Neuroprotection and traumatic brain injury: theoretical option or realistic proposition. Curr Opin Neurol 2002; 15(6): 707–712, https://doi.org/10.1097/00019052-200212000-00008.
10. Shokin М.N., Vlasov A.P., Khovryakov A.V. Clinical laboratory effect of mexidol at craniocerebral injury. Vestnik novykh meditsinskikh tekhnologiy. Elektronnoe izdanie 2011; 1. URL: http://medtsu.tula.ru/VNMT/Bulletin/E2011-1/3529.pdf.
11. Golubev S.S., Khovryakov A.V. The change of biochemical hypoxic indices in cerebrospinal fluid in traumatic brain injury in survived patients against the background of standard therapy and against the background of therapy with Citicoline and Mexidol. Molodoy uchenyy 2013; 6: 755–757.
12. Sernov L.N., Smirnov L.D., Shaposhnikova G.I., Guranova N.N. Clinical experimental study of anti-ischemic and hypolipidemic activity of Mexicor. Klinicheskie issledovaniya lekarstvennykh sredstv v Rossii 2004; 1: 24–28.
13. Aaslid R., Markwalder T.-M., Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 1982; 57(6): 769–774, https://doi.org/10.3171/jns.1982.57.6.0769.
14. Gaydar B.V., Semernya V.M., Vaynshteyn G.B. Concerning the interaction of blood flow level and reactivity of cerebral vessels with functional condition of cerebral tissue. Fiziologicheskiy zhurnal SSSR im. I.M. Sechenova 1986; 72(5): 603–611.
15. Gubler E.V., Genkin A.A. Primenenie neparametricheskikh kriteriev statistiki v mediko-biologicheskikh issledovaniyakh [The use of nonparametric statistic criteria in biomedical studies]. Leningrad: Meditsina; 1973; 144 p.
16. Lakina G.F. Biometriya [Biometrics]. Moscow: Vysshaya shkola; 1990; 352 p.

Abramova Е.А., Trofimov А.О., Boyarinov G.А., Voennov О.V. Clinical Dopplerographic Correlates of a Continuous Long-Term Ethylmethylhydroxypyridine Succinate Infusion in Acute Concomitant Traumatic Brain Injury. Sovremennye tehnologii v medicine 2016; 8(4): 92, https://doi.org/10.17691/stm2016.8.4.12