Determination of optimal transfusion therapy for early surgical treatment of burns

Objective. To determine the optimal programme for the use of infusion solutions for the early surgical treatment of dermal superficial and deep burns. Materials and methods. The strategy of transfusion therapy is based on the concept of ROSE (Resuscitation, Optimisation, Stabilisation, Evacuation). To study the effect of a protease inhibitor in complex treatment, 12 patients of the main group and 22 patients of the control group were examined. The content of calpains, α1 – protease inhibitor, α2 – macroglobulin, tumour necrosis factor–α and interleukin–6 in peripheral blood was determined on the 2nd – 3rd and 7th – 8th day after the burn. Results. The determined content of calpains, α1 –inhibitor, α2 –macroglobulin and proinflammatory cytokines in the peripheral blood on the 2nd – 3rd day after the burn was high. The use of ulinastatin in the main group reduced the level of calpains by 1.16 times compared to the control group on day 7–8, the levels of α1 –protease inhibitor and α2 –macroglobulin remained at baseline, the level of tumour necrosis factor–α was 1.15 times lower and interleukin–6 was 1.6 times lower than the corresponding values in the control group. In the main group, the average period of early closure of burn wounds with autodermografts decreased by 3.36 days, the period of complete final wound closure – to (22.1 ± 6.92) days, which was 1.57 times less than in the control group. Conclusions. The optimal programme for the use of infusion solutions for the early surgical treatment of burns in accordance with the ROSE concept and the use of a protease inhibitor was determined. This made it possible to regulate excessive systemic inflammation by preventing an increase in the levels of interleukin–6 and tumour necrosis factor–α and to improve the balance of the proteolytic–antiproteolytic system, which in combination contributed to optimising the development of the wound process, allowing earlier performance of the first autodermoplasty and reducing the time for complete final closure of wound surfaces by 1.57 times.