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DOI
10.34660/INF.2020.44.58.010
重度燒傷毒血症期間脈搏血壓的晝夜節律動態
DYNAMICS OF THE CIRCADIAN RHYTHM OF PULSE BLOOD
PRESSURE DURING TOXEMIA IN SEVERE BURNS
Muhitdinova Hura Nuritdinovna
Doctor of Medical Sciences, Full Professor
Tashkent Institute for Post-Graduate Medical Education
Hamdamov Abdumajid Sabitovich
Anesthesiologist-resuscitator
Republican Scientific Center for Emergency Medical Aid
Shorahmedov Shoakmal Shoanvarovich
Assistant
Tashkent Institute for Post-Graduate Medical Education
抽象。在第一天，PBP晝夜節律標誌與所有年齡組的標準指標均無差異。
在毒血症期間，PBP晝夜節律的中膜變化呈波狀發生，第1 – 9,6,5,5,6,6
組，第2 – 8,4組波動。第3天-5、4、4、5、6、5天。 PBP晝夜節律的每日變
化在較晚的日期普遍存在（第14組在第14天后，第2組-在第8天，在第3組-在
有毒血症的14天后），這表明導致血液動力學障礙的因素之一不夠有效的抗
炎，糾正血液動力學功能的療法。最活躍的代償性血流動力學反應顯示在40
歲以下。在燒傷疾病毒血症期的較晚日期（3-4週），發現超過61歲的患者出
現最不穩定的血液動力學趨勢。
關鍵詞：脈搏血壓的晝夜節律，毒血症時期，嚴重燒傷
Abstract.
On the first day, the PBP circadian rhythm mesors did not differ from
the normative indicators in all age groups. During the period of toxemia, changes
in the mesor of the circadian rhythm of PBP occurred in a wave-like manner with
a period of fluctuations in group 1 – 9,6,5,5,6 days, in group 2 – 8,4 days, in group
3 - 5,4,4,5,6,5 days. Daily changes in the PBP circadian rhythm prevailed at a
later date (in group 1 after 14 days, in group 2 - on day 8, in group 3 - after 14
days of toxemia), which suggests that one of the factors leading to hemodynamic
disturbances is insufficiently effective anti-inflammatory, correcting hemodynamic
function therapy. The most active compensatory hemodynamic reactions were
revealed at the age of up to 40 years. The most pronounced tendency to destabilize
hemodynamics was found in patients over 61 years of age at a later date (3-4
weeks) of the period of burn disease toxemia.
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Keywords: circadian rhythm of pulse blood pressure, period of toxemia, severe
burns
Relevance
Pulse blood pressure (PBP) should normally be between 30 and 50 mmHg.
With the standard BP 120/80, the normal PP is 40 mmHg [1]. Pulse pressure is
determined by the ratio of the value of the stroke volume to the reserve capacity
of the arterial system. Any changes in hemodynamics that affect these two factors
also affect the magnitude of the pulse pressure. With aortic stenosis, the opening
diameter with open aortic valves is significantly reduced compared to the norm.
The pulse pressure in the aorta also decreases, since there is a decrease in blood
flow through the stenotic valves. In case of non-closure of the arterial (botallova)
duct, about half of the stroke volume of blood, which should enter the aorta from
the left ventricle, immediately enters the pulmonary artery and the pulmonary vas-
cular system through the wide open duct. This is accompanied by a significant
drop in diastolic pressure before each subsequent heartbeat. With aortic valve in-
sufficiency, the aortic valves are absent or incompletely closed. Therefore, after
each heartbeat, the blood that has entered the aorta immediately returns to the left
ventricle. As a result, the aortic pressure drops to zero during diastole. Pathologies
leading to a decrease in heart systole cause a decrease in PBP, and this is an alarm-
ing symptom. The causes of decreased PBP are directly related to the condition
of the heart and kidneys and, as a rule, require immediate etiopathogenetically
justified correction [1-3]. However, there are no data in the literature on changes
in pulse blood pressure and its circadian rhythm in burn disease, which was the
reason for studying the features of changes in the circadian rhythm of pulse blood
pressure in severe burns in adults.
Purpose
Study the dynamics of the circadian rhythm of pulse blood pressure during
toxemia in severe burns.
Material and research methods
The results of monitoring the PBP indicator of 25 patients admitted to the
Department of Cambustiology of the Republican Scientific Center of Emergency
Medicine due to burn injury were studied. After recovery from shock, anti-inflam-
matory, antibacterial, infusion therapy, correction of protein and water-electrolyte
balance disorders, early surgical, delayed necrectomy, additional parenteral nutri-
tion, syndromic, symptomatic therapy were performed. The dynamics of PBP was
studied by monitoring the hourly continuous recording of the indicator in patients
with severe thermal burns in three age groups - group 1, 12 patients aged 20-40
years, group 2 - 7 patients aged 41-60 years, group 3, 6 patients - 61-78 years. The
division into groups was dictated by the well-known characteristics inherent in
each age group, described in detail in the literature.
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Table 1
Patient characteristics (25)
Age,
years
Height,
cm
Weight,
kg
Total
burn
area,%
Burn of
3B grade IF, units
Days in
the ICU
Group 1 27,3±5,6 174,9±5,7 73,0±22,2 59,4±13,5 21,3±13,3 119,4±38,4 22,4±14,6
Group 2 50,7±7,1 165,8±6,3 73,8±14,3 54,3±16,5 11,9±8,9 92,5±20,8 13,3±2,4
Group 3 71,3±7,0 165,3±8,4 73,3±8,9
40,8±5,8
21,7±6,7 86,7±12,8 18,8±9,5
As can be seen from Table 1, the age groups were significantly different and
averaged 27.3 ± 5.6 years in group 1, 50.7 ± 7.1 years in the second, and 71.3 ± 7.0
years in the third. The total area and area of deep skin burn lesions did not differ
significantly between the groups. The highest index of IF was revealed in group
1, which led to the longest intensive therapy in ICU conditions in the youngest
group 1. Thus, the most pronounced burns in terms of area and depth were found
in patients in group 1.
Results and discussion
Table 2
Dynamics of the mesor of the circadian rhythm of pulse pressure
Days
Group 1
Group 2
Group 3
1
45,0±1,9
49,6±2,5
47,4±3,1
2
45,4±1,7
47,5±1,6
48,6±2,7
3
48,0±1,9
46,7±1,6
54,1±3,0*
4
51,6±1,0**
49,4±2,3
53,2±2,1
5
51,6±1,1**
52,6±1,8
45,9±3,6*
6
52,9±2,0**
51,7±3,2
48,1±2,5
7
52,7±1,9**
53,5±2,4
52,5±1,7
8
53,4±2,0**
49,0±2,6
46,2±4,2
9
51,0±1,7**
50,9±1,5
46,9±3,5
10
51,6±1,5**
43,9±2,3
47,2±3,4
11
53,1±2,7**
50,1±3,3
53,5±3,1
12
52,1±1,6**
50,4±1,4
42,8±4,3*
13
50,5±2,1
51,1±3,6
14
56,5±3,4**
44,5±4,4*
15
49,9±2,9
43,3±4,8
16
55,0±2,5**
42,3±3,8*
17
55,9±2,6**
41,0±3,8*
18
55,3±3,5**
46,0±2,2*
19
56,9±1,7**
50,1±3,5
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20
53,8±1,8**
51,9±3,1
21
55,4±3,4**
47,5±2,7
22
61,5±2,5**
48,1±5,6*
23
54,1±2,8**
44,3±5,6
24
55,3±3,7**
47,0±5,7
25
53,0±1,6**
45,6±7,3
26
49,1±3,2
46,7±4,8
27
52,1±2,0**
41,1±5,6
28
52,9±2,5**
42,7±4,3*
29
54,1±2,6**
45,8±4,5
30
50,3±2,6
42,8±4,7
*- reliable relative to the indicator in group 1
**- reliable relative to the indicator on the first day
As can be seen from the data presented in Table 2, on the first day, the PBP cir-
cadian rhythm mesor did not differ from the normative indicators. Group 1 showed
a reliably significant increase in the mesor of the circadian rhythm PBP on days
4-12 of the toxemia period by 13-17% (p <0.05), remaining elevated throughout
the observation period up to a maximum increase on days 22 by 36% (p < 0.05)
relative to PBP on day 1 of toxemia. Attention was drawn to the relative stability
of the mesor of the circadian rhythm PBP in patients of group 2, which was most
likely due to a smaller burn area of grade 3B than in groups 1 and 3, 11.9 ± 8.9%.
Also, in group 3, the PBP mesor of the circadian rhythm did not differ from the
indicator on the first day during the period of toxemia. However, comparative
analysis made it possible to establish a reliably significant difference between the
results of patients in group 3 and those in patients in group 1. So, on the 3rd day,
the mesor of the circadian rhythm PBP of patients of group 3 was higher than in
group 1 by 12.5%, on the 5th day less by 14%, on the 12th day less by 17%, on the
14th day by 21%, by 16 -18 days by 22%, 22 days by 21%, remaining less than the
same indicator for 28 days less by 19% (table 2). Thus, despite the absence of a
significant difference from the normative data in patients over 61 years old, it was
revealed after a short-term increase in the PBP mesor on day 3 with a decrease in
the PBP mesor of the circadian rhythm on day 5 and with a tendency to progres-
sion in the third week and the entire subsequent period of the toxemia period. burn
disease. The revealed difference in the results of PBP monitoring in groups 1 and
3, apparently, is directly related to the state of the heart, respectively, required
etiopathogenetically justified correction.
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Dynamics of PBP mesor during toxemia depending on age
Fig.1
Changes in the mesor of the PBP circadian rhythm occurred in waves with
a period of fluctuations in the 1st group - 9,6,5,5,6 days, in the 2nd group – 8,4
days, in the 3rd group - 5,4,4,5,6,5 days. That is, in the process of adaptation, the
stress response of the PBP circadian rhythm was also expressed in a change in the
wavelength of PBP around-week fluctuations, fitting into the 4,5,9 days sinusoids
(fig. 1).
Changes in PBP in acrophase during toxemia
Fig.2
Also, the PBP parameters in acrophase (fig. 2) and bathiphase (fig. 3) changed
in waves.
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There was no synchronicity in fluctuations in the PBP values of the mesor with
those in the acrophase and bathiphase.
PBP dynamics in the bathyphase of the toxemia period
20,0
25,0
30,0
35,0
40,0
45,0
50,0
55,0
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29
PBP dynamics in the bathyphase of the toxemia period
1 группа
2 группа
3 группа
Fig.3
Correlation links of parameters of the circadian rhythm of pulse pressure during
toxemia
Fig.4
Thus, a reliably significant correlation was found between the parameters of
the mesor and the PBP value in the acrophase in groups 1 and 2 (table 3), between
the mesor and bathiphase in groups 1 and 3, while the correlation between the PBP
indicator in the acrophase and bathiphase was insignificant in all three groups of
patients (fig. 4).
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Table 3
Correlations between PBP circadian rhythm parameters during toxemia
Parameters
Group 1
Group 2
Group 3
mesor/acrophase
0,7715
0,8341
0,5900
mesor/bathiphase
0,7361
0,5147
0,8072
acrophase/bathiphase
0,2831
0,3173
0,2831
Changes in the mesor of the PBP circadian rhythm occurred in waves with
periods of fluctuations in group 1 – 9,6,5,5,6 days, in group 2 – 8,4 days, in group
3 – 5,4,4,5,6,5 days.
Fig.5
Changes in the amplitude of daily PBP fluctuations differed in group 1 by val-
ues (8-3 mmHg), increasing by 14, 19, 23 days to 16 mmHg, while the amplitude
of diurnal fluctuations in group 2 was 4-10 mmHg, that is, PBP in group 2 was sta-
ble. And in group 3, a tendency towards the increase of the amplitude of the daily
fluctuation of PBP was found on the 5, 11, 17th day with an increase on the 23rd
day to 23 mmHg, which characterized the most pronounced instability of hemody-
namics in elderly patients in the late periods of the toxemia of burn disease (fig. 5).
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Dynamics of the range of daily fluctuations of pulse pressure
Fig.6
Changes in the daily range of fluctuations in the circadian rhythm of PBP in
group 1 indicated the prevalence of more significant changes in PBP at 14 (22
mmHg), 18 (22 mmHg), 21 (24 mmHg), 26 (28 mmHg) days of the toxemia pe-
riod. While the maximum range of the daily fluctuation of PBP was found only
on day 8 (20 mmHg). In patients of group 3, the range of daily changes in PBP
was detected on days 12 (20 mmHg), 24 and 25 days (34.8 mmHg). Thus, daily
changes in the circadian rhythm of PBP prevailed at a later date (in group 1 after
14 days, in group 2 - on day 8, in group 3 - after 14 days of toxemia), which sug-
gests that one of the factors leading to violation of hemodynamics is the lack of
effectiveness of anti-inflammatory, correcting hemodynamic function of therapy,
more pronounced in groups 1 and 3 of patients.
During the period of burn disease toxemia, a direct correlation of SBP and PBP
mesor on div temperature (0.693; 0.598, respectively) was found only in group
1, a strong direct correlation between SBP and DBP in group 3 (0.689), as well as
a strong direct correlation between PBP and SBP in Group 1 (0.7747), gradually
weakening in 2 (0.6598) and 3 (0.5643) groups of patients.
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Fig.7
A strong negative correlation between DBP and div temperature (-0.8462)
characterized a decrease in the tone of peripheral vessels in response to an increase
in div temperature, which is characteristic of the physiological reaction of he-
modynamics to the systemic inflammatory response of the div with burns with
a total area of 54.3 ± 16.5%. 3 B degree 11.9 ± 8.9% and IF indicator 92.5 ± 20.8
units. Thus, the most active compensatory hemodynamic reactions were found in
group 1. The most pronounced tendency to destabilize hemodynamics was found
in patients over 61 years of age at a later date (3-4 weeks) of the period of burn
disease toxemia.
Conclusions
On the first day, the PBP circadian rhythm mesors did not differ from the
normative values. During toxemia, changes in the mesor of the circadian rhythm
of PBP occurred in waves with a period of fluctuations in group 1 - 9,6,5,5,6
days, in group 2 – 8,4 days, in group 3 - 5,4,4,5,6, 5 days. Daily changes in PBP
prevailed at a later date (in group 1 after 14 days, in group 2 - on day 8, in group
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3 - after 14 days of the toxemia period), which suggests that one of the factors
leading to hemodynamic disturbances is insufficient efficiency anti-inflammatory,
corrective hemodynamic function of therapy, more pronounced in groups 1 and 3
of patients. The most active compensatory hemodynamic reactions were found in
group 1. The most pronounced tendency to destabilize hemodynamics was found
in patients over 61 years of age at a later date (3-4 weeks) of the period of burn
disease toxemia.
References
1. https://nashedavlenie.ru/gipotenziya/nizkoe-pulsovoe.html
2. https://meduniver.com/Medical/Physiology/590.html
3. https://serdce-moe.ru/zabolevaniya/davlenie/arterialnoe-davlenie-pri-
ozhogah
