MECHANISMS OF DEVELOPMENT OF IMPAIRED CONSCIOUSNESS IN PATIENTS WITH TRAUMATIC BRAIN INJURY

Relevance: The ineffectiveness of existing methods of treatment of impaired consciousness of traumatic etiology indicates that the mechanisms of development of impaired consciousness in patients with TBI have not yet been clarified. This means that the determination of the mechanisms of development of impaired consciousness in patients with TBI is an urgent problem of modern medicine. Purpose: to study the mechanisms of development of impaired consciousness in patients with TBI. Materials and methods: thorough clinical and neurological, laboratory (early screening markers of coma: leukocytosis, hyperglycemia and acidosis), ECG, chronographic, Echo ES, EEG, TCD and MSCT of the brain were performed in 124 patients (80 men, 54 women) with various form of TBI. Concussion in 25% of patients, mild cerebral contusion in 17% of patients, moderate in 31% of patients, severe in 53% of patients, with cerebral compression in 23% of patients. Results: In patients with concussion, there was a short-term loss of consciousness at the time of injury. Consciousness on a scale of Glasgow 15 points. In patients with brain contusion: a) mild, 7% of patients had moderate (13-14 points), and the rest of the patients had no impairment of consciousness (15 points). Echo-encepholography, TDCG and MSCT showed signs of moderate ICH and a moderate decrease in cerebral blood flow. And in patients with moderate brain contusion, it was noted: in 22% of patients there was deep stunning (12-13 points), and the remaining 9% of patients had stupor (9-12 points). The results of additional research methods showed that all patients showed signs of increased ICH with a noticeable decrease in cerebral blood flow, with the development of acidosis and an increase in residual oxidizability of the cerebrospinal fluid. In 42% of patients with severe brain contusion, consciousness was soporous (9-12 points), 21% of patients had moderate (7-8 points), and the remaining 20% of patients had deep coma (4-7 points). In 7% of patients with severe brain contusion, there were signs of a sharp increase in intracranial pressure, cerebral edema and a deep decrease or cessation of cerebral blood flow and depression of intracellular energy synthesis. Similar results were obtained in patients with brain compression (23 patients). Analysis of the data obtained shows that the molecular mechanism of impairment of consciousness is depression of intracellular energy synthesis. (ATP synthesis), developed as a result of cerebral ischemia. And the severity of the oppression of consciousness is proportional to the intensity of the decrease in intracellular energy synthesis.