EFFECT OF ALCOHOL ON THE RATE OF RECOVERY AFTER TRAUMATIC BRAIN INJURY

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RELEVANCE In the modern world, alcohol abuse is considered one of the main problems. This issue is very relevant, since according to numerous data the age of alcoholism is getting younger. It is known that the main reason for getting craniocerebral injuries is the state of alcohol intoxication [1]. According to the latest analytical data, there are 4 cases of TBI for every 1,000 people in Russia (which is approximately 600,000 cases per year). The highest mortality rate is observed at a young age - from 21 to 40 years. Despite this, the mortality rate from TBI in older people is also high - about 21%. The mortality rate from TBI in men exceeds the mortality rate in women by 2-2.5 times. The reasons may be both alcoholic intoxication at the time of injury, and a history of chronic alcohol consumption [2]. TARGET The purpose of our work is to find out how alcohol affects the rate of recovery of the functions of the nervous system in people who have received traumatic brain injury, to characterize the clinical course of TBI in people who are often in a state of alcohol intoxication, in comparison with people who do not consume alcohol in the period of recovery (and in a healthy state it is also not abused). MATERIALS AND METHODS Study plan The sample underwent medical histories of TBI patients who suffered from alcohol dependence and who did not abuse alcohol. The duration of the study was 1 month. Used data of anamnesis, objective data, clinical and laboratory data. Data processing began with systematization of observation results and grouping of patients. Further, a statistical analysis and assessment of the reliability of the research results were carried out. Eligibility criteria The criteria for selecting patients for the study was the presence of the main diagnosis - TBI. The presence and absence of a history of chronic alcohol consumption was taken into account. The patients' age ranged from 33-60 years. The study included patients who were on outpatient treatment in the Voronezh City Polyclinic No. 3. Conditions The work is based on the analysis of the results of studying the case histories of 20 patients with various diseases associated with craniocerebral trauma, who were on outpatient treatment in the Voronezh City Polyclinic No. 3. Study duration The duration of the study was 1 month. The study of each individual patient took place within 1 week and 1 month after receiving a TBI. Patient records were examined from early September 2020 to early October 2020. During the study, work was carried out to study the medical records of patients, the selection of material for research and statistical analysis. Description of the medical intervention An immunological study was performed using blood taken from the cubital vein. This was necessary to determine the level of interleukin-1. A laboratory blood test was carried out to determine the level of ESR, erythrocytes and platelets. The neuropsychological condition of the patients was also investigated. To study the state of the cognitive sphere of patients, the following were carried out: Romberg's test, coordination tests, tests for the severity of unconditioned reflexes. Assessment of neurological status - examination of the motor and sensory spheres, assessment of cerebellar reflexes. Main study outcome The main and significant indicators for the study were the data of the anamnesis of the disease, the results of neuropsychic tests and the values ​​of the biochemical blood test. Additional study outcomes Study of hemodynamic parameters of blood flow. Subgroup analysis The patients were divided into two groups: study group 1 - patients with a history of chronic alcoholism; study group 2 - patients who do not consume alcoholic beverages at the time of treatment. Outcome registration methods To register the outcomes of the study, the program Microsoft Excel 2011 was used. The data of the patients' cards based on the case histories were entered. Statistical analysis Principles for calculating the sample size: The sample size was not pre-calculated. Methods of statistical data analysis: statistical processing of the obtained results was carried out using the STATISTICA version 6.0 and Microsoft Excel 2011 software package. RESULTS Key research findings The results of laboratory studies have shown that in people who abuse alcohol, the level of red blood cells is reduced. This effect is associated with the damaging effect of alcohol on their membrane: when alcohol enters the body, the erythrocyte membrane ruptures, as a result of which they stick together and fall into a sediment [3]. By reducing the level of "healthy" erythrocytes, the level of hemoglobin also decreases. Immediately after receiving TBI, all subjects had an increased level of interleukin-1, which, in turn, is a pro-inflammatory agent. Over For ten days, the level of IL-1 in the alcohol abuse group was still elevated. There was also a significant increase in the level of cytokines, in comparison with the group that did not have alcohol dependence. This suggests that in group 1, the inflammatory process in the TBI area increased on the 10th day. A high IL-1 index leads to a decrease in the synthesis of protective agents, which means that the process of repairing damaged tissues worsens. A decrease in the proliferative activity of projective agents leads to a decrease in humoral immunity. A functional examination of the cerebellum was performed after 1 week of treatment and after 1 month. The functioning of the cerebellum was assessed by the Romberg test (this test is performed in a standing position with feet shifted together, eyes closed, arms extended in front of you). This test detects changes in equilibrium. After the first week of treatment, all subjects showed instability in this position. Coordination tests, in both groups, were performed uncertainly on both sides. After a month of treatment, the posture in the first group was positive (the posture was not stable), while in the second group the results corresponded to the norm - the Romberg test was negative. Functional examination of the spinal cord. Tests were carried out for the severity of tendon, knee and Achilles reflexes. In the first group, the studied reflexes were sharply reduced. While in the second, they were reduced moderately. All subjects showed a decrease in muscle strength in the limbs. After a month of recovery from TBI, the same studies were conducted. In the first group, a deviation from the norm was still observed - reflexes and muscle strength in the limbs were reduced. At the same time, the results of the second group corresponded to the norm - there were no deviations. Functional examination of the hippocampus. During the first week of treatment, all study participants complained of memory impairment for current events. At the same time, their consciousness was clear, but inhibited. After a month of therapeutic measures, all subjects were guided in place, time and their own personality. However, the participants in the first group still complained of decreased memory for current events. The study of the functioning of the cerebral hemispheres led to the following results. During the first week, moderate hemiparesis was observed in all participants. A month later, in the group that did not drink alcohol, moderate hemiparesis turned into a mild type. In the other group, the condition worsened - hemiparesis became pronounced, at the same time, toxic polyneuropathy of the lower extremities joined it. Additional research findings Drinking alcohol thickens the blood and increases its viscosity, this effect is associated with the ability of alcohol to attract water to itself and remove it from the body. This occurs due to an increase in the concentration of blood corpuscles (due to lack of fluid). In addition to the above, alcohol has a vasoconstrictor effect. Together, all of these effects increase blood pressure levels, and therefore, increase the load on the cardiovascular system. DISCUSSION Discussion of the main research result A decrease in the recovery process after TBI when drinking alcohol is associated with its complex negative effect on all body systems. Ultimately, these factors will lead to disturbances in the activity of the nervous system. Research limitations Analysis of medical records of patients with other chronic diseases. Summary of the main research finding Complications after TBI are of high social significance, since patients of working age are affected, and if appropriate treatment is not carried out, and most importantly, patients follow the doctor's prescriptions, then the disorders of the nervous system will acquire an irreparable chronic nature, which will lead to disability. And this, in turn, will lead to a decrease in the level of the working-age population. CONCLUSION In the course of the research work carried out, it was found that the use of alcoholic beverages during the period of TBI treatment has a negative effect on the nervous system, not only slowing down the healing process, but also vice versa, increasing the severity of the course of the disease. Excessive alcohol consumption leads to a violation of the rheological state, which in turn increases the risk of developing diseases of the cardiovascular system. Thus, it can be concluded that alcohol consumption should be stopped not only during the treatment of TBI, but also in everyday life. Despite the fact that its harmful effect is enhanced in the presence of TBI, this does not cancel its negative effect on the body of a healthy person. Thus, in order to reduce the level of alcohol consumption by the population, it is necessary to carry out mass educational events and programs in which people will be informed about the enormous harm that alcohol carries. It is necessary to explain to people that the whole organism falls under the negative influence of alcohol and the only way to avoid these consequences is to refuse to drink it.

About the authors

Ripsime Manykian

Voronezh State Medical University named after N.N. Burdenko

Author for correspondence.
Email: rimul25@bk.ru
ORCID iD: 0000-0003-1706-2219

student

Russian Federation, Студенческая ул., 10, Воронеж, Воронежская обл., 394036

Valeria Olegovna Medvedeva

Voronezh State Medical University named after N.N. Burdenko

Email: ler.medvedeva2001@yandex.ru
ORCID iD: 0000-0002-3908-7380

student

Russian Federation, Студенческая ул., 10, Воронеж, Воронежская обл., 394036

References