Disturbances of the ultrastructure of endotheliocytes of sinusoid hemocapillaries of the liver and the hemostasis system in the acute period of cranial injury

Purpose of the study : the role of endothelial cells of the sinusoidal capillaries of the liver in the pathogenesis of the vascular-platelet and coagulation units of the hemostasis system to assess the acute period of traumatic brain injury. Materials and methods . Work is a clinical experimental study. TBI was simulated in animals and the number of blood thrombocytes was determined at 1,  3, 7, 12 days after the alteration. Also on the 3 rd , 7 th and 12 th day after the application of TBI, structural changes in sinusoidal hemocapillaries (SH) were studied in ultrathin sections of the liver. The study of patients was conducted  at the Semashko Hospital. Hemostasis systems were evaluated in patients by the indicators: activated partial thromboplastin time, prothrombin and thrombin time, prothrombin index, fibrinogen, antithrombin III,  soluble fibrin-monomer complexes, plasma fibrinolytic activity, platelet count in 1-e (on admission) and 3, 7 and 10 days of treating patients. Results . The results of electron microscopic examination of the liver SH and intravascular changes revealed that pronounced damage  to endotheliocytes and microcirculation disorders were determined in animals on the 3 rd day of the post-traumatic period. These changes were aggravated on the 7 th day after the injury. Partial restoration of blood flow and endothelium with the preservation of areas of its swelling and edema  occurred 12 days after TBI. The number of platelets significantly decreased with a maximum change  in the index by day 7 and recovered to the values of intact rats on the 12 th day after TBI. The number of platelets decreased and coagulation hemostasis increased in patients with severe concurrent TBI on the 3 rd and 7 th day after injury compared to the reference intervals of the studied hemostasis parameters. Conclusion . In this way, a combination of non-specific systemic disorders of the structural and functional integrity of the vascular endothelium and activation of the blood coagulation system is observed  in the acute period of severe TBI, which dictates the need for targeted prevention and correction of the above disorders in the complex treatment of patients.