Conformational changes in plasma proteins and erythrocytes in puerperal women and strategies of managing the perioperative period

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BACKGROUND: Cesarean delivery is associated with prolonged hospitalization compared to spontaneous delivery and the risk of intra- and postoperative complications. The introduction of an accelerated recovery program after a planned cesarean section contributes to the rapid recovery of the patient by optimizing various elements of care.

AIM: To study the effect of the components of the accelerated recovery program on the severity of oxidative stress during abdominal delivery at different stages of the perioperative period.

MATERIALS AND METHODS: This was a comparative study assessing conformational changes in plasma proteins and erythrocytes in the blood of puerperal women using fluorescence spectroscopy. The study included 81 patients from the perinatal center of Makhachkala who underwent a planned cesarean section under spinal anesthesia. The enrolled women were grouped into the following: control group (n=38), in which perioperative period was traditionally managed, i.e. fasting for 8 h before the operation and introducing an antibiotic after clamping the umbilical cord. Within this group, blood sampling was conducted in all 38 patients at different intervals. In total, 152 samples of the material under study were obtained from control mothers. The 2nd group was the main (n=43) and included women in labor; in this group, perioperative period was managed using accelerated recovery program, by introducing the antibiotic cefazolin and with the intake of a glucose-containing drink 2 h before the operation. In total, 172 samples of the material under study were obtained from the mothers of the 2nd group. Methods for the pre-preparation of biological material and spectral methods of analysis were used in this study.

RESULTS: At all stages of preparation of delivery by cesarean section (CS) after spinal anesthesia, minor conformational changes occur in the blood plasma proteins, including umbilical cord blood. In the main group, antibiotic use an hour before delivery increased the oxidative degradation of blood plasma proteins. In the control group, a change in the structural-dynamic parameters of erythrocyte membrane proteins was observed, as indicated by the blue shift in the maximum fluorescence spectrum. This was not observed in the erythrocytes of the main group of puerperal women who received a glucose-containing drink.

CONCLUSION: According to total fluorescence data of plasma proteins and umbilical cord blood, it can be assumed that using a glucose-containing drink 2 hours before CS along with an antibiotic helps restore some parameters of the fluorescence of erythrocyte membrane proteins. The data obtained do not indicate any persistent pathological phenomena in mother’s body at all stages of preparation for CS delivery using spinal anesthesia against the background of antibiotic use.

作者简介

Dzhaminat Medzhidova

Dagestan State Medical University

编辑信件的主要联系方式.
Email: dzhamilya-med@mail.ru
ORCID iD: 0000-0002-6182-9942

MD, Cand. Sci. (Med.), assistant professor

俄罗斯联邦, 25/1 Kamalov str., Makhachkala, Republic of Dagestan, 367009

Efim Shifman

M.F. Vladimirsky Moscow Regional Research Clinical Institute

Email: eshifman@mail.ru
ORCID iD: 0000-0002-6113-8498

MD, Dr. Sci. (Med.), professor; Head of the department of anaesthesiology and resuscitation, President of the Association of Obstetric Anaesthesiologists and Resuscitation Specialists

俄罗斯联邦, Moscow

Vagab Abdullaev

Dagestan State University

Email: vagab@mail.ru
ORCID iD: 0000-0002-3551-1746

MD, Cand. Sci. (Biol.), assistant professor

俄罗斯联邦, Kizlar

Aleksandr Kulikov

Urals State Medical University

Email: kulikov1905@yandex.ru

MD, Dr. Sci. (Med.), professor

俄罗斯联邦, Yekaterinburg

参考

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2. Fig. 1. The intensity of total and tryptophan fluorescence of blood plasma proteins of maternity patients of the 1st (control) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. Iф ― fluorescence intensity, conventional units; 2ПСФ ― the second derivatives of the fluorescence spectra.

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3. Fig. 2. The intensity of total fluorescence of proteins of erythrocyte membranes of the blood of maternity women of the 1st (control) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. Iф ― fluorescence intensity, conventional units; 2ПСФ ― the second derivatives of the fluorescence spectra.

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4. Fig. 3. The intensity of total fluorescence of plasma proteins of maternity mothers in the 2nd (main) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. Iф ― fluorescence intensity, conventional units; 2ПСФ ― the second derivatives of the fluorescence spectra.

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5. Fig. 4. The intensity of total fluorescence of erythrocyte membrane proteins in the 2nd (main) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. Iф ― fluorescence intensity, conventional units; 2ПСФ ― the second derivatives of the fluorescence spectra.

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6. Fig. 1. The intensity of total and tryptophan fluorescence of blood plasma proteins of maternity patients of the 1st (control) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. If ― fluorescence intensity, conventional units; 2DFS ― the second derivatives of the fluorescence spectra.

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7. Fig. 2. The intensity of total fluorescence of proteins of erythrocyte membranes of the blood of maternity women of the 1st (control) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. If ― fluorescence intensity, conventional units; 2DFS ― the second derivatives of the fluorescence spectra.

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8. Fig. 3. The intensity of total fluorescence of plasma proteins of maternity mothers in the 2nd (main) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. If ― fluorescence intensity, conventional units; 2DFS ― the second derivatives of the fluorescence spectra.

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9. Fig. 4. The intensity of total fluorescence of erythrocyte membrane proteins in the 2nd (main) group: a ― before the start of anesthesia; b ― after the development of anesthesia before the incision on the skin; c ― by the end of the operation; d ― intraoperatively, umbilical cord blood. If ― fluorescence intensity, conventional units; 2DFS ― the second derivatives of the fluorescence spectra.

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