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ВЫБОР МЕТОДА РЕДУКЦИИ ОБЪЕМА КРОВОПОТЕРИ В РЕКОНСТРУКТИВНОЙ ЧЕЛЮСТНО-ЛИЦЕВОЙ ХИРУРГИИ
Get PDFGoal of the study: to define the most optimal technique for blood loss reduction during reconstructive surgeries in maxillofacilal area. Materials and methods. The study included 100 patients, the patients were randomly divided into 5 groups, and after the randomization the cohort included 80 patients. Group 1 (control) (n = 12) – acute normal and hypervolemic hemodilution (ANH and AHH), infusion volume made 8-10 ml/kg x h-1. Group 2 (n = 17) – reduction of infusion volume down to 4-6 ml/kg x h-1 in combination with prescription of aprotinin. Group 3 (n = 17) – reduction of infusion volume down to 6-8 ml/kg x h-1 in combination with prescription of tranexamic acid (TA). Group 4 (n = 19) – reduction of infusion volume down to 6-8 ml/kg x h-1, TA in combination with regional blocks in order to provide sympatholysis. Group 5 (n = 15) – reduction of infusion volume down to 6-8 ml/kg x h-1, TA in combination with system sympatholysis. Colorimetry was used to evaluate blood loss. Results. All groups included into the study compared to the control group manifested reduction of blood loss and as a result reduction in the need for blood preparations transfusion. The most effective blood saving approach was the combination of the infusion volume reduction with the use of TA. The use of local and system sympatholysis did not result in the additional reduction of the blood volume. Use of ANH and AHH could result in the development of massive blood loss.
МИТОХОНДРИАЛЬНО-АДРЕСОВАННАЯ АНТИОКСИДАНТНАЯ ТЕРАПИЯ В ПРОФИЛАКТИКЕ ПЕРИОПЕРАЦИОННОЙ ЭРОЗИИ РОГОВИЦЫ
Get PDFСЛУЧАЙ УСПЕШНОГО ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ТРОМБОЭМБОЛИИ ЛЕГОЧНОЙ АРТЕРИИ У БОЛЬНОЙ НА СРОКЕ БЕРЕМЕННОСТИ 11 НЕДЕЛЬ
Get PDFPulmonary embolism in pregnant women is fairly common complication, and it remains to be the one of major causes of maternal mortality in the number of countries. The need to compare risks of the mother and child makes the search for optimal treatment tactics very complicated in this specific case. The experience of the last decades provides evidences for choosing aggressive treatment tactics, accurate diagnostics and early surgical intervention. The authors of this article describe the clinical case of successful treatment of the young woman whose pregnancy course was complicated by pulmonary embolism at the 11th week of gestation. The article describes the results of laboratory and instrumental diagnostics and anasthesiological support technique within available scope of pharmacological and technical means. Also the article reviews the literature data on this problem. The conclusion contains recommendations for intra-operative management of such patients. Тромбоэмболия легочной артерии (ТЭЛА) у беременных женщин является весьма частым осложнением, она остается одной из ведущих причин материнской смертности в ряде стран. Необходимость соотнесения рисков для организма матери и ребенка делает поиск оптимальной тактики лечения в данном случае очень сложной задачей. Опыт последних десятилетий свидетельствует в пользу избрания агрессивной тактики лечения, точной диагностики и раннего оперативного вмешательства. В данной статье авторы представляют случай успешного лечения молодой женщины, течение беременности которой осложнилось ТЭЛА на сроке гестации 11 недель. Описываются результаты проведенной лабораторной и инструментальной диагностики, а также методика анестезиологического пособия в рамках доступного объема фармакологических и технических средств. Приводится анализ данных литературы по этой актуальной проблеме. В заключении даны рекомендации по интраоперационному ведению подобных больных.
ФАКТОРЫ РИСКА СИМУЛЬТАННЫХ ОПЕРАЦИЙ ПРИ СОЧЕТАНИИ РАКА ЛЕГКОГО И СЕРДЕЧНО-СОСУДИСТОЙ ПАТОЛОГИИ
Get PDFCurrently, there is a global trend of growing frequency of concurrent lung malignant tumors and cardiac vascular pathology, in particular, ischemic heard disease. The literature review demonstrates, that development of surgery, anesthesiology and intensive care allows expanding limits for treatment of such patients through simultaneous surgery when lungs and heart are operated at the same time.The article analyzes the personal experience of the authors and international publications, it contemplates on safe performance of simultaneous and multi-organ surgeries, involving respiratory and blood circulation systems, different approaches to surgery, its specific features, benefits, and limitations. Specialists from Russian Surgery Research Center named after B.V. Petrovsky find it preferable to perform simultaneous staged surgery of the lungs, mediastinum and cardiac vascular system. There is a certain sequence of stages. It demonstrates that the first stage may include isolation of abnormal masses of the lung (mediastinum) and lung hilus, if necessary. After that cardiac surgery is performed, and as a final stage, the whole abnormal focus is isolated and resected.В настоящее время во всем мире отмечается тенденция к увеличению частоты встречаемости сочетания злокачественных новообразований легких с сердечно-сосудистой патологией, в частности ишемической болезнью сердца. Анализ литературы показывает, что развитие хирургии, анестезиологии и реаниматологии позволяет расширить границы лечения таких больных путем проведения симультанных операций, когда вмешательство на сердце и легких происходит одновременно.В статье представлен анализ собственного опыта, а также зарубежных авторов, рассмотрены проблемы безопасного проведения сочетанных и мультиорганных операций на органах системы дыхания и кровообращения и варианты подходов к хирургическому лечению, их особенности, преимущества и недостатки. Специалисты РНЦХ считают предпочтительным одномоментное этапное проведение хирургического вмешательства на легком и структурах средостения и сердечно-сосудистой системы. Предусмотрена последовательность этапов. Показано, что первым этапом может выполняться выделение патологических образований легкого (средостения) и корня легкого при необходимости. Затем проводится кардиохирургический этап и в заключение ‒ выделение и удаление всего патологического очага в комплексе
ВЛИЯНИЕ ОБЕЗБОЛИВАНИЯ ПРИ РОДОРАЗРЕШЕНИИ НА ЧАСТОТУ РАЗВИТИЯ ПОСЛЕРОДОВОЙ ДЕПРЕССИИ У РОДИЛЬНИЦ
Get PDFThe article evaluates the effect of various anesthetic techniques in delivery on the frequency of postpartum depression in new mothers. Materials and methods. 209 women were enrolled into the study, medium age made 31 years and gestation period made 39.4 weeks. All patients were divided into 4 groups: groups 1 and 2 had vaginal delivery; continuous epidural anesthesia was used in group 1, 0.08% solution of ropivacaine hydrochloride was used as a local anesthetic. No pain relief was used in group 2. Cesarean section with intraspinal anesthesia was performed in groups 3 and 4; transversus abdominis plane block with parenteral administration of non-steroidal anti-inflammatory agents was used in group 3. Only system narcotic analgesics and non-steroidal anti-inflammatory agents were used for anesthetic purposes in group 4. Specific features of postpartum depression were searched for within the following time periods: in 6 hours, 3 days and 6 weeks after the delivery. Results of the study. It has been found out that using continuous epidural anesthesia for pain relief purposes during vaginal delivery results in no reduction of postpartum depression frequency in 6 weeks after the delivery compared to the patients who had no anesthesia during delivery. No effect of delivery type on postpartum depression frequency has been observed. The reduction of postpartum blues has been noted when transversus abdominis plane block was used as a part of multi-modal pain relief. No effect of transversus abdominis plane block on the postpartum depression development in 6 weeks after delivery has been observed.
ВЛИЯНИЕ КОНЦЕНТРАЦИИ ПИРУВАТА В КРОВИ НА РАЗВИТИЕ ПОСТПЕРФУЗИОННОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ ПРИ ОПЕРАЦИИ РЕВАСКУЛЯРИЗАЦИИ МИОКАРДА В УСЛОВИЯХ ИСКУССТВЕННОГО КРОВООБРАЩЕНИЯ
Get PDFПЕРВЫЙ КЛИНИЧЕСКИЙ ОПЫТ ПРИМЕНЕНИЯ КОЛОНОК ДЛЯ ЛПС-АДСОРБЦИИ «ТОКСИПАК» В ЛЕЧЕНИИ ПАЦИЕНТОВ С СЕПСИСОМ
Get PDFEndotoxicosis is one of the main factors of the pathogenesis of multiple organic dysfunctions in gram-negative sepsis, induced by the accumulation of lipopolysaccharides - wall components of gram-negative bacteria. In vitro removal of them (LPS-adsorption) promotes better treatment outcomes in sepsis patients. Development and introduction of the Russian tools for LPS-adsorption becomes more crucial. Objective: to evaluate the efficiency and safety of the column of Toxipak for endotoxin removal, manufactured by POCARD Ltd. Materials and methods: 7 adult sepsis patients who had LPS-adsorption were included into the study. The changes of the following parameters were monitored in the patients: temperature, pulse, arterial pressure, respiration rate, central venous pressure, oxygen saturation, hourly rate of diuresis, oxygenation index was calculated, hematologic and biochemical blood parameters were tested as well as coagulation system rates, endotoxin level, C-reactive protein (CRP), procalcitonin, and interleukins (IL) 1, 6, 8. Criteria of the system inflammatory response and SOFA score were used for the comprehensive evaluation of clinical status. The adverse events, duration of stay in the intensive care ward and 18- and 24-day mortality were followed up during manipulations. Results: the studied column provided no negative effect on the cellular and biochemical composition, main parameters of clotting system and acid-base balance of blood. Its use resulted in the reduction of endotoxin (LPS) (by 64%), CRP (by 14%), IL-1 (by 38%) in blood, increase of oxygenation index, and renal function improvement. LPS adsorption promoted the reduction of clinical and laboratory signs of system inflammatory response, and severity of organ dysfunction (from 6.0 to 3.0 as per SOFA score) in patients with sepsis and septic shock. Conclusion: Toxipak column is safe and efficient for removal of endotoxins from blood.
ИНГАЛЯЦИОННАЯ СЕДАЦИЯ У ПАЦИЕНТОВ С СЕПСИС-АССОЦИИРОВАННЫМ ДЕЛИРИЕМ
Get PDFDelirium in the intensive care ward is actively being discussed by anesthesiologists for a long period of time. However at present there are fairly scarce evidences on the efficiency of various techniques of prevention and management of this disorder. Goal of the research: to assess the impact of inhalation sedation on the intensity and duration of sepsis-associated delirium in the intensive care ward of the surgical hospital. Methods. The one-centered, prospective, randomized comparative study was conducted in order to assess the efficiency of inhalation sedation in the patients with sepsis-associated delirium. Propofol was used for the intravenous sedation in the control group. 187 adult patients, admitted to the intensive care ward of Vorokhobov City Clinical Hospital no. 67, were included into the study. Results. Inhalation sedation reduced the delirium duration compared to intravenous use of propofol: delirium was fully managed on the 5th day in the group where sevorane was used [4; 7], while in the group where propofol was used delirium lasted for 7 days [6; 8] (p = 0.03). The study did not detect any effect of inhalation sedation on the intensity of oxidative stress (level of oxidized peptides in the blood plasma of the patients) and degree of neuronal damage (differences between groups are not significant, p = 0.37). No differences were recorded in the value of procalcitonin and SOFA score at any stage of the study. Conclusion. The frequency of delirium in the mixed population of sepsis patients makes 27.9%. Use of inhalation sedation with sevoflurane compared to intravenous administration of propofol reduces the duration of delirium therapy from 7 to 5 days.
ЭФФЕКТЫ ТРАНЕКСАМОВОЙ КИСЛОТЫ ПРИ РАСШИРЕННЫХ РЕКОНСТРУКТИВНЫХ ВМЕШАТЕЛЬСТВАХ НА ТАЗОБЕДРЕННОМ СУСТАВЕ
Get PDFThe wide surgery on hip joint is followed by the blood loss, local and systematic inflammatory response. Tranexamic acid is widely used in surgery for conservative homeostasis and its anti-inflammatory effect is also well known. The purpose: to justify the dosing regimen of tranexamic acid from the position of minimum blood loss and inflammatory response. Materials and methods: 32 patients from the control group received standard therapy with tranexamic acid at the dose of 20 mg/kg intravenously twice a day: 30 minutes prior to the surgery and in 6 hours since the 1st administration; in the main group (29 patients) the standard regimen was supplemented by intra-operative administration – 10 mg per kg-1 ∙ h-1. Results. The volume of the intra-surgery, drainage, general and estimated peri-operative blood loss was not statistically different between two groups. The level of pro-inflammatory and anti-inflammatory cytokines was higher in the drainage blood compared to the peripheral one (p < 0.001). The concentration of soluble receptors to IL-6 and FNO-α was statistically and clinically confidently higher in the control group compared to the main one at the majority stages of the study (p < 0.05). Conclusion. Tranexamic acid possesses anti-inflammatory action regardless of the dose.