General Reanimatology (E-Journal) / Общая реаниматология
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Проведение липидной «он лайн» гемодиафильтрации (экспериментальное исследование)
Get PDFObjective: to develop technology for the transmembrane mass transfer of fat-soluble substances with emulsified solution of the essential lipids exposed to dialysis. Materialaadmethods. The pharmacopoeia lipofundin MCT/LCT (20% intravenous fat emulsion) (B. Braun, Germany) was used at all study stages. Coaclusioa. Bicarbonate hemodialysis-modified lipofundin solution contains no triglycerides; its osmolarity is normalized and the solution is ready to use for lipid on-line hemodiafiltration, which allows fat-soluble substances that accumulate in acute liver failure to be removed. Key words: lipid hemodi-afiltration, lipofundin, acute liver failure.Цель работы — разработка технологии трансмембранного массопереноса жирорастворимых веществ эмульгированным раствором эссенциальных липидов, подвергшихся диализу. Материал и методы. Для всех этапов исследования использовали фармакопейный липофундин МСТ/ЛСТ (B.Braun, Германия) — 20% жировую эмульсию для внутривенного введения. Выводы. Модифицированный бикарбонатным гемодиализом раствор липофундина не содержит триглицеридов, нормализуется его осмолярность и он готов к применению для проведение липидной on line гемодиа-фильтрации, что позволяет удалять жирорастворимые вещества, накапливающиеся при острой печеночной недостаточности. Ключевые слова: липидная гемодиафильтрация, липофундин, острая печеночная недостаточность
Экстракорпоральная мембранная оксигенация при остром инфаркте миокарда, осложненном кардиогенным шоком
Get PDFCardiogenic shock is one of the main causes of death in patients with acute myocardial infarction with the mortality rates being as high as 60—80%. Extracorporeal membrane oxygenation (ECMO) is a life-saving technique in patients with cardiogenic shock. Subjects and methods. Veno-arterial ECMO was connected and the coronary arteries were stented in a 53-year-old female patient with acute myocardial infarction complicated by severe cardiogenic shock refractory to drug therapy and intra-aortic counterpulsation (IACP). ECMO was maintained at a volumetric perfusion rate of 4.5 l/min (2.5 l/min/m2). The duration of ECMO was 138.5 hours (5.8 days); that of IACP was 9 days. In the first 24 hours, there were no ECMO-related complications apart from mild bleeding from the site of cannula insertion. The patient stayed in the intensive care unit 12 days. Results. IACP is used to treat cardiogenic shock, but it is ineffective in severe cardiogenic shock. ECMO is one of the possible options for maintaining life and for stabilizing the condition. Current ECMO systems may be employed for urgent peripheral connection and coronary artery intervention. ECMO may be used for resuscitation and temporary life support, which permits as high as 50—75% of patients with refractory cardiogenic shock to be saved. Conclusion: emergency coronary stenting with ECMO support is the technique of choice for the treatment of acute myocardial infarction complicated by severe cardiogenic shock. Key words: extracorporeal membrane oxygenation, cardiogenic shock, coronary artery stenting
Жировая эмболия
Get PDFThe incidence of fat embolism ranges from 0.5 to 30% in injuries with long and pelvic bone fractures; it also occurs in other diseases and conditions. Moreover, mortality accounts for 3 to 67%. There is still no clear idea on the pathogenesis, prevention, and treatment of fat embolism. This review gives current views on this problem. Key words: fat embolism, poly-trauma.Частота развития жировой эмболии колеблется от 0,5 до 30% при травмах с переломами длинных трубчатых костей и костей таза, а также встречается при других заболеваниях и состояниях. При этом летальность составляет от 3 до 67%. До сих пор нет четкого представления по вопросам патогенеза, профилактики и лечения жировой эмболии. В данном обзоре представлены современные взгляды на эту проблему. Ключевые слова: жировая эмболия, политравма
Агонист α2-адренорецепторов дексмедетомидин в практике современной седации
No full textThe problem of sedation in intensive care units has obvious scientific-and-practical relevance. Many current studies deal with the practical introduction of novel medications for sedation, with the specific features of their pharmacodynamic effects in different clinical situations, with the advantages and disadvantages of their use. Recent years are marked by an increase in the number of publications on the o^-adrenoceptor agonist dexmedetomidine used for sedation. The paper reviews current publications on o^-adrenoceptor agonists used in anesthesiology and resuscitation, considers their physiology and the mechanism of sedative action of dexmedetomidine, its pharmacokinetics and pharmacodynamics at different plasma concentrations of the drug. The experience in using dexmedetomidine sedation in clinical practice is discussed in detail, by analyzing the data of current multicenter randomized trials in which the drug has been compared with other sedative medications (propofol, midazolam, lorazepam). Some aspects of the clinical pharmacology of dexmedetomidine, such as its effect on the brain and its blood flow, nociception, sympathoadrenal system, hemodynamics, respiratory system, thermoregulation, immunity, and neuroendocrine system, are analyzed. The clinical value of different receptor-dependent effects of the drug and the specific features of its application in different situations are also analyzed. Key words: dexmedetomidine; sedation in intensive care patients; sedative drugs; o^-adrenoceptor agonists; delirium in intensive care unit patients
Мутации Лейдена и течение острого панкреатита тяжелой степени
No full textObjective: to evaluate the impact of Leiden mutation on the course of severe acute pancreatitis. Subjects and methods. One hundred and twelve people were examined. Group 1 comprised 50 patients diagnosed with severe acute pancreatitis without coagulation factor V (Leiden) mutation. Group 2 included 42 patients with severe acute pancreatitis who were found to have Leiden mutation. Acute pancreatitis was first diagnosed in both groups. Group 3 consisted of 20 apparently healthy individuals (a control group). The severity of the underlying disease was determined in accordance with the clinical and laboratory parameters recommended by the I. I. Dzhanelidze Saint Petersburg Research Institute of Emergence Care. Results. This investigation revealed an association of Leiden mutation with trends in the development of acute pancreatitis. Group 2 exhibited a more severe disease: large focal pancreatic necrosis was twice more common and infectious complications developed more frequently; more aggressive and radical treatments were more often used. The patients with Leiden mutation had higher mortality rates (33% in the Leiden mutation group and 24% in the non-mutation group. Conclusion. The findings should be kept in mind in elaborating new diagnostic methods and principles in the treatment of the underlying disease and in the prevention of its complications in patients with severe acute pancreatitis. Key words: acute pancreatitis, Leiden mutation
Механизмы повреждения и защиты клетки при ишемии/реперфузии и экспериментальное обоснование применения препаратов на основе лития в анестезиологии
Get PDFPharmaceuticals based on lithium ions have been already used in clinical practice for over 60 years for the treatment of bipolar disorders and remain a basic pharmacological therapy for patients with this disease. In spite of this, the therapeutic mechanisms of action of lithium ions have not been fully investigated. In the past decade, in vitro and in vivo experiments have provided a good deal of data suggesting that lithium ions have previously undescribed neuro-, cardio-, and nephro-protective properties. Numerous investigations have demonstrated that glycogen synthase kinase-3/3, the key enzyme of different pathological and protective signaling pathways, is the target of lithium ions in displaying these effects. This review deals with just these new properties of lithium ions, which make them utterly promising for clinical use in circulatory arrest-associated conditions, which is particularly relevant for anesthesiology and resuscitation. Key words: lithium ions, brain, heart, kidney, postresuscitation disease.Фармакологические препараты на основе ионов лития уже более 60 лет используются в клинической практике для лечения биполярных расстройств и остаются основой фармакотерапии пациентов с этой группой заболеваний. Несмотря на это, терапевтические механизмы действия ионов лития изучены не в полной мере. В течение последних 10 лет в экспериментах in vitro и in vivo было получено множество данных, свидетельствующих о наличии у ионов лития ранее не описанных нейро-, кардио- и нефропротекторных свойств. Основной мишенью ионов лития при реализации этих эффектов является киназа гликогенсинтазы-3в, ключевой фермент различных патологических и защитных сигнальных путей. Данный обзор посвящен новым свойствам ионов лития, делающих их чрезвычайно перспективными для клинического применения при состояниях, связанных с остановкой кровообращения, что особенно актуально для анестезиологии и реаниматологии. Ключевые слова: ионы лития, мозг, сердце, почка, постреанимационная болезнь
Окислительный дистресс и его коррекция реамберином у больных с острым отравлением смесью психотропных веществ
Get PDFObjective: to determine the impact of reamberin incorporation into intensive care on the antioxidant defense system and the activity of lipid peroxidation in patients with toxic-hypoxic encephalopathy. Subjects and methods. The investigation enrolled 84 patients with acute severe poisoning by a mixture of psychotropic substances (hypnotics, neuroleptics, antidepressants, 1,4-benzodiazepine derivatives, ethanol). Oxygen balance parameters (oxygen consumption, oxygen utilization quotient, and arteriovenous oxygen difference) were calculated. The antiradical defense system was evaluated determining the levels of reduced glutathione and free sulfhydryl groups of proteins activity of the antiradical enzymes glutathione peroxidase, glutathione-S-transferase, and catalase in red blood cells. Lipid peroxidation rate in red blood cells was determined by measuring the concentration of malondialdehyde. Results. The incorporation of reamberin into intensive care was found to be accompanied by a reduction in tissue hypoxia, more rapid recovery of the antioxidant defense system, and a decrease in the activity of lipid peroxidation processes. Сorrection of metabolic disturbances in its turn leads to the improved clinical course of acute poisoning, which manifests itself as a reduction in the duration of coma, the length of stay in the intensive care unit, and mortality. Conclusion. The reduction in the severity of metabolic disturbances associated with the development of hypoxia and free radical disorders leads to substantial improvement of the clinical course and outcomes of toxic-hypoxic encephalopathy. Key words: toxic-hypoxic encephalopathy, hypoxia, antioxidant system, lipid peroxida-tion, reamberin
Влияние перфторана на морфологию эритроцита при острой кровопотере
Get PDFObjective: to evaluate the cytoprotective effect of perfluoran when pre-administered in massive blood loss. Material and methods. Experiments were performed on 21 nembutal-anesthetized rats. Acute blood loss from the rat caudal artery served as a model for a terminal state. Perfluoran had been injected 45 minutes prior to blood loss. Morphological and morphome-tric analyses of monolayer dried unstained blood smear slides were made using an Olympus BX-50 light microscope at a magnification of 1000 (10X100). Cytometry was carried out using Image scope color software. Results. In the control group of experiments, i. e. without perfluoran preadministration, at 5 minutes of blood loss, the circulating blood showed only 20% of discoid forms; the other forms of the red blood cells were grades 1-to-3 transformation stomatocytes. By 60 minutes of hypotension, there was a decrease in stomatocyte counts to 5.2% and a change in the ratio of circulating red blood cell populations. The number of smaller, i.e. senescent, cells was increased and that of large cells was reduced. The preventive administration of perfluoran in small amounts playing no prominent role in the delivery of oxygen and the alteration of circulating blood volume, substantially changed the ratio of different shapes and sizes of erythrocytes, increased their average diameter, and stabilized the membrane of a red blood cell. Conclusion. The preadministration of low-dose perfluoran before blood loss prevents deformational stress, increases the surface of a red blood cell, and stabilizes its membrane. Key words: blood loss, perfluoran, red blood cell, stomatocyte, deformation stress, rheology
