General Reanimatology (E-Journal) / Общая реаниматология
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Коррекция стрессовой гипергликемии у больных с острой хирургической патологией органов брюшной полости
Get PDFCritically ill patients admitted to intensive care units for the clinical manifestations of stress hyperglycemia represent a group in which attempts are most frequently undertaken to employ various methods of its correction. Objective: to compare different techniques for correction of stress hyperglycemia in patients with acute surgical abdominal disease complicated by peritonitis. Materials and methods: In this single-center randomized controlled trial, stress hyperglycemia was corrected by different procedures in 60 patients with acute surgical abdominal disease complicated by peritonitis. Results: As compared with traditional procedures for correction of stress hyperglycemia, the human insulin analogue aspart (Novorapid) improves stressful glycemic control and reduces the risk of hypoglycemia. During intensive insulin therapy, the ultrashort-acting insulin group showed showed a trend for a reduction in the number of manifestations of multiple organ failure and signs of systemic inflammation and decline in the number of hospital days. The least duration of mechanical ventilation was noted in the small-volume food group
Скрининг нутриционного статуса в кардиохирургии
Get PDFObjective: to compare the informative value of four nutritional screening scales in patients operated on the heart under extracorporeal circulation (EC). Subjects and methods. A prospective cohort study was conducted to examine the results of treatment in 894 adult patients operated on under EC. Nutritional screening was carried out using four scales: Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), Mini Nutritional Assessment (MNA), and Short Nutritional Assessment Questionnaire (SNAQ). Their nutritional status was assessed by the Subjective Global Assessment (SGA) scale. Mortality and postoperative complications were analyzed. Results. The MUST scale had the highest sensitivity (97.9%) in identifying malnutrition (MN). Univariate analysis of postoperative complications indicated that all the scales had a similar prognostic value: MUST [OR 2 (95% CI, 1.4—2.8); р = 0.0001], SNAQ [OR 1.8 (1.2—2.5); р=0.002], NRS-2002 [OR 1.8 (1.1—3.1); р=0.03], MNA [OR 1.8 (1.3—2.4); р=0.0007] and lower sensitivity (21.2, 23.3, 8.5, and 25.7% for SNAQ, MUST, NRS-2002, and MNA, respectively). However, multivariate analysis along with the commonly known risk factors (age, gender, EC duration) confirmed the prognostic value of the MUST [OR 1.6 (1.1—2.4); р=0.01] and MNA [OR 1.5 (1.1—2.1); р=0.02] scales. Conclusion. The MUST scale is of the most informative value in terms of its sensitivity in detecting MN and of independent prognostic value as to postoperative complications. All the scales have a poor prognostic value regarding the postoperative complications, which determines the urgency of developing a special cardiac screening scale for the nutritional status. Key words: cardiac surgery, nutritional screening, nutritional assessment, malnutrition
Послеоперационное обезболивание в России: клинические и организационные аспекты
Get PDFThis review addresses the issue of postoperative pain relief in Russian medical institutions and provides the analysis of the causes of inadequate administration of the opioid analgesics that lead to inadequate pain relief in patients who undergo operations. In Russia opioid analgesics are hard-to-reach even for incurable patients with oncological diseases and chronic pain syndrome. In order to improve the situation with the postoperative pain relief in Russia wide discussion of this topic is necessary. Poor availability of effective analgetics for patients is caused by administrative barriers within the medical institutions. These barriers are the consequence of the present system of reporting and control of narcotic analgetics administration and usage in Russia. This system is based on the strict requirements of Federal Service of the narcotics control and related orders and directions of Ministry of Health that block the appropriate administration of opioid analgetics by physicians. All these prescriptions must be coordinated with authorities. This situation contradicts with international principles of supply of patients with acute and chronic pain with analgetics. These principles are secured by official documents and publications by UNO, WHO and International Narcotic control Board (INCB) which are available in Russian on the INCB website cited in the article
Пути снижения госпитальной летальности у пациентов с кардиогенным шоком при остром коронарном синдроме
Get PDFПослеоперационная тошнота и рвота в онкохирургии. Современные взгляды на решение старой проблемы
Get PDFPostoperative nausea and vomiting (PONV) is one of the most common and unpleasant complications after surgery. It is distressing for patients, results in increased treatment costs, and may cause very serious complications in the early postoperative period. The incidence of PONV in different surgical fields varies with the pattern of a surgical intervention, by assuming particular importance in cancer surgical practice where the likelihood of its development is very high for a number of reasons. A large number of studies currently deal with the development of PONV prevention schemes. Major risk factors have been identified; there are novel recommendations on anesthetic maintenance from the antiemetogenic point of view; however, the described procedures are not yet able to fully get rid of a patient’s risk for developing a complication. Drugs from a group of serotonin 5HT3-receptor antagonists and metoclopramide hydrochloride in combinations with glu-cocorticosteroids and butyrophenones are most frequently included into PONV prevention regimens. There are more and more data on the antiemetogenic activity of ^-adrenoblockers and fl^-adrenoceptor agonists and on the possibilities of using them during anesthesia. In this review, we attempted to summarize today’s accumulated knowledge about risk factors and procedures for preventing PONV and to define some new and promising areas in its prevention after cancer surgery
Реакция лейкоцитов и апоптоз лимфоцитов периферической венозной крови как маркер тканевой ишемии при острой массивной кровопотере
Get PDFObjective: to estimate the level of peripheral venous blood lymphocyte apoptosis and intraoperative hypoxia in victims with acute massive blood loss. Subjects and methods. Twenty-two patients with open and close chest and abdominal traumas complicated by acute massive blood loss were examined. All the patients were emergently operated on to stop bleeding. Tissue metabolism was evaluated from gases, acid-base parameters, and plasma lactate, glucose, potassium, and sodium levels. Apoptosis of mononuclear cells was studied and dead leukocytes were counted using flow cytometry. Results. Preoperatively, the victims were found to have venous hypoxemia, hyperlactatemia, hyperglycemia, moderate leukocytosis, and higher dead leukocyte counts. There were also raised counts of lymphocytes coming into the process of apoptosis. A significant relationship was found between monocyte counts and hypoxia values. At the end of surgery, oxygen balance values became stable and exerted an effect on the count of leukocytes, the relative level of granulocytes, the relative and absolute counts of dead and damaged leukocytes, and the concentration of lymphocytes in the victims’ venous blood during the early stages of apoptosis, as evidenced by nonlinear regression models. Conclusion. The indicators of immunocompetent cell apoptosis and the count of venous blood dead leukocytes along with lactate levels and venous hypoxemia parameters reflect the degree of tissue hypoxia and may be used as specific markers
Применение PHBQ-теста для оценки психосоматических нарушений у детей 3—7 лет в периоперационный период
No full textThis paper validates the PHBQ test that has been thrice translated from English into Russian; then its three variants translated into English again. The variant whose meaning was the most significant was taken for further patient testing and researches. To confirm that the translated variant was a systemic tool for work with patients, it was compared with modified PHBQ and CBCL tests for 3—7-year-old children. The latter has been translated into Russian and is commercial. The statistical significance of each of these tests was estimated using different statistical data processing methods, such as a factor analysis, a reliability analysis (Cronbach’s alpha), a correlation and regression statistical analysis that is used to test the validity of different mathematical models. The findings may suggest that the Russian language-adapted test may be employed as a reliable tool for patient testing in detecting post-hospitalization disorders; the correlation observed in the comparison of the three tests being rather high. Key words: post-hospitalization syndrome, surgical interventions, fear, distress, PHBQ test
Опыт ингаляционного применения илопроста при хирургическом лечении хронической посттромбэмболической легочной гипертензии
Get PDFThe paper describes a case of inhaled iloprost use in a female patient with severe respiratory failure after pulmonary artery thromboendarterectomy, who was on venovenous extracorporeal membrane oxygenation. To reduce pulmonary hypertension and to prevent reperfusion syndrome, the patient received inhaled iloprost in a dose of 5 ^g every 3 hours during surgery and in the first two days after surgery. On day 14 after surgery, extracorporeal membrane oxygenation was stopped as there were satisfactory respiratory and hemodynamic parameters. Four days later, the patient was weaned from mechanical ventilation. The length of stay in the intensive care unit was 24 days. The patient was discharged from hospital in a satisfactory condition. Thus, the perioperative use of iloprost could reduce pulmonary artery pressure by twice; however, reperfusion syndrome could not prevent significant respiratory failure. The data available in the literature on the use of ilo-prost in patients after pulmonary artery thromboendarterectomy are single and their results are ambiguous. There is a need for large-scale multicenter studies in this group of patients. Key words: chronic postthromboembolic pulmonary hypertension, pulmonary artery thromboendarterectomy, iloprost, extracorporeal membrane oxygenation
Сравнительная оценка профилактического использования внутриаортальной баллонной контрпульсации и левосимендана у пациентов ИБС с низкой фракцией выброса левого желудочка
Get PDFThe aim of our study was to compare the efficiency of the use of intraaortic balloon counterpulsation (IABP) and levosi-mendan in patients with low left ventricular ejection fraction operated on under cardiopulmonary bypass. The study included 90 patients who were randomized into three groups according to the strategy of hemodynamic support. Group A patients received IABP 24 hours before surgery. In group B, preventive IABP was combined with intraoperative levosimendan infusion. Group C patients received intraoperative levosimendan infusion only. Hemodynamics, the markers of myocardial damage and heart failure, postoperative complications and length of hospital stay were observed. The patients treated with lev-osimendan had a more stable hemodynamic profile. Troponin I level was significantly lower in Group C six hours after cardiopulmonary bypass than that in group A. Length of stay in intensive care was significantly lower in Group C. The pre-operative concentration of BNP (>360 pg/ml) is a predictor of inotropic support in the postoperative period. The results of our study indicate that the use of levosimendan in high-risk patients is effective and shows the results comparable with those of intra-aortic balloon counterpulsation