General Reanimatology (E-Journal) / Общая реаниматология
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Изменения структуры мембран эритроцитов при действии гемина
Get PDFObjective: to determine whether the supplementation with hemin affects the nanostructure of red blood cell memranes. Subjects and methods. Human whole blood was supplemented or not with hemin and nanostructure of red blood cell membranes was studied using atomic force microscopy. Conclusion. Experiments demonstrated that hemin exerted a specific effect on the nanostructure of red blood cell membranes to form domains upon their surface. The size of granular structures in the domains was 100—200 nm, which coincides with that of a spectrin matrix. The effect of domain generation possesed threshold character starting from hemine concentrations of 1.3—1.7 mM. These results demonstrate the potential of the use of nanostructural changes within the erythrocyte membrane as surrogate biomarkers of erythrocyte response to hemoglobin derivatives in future studies. Key words: red blood cell membranes, hemin, nanostructure, atomic force microscopy.Цель исследования — исследовать изменение наноструктуры мембран эритроцитов при воздействии гемина на кровь в различных концентрациях. Материал и методы. Исследования проводили in vitro на цельной крови человека, в которую добавляли гемин. Наноструктуру мембран эритроцитов изучали с помощью атомной силовой микроскопии. Заключение. Экспериментально установлено, что гемин оказывал специфическое воздействие на наноструктуру мембран эритроцитов, образуя домены на поверхности. Характерный размер зернистых структур в доменах составил 100—200 нм, что совпадает с характерным размером спектринового матрикса. Эффект образования доменов носил пороговый характер и проявлялся только при определенных концентрациях (1,3—1,7 мМ). Данные результаты могут быть положены в основу изучения воздействия производных гемоглобина на красные клетки крови. Ключевые слова: мембраны эритроцитов, гемин, наноструктура, атомная силовая микроскопия
Изменения структуры поверхности мембран эритроцитов при длительном хранении донорской крови
Get PDFObjective: to study changes in the surface of red blood cell membranes of donor blood at the macro- and ultrastructural level during its storage for 30 days and to evaluate the functional state of the red blood cell membrane during the whole storage period. Material and methods. The investigation was conducted on human whole blood and packed red blood cells placed in the specialized packs containing the preservative CPDA-1, by using calibrated electroporation and atomic force microscopy and measuring plasma pH. Conclusion. The long-term, up to 30-day, storage of whole blood and packed red blood cells at 4°C was attended by lower plasma pH and increased hemolysis rate constant during calibrated electroporation and by the development of oxidative processes. The hemolysis rate constant was also higher in the packed red blood cells than that in the whole blood. On days 5—6, the membrane structure showed defects that developed, as the blood was stored, and caused irreversible cell membrane damage by day 30. Key words: donor blood, red blood cell membranes, atomic force microscopy
Психомоторное возбуждение и делирий у больных в критических состояниях и роль седации
Get PDFCritically ill patients often receive analgesia and sedation to keep them comfortable and to prevent agitation and delirium, which are serious, common and yet frequently underdiagnosed forms of brain dysfunction in intensive care environment with unclear but often unfavorable contribution to patient outcomes. Apart from delirium assessment and screening the most important aspect of ICU management is understanding the drugs given to patients and their specific advantages and disadvantages. It is crucial for clinicians and units to develop guidelines and protocols for the administration of sedatives depending on the type of patient population. Newer drugs, such as dexmedetomidine and remifentanyl, should be introduced and extensively studied. The immunomodulating effects of sedation also must be explored, as these properties may greatly affect outcome. With an increased understanding of sedative drugs will come an improved ability to use multiple drugs at specific times during the course of hospital treatment. Key words: delirium, sedation, analgesia
Влияние различных концентраций кислорода, применяемых во время многокомпонентной эндотрахеальной анестезии, на структурно-функциональные параметры эритроцитов
Get PDFObjective: to study the effect of different concentrations of oxygen on structural and functional parameters of red blood cells during balanced multicomponent sevoflurane-based endotracheal anesthesia. Subjects and methods. The prospective, randomized trial enrolled 20 persons (aged 52.7±16.2 years) who underwent the same surgical procedure. The patients were divided into 2 groups, which differed inintraoperatively used oxygen concentration in the inspired mixture,50% FiO2 (group 1) and 21% FiO2 (Group 2). A morphological difractometric analysis of patients’ red blood cells was performed preoperatively, intraoperatively, and after anesthesia. Results. In Group 1, red blood cells demonstrated statistically significant trend towards macrocytosis (82.4±23.3 fl before general anesthesia versus 85.1±20.6 fl after anesthesia; р=0.02); in group 2, there were no statistically significant changes in red blood cell volumes. Lateral light scattering was ignificantly decreased after anesthesia in Group 1 (146.2±17.7 U versus 162.9±23.0 U prior to anesthesia (р<0.005) and 156.4±16.3 U during the surgery (р<0.05)). The coefficient of variation in half-height of lateral light scattering of red blood cells was also significantly increased at the final stage of observation in Group 1 (26.3±3.1 U versus 22.1±5.0 U during surgery, рKey words: red blood cells, homeostasis, general anesthesia, hyperoxia, morphological difractometry
Функциональное состояние микроциркуляции кишечника при разлитом перитоните
Get PDFObjective: to evaluate the functional state of intestinal microcirculation in diffuse peritonitis caused by hollow organ perforation and to determine its possible relationship to skin microcirculation. Subjects and methods. Seventeen patients with diffuse peritonitis resulting from hollow organ perforation were examined. The patients’ mean age was 58.5±2.8 years; a control group consisted of 35 apparently healthy individuals. The functional state of the intestinal microcirculatory bed (the mid-transverse colon, the ileum at a distance of 60 cm from the ileocecal corner, the small bowel at a distance of 50 cm of the ligament of Treitz, and an area next hollow organ perforation) and skin was evaluated by laser Doppler flowmetry by means of a ЛАКК-02 laser capillary blood flow analyzer made in the Russian Federation (LAZMA Research-and-Production Association, Russian Federation). Results. Perforation of the affected intestinal portion became worse in patients with diffuse peritonitis. Blood flow stability was ensured by the higher effect of mainly active components of vascular tone regulation on the microvascular bed. Regulatory changes were equally pronounced at both the intraorgan and skin levels. Conclusion. The findings suggest that the patients with diffuse peritonitis have changes in microcirculatory regulation aimed at maintaining tissue perfusion. These changes are universal at both the intraorgan and skin levels. Key words: microcirculation, micro blood flow, intestine, peritonitis, tissue perfusion
Использование гипертонического раствора хлорида натрия при операциях в условиях искусственного кровообращения
Get PDFThe paper analyzes the data available in the references on different aspects of using hypertonic sodium chloride solution during surgery under extracorporeal circulation in cardiosurgical care. The hypertonic solution is shown to lower positive fluid balance in the perioperative period, to increase cardiac output with simultaneously decreased vascular resistance, to improve lung oxygenating function, and to normalize tissue blood circulation and neurological status in patients exposed to artificial perfusion. There is evidence for its effect on the immune system and capillary endothelium. It is suggested that it is necessary to study the effect of the hypertonic solution on the incidence of complications and death rates during surgery under extracorporeal circulation and it is proposed to use the solution under long-term extracorporeal circulation. Key words: hypertonic saline, sodium chloride, extracorporeal circulation.Представлен анализ литературы о различных аспектах применения гипертонического раствора хлорида натрия при операциях в условиях искусственного кровообращения в кардиохирургической практике. Показано, что гипертонический раствор уменьшает положительный баланс жидкости в периоперационном периоде, увеличивает сердечный выброс с одновременным снижением сосудистого сопротивления, улучшает оксигенирующую функцию легких, способствует нормализации тканевого кровообращения, а также неврологического статуса у пациентов, подвергшихся искусственной перфузии. Представлены данные о его влиянии на иммунную систему и эндотелий капилляров. Предложена необходимость исследований влияния гипертонического раствора на частоту развития осложнений и летальность при операциях в условиях искусственного кровообращения, а также его использование при длительном искусственном кровообращении. Ключевые слова: гипертонический раствор, хлорид натрия, искусственное кровообращение
Изменения гормонально-метаболических показателей у пациентов, находящихся в критическом состоянии
Get PDFThe review presents the current view of the etiology and pathogenesis of hormonal and metabolic changes in critically ill patients. To build up a system accessible to clinicians to establish an early diagnosis of hypermetabolism syndrome will be able to make differential correction of endocrine and metabolic disorders until decompensated multiple organ failure develops. Key words: critical condition, metabolism, hypercatabolism, somatotropin, insulin-like growth factor.В обзоре представлен современный взгляд на вопросы этиологии и патогенеза гормональных и метаболических изменений у пациентов, находящихся в критическом состоянии. Создание доступной для клиницистов системы ранней диагностики синдрома гиперметаболизма позволит проводить дифференцированную коррекцию эндокринно-метаболи-ческих нарушений до развития декомпенсированной стадии полиорганной недостаточности. Ключевые слова: критическое состояние, метаболизм, гиперкатаболизм, соматотропин, инсулиноподобный фактор роста
Влияние гипербарической оксигенации на кинетику глутамина в организме при печёночной недостаточности
Get PDFObjective: to study body glutamine kinetics in hepatic failure and in the course use of hyperbaric oxygenation (HBO). Material and methods. Experiments were performed on 210 female albino rats. HBO was thrice conducted at 3 ata as a 50-min session once daily after hepatectomy (HE, 15—20% of the liver weight); glutamine levels were measured in their visceral organs and blood from the following vessels: the aorta, v. porta, v. hepatica, v. renalis. Results. By eliminating the glutamine-excretory dysfunction of the operated liver, HBO corrects its glutamine deficiency. At the same time, HBO activates glutamine production by gastrointestinal organs with its further incretion into the portal blood flow. It also stimulates the absorption of glutamine by lung tissue and its deamidation in the latter, but causes a reduction in myocardial glutamine concentrations. By stimulating the development of arterial hyperglutaminemia, HBO prevents the development of transient glutamine deficiency in the splenocytes and delayed postoperative portal hypoglutaminemia. HBO does not exert a substantial impact on brain tissue glutamine changes, but it regulates renal glutamine kinetic changes induced by partial HE. Conclusion. Hyperbaric oxygen used for hepatic failure induced by HE recovers body kinetic disorders of glutamine in this abnormality, by concurrently regulating the adaptive changes in its metabolism in the organs, which occur in response to liver damage. Key words: glutamine, metabolism, hepatic failure, hyperoxia
Морфологические изменения головного мозга при острых комбинированных отравлениях азалептином и этиловым алкоголем
Get PDFObjective: to study brain morphological changes in acute combined intoxication with asaleptin and ethyl alcohol. Material and methods. The cerebral cortex (the parietal region) was histologically examined in 26 patients (19 men and 7 women, 22 to 63 years old) who had died of acute (first 24hour) combined intoxication with asaleptin and ethyl alcohol. Blood ethyl alcohol concentrations varied from 1.4 to 4.1%o. Brain pieces were fixed in 10% formalin and embedded in paraffin. Histologic specimens were stained with hematoxilin and eosin by Nissl and analyzed using the Olympus BX 41 microscope. Morphological changes in the nerve cells were assessed according to existing classification and protocols («Histopathology of the central nervous system», Meditsina Publishers, Moscow, 1969). Results. In cases of death from acute combined intoxication with asaleptin and ethyl alcohol morphological patterns of acute brain neuronal damages were detected. They included (a) nonspecific reversible and irreversible neuronal damages and (b) circulatory disorders comprising of vascular plethora in the microcircula-tory bed and developed perivascular and pericellulary edema. Conclusion. Detection of brain neuronal damage patterns in acute combined intoxications with asaleptin and ethyl alcohol might aid in justification of an immediate death cause as a supplement to forensic chemical analysis. Key words: brain morphological changes, intoxications, asaleptin, ethyl alcohol
Подготовка анестезиологов_реаниматологов в Норвегии и Канаде
Get PDFThe paper gives data on a training system for specialists in anesthesiology and reanimatology in Norway and Canada. Their training in these countries is a long-term (7—8-year), well-planned, and strictly controlled process that provides high-level specialists. The Russia system for training the specialists in anesthesiology and reanimatology should be reconsidered, by taking into account the European experience. Key words: specialists’ training, anesthesiologists, reanimatologists.В данной статье приведены данные о системе подготовки анестезиологов-реаниматологов в Норвегии и Канаде. Обучение анестезиологов-реаниматологов в этих странах представляет собой длительный, хорошо спланированный и жестко контролируемый процесс, обеспечивающий подготовку специалистов высокого уровня в течение 7—8 лет. Система подготовки российских анестезиологов-реаниматологов должна быть пересмотрена с учетом европейского опыта. Ключевые слова: подготовка специалистов, анестизиологи-реаниматоги