General Reanimatology (E-Journal) / Общая реаниматология
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Отечественная история дефибрилляции сердца
Get PDFThe year 2012 is the anniversary year of the Russian history of cardiac defibrillation. Two anniversaries associated with the name of N. L. Gurvich, the founder of impulse defibrillation by high-voltage capacitor discharge, are being celebrated this year.2012 год — юбилейный для отечественной истории развития дефибрилляции сердца. В этом году отмечаются два юбилея, связанные с именем Н. Л. Гурвича — основоположника импульсной дефибрилляции высоковольтным разрядом конденсатора
Гемофильтрация и гемодиализ в профилактике и лечении острой почечной недостаточности после операций на сердце с искусственным кровообращением
Get PDFObjective: to analyze the efficiency of hemofiltration (HF) in the stage of extracorporeal circulation (EC) during cardiac surgery in order to prevent acute renal function lowering and the development of acute renal failure (ARF). Materials and methods. The risk of postoperative ARF requiring renal replacement therapy (RRT) was preoperatively assessed by the summed Cleveland risk score and percentage (2005). HF during EC was used in patients at high risk for ARF. The procedure was performed, by combining 2 extracorporeal circuits: EC and a Diapact®CRRT apparatus. With evolving ARF, Stage 3 after Risk, Injury, Failure, Loss of Kidney Function, End-stage Renal Disease (RIFLE), 2004, and Acute Kidney Injury Network (AKIN), 2007, continuous venovenous hemofiltration (CVVHF) and continuous high-flow hemodialysis (CHFHD) were done in the dialysate recirculation mode after surgery under EC. The Mann-Whitney non-parametric test was used to estimate the significance of intergroup differences. The results are presented: median (lower quartile; upper quartile), the differences considered to be significant atpResults. HF during EC; 6 patients were aged 65.5 (range 57—70) years with chronic kidney disease, preoperative glomerular filtration rate (GFR) was 50 (range 41.5—65) ml/min/1.73 m2 using the Cockroft-Gault formula. The maximum GFR decrease by 2.9 (range 0.7—7) ml/min/1.73 m2 was seen after EC. A control group comprised 12 patients aged 73 (range 63—75) years. There was a postoperative GFR reduction by 17 (range 13.7—22) ml/min/1.73 m2. One patient from the control group developed ARF and multiple organ dysfunction, which required CVVHF and CHFHD. Conclusion. The use of intraoperative HF in patients at high risk for renal function lowering is likely to prevent a considerable GFR reduction and ARF after surgery under EC
Эволюция диагностики и лечения острого респираторного дистресс-синдрома на основе новейших медицинских технологий
Get PDFThe paper generalizes the 15 years’ experience of the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, in conducting fundamental studies of the morphological, functional, and clinical patterns of the development of acute respiratory distress syndrome (ARDS), by using up-to-date medical technologies. The developed and clinically introduced new scientifically grounded methods for the prevention, diagnosis, and combination, differentiated treatment of ARDS could reduce the number of complications, the duration of mechanical ventilation, the length of stay in the intensive care unit, and mortality rates. Key words: acute respiratory distress syndrome, V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences.В статье обобщается 15-летний опыт фундаментальных исследований НИИ общей реаниматологии им. В. А. Неговского РАМН по изучению морфологических, функциональных и клинических закономерностей развития острого респираторного дистресс-синдрома на основе новейших медицинских технологий. Разработанные и внедренные в клиническую практику новые научно обоснованные методы профилактики, диагностики и комплексного, дифференцированного лечения ОРДС позволяют сократить количество осложнений, продолжительность ИВЛ, длительность пребывания в отделении реаниматологиии, летальность. Ключевые слова: острый респираторный дистресс-синдром, НИИ общей реаниматологии им. В. А. Неговского» РАМН
Ингаляционный тобрамицин в лечении тяжелых нозокомиальных пневмоний
Get PDFObjective: to evaluate the efficiency of using inhaled tobramycin in addition to systemic antibacterial therapy in the treatment of severe nosocomial pneumonias (NP) in critically ill patients. NP remains one of the most urgent problems in resuscitative units. Traditional intravenous injection of broad-spectrum antibiotics does not allow their bactericidal concentration to be achieved in the lung. Inhaled antibiotics in addition to systemic antibacterial therapy reduce the clinical symptoms of NP, assist the switching of patients to spontaneous breathing, and decrease the titer of microbes in bronchial lavage fluid. Subject and methods. This paper describes the experience of successfully using inhaled tobramycin during systemic antibiotic therapy in 10 patients with severe NP. Results. The use of inhaled tobramycin in addition to systemic antibiotic therapy is accompanied by a reduction in the signs of endogenous intoxication and acute respiratory failure, by a decrease in the titer of pathogenic microorganisms in bronchial alveolar fluid, and by an increase in their response to systemic antibiotics, by positive X-ray changes in 60% of the patients, and by the switch of 30% of the patients to spontaneous breathing. Adverse reactions as oto- and vestibu-lotoxicity were recorded in two patients; there were no cases of nephrotoxicity. Conclusion. The administration of inhaled tobramycin in a dose of 300 mg twice daily is effective and safe as a supplement to systemic antibiotic therapy in the treatment of severe NP caused by polyresistant gram-negative pathogens. Key words: nosocomial pneumonia, inhaled tobramycin
Оценка внесосудистой воды легких во время обширных торакальных вмешательств и в послеоперационном периоде
Get PDFBackground. Postoperative lung injury is a cause of most fatal outcomes after extensive lung resections. Death rates due to postpneumonectomy pulmonary edema have remained unchanged within the past 20 years and are currently tending to 100%. Objective: to make prolonged lung edema monitoring in patients after extensive thoracic interventions. Subjects and methods. The observational study covered 27 patients who had undergone pneumonectomy (PE) (n=16) or lung resection (n=11). Invasive monitoring by the PiCCOplus system was performed to examine the systemic and pulmonary hemodynamics of all the patients during surgery and within 48 postoperative hours. Results. PE rather than lung resection was accompanied by a significant reduction in the extravascular lung water index (EVLWI). Most patients who had undergone PE were found to have a subclinical increase in EVLWI 36-48 hours after termination of the intervention. Conclusion. In this observational clinical study, isolated thermodilution showed an immediate decrease in EVLWI after PE and its increase at 36—48 postoperative hours. Lobar or segmental interventions failed to cause significant changes in EVLWI in the perioperative period. Key words: pneumonectomy, lung resection, lung edema, extravascular lung water, acute lung injury
Церебральная оксиметрия в кардиохирургии
Get PDFBased on the data of numerous current references, the review describes different neuromonitoring methods during cardiac surgery under extracorporeal circulation. It shows that it is important and necessary to make neuromonitoring for the early diagnosis and prevention of neurological complications after cardiac surgery. Particular attention is given to cerebral oximetry; the possibilities and advantages of this technique are described. Correction of cerebral oximetric values is shown to improve survival rates and to reduce the incidence of postoperative complications. Lack of cerebral oximetry monitoring denudes a clinician of important information and possibilities to optimize patient status and to prevent potentially menacing complications, which allows one to conclude that it is necessary to use cerebral oximetry procedures within neu-romonitoring in cardiac surgery. Key words: extracorporeal circulation, cerebral oximetry, neurological dysfunction, cerebral oxygenation.В обзоре по данным многочисленных современных источников описаны различные методы нейромониторинга при операциях на сердце с искусственным кровообращением. Показана важность и необходимость нейромониторинга для ранней диагностики и предотвращения неврологических осложнений после кардиохирургических операций. Особое внимание уделяется методу церебральной оксиметрии, описываются возможности и преимущества данного метода. Показано, что коррекция значений церебральной оксиметрии улучшает показатели выживаемости, снижает количество осложнений послеоперационного периода. Отсутствие мониторинга церебральной оксиметрии лишает клинициста важной информации, возможностей оптимизировать состояние пациента, предотвратить потенциально опасные осложнения, что позволяет сделать вывод о необходимости применения методики церебральной оксиметрии в рамках нейромониторинга в кардиохирургии. Ключевые слова: искусственное кровообращение, церебральная ок-симетрия, неврологическая дисфункция, церебральная оксигенация
Сравнительное исследование эффективности нестероидных противовоспалительных средств неселективного действия у пациентов с тотальным эндопротезированием коленного и тазобедренного суставов
Get PDFObjective: to compare the postoperative efficacy and safety of non-selective nonsteroidal anti-inflammatory drugs in patients undergoing endoprosthetic total knee and hip arthroplasty (ETKAP and ETHAP). Subjects and methods. The study included 60 patients who were referred for ETKAP or ETHAP and randomly assigned to 3 groups. Groups 1, 2, and 3 patients were anesthetized with ketorolac, metamizol, and paracetamol, respectively. Real-time evaluation of the efficiency of postoperative analgesia was carried out within 3 days after surgery; the patients were questioned about bowel function, the onset of the first active movement in the ward, and occurring unpleasant sensations. Results. Reduced or no appetite was more common in the paracetamol and metamizol groups than in the ketorolac; the paracetamol group was found to have dizziness in 20% of cases, which was not observed in the two other groups. The patients who started to have routine hospital diet in the first 24 postoperative hours were significantly fewer among the paracetamol-treated patients. The shortest time to the first active movement was observed in the ketorolac group, which corresponded to the end of the first 24 hours and significantly distinguished it from the other groups. This appeared to be due to the best analgesic effect that, after epidural block, was significantly more effective (according to VAS scores) in the ketorolac group, if not enhanced in any group, which agrees with information available on the drug as a worthy alternative to opioids due to its valid analgesic effect. Conclusion. __Intravenous ketorolac is a worthy alternative to narcotic analgesics in ensuring the comfortable course of the immediate postoperative period in patients operated on the knee and hip joints. Key words: ketorolac (ketorol), postoperative analgesia, endoprosthetic knee and hip arthroplasty
Диагностическая значимость белка S100B при критических состояниях
Get PDFThe review deals with possibilities for the quantitative assessment of the degree of brain injury, by measuring the level of S100B protein in various biological fluids. Data are given on changes in the concentration of this protein in different categories of patients, including those who are critically ill. Key words: S100B protein, laboratory diagnosis of critical conditions, biomarkers, perinatal brain lesions.Обзор посвящен возможности количественной оценки степени повреждений мозга путем измерения уровня белка S100B в различных биологических жидкостях. Приводятся данные по изменению концентрации данного протеина у разных категорий больных, в том числе — находящихся в критическом состоянии. Ключевые слова: S100B, лабораторная диагностика критических состояний, биомаркеры, перинатальные повреждения головного мозга
Влияние регионарной анестезии на метаболические и воспалительные изменения при абдоминальных операциях
Get PDFSurgical intervention is associated with the development of endocrine, metabolic, and inflammatory changes that may give rise to postoperative complications. Objective: to evaluate the impact of regional anesthesia on the magnitude of these changes during and after abdominal surgery. Subjects and methods. One hundred and twenty patients were examined during elective lower abdominal operations. The patients were divided into groups according to the anesthetic modality: general anesthesia alone (n=40) and in combination with continuous epidural (n=40) and spinal anesthesia (n=40). Cortisol, glucose, lactate, interleukins 6, 8, and 10 concentrations and daily urinary nitrogen excretion were studied before, during, and after surgery. Results. The two regional anesthesia modalities lowered the degree of an increase in the concentrations of cortisol, glucose, and lactate in the perioperative period and restricted a rise in the concentrations of both proinflammatory and anti-inflammatory cytokines. Spinal and epidural anesthesia both reduced daily urinary nitrogen excretion. Epidural versus spinal anesthesia/analgesia assured better quality of postoperative analgesia and was attended by less significant hemodynamic disorders. Conclusion. Both spinal and epidural anesthesia restrict the perioperative rise in the concentrations of cortisol, glucose, lactate, and cytokines and suppress protein catabolism after abdominal surgery. Key words: regional anesthesia, abdominal surgery, cortisol, protein and carbohydrate metabolism, inflammatory response
Анализ и прогнозирование сорбции лекарственных веществ перфтораном на основе физико-химических свойств лигандов
No full textThe relationships between drug affinity constant (Kag) for the particles of perfluorane nanoemulsion and physicochemical properties of ligands were studied by correlation and multiple regression analyses. The following parameters were applied: lipophilicity (LogP), molecular weight (MW), topological polar surface area (TPSA), the number of hydrogen donors (Don) and acceptors (Acc) in the formation of a hydrogen bonds, the number of rotating bonds (Rot), and drug molecule ionization constant (pKa). The Kaf — physicochemical properties relationships were found to be mainly nonlinear and to mostly show up in the lipophilicility parameter LogP of ligands. During the multiple regression analysis, a number of regression equations were derived, which described the relationship of the perfluorane affinity Kaf to the physicochemical properties of drugs and could predict this interaction for both existing and newly synthesized compounds.В работе с использованием методов корреляционного и множественного регрессионного анализа проведен анализ зависимости константы взаимодействия Kf лекарственных веществ с частицами наноэмульсии перфто-ран от физико-химических свойств лигандов. Были использованы следующие показатели: липофильность LogP, молекулярная масса MW, площадь топологической полярной поверхности TPSA, число доноров Don и акцепторов водорода Acc при образовании водородной связи, число вращающихся связей Rot и константа ионизации молекулы лекарственного вещества pKa. Установлено, что зависимость Kf от физико-химических свойств носит преимущественно нелинейный характер и в наибольшей мере проявляется в отношении параметра липофильности LogP лигандов. В результате проведенного множественного регрессионного анализа разработан ряд уравнений регрессии, описывающих зависимость константы взаимодействия с перфтораном Kf от физико-химических свойств лекарственных веществ и позволяющих прогнозировать данное взаимодействие как для существующих, так и для вновь синтезированных соединений