General Reanimatology (E-Journal) / Общая реаниматология
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Исследование сорбции лекарственных веществ перфтораном
Get PDFObjective: to estimate the perfluorane adsorption capacity of the drugs belonging to different pharmacological groups. Materials and methods. The binding of perfluorane to 50 drugs at concentrations of 12.5 to 100 ^M was studied in vitro using equilibrium dialysis. Results. Interactions of ligands with the particles of perfluorane emulsion were found to be of three types. Type 1 substances were characterized by negative affinity to perfluorane; type 2 ligands acted indifferently with the emulsion; type 3 compounds were reversibly adsorbed with the particles of the blood substitute by the affinity constants ( Kaff) of 104 M-1. Conclusion. The perfluorane adsorption capacity is ambiguous and seems to depend on the properties of ligands. Type 3 interactions, which may lead to an increase in blood adsorption capacity and change in the pharmacokinet-ics of drugs used in combination with perfluorane, appear to be the most important. Key words: perfluorane, binding, drugs, drug interactions
Функциональные изменения микроциркуляции у шахтеров в зависимости от стажа подземных работ
Get PDFObjective: to study microcirculation in miners in relation to the length of their underground work. Subjects and methods. Microcirculation was studied in 328 miners who were divided into three groups according to the length of their underground work. It was examined in the skin of the outer lower third of the shoulder, by applying skin laser Doppler flowme-try by means of a ЛАКК-01 laser capillary blood flow analyzer (Lazma RPA, Russian Federation). Results. The performed studies determined a relationship between microcirculatory changes and the length of underground work. Group 1 (length, 1—9 years) showed a decrease in the major indicator of microcirculation through various mechanisms aimed at reducing peripheral resistance. As the length of underground work was more, there was an increase in total peripheral resistance and blood flow bypass. Conclusion. Microcirculatory deterioration occurs in miners who have worked underground longer. The found changes are comparable with the stages of total adjustment syndrome. The stress stage developing in miners with an underground work length of 1 to 9 years is characterized by decreased peripheral resistance. The resistance stage of adjustment syndrome occurs when different compensatory mechanisms are activated in miners who have been working under harmful conditions for 10 to 19 years. Dysadjustment signs characterized by increases in peripheral resistance and blood flow bypass occur with exhaustion of compensatory systems in miners who have been working underground for 20 years or more. Key words: microcirculation, miners, length of underground work
Судебно-медицинская экспертиза по гражданским делам — состояние, проблемы, перспективы
Get PDFThe state of forensic medical examinations in civil cases related to health harm while rendering medical services is not shown to meet the need for a legal procedure. Key words: forensic medical examination, civil procedure, medical cases.Показано, что состояние судебно-медицинских экспертиз по гражданским делам о причинении вреда здоровью при оказании медицинских услуг не удовлетворяет потребности правовой процедуры. Ключевые слова: судебно-медицинская экспертиза, гражданский процесс, медицинские дела; forensic medicine expert examination, civil procedure, medical cases
Особенности центральной гемодинамики у пациентов пожилого возраста при общей анестезии севофлураном
Get PDFObjective: to reduce the number of perioperative cardiovascular events in elderly patients during traditional cholecystectomy, by using anesthesia based on sevoflurane (SF) and fentanyl (FL). Subjects and methods. Forty-eight patients aged 60 to 75 years, who were divided into 2 groups, operated on by a classical surgical technique for chronic calculous cholecystitis in the presence of concomitant coronary heart disease and essential hypertension, and had grade 3 surgical risk according to the classification of the Moscow Research Society of Anesthesiologists and Reanimatologists, were examined. Premedicaton was routine. The induction of anesthesia was as follows: intravenous propofol (PF) (1.8±0.2 mg/kg) and FL (2.2±0.4 mg/kg) in Groups 1 and 2. General anesthesia (GA) was maintained by SF (1.1±0.2 MAC) and FL (2.4±0.4 jBg/kg/hr) in Group 1 (n=25) and by PF (2.0—4.0 mg/kg/hr) and FL (3.5±0.7 ^Bg/kg/hr) in Group 2 (n=23). In both groups, mechanical ventilation was as follows: N2O:O2 = 2:1; air flow, 6 l/min. Myoplegia was rocuronium bromide (RB) (0.075—0.1 mg/kg) in Group 1 and RB (0.15 mg/kg) in Group 2. Hemodynamics was studied during 5 stages of surgery. Results. Central hemodynamics (CH) was rather stable in patients after GA with SF. Significant CH changes were noted only during the traumatic stage of surgery, which were less pronounced than those in patients following GA with PF. CH parameters returned gradually to the baseline values at the end of surgery and virtually to the background values after tracheal extubation. The patients under GA with PF showed significant CH changes at all stages of the study. Conclusion. Analysis of the systemic hemodynamic changes induced by the use of SF and PF suggests that GA with SF in elderly patients is more preferable than that in those with PF. Key words: sevoflurane, hemodynamics, elderly
Применение левосимендана в кардиоанестезиологии
Get PDFThe authors consider the main aspects of the rational use of the novel inotropic drug levosimendan in cardiosurgical patients on the basis of the results of the trials described in the literature and on their own findings in this review. The purpose of the analysis made was to provide a rationale for the effective use of this drug. The review shows the role of the ultrasound indicator left ventricular ejection fraction, the prognostic scale EuroSCORE, and the natriuretic peptides NT-proBNP and BNP in defining indications for levosimendan administration for preoperative preparation. There are original data on the lower level of the natriuretic peptides due to levosimendan therapy. The target hemodynamic monitoring values indicating that it is essential to use levosimendan in postperfusion heart failure are discussed. It is shown that it is expedient to use levosimendan simultaneously with traditional medical measures, by taking into account the pharmacokinetic features of a calcium sensitizer. The problem of levosimendan readministration in patients operated on the heart as well is stated. That there are no clear algorithms for repeated use of the drug is shown. At the same time, possible options of this therapy in different clinical situations are given. Key words: levosimendan, cardiosurgery, heart failure
Цитокины — маркеры иммунореактивности у недоношенных новорожденных
Get PDFThe present paper gives information on cytokines during pregnancy, their role in its physiological course and development of adaptation in premature neonates in the postnatal period. Key words: cytokines, preterm labor, innate immunity, premature neonate, respiratory distress syndrome.В настоящей работе представлены сведения о цитокинах во время беременности, их роли в физиологическом ее течении и развитии реакций адаптации в постнатальном периоде у недоношенных новорожденных. Ключевые слова: ци-токины, преждевременные роды, врожденный иммунитет, недоношенный новорожденный, респираторный дистресс-синдром
Информативность натрийуретического пептида В-типа у кардиохирургических больных с гиперкреатининемией
No full textСнижение периоперационной кровопотери при эндопротезировании крупных суставов
Get PDFObjective: to estimate changes in respiratory and circulatory functions in the acutest period in patients with pulmonary artery thromboembolism (PATE) without arterial hypotension during their first visit. Subjects and methods. The authors analyzed 28 cases of PATE without lowered blood pressure (BP) on primary examination in the prehospital stage (systolic BP (SBP) was less than 100 mm Hg). The study enrolled 17 men and 11 women; their mean age was 67.5±14.5 years. The clinical and ECG pattern was compared on primary examination and over time (following an average of 87±29.7 min). Results. With emergency team care, the rate of tachypnea decreased from 75% on primary examination to 64% over time (p=0.07). Mean respiration rate (RR) fell from 24.0±5.7 to 21.0±5.6 per min (p=0.02). The manifestations of cyanosis were also reduced from 39 to 32% (p=0.4). On primary examination, mean RR, SBP, and diastolic BP were 100.0±19.1 per min, 140.0±21.9 and 80.0±11.5 mm Hg, respectively; after prehospital therapy, these were 100.0±28.2 per min, 130.0±36.8 and 80.0±21.9 mm Hg, respectively (p>0.5). Tachycardia was observed in 60% of the patients both on primary examination and following therapy. One (4%) patient, over time, developed hypotension. ECG analysis revealed an increase in the signs of right cardiac cavity overload. Conclusion. A prehospital fatal outcome was recorded in 1 (4%) patient of those having PATE without arterial hypotension; _ total mortality was 18%. There was progressive deterioration in 32% of the patients due to the progression of both respiratory and cardiovascular failures correctable in the prehospital stage in more than 32 and 39% of cases, respectively. Key words: pulmonary artery thromboembolism, prehospital stage, mortality
Токсическое повреждение миокарда и нарушения системной гемодинамики при остром отравлении пропранололом в эксперименте
Get PDFИнфекционные легочные осложнения в реанимации и интенсивной терапии у пострадавших с сочетанной травмой
Get PDFObjective: to analyze the incidence of infectious pulmonary complications depending on the duration of mechanical ventilation and to study a spectrum of pneumonia pathogens and their antibiotic resistance in intensive care unit (ICU) victims with severe concomitant injury. Subjects and methods. Forty-eight ICU victims with severe concomitant injury were examined. The incidence of purulent tracheobronchitis and pneumonia was analyzed depending on injury severity scores (ISS) and mechanical ventilation (MV) duration. Microorganisms were identified and their antibiotic susceptibility was determined. Results. The risk of infectious pulmonary complications was significantly higher and proportional to MV duration in victims with severe concomitant injury on traditional MV as compared those without MV (or on noninvasive ventilation). The pathogens of infectious pulmonary complications were chiefly gram-negative bacteria. Conclusion. There is evidence that there is an association between the ISS, the performance and duration of MV, the structure of pathogens, and their antibiotic resistance. Key words: infectious pulmonary complications, pneumonia, concomitant injury, mortality