Objective: to study the specific features of lung gas exchange and mechanical properties in comas induced by acute stroke (AS) in miners having an underground length of 10 years or more for the further optimization of intensive care. Subject and methods. Gas exchange (oxygenation index (PaO2/FiO2), the degree of intrapulmonary blood shunting (Qs/Qt)), the mechanical properties of the lung (mean airway pressure (Pmean), airway resistance (Raw), static thoracopulmonary compliance (Cltst)), and intracranial pressure (ICP) were studied and brain spiral computed tomography was conducted on days 1, 3, 5, and 7 of the acute phase of AS in 49 patients. The patients were divided into 2 groups: 1) 12 miners (pensioners) (a study group) and 2) 37 patients without underground work length (a control group). Results. Pmean values increased in both groups on days 3 to 7, rose on day 5 in miners. Cltst was decreased and Raw increased. PaO2/FiO2 decreased on days 3—5, more in the miners and Qs/Qt increased ICP persisted in the upper normal range in both groups. The miners were found to have a higher incidence of pneumonias than the patients having no underground length and the former had longer mechanical ventilation and a higher overall mortality. Conclusion. As compared to the patients without underground length, the miners with existing baseline changes in the respiratory organs showed earlier and pronounced development of impairments in gas exchange and the mechanical properties of the lung in the presence of comas induced by acute stroke. This leads to severer acute respiratory distress syndrome, increases the frequency of other complications, irnd results in higher mortality in this group of patients. Keywords: ischemic stroke; coma; gas exchange; mechanical properties of the lung; underground work length; miner.

Objective: to compare the efficiency of using the values of transpulmonary (PiCCO) and prepulmonary (Swan-Ganz catheter) thermodilution as guides to targeted therapy for hemodynamic disorders in the surgical correction of mixed cardiac valvular defects. Subjects and methods. The study enrolled 40 patients operated on for acquired cardiac diseases who were randomized to two matched groups. Hemodynamics was monitored by means of a Swan-Ganz catheter in Group 1 and by transpulmonary thermodilution in Group 2. Anesthesia was maintained with propofol and fentanyl. Infusion therapy was performed using crystalloid and colloid solutions. Continuous intravenous infusion of inotropic agents was used when heart failure was developed. Hemodynamic, clinical, and laboratory parameters were estimated intraoperatively and within 24 hours postoperatively. Results. The groups did not differ in the degree of baseline heart failure, the duration of an operation and myocardial ischemia, and the length of extracorporeal circulation. In the PiCCO group, postoperative infusion volume was 33% higher than that in the Swan-Ganz group, which ensured increases in stroke volume and oxygen delivery in the early postoperative period (p<0.05). Respiratory support was 26% shorter in the PiCCO group (p<0.04). Conclusion. After surgical interventions for mixed cardiac defects, the targeted therapy algorithm based on transpulmonary thermodilution provided more steady-state values of hemodynamics and oxygen transport, which was followed by the increased scope of infusion therapy and the shorter length of postoperative mechanical ventilation than that based on hemodynamics being corrected from the values of prepul-monary thermodilution. Key words: transpulmonary thermodilution, targeted therapy, prepulmonary ther-modilution, acquired heart disease.

Objective: to clarify the mechanisms underlying the development of systemic hemodynamic disorders in acute propranolol poisoning and possible ways of their correction. Materials and methods. The experiments were carried out on 40 male rats in 4 groups: 1) intact animals (n=10); 2) animals receiving propranolol in a dose of 1 mg/100 g body weight (n=10); 3) those receiving the drug in a dose of 2 mg/100 g body weight (n=10); 4) animals given noradrenaline in a single dose of 0.006 mg/100 g body weight 20 min after acute poisoning by propranol (2 mg/100 g body weight) (n=10). After administration of calypsol in a dose of 100 mg/kg body weight, the investigator catheterized the carotid artery to measure blood pressure (BP) (mm Hg) and the jugular vein to estimate central venous pressure (CVP) (cm H2O). An integral rheogram was recorded and stroke output (^l), cardiac output (CO) (ml/min), and total peripheral vascular resistance (TPVR) (103 din^s^cm-5) were calculated during 60 min. ECG was recorded. At min 60 of poisoning, blood samples were taken and estimated for the levels of glucose, lactate, pyruvate, and uric acid to determine the level of metabolic changes. The serum activity of enzymes, such as aspartate aminotransferase, lactate dehydrogenase, and cre-atine kinase MB fraction, was evaluated. The rate of free radical oxidation processes was estimated by the plasma chemilumines-cence technique. After the end of the experiment, the rats were killed by decapitation under calypsol anesthesia. The hearts were removed and fixed in 10% neutral buffered formalin. 5-^m-thick hematoxylin and eosin-stained paraffin-embedded sections were examined on an Axio Cam MRcS digital video fixation microscope. Results. The administration of propranolol suppresses cardiac hemodynamics and causes respiratory depression in a dose-dependent manner. At the same time compensatory mechanisms are aimed at eliminating hemodynamic disorders and hypoxia. To increase the dose of propranolol results in rapid circulatory decompensation, as suggested by the changes in heart rate, BP, TPVR, CVP, and CO. With smaller propranol doses (Group 2), BP is maintained by a less pronounced decrease in TPVR. Worse provision of O2 and oxidation substrates to tissues causes their metabolic disturbances and generalized cell damage — a change in the levels of carbohydrate metabolites, enzymes, and chemiluminescence values. Noradrenaline-induced stimulation of o^-adrenoceptors in the heart stabilizes hemodynamics and the analyzed biochemical parameters. Conclusion. When injected intraabdominally in a single dose of 1 and 2 mg/100 animal body weight, propranolol causes dose-dependent changes in systemic hemodynamics, respiration, carbohydrate metabolites, blood enzyme levels, and the activity of prooxidant and antioxidant systems. Noradrenaline-induced stimulation of 0^-adrenoceptors in the heart stabilized systemic hemodynamics, the values of plasma chemiluminescence, the activity of enzymes, and the level of carbohydrate metabolites. Key words: poisoning, experiment, propranolol, myocardium, systemic hemodynamics.

Objective: to study the mechanisms of toxic action of amitriptyline on the myocardium. Material and methods. Investigations were conducted using the hearts from 30 outbred albino rats, which had been isolated and perfused according to the procedure described by Fallen et al. There were two series of experiments: 1) amitriptyline was added in a dose of 250 ng/ml to Krebs-Henseleit solution (Group 1); 2) the agent was added at another concentration (1250 ng/ml) to the solution passing through the coronary bed (Group 2). The animals were anesthetized with thiopental sodium (25 mg/kg) peritoneally. Results. Amitriptyline depresses myocardial contractility, which is particularly obvious with high-rate pacing. This manifests itself as reduced contractile velocity and force-power parameters and elevated left ventricular diastolic pressure. Amitriptyline lowers the efficacy of glucose and increases the release of enzymes into the coronary duct. Conclusion. Hypoergosis, membrane destruction, and cardiomyocyte ion pump failure have been shown to underlie negative chronotropic and inotropic effects in amitriptyline poisoning. Key words: amitriptyline, acute poisoning, isolated heart, myocardial damage.

Objective: to reveal an association of the changes in GRP78 protein expression with the state of hippocampal neuronal populations in the postresuscitative period. Materials and methods. Adult albino rats of both sexes underwent 10-minute cardiac arrest, followed by resuscitation. On postresuscitative days 1, 7, and 14, the density and composition of pyramidal neuronal populations in the CA1 and CA4 hippocampal sectors were determined by differentiated morpho-metric analysis and the level of GRP78 protein expression was estimated in these neuronal populations. The results were statistically processed using the ANOVA procedure (Post-hog comparisons of means). Results. Gender differences were found in the damageability of hippocampal neuronal populations after ischemia-perfusion. Thus, the resuscitated females, unlike the resuscitated males, showed postresuscitative changes only in the CA1 hippocampal sector, rather than in the CA4 one. At the same time the changes and magnitude of postresuscitative changes within one neuronal population (CA1 sector) were dissimilar in the animals of both sexes. There were trends and gender differences in the postresuscitative changes in the immune responsiveness of hippocampal CA1 and CA4 neuronal populations to GRP78 protein. Complex analysis indicated that neuronal loss occurred with a lower immune responsiveness to GRP78 and the elevated expression of GRP78 protein in the early postoperative period promoted the prevention of neuronal dystrophic changes and/or death. The findings favor the idea of the neuroprotective properties of GRP78 protein. Conclusion. The results of the present study are promising for the elaboration of new approaches to the pathogeneti-cally sounded prevention and therapy for posthypoxic encephalopathies. Key words: ischemia-reperfusion, neurons, GRP78 protein, hippocampus, gender differences.

Objective: to attempt to reduce the hemostatic, detoxifying, and antioxidant dysfunctions of the liver in experimental pancreonecrosis and the degree of pancreatogenic endotoxemia, by using the hepatoprotector heptral. Materials and methods. Experiments were carried out on 142 outbred male rats divided into 3 groups: 1) control (n=20); 2) study (n=69); 3) comparison (n=53). Pancreonecrosis was simulated in the study and comparison groups. In Stage 1, coagulation hemostatic parameters were studied and the levels of low and medium molecular weight substances and the rate of free radical oxidation processes were determined. In Stage 2, five minutes after stimulation of pancreonecrosis, heptral was given in a dose of 11.4 mg/kg to the comparison animals, by studying the same parameters as in the study and control groups. The results were processed using the nonparametric statistical methods. Results. It has been found that hepatic detoxifying and antioxidant functions are impaired and free radical oxidation processes activated within 2 days after simulation of pancreonecrosis. Blood coagulation activity is considerably higher due to activated coagulation factors. Heptral increases the capacity of the liver to synthesize blood coagulation factors, which proves improvement of some of the study parameters of the hemostatic system. Furthermore, its administration preserves the antitoxic function of hepatocytes, as shown by the decreased concentrations of low and median molecular weight substances in plasma and red blood cells. At the same time, there is an increase in antioxidant system activity detectable by chemiluminescence which also testifies that hepatic functional and metabolic impairments are ameliorated. Key words: pancreonecrosis, liver, endotoxemia, hemo-stasis, free radical oxidation, heptral.

Objective: to study the informative value of a dramatic increase in the preoperative blood level of the inactive moiety of the precursor of N-terminal pro-type B natriuretic peptide (NT-proBNP) in cardiac surgical patients with hypercreatininemia. Subjects and materials. Twenty-one patients with a preoperative NT-proBNP level of 1000 pg/ml or more, who underwent myocardial revascularization under extracorporeal circulation (ECC), were examined. The patients were divided into groups with normal (up to 120 ^mol/l) (Group 1; n=11) and elevated (Group 2; n=10) creatinine concentrations. The values of circulation were processed after skin incision and at the end of surgery. The clinical features of a perioperative period were analyzed. Results. Creatininemia was 103±3.3 and 183±12.9 ^mol/l in Groups 1 and 2, respectively (p<0.05); NT-proBNP was 1397±139 and 1908±170 pg/ml (p<0.05). EuroSCORE-predicted mortality ran to 9.8±1.6 and 9.1±1.7% (p>0.05). There were no intergroup differences in intraoperative circulatory parameters. The intensity of sympatomimetic therapy after ECC was equal in the identified patient groups and there were either no differences (p>0.05) in the frequency of intra-aortic balloon counterpulsation (18.2 and 10.0%), the length of mechanical ventilation (15±1.5 and 18.7±2.3 hours) and intensive care unit stay (1.8±0.5 and 2.0±0.7 days) in survivors, and inpatient mortality (23.7 and 20.0%) that proved to be substantially higher than the EuroSCORE-predicted one. Regression analysis showed that in the entire group of operated patients, the level of NT-proBNP turned out to be a more significant predictor of inpatient mortality (p=0.012) than EuroSCORE-predicted one (p = 0.04). The similar regularity was characteristic for patients with hypercreatininemia. In the patients with hypercholesterolemia, the EuroSCORE-predicted mortality completely lost its significance (p=0.61) in predicting actual mortality rates. In this group, NT-proBNP showed a predicting trend. Conclusion. The blood NT-proBNP concentration of 1000 pg/ml or more preserves its significance as a high operative risk factor in the presence of myocardial revascularization under ECC in patients with the blood creatinine level of 140—270 ^mol/l. Key words: N-terminal pro-type B natriuretic peptide (NT-proBNP), myocardial revascularization, extracorporeal circulation, hypercreatininemia.

Objective: to optimize anesthetic tactics for perioperative management in elderly patients during lower abdominal surgery under mixed anesthesia with preserved spontaneous breathing without myoplegia. Subjects and methods. Examinations were made in 142 patients aged over 65 years. The patients were divided into 2 groups: 1) inhalation anesthesia under total myoplegia and controlled mechanical ventilation (MV); 2) inhalation anesthesia without myoplegia with preserved spontaneous breathing or assisted mechanical ventilation (AMV) in the pressure-support (PS) mode. Results and discussion. The AMV procedure allows mixed anesthesia with preserved spontaneous breathing in elderly patients during operations on the lower abdomen and great vessels in 89% of the patients without a risk for inadequate transport of oxygen under its relative uptake. MV used to maintain external respiratory function under mixed anesthesia and total myoplegia causes a decrease in cardiac index (CI) by 58.8% (p<0.05) and increases in total peripheral resistance (TPR) by 50% or more (p<0.05), and intrapulmonary shunt threefold (p<0.05). Mixed anesthesia without myoplegia and MV prevents induced changes in CI, TPR, and Qs/Qt. The differences were significant throughout the follow-up (an intraoperative stage and 9 postoperative hours). The older age group patients are more susceptible to the damaging action of MV; they were also found to have a more pronounced preventive effect of modified anesthesia. Conclusion. To rule out myoplegia and MV during mixed anesthesia prevents MV-induced changes in CI, TPR, and Qs/Qt. Key words: mixed anesthesia in elderly patients, spontaneous breathing, hemodynamics, blood oxygen transporting function.

Objective: to optimize preoperative preparation of patients with multifocal atherosclerosis and reduced baseline left ventricular ejection fraction for coronary bypass surgery, by providing a rationale for the use of mechanical and medical circulatory support methods. Subjects and methods. Sixty-one patients with multifocal atherosclerosis, coronary heart disease (CHD), and reduced baseline left ventricular ejection fraction, who underwent coronary bypass surgery, were examined. Levosimendan was administered to 2 groups of patients: 1) 28 patients with preoperative intra-aortic balloon counterpulsation; 2) as inotropic support in 33 patients. There were central and intracardiac hemodynamic changes as evidenced by transpulmonary thermodilution and pulsed Doppler ultrasound echocardiog-raphy during different preoperative preparations. Conclusion. The use of levosimendan in patients with multifocal atherosclerosis, CHD, and planned coronary bypass surgery, by taking into account contraindications to intra-aor-tic balloon counterpulsation, makes it possible to improve central hemodynamical parameters and to reduce the degree of diastolic dysfunction, the incidence of organ dysfunctions, and the length of intensive care unit stay. Key words: coronary bypass surgery, left ventricular ejection fraction, multifocal atherosclerosis, levosimendan, intra-aortic balloon counterpulsation.

The review article deals with the problem of ischemic preconditioning, the universal physiological mechanism of cell protection from hypoxia. Preconditioning is the term used to describe a phenomenon of the enhanced tolerance of a cell to a damaging factor due to its preliminary effects of stressful stimuli. The article describes the phenomenon of ischemic preconditioning and summarizes the results of a study of the possible mechanisms of this effect in organs and tissues. It discusses the key role of the enzyme glycogen synthase 3fl in the regulation of the mitochondrial pore and that of the latter in the protection of a cell from hypoxia. Experimental data are given on the testing of different drugs as pharmacological agents that initiate/inhibit preconditioning. Reasons for the selective efficacy of some antihypoxants and antioxidants are analyzed in the context of the ischemic preconditioning theory. Conventional anesthetics and analgesics as potential inductors or inhibitors of the process in question are discussed. Key words: ischemic preconditioning, hypoxia, anesthetics, cyto-protection.

This analytical literature review generalizes the currently available data on the treatment of multiorgan dysfunction (MOD). The review describes the pathogenesis, triggers, and components of MOD, as well as current approaches to treating this pathology with up-to-date technologies. Key words: MARS therapy, low flow-rate continuous venovenous hemodiafiltra-tion, multiorgan dysfunction.

The 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.