Objective: to define the blood hemostatic potential in patients with chronic coronary heart disease and acute coronary syndrome (ACS). Subjects and methods. The investigation is based on the in-depth dynamic clinicobiochemical study of 43 patients who has undergone surgical myocardial revascularization under extracorporeal circulation. Ten current standardized laboratory tests were used to evaluate the hemostatic system. At the stages of the investigation, the parameters of the latter were determined and the blood hemostatic potential was estimated in the patients with coronary heart disease. Results. The investigation has indicated that in patients with chronic heart disease, hypercoagulation was compensated due to the changes in the anticoagulation and fibrinolytic systems. In patients with the acute coronary syndrome, the indices of the external and internal mechanisms of coagulation were in the normal physiological range at all the stages of the investigation, even at its stage 3 whereas the parameters, such as the levels of soluble fibrin monomer complex (SFMC), fibrinogen, and D-dimers, suggest thrombinemia and activated coagulation. Conclusion. The absence of activation of the external and internal coagulation pathways with the elevated level of markers of activated coagulation of SFMC and D-dimers in patients with ACS is not that of activation, as such. The patients of this group show a reduction in coagulation factors due to their uptake for the stabilization of the functional status of the hemostatic system. The investigation has demonstrated that in patients with chronic coronary heart disease, the spare capacities of the hemostatic system are higher due to no deficit of individual coagulation factors and to the higher spare capacities of the fibrinolytic system. Key words: hemostat-ic system, acute coronary syndrome, hypercoagulation, fibrinolysis, D-dimers.

Objective: to study impairments in gas exchange and mechanical properties of the lung in relation to the pattern of a brain lesion in acute cerebral circulatory disorders (ACCD). Subjects and methods. Gas exchange (oxygenation index (PaO2/FiO2) and the degree of intrapulmonary blood shunting (Qs/Qt)), the mechanical properties of the lung (mean airway pressure (Р^^), airway resistance (Raw), static thoracopulmonary compliance (Cltst)), intracranial pressure (ICP) were studied and brain spiral computed tomography (SCT) was conducted on days 1, 3, 5, and 7 of the acute phase of ACCD in 18 patients. Results. Pmean increased in both groups on days 3 to 7, rose from day 5 in the presence of hemorrhagic stroke. Cltst was decreased and Raw was increased. From day 3 of hemorrhagic stroke, Cltst significantly became lower and Raw was higher. PaO2/FiO2 decreased from day 5, more in hemorrhagic stroke and Qs/Qt increased. ICP persisted in the upper normal range in ischemic stroke and rose up to 27.5±2.7 mm Hg in hemorrhagic stroke. A strong inverse correlation was found between ICP and PaO2/FiO2. SCT revealed dislocation in 13 patients. Conclusion. Gas exchange and the mechanical properties of the lung are impaired in acute cerebral circulatory disorders. The causes of this are multiple, but one of them is dysfunction of the stem structures of the brain due to its dislocation in the presence of high intracranial pressure. In hemorrhagic stroke, the impairments in gas exchange and mechanical properties of the lung are more marked and develop earlier than in ischemic stroke. Key words: acute cerebral circulatory disorder, respiratory failure, gas exchange, mechanical properties of the lung, intracranial pressure.

Objective: to study hemostatic changes during abdominal operations in relation to the mode of anesthesia, as well as the lower incidence of perioperative hemostatic complications. Subjects and methods. Two hundred patients were examined during elective high-traumatic abdominal operations in relation to the surgical site (the upper or lower abdomen) and anesthetic method (total intravenous anesthesia alone or in combination with epidural (prolonged) or spinal anesthesia). The intensity of postoperative pain syndrome, the time course of changes in plasma cortisol concentrations, the readings of a coagulogram and an agreggatogram, the rate of venous thromboses, thromboembolisms, bleedings, and blood transfusions were examined. Results. Prolonged epidural anesthesia was followed by a considerable reduction in the manifestations of the postoperative pain syndrome and by a limited increase in plasma cortisol concentrations. Without significantly affecting the quality of postoperative analgesia, spinal anesthesia also, nevertheless, inhibited a cortisol response effectively. Postoperative hemostatic parameters characterized the hypercoagulation with a higher platelet aggregation, which was followed by accelerated fibri-nolysis when isolated general anesthesia was applied. The use of both regional anesthetic modes limited the activation of the hemostatic system and prevented accelerated fibrinolysis. The rate of thromboembolic events was low (4%) and did not significantly differ between the groups while there was a less need for blood transfusions when regional anesthesia was employed. Conclusion. By ensuring a more adequate antinociceptive protection, regional anesthesia promotes less perioperative hemo-static changes, which reduces a need for blood transfusions and creates prerequisites for lowering the rate of thromboembol-ic and hemorrhagic events. Key words: abdominal surgery, regional anesthesia, hemostasis, thromboembolic events, bleeding, blood transfusion.

Objective: to study whether posthypoxic brain dysfunctions may be corrected by low-intensity laser irradiation an hour after hypovolemic hypotension at late postresuscitation stages (following 30 days). Material and methods. Experiments were carried out on high-anxious male albino rats weighing 280—300 g. The study model was one-hour hypovolemic hypotension (blood pressure 40 mm Hg), followed by blood reinfusion. The integrative brain function was evaluated from the indices of the rat orientative-trying behavior in the elevated cross labyrinth test. The depressive component of the rats’ behavior was examined in the forced swimming test. Plasma norepinephrine levels were measured. Laser irradiation was performed 30 days after blood reinfusion. Results. Laser irradiation used at late postresuscitation stages leads to the normalization of plasma norepinephrine levels, the reduction of anxiety in the rats, and their improved orientative-trying behavior. Conclusion. The positive impact of laser irradiation on the rat orientative-trying behavior is associated with its anxiolytic effect, in which the recovery of autonomic homeostasis plays a considerable role. Key words: blood loss, postresuscitative period, behavior, laser, posthypoxic encephalopathy, norepinephrine.

Objective: to evaluate the von Willebrand factor (vWF) collagen-binding activity and to measure the concentration of tissue-type plasminogen activator (t-PA) and its inhibitor (PAI-1) in the plasma of patients with traumatic shock. Subjects and methods. Forty-four patients were examined. The vWF collagen-binding activity and the concentrations of t-PA and PAI-1 in the plasma were measured by enzyme immunoassay. Results. The plasma taken from patients with second-degree traumatic shock showed a 2.5-fold increase in vWF collagen-binding activity, as compared with the controls. With severer injury, the collagen-binding activity of vWF increased by 2.9 times in a group of patients with third-degree shock. It was established that in patients with second-degree traumatic shock, the euglobulin fibrinolysis (EF) time was more 1.6 times longer, the plasma concentrations of t-PA and PAI-1 being decreased by 2 and 1.7 times, respectively. Moreover, in patients with third-degree traumatic shock, EF was 2.1 longer and the levels of t-PA and PAI-1 were 3 and 1.8 times lower. Conclusion. The plasma collagen-binding activity of vWF was increased by 2.5—2.9 times in patients with traumatic shock. The victims with traumatic shock showed 2—3- and 1.8—2-fold reductions in the level of t-PA and its inhibitor, respectively. Key words: shock, hemostasis, fibrinolysis.

Objective: to study the general mechanisms responsible for the formation and stepwise development of the endogenous intoxication syndrome in the injury. Material and methods. One hundred and thirty animals with experimental brain injury (a blow upon the calvarium delivered by a free weight falling) were examined to study the pro- and antioxidant systems, the enzymatic activity in the blood and brain tissue homogenates; the markers of endogenous intoxication, such as medium-weight molecules, were determined. According to the neurological deficit scale developed by A. Ya. Yevtushenko (1989), the animals were divided into 2 groups: 1) those with a good (compensated) posttraumatic course and 2) those with a poor (decompensated) one. A package of the applied statistical programs «STADIA.6.1/prof» and «STATISTIKA» was employed. Results. Brain injury was used as an example to show how the posttraumatic endogenous intoxication syndrome developed. The latter developed on the cascade principle with the stepwise involvement of the homeostatic systems and with the more aggravated injury. The syndrome is determined by the initiation of processes of lipid peroxidation with the accumulation of its products and by the exhausted spares of antioxidant systems. This leads to hyperenzymemia (the enhanced activity of cathepsin D, acid phosphatase in the brain tissues and blood) and to the blood accumulation of toxic substances (medium-weight molecules) (toxemia). Key words: posttraumatic endogenous intoxication syndrome, lipid peroxidation, brain injury.

Objective: to determine the rational time of neuroprotective therapy used in women with moderate and severe perioperative gestosis, by studying the peripheral blood concentration of neuron-specific enolase (NSE). Subjects and methods. Eighty-five females in whom surgical delivery had been performed under spinal anesthesia were divided into the following groups: a control group comprised 30 women with uncomplicated pregnancy; Group 1 included 26 women with moderate gestosis; Group 2 consisted of 29 women with severe gestosis. The level of NSE was measured by enzyme immunoassay over time: Step 1 was made before surgery; Steps 2, 3, and 4 were performed on days 1, 3, and 5 postoperatively. Results. In females with uncomplicated pregnancy, surgical delivery under spinal anesthesia elevated the level of NSE in the normal range. In those with moderate gestosis, higher NSE concentrations were recorded within the first 24 hours after cesarean section. In pregnant women with severe gestosis, the level of NSE was considerably increased, suggesting a hypoxic brain lesion. Within the first 3 days following cesarean section, they were found to have a rise in NSE concentrations to high values. Conclusion: In women with severe gestosis, surgical stress progresses hypoxic lesion of the central nervous system during and within 3 days after surgery. Key words: gestosis, cesarean section, neuron-specific enolase.

Objective: to study whether reamberin and hydroxyethyl starch may be used to correct dyslipoproteinemia in gestosis. Subjects and methods: Twenty-two patients with early postoperative gestosis were examined. Group 1 patients (n=8) received the standard treatment. In addition to the standard treatment, Group 2 patients (n=7) were given 6% hydroxyethyl starch solution infusion at concentrations of 5-6 ml/kg body weight at a rate of 3 ml/ml. Just after hydroxyethyl starch infusion, Group 3 patients (n=7) were additionally injected 1.5% reamberin by the above scheme. The results of examinations were compared with the data obtained on examination of 8 puerperas after pregnancy and normal delivery (Group 4). The plasma concentration of triglycerides, total cholesterol (TC), and the cholesterols of high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) were measured. Results and discussion. All the puerperas with gestosis were found to have hypertriglyceridemia and elevated levels of VLDL cholesterol with decreased concentrations of HDL cholesterol. The moderately higher levels of triglycerides and TC were also observed in patients without gestosis. Hydroxyethyl starch lowered the concentration of triglycerides by postpartum days 3—4. When hydroxyethyl starch was used in combination with reamberin, there was a significant reduction in the concentrations of triglycerides and VLDL and LDL cholesterols and a substantial rise in the level of HDL cholesterol. By postpartum days 3 and 4, Group 1 showed a considerable increase in the atherogenicity coefficient, which was significant as compared with the baseline level. Hydroxyethyl starch alone prevented an increase in the atherogenici-ty coefficient while its use in combination with reamberin significantly lowered this index and normalized it by postpartum days 3—4. Conclusion. Hydroxyethyl starch alone and in combination with reamberin shows an antiatherogenic effect in the treatment of gestosis in the early postpartum period, the action of hydroxyethyl starch in combination with reamberin was much more pronounced. Key words: gestosis, blood lipoproteins, atherogenicity coefficient, reamberin.

Objective: to make a complex analysis of the efficacy of xenon as the major agent in maintaining anesthesia during early activation of patients operated on under extracorporeal circulation for coronary heart disease. Subjects and methods. Forty-two patients aged 59±3 years were examined. A total of 3±0.2 coronary arteries were shunted. General anesthesia was induced and maintained by propofol and fentanyl under extracorporeal circulation. Anesthesia was maintained by xenon inhalation in the preperfusion and postperfusion periods. General anesthesia was combined with high (Th3—Th4) epidural anesthesia in 10 cases. Results. During xenon inhalation, the central hemodynamic parameters were maximally steady-state both before and after extracorporeal circulation. The coronary perfusion conditions estimated from the coronary perfusion gradients were stable. The study of the conditions for coronary perfusion and the values of myocardial demand showed the persistence of their balance (r=0.55—0.83; p<0.05). With the use of epidural anesthesia as a component of maintenance, there was a two-fold increase (p<0.05) in the use of sympathomimetic agents. Lower Pa02 after initiation of xenon inhalation and, accordingly, decreased Fi02 were not associated with worse Pa02/Fi02 and increased intrapulmonary blood shunting; there were no changes in blood oxygen-transport function. Emergence from anesthesia occurred 9±1.2 min after the termination of xenon delivery and failed to be accelerated when epidural anesthesia was applied. The latter could reduce the inhaled concentration of xenon from 59.2±0.5 to 51.5±0.5% (p<0.05) and the dosage of fentanyl from 2.9±0.15 to 2.1±0.26 ^g/kg/hr <p<0.°5). The use of xenon as a basic anesthetic has prospects during early activation after myocardial revascularization under extracorporeal circulation. The advantage of xenon is the absence of negative effects on central hemodynamics and the presence of conditions for coronary perfusion in patients with coronary heart disease. This mode of maintenance provides not only an effective anesthetic protection, but also emergence from anesthesia in the range of 3 to 25 minutes after the end of operations, which allows one to make an early activation in the operating suite in more than 90% of cases. Key words: xenon, xenon anesthesia, early activation after surgery under extracorporeal circulation, anesthesia in patients with coronary heart disease.

Objective: to evaluate the efficiency of high thoracic paravertebral block as an anesthetic component in the surgical treatment of unstable angina pectoris. Subjects and methods. Twenty-six patients aged 38 to 67 years who had unstable angina pectoris and who had underwent surgical myocardial revascularization were examined. A study group included 12 patients in whom high thoracic paravertebral block (Th3—Th4—Th5) with 0.75% ropivacaine solution was used as an additional component of general anesthesia. No paravertebral block was conducted in a comparison group (n=14). Randomization was made by the envelop method in a ratio of 2:1. The groups were stratified by age, gender, the class of unstable angina, myocardial contractility, and the type of an operation. Results. Paravertebral block was ascertained to significantly increase the analgesic component of general anesthesia in the surgical treatment of unstable angina. In the study group of patients, there were more steady-state central hemodynamic parameters at surgical stages than in the comparison group, which contributed to a reduction in the number of critical episodes during anesthesia. The level of stress hormones at the surgical stages also indicated effective analgesia when high thoracic paravertebral block was used. Furthermore, the use of this technique of regional anesthesia substantially optimized an early postoperative period — there were fewer needs for opioids. Key words: paravertebral block, regional anesthesia, acute coronary syndrome, surgical myocardial revascularization.

The problem of postoperative analgesia has been attracting scrupulous attention for many years. The consequences of inadequate treatment for pain are highly significant in terms of physical or emotional injury. Objective: to optimize analgesia in the emergence period after the surgical correction of scoliosis. Subjects and methods. A total of 64 patients divided into groups by the mode of analgesia were examined. The parameters of hemodynamics, cardiointervalography, and the scores of pain, the therapy of which involved perfalgan at the final stage of anesthesia met the criteria for adequate analgesia. Results. Increased pain sensation was observed at the emergence stage in the group of patients where fentanyl administration was routinely stopped 30 minutes before the end of surgery. To prevent the intractable pain syndrome, therapy should be initiated at once when it occurs and preventive analgesia should be initiated in predictable pain (such as elective surgical intervention). The preemptive administration of perfalgan at the final stage of anesthesia with a controlled intravenous anesthetic (diprivan) prevented the development of intensive pain sensations after extubation, failed to prolong the emergence period, and made reversal of anesthesia and transportation of patients to a unit comfortable and less painful. Key words: analgesia, scoliosis, perfalgan.

A need for further development of day case anesthesia is obvious and it has been proved if the due principles used in hospital anesthetic provision are met. The optimization of all perioperative stages in the one-day clinic was the subject of many studies, the main objective of which is to search for new ways of saving financial resources. However, to secure a patient’s safety is the basis of modern anesthesiology and any compromises are impermissible in this situation. Many Russian and foreign investigators pay great attention to the problems of monitoring a patient in a postanesthesia care unit (PACU) and some foreign authors discuss postanesthesia monitoring of a patient, without transferring him/her to the PACU, the so-called fast-track, and its introduction into the practice of one-day surgery clinics for stable patients if this is correctly organized. However, the opinion of authors differs in the results of some studies, in the fast-track group, the total time of emergence from anesthesia and adaptation in patients is much shorter, which provides their more rapid discharge from the clinic, but, according to the data of other studies, the patients’ adaptation period occurs more slowly in the fast-tract group, accordingly, with delayed discharge home. The clinical benefit in the fast-track group is not significant; the economic costs are similar to those in the recovery group under the conditions of the PACU, the financial benefit is not great. Whether it is expedient to introduce the fast-track monitoring into the one-day clinic is debated; the use of this type of monitoring may be associated with a significant risk, as often happens to some innovations; in addition, the ineffective use of manpower leads to increased expenditures. Key words: one-day surgery hospital, postanesthetic monitoring, postoperative ward, second-level monitoring ward, fast tract.

Objective: to define the clinical significance of rhabdomyolysis in patients with hemoblastoses during intensive chemotherapy. Subjects and methods. The study included 63 hematoblastosis patients aged 20 to 71 years (median 42 years) who received intensive chemotherapy that was referred as to grade 4 hematological toxicity. Serum myoglobin levels were monitored before and during chemotherapy, in the period of development of myelotoxic agranulocytosis and at the end of the treatment. Along with this, hematological shifts, biochemical parameters, and changes in acid-base and water-electrolytic balances were estimated. The condition was assessed using the APACHE II scale and organ dysfunctions were evaluated by the SOFA scale. The presence or absence of the systemic inflammatory response syndrome (SIRS) was determined. Results. The study revealed a 16-fold increase in myoglobin levels along with significant changes in laboratory indices. Myoglobinemia was found to be associated with the incidence of SIRS. The level of myoglobulin directly correlates with the severity of the disease, by using the APACHE II scale, and the degree of the SOFA scale organ dysfunctions. Multivariate analysis was used to define a role of the elevated level of myoglobin as an additional indicator of a poor prognosis. Conclusion. The findings suggest that muscular tissue damage is a manifestation of multiple organ dysfunctions and may be one of the key links of the development of a vicious circle of the pathogenesis of multiple organ failures. The obtained results necessitate the elaboration of measures to prevent or diminish muscular tissue damage in patients with hemoblastoses. Taking into account muscle damages can improve a prognosis when multiple organ failures develop. Key words: myoglobin, rhabdomyolysis, hemoblastoses, systemic inflammation, severity scales, prognosis.

Objective: to reveal the basic regularities in the development of lipid metabolic disturbances in severe sepsis and to evaluate the efficiency of parenteral use of new balanced lipid emulsions in this cohort of patients. Subjects and methods. A prospective study was conducted in 88 patients with severe sepsis of different etiologies in the intensive care unit (ICI), Sverdlovsk Regional Clinical Hospital One. Among the lipid metabolic parameters, serum cholesterol, triglycerides (TG), high-density lipoproteins, low-density lipoproteins, and atherogenicity index were measured. Out of the systemic inflammatory markers and the additional criteria for sepsis severity, the serum levels of C-reactive protein, nitric oxide, lactate, D-dimers, the anti-inflammatory cytokine IL-4 and the proinflammatory cytokine IL-8 were determined. Serum was taken on days 1, 3, 5, and 7 after admission to the ICI. The quantitative attributes were comparatively analyzed by the statistical program «Statistica 6.0». Results. The severity assessed by the APACHE II scale, the degree of multiple organ failures (MOF) evaluated by the SOFA scale, and lung lesion according to the MURREY scale were found to be closely related to the baseline serum TG levels in patients with severe sepsis. The findings suggest that patients with high TG levels have much higher resuscitative mortality rates. The clinical evaluation of the efficiency of the new method for correction of lipid metabolic disturbances in severe sepsis has indicated that the patients receiving balanced (omega-3 fatty acids-enriched) fat emulsions as 20% Lipoplus solution had lower APACHE II scores within the first 7 days of intensive therapy and significantly more positive SOFA MOF changes. Specific changes were revealed in the presence of systemic inflammatory markers, such as C-reactive protein, IL-8, and IL-4, which confirms that balanced lipid emulsions are able to affect the system of pro- and anti-inflammatory mediators. Conclusion. The baseline increased serum TG level may be regarded as an additional criterion for the severity of sepsis. The new-generation balanced fat emulsions used in the parenteral feeding program for patients with severe sepsis can reduce the severity of their condition and the manifestations of MOF and affect the system of pro- and anti-inflammatory mediators. Key words: severe sepsis, lipid metabolic disturbances, balanced lipid emulsions.