Objective: to study systemic hemodynamic changes, by taking into account the typological features of a blood circulatory device in anemic animals when therapeutic measures were implemented.

Materials and methods. Experiments were made on 58 dogs in 3 series of experiments: 1) 20 animals under hemorrhagic shock (a control group); 2) 18 anemic animals receiving further infusion therapy; and 3) 20 anemic animals exposed to hyperbaric oxygenation (HBO) (pO2 = 300 kPa; 60-min session). In each series, animals with eukinetic, hypokinetic, and hyperkinetic circulations were identified. Cardiac and stroke indices (CI and SI), left ventricular stroke output index (LVSOI), specific peripheral vascular resistance (SPVR), double product (DP), heart rate, and blood pressure (BP) were determined at the baseline, at 30- and 90-minute shock and after treatment.

Results. In the late posthemorrhagic period (at min 90), the preferential preponderance of hyperkinetic circulation in untreated animals in the late stage was characterized by the exhaustion of cardiovascular compensatory reactions and attended by a reduction in BP and central hemodynamic parameters (CI, SI, LVSOI) and evolving tachycardia. In the animals with all typological groups, infusion therapy produced a short-term impact on the activation of compensatory hemodynamic reactions, by increasing vascular tone with relatively low baseline central hemodynamic values, which was due to the fact that the heart was overloaded with the excess volume of an infusion mixture and myocardial contractility was diminished. Under HBO, recovery of the baseline ratio of circulatory types increased cardiac functional reserves and eliminated myocardial hypoxia (DP normalization).

Conclusion. In hypoxia, recovery of hemodynamic homeostasis in anemic animals is determined by the optimization of adaptive functional mechanisms responsible for circulatory regulation.

 

 

Objective. To study the hemodynamic effect of benzodiazepine tranquilizers in explosive mine injury in an experiment.

Materials and methods. The study was performed on non-inbred male rats; hemodynamic parameters were examined at the systemic, organ, and microcirculatory levels.

Results. Circulatory adaptive changes occurring at the beginning of a premorbid load further become pathogenic, which in combination with a progressive change in blood-brain barrier resistance results in the severer course of premorbid load-complicated explosive mine injury than that of isolated one. Correction of occurring disorders, by stimulating the stress-limiting GABAergic system with diazepam, is most effective within the first 25 minutes after isolated explosive mine injury and within the first 15 minutes after complicated one.

 

Conclusion. Under the conditions of deep collieries where medical aid was generally late, emergency medical activation of urgent adaptation mechanisms by the techniques specially developed by the authors for these conditions is the most effective way of preventing the complications of explosive mine injury.

 

Objective: To determine the regularities of iron metabolic disturbances and their impact on the hemostatic system in critically ill patients due to the severe course of generalized purulent peritonitis, acute pancreatitis, and thermal skin injuries. Materials and methods. In 36 patients with an APACHE II of 22.6±3.4 scores, endogenous iron metabolism was assessed by the level of serum iron, total serum syderopexy power, transferrin iron accumulation, ferritin concentrations, and free hemoglobin levels in blood; the antioxidative protective system, lipid peroxidation activity, and hemostatic parameters are studied. Results. There are general regularities in the hemostatic influence of the high concentrations of free hemoglobin and free radical oxidation products in critically ill patients due to generalized peritonitis, acute pancreatitis, or thermal skin injuries. In these patients, iron metabolism occurs with the overload of transporter proteins, such as transferrin and ferritin. Conclusion. Microcirculatory disorders as intravascular hemolysis and hemoglobin metabolism to ionized iron activate lipid peroxidation in the presence of excess Fe2+, which favors strain of the hemostatic system, by determining a tendency toward hypo- or hypercoagulation via the lowered activity of the platelets dependent on the state of free radical processes. Key words: ionized iron, transferrin, ferritin, lipid peroxidation, intravascular hemolysis, hemostasis.

Objective: to study the level of peroxides and the activity of superoxide dismutase (SOD) in females with gestosis in the perioperative period.

Materials and methods: 85 females in whom delivery had been performed under spinal anesthesia using conventional perioperative intensive care were examined. A control group comprised 30 females with uncomplicated pregnancy; Group 1 included 26 females with moderate gestosis; Group 2 consisted of 29 females with severe gestosis. The severity of gestosis was determined by means of the Goecke scale that had been modified by G. M. Savelyeva. The groups of the examinees were matched by height, weight, age, and gender.

Results: there is intensification of free radical processes and a standard adaptive response of the antioxidative system forms in the pregnant females exposed to surgical delivery under spinal anesthesia. In dynamics, this reaction is characterized by a certain pattern: the maximum activation on the first postoperative day, some depletion on day 3, and recovery of compensatory capacities on day 5. The antioxidative system of the females with uncomplicated pregnancy generally shows a balanced response to activated free radical processes during surgical delivery and in the postoperative period. There is stress in moderate gestosis-complicated pregnancy and depletion of the antiox-idative system in severely progressive gestosis, which diminishes the body’s adaptive capacities and leads to the formation of chronic oxidative stress as a leading factor of the pathogenesis of the disease. Imbalance between free radical oxidation processes and the antioxidative system increases when surgical delivery is performed. In the females with moderate gestosis, oxidative stress may be characterized as subcompensated with a moderate increase in the concentration of peroxides in the intra- and postoperative period, as compared with those with physiological pregnancy.

Conclusion. Severe gestosis is characterized by a decompensated stress with a pronounced increase in the level of peroxides before and during surgical delivery and within 5 postoperative days.

 

Objective: to evaluate the efficiency of hydroxyethyl starch solution (6% refortane, Berlin-Chemie) versus fresh frozen plasma used to correct neonatal hypovolemia.

Materials and methods. In 12 neonatal infants with hypoco-agulation, hypovolemia was corrected with fresh frozen plasma (10 ml/kg body weight). In 13 neonates, it was corrected with 6% refortane infusion in a dose of 10 ml/kg. Doppler echocardiography was used to study central hemodynamic parameters and Doppler study was employed to examine regional blood flow in the anterior cerebral and renal arteries.

Results. Infusion of 6% refortane and fresh frozen plasma at a rate of 10 ml/hour during an hour was found to normalize the parameters of central hemodynamics and regional blood flow.

Conclusion. Comparative analysis of the findings suggests that 6% refortane is the drug of choice in correcting neonatal hypovolemia. Fresh frozen plasma should be infused in hemostatic disorders.

 

Objective: to study the specific features of remodeling of the aorta, carotid, and femoral artery in the late postresuscitative period.

Materials and methods. Experiments were carried out on non-inbred albino rats when clinical death was stimulated by the method of V. G. Korpachev due to 10-minute cardiovascular fascicle ligation. Before clinical death and 60 days after resuscitation, blood pressure, vascular tissue malonic dialdehyde levels, and plasma biochemiluminescence parameters were recorded and great vascular tissue microscopic and ultramicroscopic studies were conducted.

Results. On day 60 following resuscitation, a unitary connective tissue carcass was shown to form in the great vascular intima and media via chaotic synthesis of heretodirection-al fibers. This appeared as elevated levels of collagenous fibers in the intima and media as shown by light microscopy. The aortic, carotid, and femoral arterial media displayed a large number of secreting smooth muscle cells and elevated levels of collagenous fibers, which was an active vascular wall remodeling process. Enhanced free radical processes during reperfusion both in the whole organism and vascular wall tissue were one of the triggers of remodeling processes after ischemia. Impaired vascular tone regulation caused by the development of vascular wall remodeling by the connective tissue vegetation growth type contributed to the development of a hypertensive response in the late period.

 

Conclusion. The late postresuscitative period was marked by increased connective tissue in the media of great vessels, by imperfect recovery of the morphofunc-tional status of the endothelial lining, which was likely to be a cause of increased vascular stiffness and elevated blood pressure in rats 2 months after resuscitation.

 

Objective: to evaluate the structural and functional state of the right cardiac cavities in acute left ventricular myocardial infarction and in progressive chronic heart failure (CHF) in patients with coronary heart disease.

Materials and methods. 20 patients with acute myocardial infarction and 48 with postinfarct cardiosclerosis with NYHA functional classes I to IV CHF were examined. The structural and functional state of the right heart was evaluated in progressive left ventricular systolic and diastolic dysfunction by echocardiography.

Results. In the acute period of infarction, remodeling processes occur in the left ventricle, with normal postload values, volumetric indices and right ventricular contractility are in the normal range. There is right cardiac dilatation at the early stage of left ventricular systolic and diastolic dysfunction in postinfarct remodeling and evolving CHF, normal pulmonary arterial and right atrial pressures. With a significant reduction in left ventricular contractility and its pronounced filling impairment, increases in post- and preload for the right ventricle occur with a just considerable change in its structural and functional state.

Conclusion. In impaired myocardial relaxation in the presence of CHF, remodeling of the right cardiac cavities takes place without the influence of a hemodynamic factor. There is a close relationship of remodeling of both ventricles from the very early CHF stages, which suggests that there are common pathogenetic mechanisms responsible for the development of myocardial dysfunction.

 

Three different extubation procedures were compared in 31 patients with acute stenotic laryngotracheitis. The influence of each method on extubation components, such as inflammation, stress, allergy, by eosinophilic changes and glycemia and cortisol levels, was evaluated. The proposed extubation procedure was found to have an advantage over traditional ones.

 

Objective: to study external respiratory function in miners with a varying length of underground service in order to further develop differential respiratory therapy for evolving critical conditions.

Materials and methods. The studies were performed in 530 miners who were able-bodied drift miners and diggers from two Novokuznetsk mines (a study group). The group was divided into 4 subgroups in relation to the length of underground service and age. In both groups, expiratory respiratory function was studied on a «MicroLoop» spirometer (Micro Medical Ltd (United Kingdom), by mathematically processing the Results. Velocity and capacity values were measured.

Results. The study has shown similar external respiratory changes: a reduction in capacity indices (vital capacity, forced vital capacity) in the presence of preserved velocity indices, which occur just with a length of underground service of up to 10 years. As the length of underground service and age of the examined miners increase, these disorders progress — there is a significant reduction in capacity and then velocity (MVR 25-50) spirographic characteristics.

Conclusion. While working in the mine, drift miners and diggers develop a mixed type of external respiratory disorders with a preponderance of restrictive ones. Ventilation disorders progress with increases in the length of underground service and age. When a critical condition emerges at this background, adequate respiratory therapy is obviously one of the leading components of successful treatment.

 

The review describes approaches to correcting oxygen balance in the prevention and treatment of sepsis and multiple organ dysfunction. Whether there is a relationship of the consumption of oxygen to its supply, what prognostic value of these indices is, and whether it is justifiable to enhance oxygen delivery by various modes (infusion therapy, inotropic and respiratory support) are discussed.

 

Objective: to optimize the transportation of cardiosurgical patients from the operating-room to an intensive care unit (ICU), by developing and introducing a pathogenetically grounded measure to prevent poor circulatory reactions.

Materials and methods. 94 patients operated on under extracorporeal circulation for coronary heart disease and transferred to an ICU for sustained artificial ventilation (AV) during moderate sympathomimetic therapy. The patients were prospectively divided into 2 groups: 1) patients who were transported during sympathomimetic therapy selected by the end of an operation; 2) those who were additionally given dobutamine in a dose of 2—3 (2.5±0.01) ^g/kg/min just before putting them from the operating table to the intensive care bed if this drug was not used, or its dosage was increased by 25% of the administered dose. The patients of the identified groups did not differ in age, severity, and undergone operations. In the groups, the sympathomimetic therapy selected by the end of an operation was virtually identical. Central hemodynamics (CHD) and blood oxygen-transporting function (BOTF) were examined before placing the patients from the operating table to the intensive care bed and after referral to the ICU. During transportation, circulatory parameters were recorded every minute and Holter ECG monitoring was done.

Results. During transportation blood pressure significantly elevated, cardiac pump function and BOTF parameters decreased. Holter monitoring demonstrated substantial changes that may reflect the activation of the sympathetic and parasympathetic parts of the autonomic nervous system. The use of dobutamine (Group 2) effectively prevented cardiac depression in the patients transferring to the ICU.

Conclusion. During transportation of cardiosurgical patients who are on AV and receive moderate sympathomimetic therapy, there may be a worse cardiac pump function due to a complex of autonomic reactions that alter vascular tone and, possibly, myocardial contractility. Dobutamine-induced enhanced inotropic support may prevent circulatory changes.

 

Objective: to enhance the efficiency of treatment for limb ischemia-reperfusion syndrome in an experiment, by using the modified hemosorbents that have oxidative properties.

Materials and methods. The investigation was conducted on 94 mongrel male dogs divided into 3 groups: 1) intact animals (n=20); 2) animals treated with hemocarboperfusion on the standard sorbent CKH-1K (n=36); 3) animals received hemocarboperfusion on sodium hypochloride-modified sorbent CKH-1K (n=38). A model of acute ischemia-reperfusion syndrome was created by the method of V. D. Pasechnikov et al. Partial oxygen tension (pO2) was determined by pin polarography. The levels of vasoactive eicosanoids were measured by enzyme immunoassay.

Results. In the animals with leg ischemia syndrome, there is a significant pO2 reduction in the muscles of the hip and shin, which does not completely recover after reperfusion. Standard CKN-1K sorbent hemocarboperfusion reduces pO2 as compared with the reperfusion period while the use of modified CKH-1K hemosorbent increased pO2 in the study hind limb muscles to the level observed in intact animals. The development of ischemia and reperfusion is accompanied by the elevated levels of inflammatory mediators that have vasoconstrictive properties (thromboxane B2, endothelin-1, leukotrienes C4/D4/E4) and the lower concentration of the vasodilator prostacyclin. Standard CKN-1K sorbent hemocarboperfusion results in a further increase in the concentrations of thromboxane B2 and leukotrienes C4/D4/E4, a decrease in the concentration of endothelin-1, and an elevation of the levels of prostacyclin and prostaglandin E2. When sodium hypochlorite-modified CKN-1K sorbent hemocarboperfusion is employed, the concentrations of thromboxane B2, endothelin-1, and leukotrienes C4/D4/E4 decrease, and the level of prostacyclin increases.

Conclusion. Hemocarboperfusion used in the treatment of leg ischemia-reperfusion syndrome leads to restoration of tissue oxygenation and can restore compensatory mechanisms at the tissue and metabolic levels. At this time, sodium hypochlorite-modified CKN-1K sorbent has the highest efficacy.

 

Objective: to study the specific features of sorption of some protein molecules (cytokines, immunoglobulins) in vitro, by using the carbon hemosorbent designed at the Institute of Hydrocarbon Process Problems, Siberian Branch, Russian Academy of Sciences.

Materials and methods. 42 plasma samples from 14 patients with peritonitis were examined before and after hemosorption. Plasma was perfused through the hemosorbent with a plasma:hemosorbent ratio of 10:1 and a 5-cm3-column volume on an УНИРОЛ-1 at a rate of 15 ml/min.

Results. The designed hemosorbent was found to absorb proinflammatory cytokines, such as tumor necrosis fac-tor-a and interleukin-1/J more than the hemosorbent VNIITU-1, and to significantly unchange the content of immunoglobulins M, G, and A. The absorptive capacity of the new hemosorbent was 48% greater than that of VNIITU-1.

Conclusion. The findings may serve as a guide for further more in-depth studies of the specific features of sorption of plasma protein molecules from critically ill patients, by employingjust this carbon sorbent.

 

Objective: To evaluate the efficiency of extracorporeal hemocorrection used in the complex therapy in patients with a pyoinflammatory process in the lung.

Materials and methods: 62 patients, including 22 patients with lung abscess who underwent routine plasmapheresis and 40 patients with varying pyoinflammatory lung diseases who received modified hemocorrection — plasma exchange combined with laser extracorporeally washed-off cytomass irradiation, were examined and treated. The severity of their general condition was assessed by the SAPS scale and the severity of intoxication was evaluated by the content of low and medium-molecular weight substances (LMMWSs). The hemostatic system was studied by standardized studies.

Results. Routine plasmapheresis was established to produce no impact on platelet functional activity within the first 24 hours and, three days later, promoted the progression of disseminated intravascular coagulation. A combination of plasma exchange and laser extracorporeally washed-off cytomass irradiation in patients with pyoinflam-matory lung diseases was attended by a lower blood coagulative activity and plasmin stabilization with attenuated throm-binemia. The plasma and erythrocytic levels of LMMWSs decreased and their urinary concentrations increased, which is indicative of the body’s detoxification block disorders irrespective of the severity of the disease.

Conclusion. It is expedient to apply the plasma-exchanging technique in combination with laser extracorporeally washed-off cytomass irradiation to patients with the uncomplicated and complicated course of pulmonary pyoinflammatory processes without the signs of multiple organ dysfunction on admission to a specialized hospital.

 

The paper summarizes the principles of ethics of scientific publications. These principles have been elaborated on the basis of the «Uniform Requirements for Papers Submitted to Biomedical Journals» of the International Committee of Editors of Medical Periodicals. They should be kept in mind when developing the strategy of scientific journals. Each journal should adopt a high profile that readers, authors, and reviewers should familiarize with.

 

The authors continue to consider the historical aspects of anesthesiology and reanimatology. Part II deals with the historical development of intravascular anesthesia.