The investigation was undertaken to study rheological and hemolytic changes occurring in the acute period of injury and blood loss. For this 64 patients with injury and blood loss were examined and treated. It was established that within the first 48 hours after injury there were worse microrheological parameters and higher erythrodieresis, which appeared as the increased erythro-cytic rigidity index, impaired ratio of erythrocytic forms by the maturity degree with a relative increase in the count of highly resistant forms, as well as there was enhanced serum hemolytic activity. At the same time the severity of patients’ status was accompanied by increases in plasma viscosity, erythrocytic rigidity index, intravascular aggregation, serum hemolytic activity, and highly resistant red blood cells. Perfluorane used in a dose of 6—10 ml/kg in patients with severe injury and blood loss improved blood rheological properties, by stabilizing the microrheological indices — erythrocytic rigidity and aggregation and by decreasing plasma viscosity. The administration of perfluorane in the acute period of injury did not increase free hemoglobin concentrations, serum hemolytic activity and highly resistant erythrocytes, which suggests its hemoprotective activity. Key words: perfluorane, blood rheology, injury, blood loss.

A rapid diagnosis of hemostatic disorders in the acute period of severe brain injury was clinically tested by using the continuous automatic recording of resonance oscillations occurring with the formation, retraction, and lysis of a clot. Pathogenetic correction of hemostatic disorders was developed and clinically tested in severe brain injury, which was performed, by taking into account the severity of neurological symptoms. This made it possible to reduce the incidence of pulmonary complications and the rates of mortality.

Objective. To optimize the results of treatment in patients with acute respiratory failure (ARF) due to lung contusion, by using the methods of non-invasive mask respiratory support.

Materials and methods. The study covered 31 patients with severe blunt chest injury, multiple costal fractures, and hypoxemic ARF. The patients underwent assisted ventilation (AV) in the CPAP+PSV mode through a facial or nasal mask. Physiological parameters were recorded during non-invasive mask ventilation (NIMV) in the stepwise fashion. A control group comprised 25 patients with the similar severity of injury and ARF who were given conventional AV.

Results. In 67.7% of the study group patients, NIMV was effective in improving oxygenation and external respiration, without exerting negative hemodynamic effects. Endotracheal intubation and AV could be avoided in these patients. Comparison of the study and control groups revealed a significant reduction in the incidence of secondary pneumonias in the NIMV group and in the duration of treatment. Mask ventilation could decrease mortality from 44% in the control group to 9.7% in the NIMV group.

Conclusion. NIMV applied to patients with hypoxemic ARF in the presence of lung contusion improves pulmonary function and, in the bulk of patients, allows endotracheal intubation and AV and consequently their associated complications. When mask ventilation is employed, management of patients becomes shorter and simpler and mortality rates substantially decrease. 

Postoperative respiratory failure is a most common complication and a main cause of postoperative death. The lung opening maneuver is a most effective method of respiratory therapy for this syndrome.

Objective. To evaluate the impact of recruiting maneuver on gas exchange parameters, the biomechanical properties of the lung, and hemodynamic parameters. To determine whether the lung opening maneuver can be fully performed in patients undergoing cardiac surgery.

Materials and methods. The study covered 19 patients aged 53 to 70 years who had postoperative failure. The indication for the recruiting maneuver was a decrease in the oxygenation index below 250 mm Hg during assisted ventilation (AV) with FiO2>0.5, an inspiratory-expira-tory phase ratio of 1:1 to 3:1, and a positive end-expiratory pressure of 5—10 cm H2O.

Results. A decrease in the oxygenation index to 139±36 mm Hg was observed before the recruiting maneuver was applied. Cd;n. averaged 41.1±8.4 ml/cm H2O. After use of the recruiting maneuver, there were increases in the oxygenation index up to 371±121 mm Hg and in Cd;n. up to 64.3±10 ml/cm H2O in all the patients. When the recruiting maneuver was employed, 14 patients were observed to have elevated blood pressures corrected with a vasopressor. One patient developed pneumothorax that was drained in proper time.

Conclusion. The application of the lung opening maneuver leads to a considerable improvement of gas exchange parameters and lung mechanical properties.

The paper deals with the study of hemodynamic features in miner in relation to the length of service. For this, 391 miners aged 20 to 60 years who had been working underground for 1 to 40 years were examined. Hemodynamics was studied by a non-invasive technique. The time course of changes in the basic functional parameters of the blood circulatory system and in the sympathetic activity index was estimated. The study has revealed that hemo-dynamic functional shifts in miners undergo significant changes even in young miners having a length of underground service of less than 10 years. The revealed hemodynamic changes suggest that there are two types of adaptation of the cardiovascular system to tiring physical work under high dust and gas concentrations due to underground openings. There is a cardiac type of adaptation that develops in miners having a length of underground service of less than 10 years and a vascular type that develops of adaptation in those having the length of 20 years or more. In critical conditions (severe skeletal injury or acute blood loss), adaptation disruption is most probable due to diminished precardiac loads. Not only functional, but also morphological changes in the circulatory system occur in the vascular type of adaptation due to its least physiological capacities.

To study the long-term results of coronary arterial stenting in relation to the baseline clinical and angiographic findings and the presence of acute coronary syndrome at the moment of a procedure, the authors made a retrospective comparison of groups of patients undergone balloon angioplasty with a stent being inserted. The findings indicate that while choosing the tactics of treatment for patients with coronary heart disease (CHD) and assessing the risk of development of poor outcomes of coronary stenting, it is necessary to take into account a combination of factors significantly affecting the occurrence of coronary events and the development of restenosis after surgery (smoking, acute coronary syndrome at the moment of a procedure, serum triglyceride levels, extent of coronary bed affliction, type of stenosis, diameter of a revas-cularized vessel) and to apply, where possible, the minimal effective exposure principle to achieve the optimal result of a procedure.

External respiratory function was studied in those engaged in mountaineering. A negative correlation was found between the intensity of exercise and the changes in vital capacity under mountainous conditions. Changes occurring in the levels of glucose and cholesterol were considered in tourists.

Objective. To conduct an experimental study of the impact of the time of administration of succinic acid preparations on central nervous system (CNS) function and gas exchange while simulating metabolic therapy for severe poisoning by ethyl alcohol. The study was performed on 74 male albino rats weighing 140—180 g. Acute severe and very severe intoxication was simulated, by intraabdominally administering 30% ethanol to the rats. Cytoflavin was used to simulate experimental therapy. The rate of gas exchange was estimated by the oxygen uptake determined by the closed chamber method in a Regnault apparatus (Germany). Spontaneous bioelectrical activity was recorded in the frontooccipital lead by the routine procedure. External pain stimulation and rhythmical photostimulation were employed to evaluate cerebral responsiveness. Heterodirectional EEG changes in the «early» and «late» administration of succinate were not followed by the similar alterations of gas exchange: oxygen consumption in both the «early» and «late» administration of succinate remained significantly lower than in the control animals. With the late administration of succinate to the animals with mixed (toxic and hypoxic) coma, the so-called discrepancy between the noticeably increased energy production and brutally diminished metabolism occurred. It may be just the pathological mechanism that was the basis for higher mortality in the late succinate administration group. The findings and their analysis make it possible to advance a hypothesis that succinate may cause metabolic desynchronization if activation of metabolic processes takes place under severe tissue respiratory tissue depression. In these cases, there is a severe damage to tissue and chiefly the brain. This manifests itself as EEG epileptiform activity splashes preceding the animals’ death. Therefore, resuscitation aimed at restoring the transport of oxygen and its involvement in tissue energy processes should be followed by the administration of succinic acid preparations. The drug of this kind is now perfluorane, as demonstrated by experimental and clinical studies. It should be noted that the more potent a metabolic agent is, the more strictly the rules of its use should be observed.

The experiment demonstrated the modulating effect of the antihypoxic agent perfluorane, a blood substitute having multifunctional properties, on the ratio of pro- to antioxidative systems in different organs. In the heart, perfluorane prevented the activation of free radical oxidation under stress, by increasing the activity of superoxide dismutase (SOD) and other enzymes of antioxidative defense. In the liver less resistant to free radical tissue oxidation, acute stress lowered the activity of SOD by 37% during administration of perfluorane, which was followed by the unchanged baseline level of oxidation products and by the hypersensitivity of membranous structures to induction of free radical oxidation. Under stress, proxanol in the heart and liver protected membranous structures from the influence of APK-induced damaging factors without substantially activating the enzymes of antioxidative defense. It is concluded that it is necessary to choose the optimum dosage of the drugs modulating the ratio of pro- to antioxidants in the cell, by taking into account the state of organs that are most sensitive to active oxygen forms.

Objective. To improve the outcomes of surgical treatment of coronary heart disease, by using high epidural block on the basis of evaluation of myocardial diastolic function in the preoperative and early postoperative periods. Materials and methods. 61 patients with coronary heart disease underwent coronary bypass surgery. According to the methods of analgesia, the patients were divided into 2 groups. A study group included 30 patients who had undergone high epidural block in the early postoperative period. A control group comprised 31 patients, wherein the conventional method for analgesia was applied through the parenteral administration of narcotic analgesics. Follow-up EchoCG was made, by examining the parameters of transmitral flow. The clinical course of a postoperative period and the length of stay in intensive care units were estimated. Results. Baseline diastolic dysfunction was detected in practically all patients. In the early postoperative period, the study group showed a significantly better myocardial diastolic function during high epidural block. In the control group, there was no improvement of the parameters characterizing left ventricular diastolic function. These patients longer stayed in a specialized intensive care unit. Conclusion. The postoperative employment of epidural block results in improved left ventricular diastolic function.

The paper summarizes the results of studies of cerebral metabolism in 38 patients with delirium tremens. The findings have led to the conclusion that the leading factor of the pathogenesis of acute cerebral insufficiency in this case is energy deficiency caused by impaired cerebral glucose utilization rather than hypoxia itself.

Objective. To compare the efficacy of antisecretory agents used to prevent early postoperative mucosal erosive and ulcerative lesions of the upper gastrointestinal tract (GIT) in patients undergone cardiac surgery under extracorporeal circulation (EC). The study was performed by stratification randomization. Sixty-three adult patients with acquired cardiac diseases who had undergone operations on the heart under EC were clinically and endoscopically examined. To prevent acute proximal GIT ulcerations in the early postoperative period, all the patients were given antisecretory agents: ^-histamine receptor blockers or proton pump inhibitors (PPI). A drug was chosen by the blind method (envelope one). One group (n=31) took ^-histamine receptor blockers, the other (n=32) received PPI (omeprazole). To examine the upper GIT mucosa and to determine gastric acid-producing function, esophagogastroduodenoscopy with parietal pH-metry and chromoscopy were performed on postoperative days 5 and 9. Analysis of the findings revealed acute erosive and ulcerative lesions in 12.7% of all the examinees only in the ^-blocker group. Suppressed hydrochloric acid was significantly pronounced in the PPI group, as evidenced by chromoscopy. In the H2-blocker and PPI groups, the mean gastric pH value was 2.4±1.0 and 5.5±06 (F=224 and 259, respectively; p=0.0001).

Objective. To employ bile stimulation as a method for preventing and treating acute hepatic failure.

Materials and methods. The results of the clinical examination and treatment of 52 inpatients treated for obstructive jaundice-complicated cholelithiasis, by stimulating bile production and outflow.

Results. All the patients with acute hepatic failure underwent 48 endoscopic interventions (endoscopic papillosphincterotomy) and 4 choledochotomy, followed by stimulation of bile production and outflow. Enhanced bile production and outflow with adequate bile outflow into the duodenum completely evacuated gallstones from the biliary tract into the duodenum and normalized the composition of hepatic bile, which could, as a rule, get clear of the signs of hepatic failure completely within 10—12 days.

Conclusion. The actual possibility exists of treating and preventing acute hepatic failure, by stimulating bile production and outflow in patients with obstructive jaundice-complicated cholelithiasis. Open-access surgery (laparotomy, choledochotomy, external choledochal drainage) is indicated when endoscopic drainage of the bilious tree is ineffective and when the clinical manifestations of hepatic failure increase in cholelithiasis.  

The paper deals with the study of protective and fixed means in the prevention of bacterial contamination at the standing site of catheters used for different purposes and the reliability of their fixation. The study covered 136 patients and victims. Special means for fixing and protecting central venous and epidural catheters were applied in the study group. Adhesive plaster and gauze were used to protect and fix the standing site of catheters in the control group. High-technology protective fixed means have evident advantages, such as effective protection from bacterial contamination, reliable fixation of catheters used for different purposes, comfort for patients, safety, and serviceability in the work of medical staff. The routine use of fixation as an adhesive plaster and gauze fails to provide a valid protection and a reliable  fixation  in  critically  ill  patients.