As a plasma substitute clinical medicine uses perfluorane that is an antishock, antiischemic, and cardioprotective agent having a function of transferring O2 and CO2. The authors have investigated the interaction of perfluorane particles with human erythrocytic membranes. The erythrocytic membranes were modified with an impulse electrical field in the experiment. The induced calibrated electroporation of the membranes permitted the detection of the masked effects of perfluorane on blood cells. A clinical defibrillator was used as a source of an impulse electrical field. An electrical impulse was applied to the titanium electrodes placed into the quartz cuvette containing a red blood suspension. Perfluorane was added at concentrations of 5—100 ^l/ml of the suspension. The results were assessed by the optical density of the suspension before and after the action of perfluorane and the impulse electrical field. More than 450 experiments were carried out in three series. The authors studied the effect of perfluorane at concentrations of 10—100 ^l/ml on the modified erythrocytic membranes in the first series, the combined effect of the agent and the second electrical impulse in the second series, and the effect of perfluorane at concentrations of 5, 25, and 100 ^l/ml on the membrane upon combined exposures to positive and negative impulse electrical field in the third series. The first and second series of experiments indicated the strengthening (decelerating the rate of hemolysis) effect of perfluorane administered at small concentrations and its damaging effect given at high concentrations. Exposure to electrical fields of different directions in the second and third series made it possible to change the shear vector of charged perfluorane particles against the blood cells and to reveal a number of composite nonlinear effects of their interaction. The paper discusses the possible mechanisms of interaction of perfluorane with erythrocytic membranes, which are associated with the structural, charge, and electrochemical asymmetry of the mem-brane-perfluorane system.

The results of comparative determination of the values of stroke volume (SV) and cardiac index measured by integral rheography (IRG) after M. I. Tishchenko, thermodilution (using a Swan-Ganz catheter), and echocardiography (EchoCG) were studied in 139 patients with acquired heart diseases (AHD) and coronary heart disease (CHD) in different periods after cardiosurgical operations under extracorporeal circulation. The reasons for lowering SV measured by rheography were revealed. The changes in the oscillations of terminal circulatory vessels, which are associated with altered ejection fraction and decreased capillary blood flow velocity pulse under the action of different doses of adrenaline, were shown to affect the genesis of rheograms. The problem in assessing the nature of blood flow (pulsation) in the terminal portion of the circulatory system in emergency medicine is discussed.

Objective. To assess a role of pulmonary microvascular thrombosis in the development of acute lung lesion.

Material and methods. Experiments were carried out on 60 albino non-inbred male rats. Thromboplastin solution was injected into their jugular vein under anesthesia. Experiments lasted 1 hour to 3 days. Lung specimens were fixed in 10% neutral formaldehyde solution and poured into paraffin. Histological slices were stained with hema-toxylin-eosin; periodic acid Schiff reaction was made. Morphometrical and statistical studies were employed.

Results. 1—3 hours after thromboplastin injection, there were thromboses in the lumens of minor arteries, capillaries, and veins, developed interstitial and intraalveolar edema, and diapedetic hemorrhages, epithelial desquamation into the bronchial lumen, as well as stab leukocytic infiltration of interalveolar septa. The magnitude of morphological changes in the lung is dissimilar in different animals.

Conclusion. Pulmonary microvascular thrombosis leads to the development of acute lung lesion documented by morphological studies.

Experiments on non-inbred anesthetized albino male rats weighing 250-350 g have established that blood reperfusion after acute massive blood loss substantially increases the count of micronucleated (MN) erythrocytes in the rat bone marrow by 8.4 times as a whole as compared with the control, which suggests genomic destabilization. The optimum time of elaboration of MN polychromatic erythrocytes is 24 hours after acute blood loss or reinfusion. The intraarterial administration of mexidole (50 mg/kg) just before blood reinfusion drastically decreases the count of MN erythrocytes virtually to the that seen in control animals. The observed effects during micronucleus assay generally correspond to the changes in lipid per-oxidation and overall antioxidative activity, pointing to the free radical mechanism of this phenomenon.

The authors analyzed the efficiency of different variants of infusion-transfusion therapy (ITT) programs in 47 patients with severe gestosis in whom pregnancy or labor was complicated by massive or supermassive blood loss. The use of hyperosmolar solution in combination with natural and artificial colloids in the ITT programs could reduce interstitial hyperhydration. That of erythrocyte-containing components in combination with perfluorane permitted maintenance of tissue oxygen supply even in supermassive blood loss. Addition of reamberin and neoton to infusion media could maintain inotropic myocardial function and provided antiis-chemic protection, contributing to the prevention of multiple organ dysfunction and to the reduction of maternal mortality.

Objective. To comparatively analyze the efficiency of methods for extracorporeal detoxification (ED) of the body in abdominal sepsis (AS) and to choose the optimum detoxifying methods in relation to the level of endotoxicosis.

Material and methods. 56 patients (41 males and 15 females; mean age 39.4±12.2 years) with surgical abdominal infection of various genesis, complicated by the development of sepsis whose treatment included ED methods, were examined. The level of intoxication and the efficiency of detoxification were evaluated by general clinical and biochemical blood parameters, the leukocytic intoxication index, the levels of low and medium molecular-weight substances in the body’s media. Hemosorption, plasmapheresis, hemodialysis, hemodiafiltration, and hemofiltration were used for detoxification.

Results. Surgical abdominal infection is accompanied by endotoxemia that has no clear nosological specificity, but it depends on the pattern of a clinical course of the disease and is most pronounced in the septic syndrome. In AS, 80.4% of the patients are observed to have an irreversible decompensation phase and a terminal degree of endotoxicosis, which require detoxification. The use of different ED methods according to the level of intoxication may reduce the level of endotoxicosis and yield a persistent beneficial effect in 85.2% of cases of its application.

Conclusion. Filtration and dialysis techniques (hemodialysis, hemofiltration, and hemodiafiltration) are the methods of choice in AS. Hemosorption and plasmapheresis may be recommended for use at the early stages of endotoxicosis development and in preserved renal excretory function.

The study was undertaken to substantiate a differential choice of intensive care of abdominal sepsis on the basis of its clinical and pathogenetic types. Clinical and biochemical parameters were retro- and prospectively studied in 60 patients diagnosed as having generalized peritonitis and abdominal sepsis. The patients were divided into 3 groups in accordance with their clinical and pathogenetic characteristics. The clinical and pathogenetic types of the course of abdominal sepsis were identified. The first type required additions of the above complex of intensive care by supplementing enteral detoxification. In the second clinical and pathogenetic type of abdominal sepsis, therapy is extended through simultaneous intravenous administration of perfluorane and enteral detoxification with an enterosorbent. In the third type, therapy is extended through intravenous infusion of perfluorane, followed by enteral detoxification.

The past decade is marked by very high cardiovascular mortality rates in Russia. Sudden death caused by ventricular fibrillation and asystole is one of the leading reasons for the high mortality. Sudden out-of-hospital cardiac arrest occurs in as high as 70—80% of the cases. The key factor that determines the success of resuscitation and survival in patients with cardiac arrest due to fibrillation is early defibrillation (within the first 5 minutes). Small-sized automated external defibrilla-tors that can be used not only by medical workers, but also paramedics and educated population should be introduced into prehospital resuscitative care to solve this problem in this country.

This investigation was undertaken to study the resistance of membrane structures and the level of the intracellular defense systems of the heart, brain, and liver in animals with active versus passive behavior in different periods (days 7 and 30) after resuscitation made 10 minutes following systemic circulatory arrest. All the animals in which systemic circulation had been stopped were survivors with the cession of neurological deficit. The activity of antioxidative defense enzymes, such as cata-lase and superoxide dismutase, in cardiac, cerebral, and hepatic tissues was assayed by spectrophotometry using the conventional methods. The level of stress-induced protein HSP70 was measured in the tissue cytosolic fraction by the Western blotting assay. The activity of Ca2+ transport in the myocardial sarcoplasmic reticulum was determined on an Orion EA 940 ionomer («Orion Research», USA) having a Ca2+-selective electrode. The findings show a significant tissue specificity in different postresuscitative periods (days 7 and 30) and varying (protective to damaging) cardiac, cerebral, and hepatic responses in active and passive animals to hypoxia.

The study was conducted in 60 patients with acute ischemic attack. Mexidole included into a complex of intensive care in patients with stroke promoted the abolishment of local disseminated intravascular coagulation and prevented secondary cerebral lesion and the generalization of a systemic inflammatory reaction. The rate of a reduction in the blood levels of soluble fibrin-monomer complexes and fibrinogen was higher than that in mexidole-untreated patients. By day 7, the levels of soluble fibrin-monomer complexes and fibrinogen in survivors decreased on average to 18.0±2.7 mg% and to 2—4 g/l, respectively. Mexidole optimizes the parameters of cerebral blood flow, improves venous outflow from the cranial cavity, and may be recommended for its inclusion into the intensive treatment regimen in patients with cere-brovascular diseases.

The paper analyzes the severity of varying manifestations of acute pancreatitis and considers medical measures promoting at its early stages the elimination of the inflammatory process resulting in pancreatic necrosis.

The paper considers whether current methods of analysis of research and clinical studies can be used in reanimatology, one of the most important areas of medicine. It also discusses the basic types of clinical studies, their evidence, advantages, and disadvantages. The annex gives some most frequently used statistical criteria and a glossary of terms that are also specific to evidence-based medicine.

The lecture deals with hepatocytic insufficiency, one of the urgent problems in modern clinical medicine. It also considers the major clinical signs of hepatocytic insufficiency and the mechanisms of their development, as well as the principles of treatment of its major symptoms and syndromes.