[Plasma replacement in the treatment of ischemic heart disease]. / Plazmozameshchenie pri lechenii ishemicheskoi bolezni serdtsa.

AIM: To investigate whether plasma replacement (PR) can raise efficiency of drug therapy of ischemic heart disease (IHD). MATERIAL AND METHODS: A 30-60% replacement of circulating plasma for salt or dextran using PF-05 unit has been performed in 324 patients 35-79 years of age with recurrent myocardial infarction and angina pectoris. A total of 520 PR procedures were performed. Biochemical, acid-base, coagulative, viscosity, microcirculatory blood parameters were taken, ECG and stress tests were made. RESULTS: PR resulted in a significant reduction in packed cell volume, total protein, fibrinogen, low density lipoproteins, total cholesterol and led to diminution of blood viscosity, acceleration of capillary blood flow, improvement of O2/CO2. Lowering of fibrinogen levels, number of platelets and their aggregation, enhancement of fibrinolytic blood activity created conditions for moderate controlled hypocoagulation. As shown by stress tests, two weeks after PR 60% of anginal patients of functional class IV can be transferred to class III. CONCLUSION: Because PR is beneficial by many parameters, it lessens the requirement in pharmacological support of patients with complicated IHD.

[Effect of plasmapheresis with substitution by dextran solutions on hemostatic parameters in patients with ischemic heart disease]. / Vliianie plazmafereza s zameshcheniem dekctranovymi rastvorami na pokazatelei gemostaza u bol'nykh ishimicheskoi bolezn'iu serdtsa.

Plasmapheresis on a continuous blood flow fractionator to remove 1,200-2,000 ml plasma and substitute for the same values of dextran solutions was employed in the multi-modality treatment of 25 patients with Functional Classes II-IV exertional angina and myocardial infarction. Plasma and thrombocyte hemostatic parameters were examined just before and 24 and 48 hours after plasmapheresis. The analysis of the baseline data revealed that hemostatic changes were directly related to the severity of a disease in the patients and there was a correlation between the increased platelet aggregability and the elevated levels of fibrin-monomeric complexes. Plasmapheresis along with substitution of removed plasma for dextran solutions was accompanied by a profound hypocoagulative effect, as evidenced by plasma and thrombocyte hemostatic parameters. In addition, in patients with baseline high values of platelet aggregability plasmapheresis resulted in its decrease, whereas in those with baseline low values, it led to its increase.

[Evaluation of the efficacy of extracorporeal membrane oxygenation of animals with acute respiratory insufficiency]. / Otsenka éffektivnosti ékstrakorporal'noi membrannoi oksigenatsii uzhivotnykh s ostroi dykhatel'noi nedostatochnost'iu.

The efficiency of extracorporeal membrane oxygenation was studied for 2-3 hours in experiments on dogs with severe ventilatory respiratory failure. Extracorporeal oxygenation led to the decrease in arterial hypoxaemia and hypercapnia in animals. However, the variables did not reach the initial levels and were closer to normal values during veno-venous and not veno-arterial perfusion. During extracorporeal membrane oxygenation total systemic blood flow exceeded the initial level irrespective of the means of perfusion and total oxygen transport did not decline lower than the initial level. At the same time during veno-arterial perfusion oxygen delivery provided by the cardiac output decreased almost two-fold by the second hour of perfusion. This might be the reason for inadequate oxygen delivery to the brain and heart. 67% and 71% of animals survived after veno-arterial and veno-venous perfusion, respectively.

[Hemodynamic parameters and oxygen regimen of the body in the early postresuscitation period]. / Gemodinamicheskie parametry i kislorodnyi rezhim organizma v rannem postreanimatsionnom periode

In experiments on dogs subjected under light narcosis to a 12--16-minutes full circulatory arrest produced by means of electrotrauma the parameters of the central haemodynamics and oxygen regimen were studied during the early postresuscitational period. Irrespectful of the method of reanimation conducted for 1 hour (closed cardiac massage combined with artificial pulmonary ventrilation or a heart-lung machine), a progressive reduction was noted during the restorative period (3--6 hours) in such indices as the cardiac output per 1 min., stroke volume and left ventricle work. The development of arterial hypotension was prevented by the increased total peripheral resistance. After 9 hours following the reanimation the main parameters of heamodynamics displayed a tendency towards normalization. The circulatory insufficiency was compensated for by an increased oxygen utilization from the blood supply.