[Effect of aortic clamping on hemodynamics at reconstruction of the thoracoabdominal aorta]. / Vliianie perezhatiia aorty na gemodinamiku pri rekonstruktsii grudnoi i briushnoi aorty.

This paper describes an experience with monitoring and computerized follow up of the hemodynamic status in 60 patients at and right after reconstruction of the thoracoabdominal aorta. In addition to the routine control, measurements were made of the pressure in the large vessels and cavities of the heart, duration of each heart contraction and CI. The following parameters were computed automatically: the status of the ventricles for each heart contraction, resistance of the greater end pulmonary circulation, elasticity of the arterial, venous, pulmonary arterial and pulmonary venous reservoirs, also for each cardiac cycle. At the generally accepted monitoring the hemodynamic responses to the surgeon's manipulations on the aorta appear smoothed or are not visualized at all. The control of each heart contraction reveals the responses to application of the clamp and its removal from the aorta, with their hemodynamic significance being not questionable. Aortic clamping and clamp removal from the aorta are associated with the generalized response of the regulatory systems of the body. The slow and thoroughly controlled aortic clamping and graded, controlled blood flow restoration due to clamp removal as well as the use of sodium nitroprusside (trimetafan or isofluran are preferable) allow to avoid an abrupt stroke load of the left ventricle of the heart and, respectively, the generalized response of the regulatory systems of the body.

[New system for diagnosing acute circulatory disorders and assessing drug choice and dosage]. / Novaia sistema postroeniia diagnoza ostrykh rasstroistv krovoobrashcheniia i otsenki podbora i dozirovki lekarstvennykh preparatov.

The assessment of the status of a patient and diagnosis are first made strictly algorithmically. At the same time the procedure is monitored by a physician in terms of his experience and knowledge. The dialogue is made on the basis of a model and images which reflect the pattern of blood circulation. The diagnosis is made by isolating the key pathophysiological link and interpreting it by means of a clinico-mathematical classification. The usual wording based on the evaluation of the severity and stage of a pathological process is supplemented with assessments of compensatory, protective, and other adaptive changes which greatly influence the choice of a therapy. The action of drugs is evaluated by their cumulative effects on the changes in physiological functions determining their properties, direction and magnitude of alterations of the weakest link. The clinical experience has shown that the procedure is beneficial for rapid detection of clinically significant changes, choice and assessment of therapeutical efforts just during an operation and in the early postoperative period.