[Epidemiology and prophylaxis of septic infectious complications in patients from critical and intensive therapy surgical units].

AIM: To investigate efficacy of the extended complex of preventive and antiepidemic measures for reduction of nosocomial infections incidence in patients treated in critical and intensive therapy (CIT) surgical units. MATERIAL AND METHODS: From 2003 to 2005 CIT units of N.N. Burdenko Central Military Hospital conducted a study with participation of 200 patients aged 50 to 77 years after extended abdominal operations. The patients were divided into 2 groups. Group 1 (n = 100) received standard prophylaxis of infectious complications, group 2 (n = 100) received an extended complex of prophylactic and antiepidemic measures. First-line antibacterial therapy in all the patients included cephalosporines of the third generation and metronidasol. The extended complex included air decontamination with application of the system "Clean room complex"; prevention of nosocomial, particularly ventilator-associated pneumonia (VAP); prevention of catheter-associated sepsis; use of disposable sterile items. RESULTS: Group I patients developed sepsis in 30%, septic shock and polyorganic insufficiency (POI)--in 16% cases; lethality due to infectious complications was 13%. Gram-negative microflora was dominating. In group 2 sepsis was diagnosed in 22%, septic shock and POI--in 11%, lethality was 11%. CONCLUSION: The extended complex ofpreventive and antiepidemic measures significantly reduced the rate of severe infectious complications and related lethality. Among the agents of nosocomial infection the percentage of staphylococci and blue pus bacillus decreased while that of enterococci and E. coli increased. Contamination of the ambient air and CIT units reduced significantly.

[A revised classification of hypoxic conditions]. / Utochnenie klassifikatsii gipoksicheskikh sostoianii.

The precised classification of circulatory hypoxia described in the paper is principally different from those published earlier by that it discriminates between hypoxia preconditioned by impaired cardiac-muscle constriction, on the one hand, and hypoxia due to malfunctions of smooth muscles (SM), on the other hand. The genesis of SM malfunctions is predetermined by impaired interactions of serotonin with SM serotonin receptors. The clinical use of serotonin adipinat reduces the local organic and total-tissue hypoxia in different pathologies and provides for better treatment results. The mentioned precised classification can be used to gain more data on the tissue-hypoxia pathogenesis and to schedule the clinical-and-experimental research on the purpose-oriented basis.