[Pharmacological and mechanical support of the myocardium in perioperative period in cardio-surgical patients with chronic heart failure].

The article deals with a retrospective study devoted to the combined methods of myocardial support in cardiosurgical patients with chronic heart failure (III-IY FC according to NYHA) and low myocardial reserves capacity (LVEF 28.3 +/- 9.4%). This methods include pharmacologic (Levosimendan) and mechanical support (IABP). During the work we have analyzed data of 116 patients and measured pressure in the pulmonary artery (mmHg), end-systolic volume (ESV ml), end-diastolic volume (ED, ml), stroke volume output (SVO, ml), left ventricular ejection fraction (LVEF, %). We evaluated the level of valvular insufficiency and pulmonary hypertension (PH) and BNP concentration (pg/ml). The following indications for the usage of pharmacological and/or mechanical myocardial support were identified: I) Preventive usage of pharmacological and/or mechanical myocardial support is recommended for patients with CHF III-IY FC (NYHA) and low left ventricular EF(< or = 35%), significant valvular insufficiency, PH, PICS (postinfarction cardiosclerosis); 2) The certain method of the support can be chosen with the help of Levosimendan infusion testing; 3) In case one of the above mentioned indications (point 1) or in case of mild reaction to levosimendan infusion in patients with the lesions of more than 2 coronary arteries (including the trunk of the left coronary artery) the usage of combined support is recommended; 4) In case of < or = 6 scores according to EUROSCORE scale, lesions of 2 or more coronary arteries, tricuspid insufficiency (TriI), PH, and high pressure in pulmonary artery (higher than the 2nd degree), high end-diastolic volume, end-systolic volume of LV the isolated usage of levosimendan is recommended; 5) In case of significant ischemic heart disease, PICS, lesions of more than 2 coronary arteries, (including the trunk of the left coronary artery) but without significant decrease of pressure in the pulmonary artery, end-diastolic volume, end-systolic volume and TriI the isolated usage of IABP is recommended.

[Preventive intraaortic balloon counterpulsation during surgical myocardial revascularization].

Fifty patients with low myocardial functional reserves (left ventricular ejection fraction less than 40%, disseminated cardiosclerosis, multiple affection of coronary arteries, NYHA class III-IV) after coronary artery bypass surgery (CABS) were examined. All the patients were divided into 2 groups. Preventive intraaortic balloon counterpulsation (IABC) was used in 24 patients (group 1). Group 2 consisted of 26 patients with similar physical state where IABC has not been used. It was revealed that preventive IABC leads to stabilization of the left ventricle function and cardiac output, a decrease in the doses and period of catecholamines administration. The rate of cardiac rhythm disorders in group 1 was 7 times, myocardial infarction -- 2.5 times, respiratory failure -- 5 times, stay at the intensive care unit -- 2 times less compared with those of group 2. Lethality was 12.5% in group 1 and 26.9% in group 2.

[Effects of free oxygen radicals on impaired lung oxygenating function at aortocoronary bypass surgery]. / Vliianie svobodnykh radikalov kisloroda na narushenie oksigeniruiushchei funktsii legkikh pri operatsiiakh aortokoronarnogo shuntirovaniia.

Fifty five patients with coronary heart disease were examined. Of them 10 patients underwent multiple aortocoronary bypass surgery using intrathoracic or radial arteries under natural circulation, 45 had the same surgery under extracorporeal circulation (ECC). In the patients operated on without ECC, increases in active oxygen forms were rather moderate and practically always occurred with enhancement of antioxidative protective enzymes, the oxygen balance of arterial blood was in the normal range during and after surgery. The ECC patients displayed a considerable creatinine phosphokinase (CPK) with a lower antioxidative protection coefficient particularly when ECC was changed to natural circulation and when the lung was involved in circulation. In the postoperative period, the oxygenation index decreased from 1.7 to 1.3 in virtually all patients, the functional shunt rising from 15 to 30%. In 55% of the patients, varying arterial hypoxemia preserved in the early postoperative period. The damaging factors of ECC (hyperoxia, reperfusion syndrome, etc.) that impair the permeability of lung membranes have been shown to contribute to the activation of CPK, which causes early postoperative' arterial hypoxemia in patients operated on for coronary heart diseases.

[Methods of the use of ketorolac tromethamine in patients during the early postoperative period]. / Metody primeneniia ketorolaka trometamina u bol'nykh v rannem posleoperatsionnom periode.

Analgesia with nonsteroid antiinflammatory drugs (NSAID) becomes a pressing problem today. One such drug is ketorolak tromethamine (KT), characterized by expressed analgesic activity comparable with that of opioid analgesics morphine or promedol. Our purpose was to assess KT efficacy in analgesia performed by different methods, including analgesia controlled by the patient (ACP) after surgery. In medium severe and strong pain KT was used in group I (n = 60) "as needed" in a dose of 30 mg up to 3-4 times a day, in group 2 (n = 12) by the ACP method, in group 3 (n = 16) KT was incessantly infused in a daily dose of up to 120 mg, and in group 4 (n = 11) KT was injected 3-4 times a day in a dose of 30 mg in combination with morphine ACP. The results indicate a high efficacy of KT: 83% after a single injection. Combined use of KT and promedol decreased the dose by 40-50%. Side effects were observed in 15% of patients: most often it was a sense of fever and sweating (in 4% of patients), nausea and vomiting (in 2%), insomnia (in 2%). ACP and planned injections in a daily dose of 90-120 mg is the optimal method of analgesia in patients after extensive surgical interventions.