ABSTRACT
Cerebral blood flow and metabolism were studied in 44 patients with acute severe craniocerebral injuries (contusions of the brain and removal of intracranial hematomas) with consciousness depression (moderate coma), hospitalized in intensive neurological care wards. Oxygen supply to the brain was repeatedly evaluated (acid-base status of the jugular vein blood, oxygen arterio-venous difference, oxygen extraction coefficient), oxymetry of the brain was repeatedly carried out, and vital functions were monitored over the entire period of disease. Cerebral blood flow was monitored by rheoencephalography, which helped timely detect the changes in cerebral blood flow in patients with craniocerebral injuries during different ventilation protocols used in intensive care. All studies were carried out during three stages: 1) initial stage, when the patients were brought to intensive neurological care wards after surgical intervention, and during normoventilation (paCO2 36-40 mm Hg; 2) moderate hyperventilation (paCO2 35-26 mm Hg); and 3) pronounced hyperventilation (paCO2 25-20 mm Hg). Specific changes in the cerebral blood flow during the acute period of craniocerebral injury were detected during different ventilation regimens in 2 groups of patients: group 1 with lethal outcomes and group 2 with positive changes.
Subject(s)
Brain/metabolism , Cerebrovascular Circulation , Craniocerebral Trauma/therapy , Hyperventilation , Adult , Brain/blood supply , Craniocerebral Trauma/metabolism , Craniocerebral Trauma/physiopathology , Female , Hemodynamics , Humans , Male , Middle Aged , Oxygen/metabolismABSTRACT
Electrostimulation of the phrenic nerves (ESPN) on the cervical level was conducted by the transcutaneous and direct methods in 30 neurosurgical patients in the postoperative period. Hypoventilation, hypoxemia, as well as microfocal pneumonia were relieved rapidly in 10 patients after transcutaneous ESPN. In 10 patients in whom the generally applied therapeutic measures proved ineffective, ESPN made it possible to cope with severe, rapidly progressing confluent pneumonia in the shortest time. The authors discuss the possibility of applying ESPN for restoration of spontaneous ventilation in central respiratory disorders (8 patients) and note the inefficacy of ESPN in pathological types of respiration and division of the phrenic nerve.
Subject(s)
Electric Stimulation Therapy/methods , Phrenic Nerve/physiology , Resuscitation/methods , Adolescent , Adult , Brain Neoplasms/complications , Brain Neoplasms/surgery , Evaluation Studies as Topic , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Postoperative Complications/therapy , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapyABSTRACT
The 24-hour dynamics of the oscillatory components of the heart rhythm in neurosurgical patients in the postoperative period is shown. The peculiarities of the wave structure of the spectrum density graph depending on the localization of the pathological process and the severity of the postoperative course were revealed.
