[Regional vasoactive and metabolic therapy of patients with severe cranio-cerebral traumas].

In patients with severe cranio-cerebral traumas an investigation was performed of the efficiency of using vasoactive therapy in complex treatment directed to earlier recovery of the microcirculatory blood flow and aerobic metabolism in ischemic parts of the brain.

[Perfusion disturbances and their correction in the acute period of traumatic disease in patients with concomitant shockogenic lesions].

The topicality of a study is determined by high mortality rates in victims with concomitant shockogenic injuries. A large proportion of victims die in the acute period of traumatic disease (TD). At this time, major changes are observed in the circulatory system. For optimization of intensive care, the authors have changed a clinical classification of the acute period of TD, by applying the principles of general pathology, the data on altered hemodynamics and microcirculation. The stages of infusing-transfusion therapy considering the specific features of changes during each period, which are characteristic for victims with reversible and irreversible shock, are described. Implementation of the infusion-transfusion therapy program proposed by the authors could reduce mortality in victims with concomitant mechanical shockogenic trauma.

[Acute pancreatitis (protocols of diagnosis and treatment)].

Protocols of diagnosis and treatment of acute pancreatitis are presented. Definition based on pathogenesis of the disease is given. Phases of acute pancreatitis, features of diagnosis and treatment in each phase are analyzed. Terms of surgical treatment, main principles of postoperative treatment are discussed.

[Use of Doppler fluorometry for the assessment of microcirculation in patients with severe mechanical trauma]. / Ispol'zovanie dopplerofloumetrii dlia otsenki mikrotsirkuliatsii u postradavshikh s tiazheloi mekhanicheskoi travmoi.

Described in the paper are issues related with studying the micro-hemocirculation in victims with mechanical shock-genesis trauma by using the laser Doppler fluorimetry. The results are indicative of a nature of changes occurred in the microcirculation system in such victims with different-severity traumatic shock. It is concluded that, in principle, it is possible to use the method in question within the diagnostics of the impaired microcirculation in patients with shock-genesis lesions at disease exacerbation.

[Optimization of indirect electrochemical detoxication in the treatment of different endogenous intoxications and multiple organ failure syndrome in resuscitation practice]. / Optimizatsiia nepriamoi élektrokhimicheskoi detoksikatsii pri lechenii razlichnykh éndogennykh intoksikatsii i sindroma poliorgannoi nedostatochnosti v reanimatologicheskoi praktike.

The authors have made a statistical analysis of clinical groups of patients in the units of resuscitation and intensive therapy of a general profile and of the archive materials of a laboratory of extracorporeal hemocorrection. The ultraviolet and laser photomodification of autoblood, hemosorption, plasmapheresis, ultra- and hemofiltration were used in the complex treatment of these patients. In the experimental group there were 190 patients on whom 333 operations of extracorporeal hemocorrection were made with using indirect electrochemical detoxication (IECD). In the control group there were 527 patients on whom 1048 analogous operations were made without IECD. The statistical processing of the results obtained has shown that IECD method does not have immediate detoxicating properties in relation to middle mass molecules and fails to substantially influence the processes of lipid peroxidation; sodium hypochlorite did not have a deteriorating effect on the clinical-laboratory status of patients with severe organic disorders. IECD was shown to potentiate the elimination potencies of hemosorption, plasmapheresis, ultra- and hemofiltration which resulted in 2.7 times less lethality. The mean bed-day was 2.8 days shorter, the bed-day in the resuscitation unit--1.2 days shorter.

[Changes in the kallikrein-kinin system and lipid peroxidation in patients with diffuse peritonitis, complicated by adult respiratory distress syndrome]. / Izmeneniia kallikrein-kininovoi sistemy i protsessov peroksidatsii lipidov u bol'nykh s razlitym peritonitom, oslozhnennym respiratornym distress-sindromom vzroslykh.

The authors present results of their investigation of the state of kallikrein-kinin system (KKS) and lipid peroxidation (LP) in blood of 22 patients operated upon for acute diffuse peritonitis as a complication of different surgical diseases. In 8 patients who later died the respiratory distress-syndrome of adults (RDSA) developed at the early postoperative period. Activation of KKS and LP were observed in all the patients both in the venous and arterial blood, but it was more intensive in patients with RDSA. In the same group of patients the level of the metabolites under study was higher in the arterial than in the venous blood, which suggests a disturbances of the metabolic function of the lung. The results of the investigation allow a conclusion that antiprotease drugs should be included in the complex treatment of RDSA.

[New possibilities of prevention of acute gastric and intestinal ulcers in peritonitis with drugs of anti-hypoxic and antioxidant action]. / Novye vozmozhnosti profilaktiki ostrykh iazv zheludka i kishok pri peritonite preparatami antigipoksicheskogo i antioksidantnogo riada.

A retrospective analysis has been made of 96 cases of acute erosions and peptic ulcer emerging in diffuse purulent peritonitis. The examination and treatment of 124 patients suggested that toxic peritonitis runs with excessive accumulation of lipid peroxidation products in the serum. Administration of antihypoxic drugs and antioxidants promoted stabilization of peroxidation thus preventing gastroduodenal erosions and ulcer.

[Effect of ketamine anesthesia on patients with severe trauma at the pre-hospital stage on the course and outcome of shock]. / Vliianie anestezii ketaminom, provodimoi u postradavshikh s tiazheloi travmoi na dogospital'nom étape, na techenie i iskhod shoka.

Under study were remote results of treatment of patients with critical traumas followed by shock who were given prehospital Ketamine anesthesia. The data obtained were compared with remote results of treatment of patients who did not receive anesthesia at the prehospital stage or who were given narcotic analgetic drugs for anesthesia. Reliable data were obtained showing the course of trauma disease to be more favourable in a group of patients who were given Ketamine anesthesia at the prehospital stage.

[Puncture tracheostomy at the prehospital stage]. / Punktsionnaia trakheostomiia na dogospital'nom étape.

The article describes an instrument for puncture and cannulation of the trachea. It is an arcuate tube with a mandrin and a perforator at the end with a pricking-cutting profile. The approval testing of the instrument at the prehospital stage has shown that the patency of the upper respiratory tracts may be reestablished within 30-40 sec.

[Treatment of acute pancreatitis patients with functional liver failure]. / Lechenie bol'nykh ostrym pankreatitom s funktsional'noi nedostatochnost'iu pecheni.

Methods of extracorporal detoxication hemo- and lymphosorption, intraportal injection of drugs and oxygenated solutions as well as ultraviolet irradiation of auto-blood are included in the routine scheme of treatment of patients with acute pancreatitis. The treatment concerned was used in 77 patients with acute pancreatitis and advanced hepatic insufficiency and resulted in arresting the latter in 43 of the patients. To prevent the development of acute hepatic insufficiency proved to be possible in 20 patients with a destructive form of acute pancreatitis. The intraportal injection of oxygenated solutions against the background of acute experimental pancreatitis contributed to prevention of hypoxia of the liver.

[Clinical evaluation of extramedullary osteosynthesis in multiple rib fractures in conjunction with severe mechanical trauma and accompanying shock]. / Klinicheskaia otsenka ékstramedulliarnogo osteosinteza pri mnozhestvennykh perelomakh reber i tiazheloi sochetannoi mekhanicheskoi travme, soprovozhdaiushcheisia shokom.

Extramedullary osteosynthesis of ribs was performed in 18 patients with apparatus SPG-20 for multiple rib fractures. The early surgical treatment of patients with thoracic traumas resutled in a substantial improvement of the external respiration function, the volume of intrapulmonary shunt, alveolar-arterial oxygen gradient and respiratory index being considerably decreased. The use of a mechanical suture of the ribs as a component in the complex treatment of patients with a thoracic trauma is an efficient method in the struggle against posttraumatic respiratory insufficiency and shock.