[MONITORING OF HEMODYNAMICS IN THE CHOICE OF INTENSIVE THERAPY IN THE OPERATED INFANTS].

Noninvasive monitoring in obtaining important and reliable information relevant to pediatric practices, not only in respect of dangers and complications of most invasive techniques, but also because a number of them difficult or even impossible in infants. The aim of this study was to estimate the significance of hemodynamic parameters and capabilities of ECHO and dophlercardiography for analyzing violations hemodynamics in primary diagnosis and conduct drug therapy in infants. The study included the results of a survey of 65 infants aged from 29 to 39 weeks with various surgical pathology, who received the various options the hemodynamic support. In the initial assessment and selecting tactics of therapy for hemodynamic analysis carried out routine monitoring and for evaluation of cardiac contractility used echo- and Doppler exams. All children have pointed out a number of significant changes of haemodynamics, that has required inotropic therapy with dopamine (64% of children with diaphragmatic hernia received additional dobutamine). Validation of expressed pulmonary hypertension children appointed sildenafil, and in the absence ofthe effect used nitrous oxide. Hemodynamic monitoring allows to monitor the status of circulation on the background of the treatment and to make timely changes to the script therapy.

[Central hemodynamics in the remote period in children operated for extrahepatic portal hypertension]. / Tsentral'naia gemodinamika u detei, operirovannykh po povodu vnepechenochnoi portal'noi gipertenzii.

The authors studied functional state of circulation in various terms after operation. Depending on anastomosis creation two group of patients different by visceral hemodynamics change were identified. 58 patients were examined before operation, one year and later after the operation. Functional state of central hemodynamics was evaluated with echo- and Dopplercardiography. It was revealed that after operation the number of children with hyperdynamic type of circulation decreased. A year after distal splenorenal anastomosis creation number of children with hyperdynamic type of central hemodynamics decreased by 20%. Later, regardless of anastomosis type increased cardiac index was revealed in 32.32 and 36.3% children respectively after total and selective anastomosis creation. After total bypass more severe hemodynamic disorders (diastolic dysfunction and inotropic disorders) developed. After distal splenorenal anastomosis creation hemodynamic disorders were seen later due to increase of bypass volume blood flow. Increase of venous return leads to moderate diastolic overloading and myocardial hypertrophy.