Pub Date : 2022-04-11DOI: 10.24884/2072-6716-2022-23-1-4-10
A. I. Makhnovskiy, I. Barsukova, V. V. Stozharov, A. Miroshnichenko, O. Ergashev, A. O. Bumay, S. V. Stolyarchuk, L. S. Sudyina
{"title":"The structure of rehospitalization of patients after examination and treatment on emergency department beds during the COVID‑19 pandemic","authors":"A. I. Makhnovskiy, I. Barsukova, V. V. Stozharov, A. Miroshnichenko, O. Ergashev, A. O. Bumay, S. V. Stolyarchuk, L. S. Sudyina","doi":"10.24884/2072-6716-2022-23-1-4-10","DOIUrl":"https://doi.org/10.24884/2072-6716-2022-23-1-4-10","url":null,"abstract":"","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82284371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-19DOI: 10.24884/2072-6716-2021-22-4-47-54
O. V. Grishin
We studied the possibilities of urgent monitoring of blood pressure and an objective assessment of its results at the pre-hospital stage. Of the 105 patients included in the study, 6 were excluded for technical reasons and 8 due to additional antihypertensive drugs. For emergency antihypertensive therapy, two-component combinations were used: captopril+furosemide, moxonidine+furosemide, moxonidine+nifedipine (if there was no intolerance to any of the studied drugs, they were prescribed using random numbers), blood pressure monitoring was simultaneously started, which lasted for a day. The stability of the antihypertensive effect, the frequency of excessive lowering of blood pressure in relation to its target value was evaluated. It was shown that the use of blood pressure monitoring techniques from the first minutes of sublingual use of various combinations of antihypertensive agents allows objectively assessing and documenting the safety of the effect of emergency therapy.
{"title":"The first results of an objective assessment of the safety of emergency antihypertensive therapy at the pre-hospital stage","authors":"O. V. Grishin","doi":"10.24884/2072-6716-2021-22-4-47-54","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-4-47-54","url":null,"abstract":"We studied the possibilities of urgent monitoring of blood pressure and an objective assessment of its results at the pre-hospital stage. Of the 105 patients included in the study, 6 were excluded for technical reasons and 8 due to additional antihypertensive drugs. For emergency antihypertensive therapy, two-component combinations were used: captopril+furosemide, moxonidine+furosemide, moxonidine+nifedipine (if there was no intolerance to any of the studied drugs, they were prescribed using random numbers), blood pressure monitoring was simultaneously started, which lasted for a day. The stability of the antihypertensive effect, the frequency of excessive lowering of blood pressure in relation to its target value was evaluated. It was shown that the use of blood pressure monitoring techniques from the first minutes of sublingual use of various combinations of antihypertensive agents allows objectively assessing and documenting the safety of the effect of emergency therapy.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88538068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-19DOI: 10.24884/2072-6716-2021-22-4-25-33
N. Kasimovskaya, E. A. Lavrova
Relevance. The development of methodological support for nursing services operating in the daily routines of a medical organization with increased preparedness in an emergency requires long-term scientific and methodological support and the development of practical recommendations on the organization of nursing services in emergency situations.The goal — to analyze the organization of work of nurses and assess the quality of medical care at the Research Institute of Emergency Medicine. I. I. Dzhanelidze at the arrival of victims of the terrorist attack on April 3, 2017 in the St. Petersburg metro.Materials and methods. The experience of organizing medical care upon admission of victims after a terrorist attack to the Scientific Research Institute of Emergency Care named after I. I. Dzhanelidze. During the study, the source of information was specially designed questionnaires (n=125 nurses). The main research methods: sociological, analytical, descriptive statistics.Results and discussion. It was revealed that not all nurses received information about the arrival of victims after the terrorist attack by the warning system, almost every fifth nurse does not know what post she is assigned to in the event of an emergency, and almost every tenth nurse is not sure of her responsibilities in the attack. More than half of nurses believe that in emergency situations the number of nurses should be increased, since the lack of nursing staff reduces the quality of medical care for victims of the terrorist attack.Conclusion. Identified problems require the development of universal protocols and action algorithms for organizing the work of the nursing staff of a multidisciplinary hospital during the provision of assistance with the admission of victims of emergency situations and terrorist attacks to improve the quality of medical care.
的相关性。为医疗组织日常护理服务提供方法学支持，加强对紧急情况的准备，需要长期的科学和方法学支持，并就紧急情况下护理服务的组织提出切实可行的建议。目的是分析急诊医学研究所护士的工作组织和医疗服务质量。2017年4月3日，在圣彼得堡地铁恐怖袭击的受害者到来时，扎内利泽。材料和方法。以I. I. Dzhanelidze命名的急救科学研究所在恐怖袭击受害者入院后组织医疗护理的经验。研究中，信息来源为专门设计的问卷(n=125名护士)。主要研究方法:社会学、分析统计学、描述统计学。结果和讨论。据透露，并非所有护士在恐怖袭击后都能通过警报系统收到受害者到达的信息，几乎五分之一的护士不知道自己在紧急情况下被分配到什么岗位，几乎十分之一的护士不确定自己在袭击中的职责。超过一半的护士认为，在紧急情况下，护士的数量应该增加，因为缺乏护理人员降低了对恐怖袭击受害者的医疗质量。已查明的问题要求制定通用协议和行动算法，以便组织多学科医院护理人员在协助接收紧急情况和恐怖袭击受害者期间的工作，以提高医疗质量。
{"title":"Аssessment of quality of provision of medical care to nurse personnel after a mass receipt of victims to a medical organization on the example of a terrorism in St. Petersburg","authors":"N. Kasimovskaya, E. A. Lavrova","doi":"10.24884/2072-6716-2021-22-4-25-33","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-4-25-33","url":null,"abstract":"Relevance. The development of methodological support for nursing services operating in the daily routines of a medical organization with increased preparedness in an emergency requires long-term scientific and methodological support and the development of practical recommendations on the organization of nursing services in emergency situations.The goal — to analyze the organization of work of nurses and assess the quality of medical care at the Research Institute of Emergency Medicine. I. I. Dzhanelidze at the arrival of victims of the terrorist attack on April 3, 2017 in the St. Petersburg metro.Materials and methods. The experience of organizing medical care upon admission of victims after a terrorist attack to the Scientific Research Institute of Emergency Care named after I. I. Dzhanelidze. During the study, the source of information was specially designed questionnaires (n=125 nurses). The main research methods: sociological, analytical, descriptive statistics.Results and discussion. It was revealed that not all nurses received information about the arrival of victims after the terrorist attack by the warning system, almost every fifth nurse does not know what post she is assigned to in the event of an emergency, and almost every tenth nurse is not sure of her responsibilities in the attack. More than half of nurses believe that in emergency situations the number of nurses should be increased, since the lack of nursing staff reduces the quality of medical care for victims of the terrorist attack.Conclusion. Identified problems require the development of universal protocols and action algorithms for organizing the work of the nursing staff of a multidisciplinary hospital during the provision of assistance with the admission of victims of emergency situations and terrorist attacks to improve the quality of medical care.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74100388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-19DOI: 10.24884/2072-6716-2021-22-4-60-69
I. Koshman, A. Kalinichev, A. Shchegolev, I. E. Shaludkin
Post-traumatic brain edema is integral pathophysiological process in patients with severe traumatic brain injury, leading to increase of intracranial pressure (ICP). Intracranial hypertension (ICH), in turn, increases the number of deaths in this group of patients. The most important task in the treatment of victims in the early postoperative period after the removal of traumatic intracranial hematomas is correction of ICH syndrome.Purpose of the study. To evaluate the effect of the systemic angioprotector use on the treatment outcomes of patients with traumatic intracranial hematomas in the early postoperative period.Materials and methods. The study included 50 patients with traumatic intracranial hematomas. Group I — the main group (with the use of systemic angioprotector, n=24), group II — the comparison group (without the use of the medication, n=26). The effectiveness of treatment was compared — according to the following criteria: survival in the postoperative period (14 days), level of consciousness (at admission and average value during the day throughout the treatment), course of neurological status: meningeal signs, cranial nerve function, motor sphere, response to pain stimuli, autonomic system disorders (at admission and every day throughout the treatment), monitoring of ICP (before removal of the hematoma and average value throughout the measurement), changes in the multispiral computed tomogram of the head (at admission, on the 3rd, 7th, 14th day).Results. The study found that the mortality rate in the main group of patients with intracranial hematomas in the early postoperative period decreased by 21.5%. The average value of ICP for the entire period of measurement in group I is 15.0±7.6, in group II 17.3±8.4 mm Hg. The average value of points of the Glasgow com scale on the 14th day in group I is 9.2±1.9, in group II 7.5±0.7 points. The duration of intraventricular monitoring of ICP was less in the first group — 4.3±1.2 days, compared to the second group — 6.2±1.5 days.Conclusion. The use of systemic angioprotector in the complex treatment can reduce intracranial pressure (ICP) in patients with traumatic intracranial hematomas in the early postoperative period and improve intermediate outcomes.
创伤后脑水肿是重型颅脑损伤患者不可缺少的病理生理过程，可导致颅内压升高。颅内高压反过来又增加了这类患者的死亡人数。外伤性颅内血肿切除后患者术后早期治疗的首要任务是颅内出血综合征的矫正。研究目的:目的探讨全身血管保护剂对创伤性颅内血肿术后早期治疗效果的影响。材料和方法。本研究包括50例外伤性颅内血肿患者。I组为主要组(使用全身血管保护剂，n=24)， II组为对照组(未使用药物，n=26)。根据以下标准对治疗效果进行比较:术后生存期(14天)、意识水平(入院时和整个治疗过程中白天的平均值)、神经系统状态病程:脑膜征象、脑神经功能、运动球、对疼痛刺激的反应、自主神经系统紊乱(入院时及整个治疗过程中每天)、ICP监测(血肿去除前及整个测量过程中的平均值)、头部多螺旋ct变化(入院时、第3、7、14天)。研究发现，颅内血肿主组患者术后早期死亡率下降21.5%。I组全测量期ICP平均值为15.0±7.6 mm Hg, II组为17.3±8.4 mm Hg，第14天格拉斯哥评分平均值为9.2±1.9分，II组为7.5±0.7分。第一组颅内压监测时间(4.3±1.2 d)短于第二组(6.2±1.5 d)。综合治疗中应用全身血管保护剂可降低创伤性颅内血肿术后早期颅内压(ICP)，改善中期预后。
{"title":"Traumatic intracranial hipertension correction in patients with intracranial hematomas during the early postoperative period with the use of systemic angioprotector","authors":"I. Koshman, A. Kalinichev, A. Shchegolev, I. E. Shaludkin","doi":"10.24884/2072-6716-2021-22-4-60-69","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-4-60-69","url":null,"abstract":"Post-traumatic brain edema is integral pathophysiological process in patients with severe traumatic brain injury, leading to increase of intracranial pressure (ICP). Intracranial hypertension (ICH), in turn, increases the number of deaths in this group of patients. The most important task in the treatment of victims in the early postoperative period after the removal of traumatic intracranial hematomas is correction of ICH syndrome.Purpose of the study. To evaluate the effect of the systemic angioprotector use on the treatment outcomes of patients with traumatic intracranial hematomas in the early postoperative period.Materials and methods. The study included 50 patients with traumatic intracranial hematomas. Group I — the main group (with the use of systemic angioprotector, n=24), group II — the comparison group (without the use of the medication, n=26). The effectiveness of treatment was compared — according to the following criteria: survival in the postoperative period (14 days), level of consciousness (at admission and average value during the day throughout the treatment), course of neurological status: meningeal signs, cranial nerve function, motor sphere, response to pain stimuli, autonomic system disorders (at admission and every day throughout the treatment), monitoring of ICP (before removal of the hematoma and average value throughout the measurement), changes in the multispiral computed tomogram of the head (at admission, on the 3rd, 7th, 14th day).Results. The study found that the mortality rate in the main group of patients with intracranial hematomas in the early postoperative period decreased by 21.5%. The average value of ICP for the entire period of measurement in group I is 15.0±7.6, in group II 17.3±8.4 mm Hg. The average value of points of the Glasgow com scale on the 14th day in group I is 9.2±1.9, in group II 7.5±0.7 points. The duration of intraventricular monitoring of ICP was less in the first group — 4.3±1.2 days, compared to the second group — 6.2±1.5 days.Conclusion. The use of systemic angioprotector in the complex treatment can reduce intracranial pressure (ICP) in patients with traumatic intracranial hematomas in the early postoperative period and improve intermediate outcomes.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91137266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-19DOI: 10.24884/2072-6716-2021-22-4-12-17
R. R. Kasimov, A. I. Makhnovskiy, A. Zavrazhnov, I. Samokhvalov, A. Miroshnichenko, M. Derkach
Objective: substantiate the criteria for choosing a method for inter-hospital transportation of patients with severe trauma for the territorial system of medical support for the troops of the Western Military District.Materials and methods. We studied 121 cases of inter-hospital transportation of patients with severe trauma in the territorial system of medical support for the troops of the Western Military District for the period 2015–2020. The time of inter-hospital transportation of patients by an ambulance car of class C and by helicopter was studied at various distances between medical organizations: up to 70 km, from 70 to 200 km, more than 200 km.Results and discussion. At distances between medical organizations of more than 200 km, the average time of medical aviation evacuation of patients with severe injuries by helicopter was 176±35 minutes, and the average time of medical evacuation of patients in a class C ambulance was 290±43 minutes (p=0,04). When the distance between medical organizations is less than 200 km, the average time of medical aviation evacuation of patients with severe trauma by helicopter was 126±43 minutes, and the average time of medical evacuation of patients in a class C ambulance was 137±37 minutes (p=0,85).Conclusions. The main factor in choosing a method for carrying out inter-hospital transportation of patients with severe trauma in the territorial system of medical support for the troops of the Western Military District is the distance between medical organizations. It is advisable to plan medical aviation evacuation of patients with severe trauma by helicopter when the distance between medical organizations is more than 200 km.
目的:确定西部军区属地医疗保障系统重型创伤患者医院间转运方法的选择标准。材料和方法。对2015-2020年西部军区部队属地医疗保障系统中121例重症创伤患者的院际转运进行了研究。在医疗机构之间的不同距离上，研究了C类救护车和直升机在医院间运送病人的时间:70公里以内，70至200公里，200公里以上。结果和讨论。在医疗机构间距离大于200 km的情况下，直升机对重伤员的医疗航空后送平均时间为176±35 min, C级救护车对重伤员的医疗后送平均时间为290±43 min (p= 0.04)。当医疗机构间距离小于200 km时，直升机对严重创伤患者进行医疗航空后送的平均时间为126±43 min, C级救护车对患者进行医疗后送的平均时间为137±37 min (p=0,85)。在西部军区部队属地医疗保障系统中，选择医院间转运重症创伤患者的主要因素是医疗机构之间的距离。当医疗机构之间的距离超过200公里时，建议使用直升机对严重创伤患者进行医疗航空后送。
{"title":"Criteria for choosing the method of inter-hospital transportation of patients with severe trauma","authors":"R. R. Kasimov, A. I. Makhnovskiy, A. Zavrazhnov, I. Samokhvalov, A. Miroshnichenko, M. Derkach","doi":"10.24884/2072-6716-2021-22-4-12-17","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-4-12-17","url":null,"abstract":"Objective: substantiate the criteria for choosing a method for inter-hospital transportation of patients with severe trauma for the territorial system of medical support for the troops of the Western Military District.Materials and methods. We studied 121 cases of inter-hospital transportation of patients with severe trauma in the territorial system of medical support for the troops of the Western Military District for the period 2015–2020. The time of inter-hospital transportation of patients by an ambulance car of class C and by helicopter was studied at various distances between medical organizations: up to 70 km, from 70 to 200 km, more than 200 km.Results and discussion. At distances between medical organizations of more than 200 km, the average time of medical aviation evacuation of patients with severe injuries by helicopter was 176±35 minutes, and the average time of medical evacuation of patients in a class C ambulance was 290±43 minutes (p=0,04). When the distance between medical organizations is less than 200 km, the average time of medical aviation evacuation of patients with severe trauma by helicopter was 126±43 minutes, and the average time of medical evacuation of patients in a class C ambulance was 137±37 minutes (p=0,85).Conclusions. The main factor in choosing a method for carrying out inter-hospital transportation of patients with severe trauma in the territorial system of medical support for the troops of the Western Military District is the distance between medical organizations. It is advisable to plan medical aviation evacuation of patients with severe trauma by helicopter when the distance between medical organizations is more than 200 km.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76565969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-19DOI: 10.24884/2072-6716-2021-22-4-4-11
V. Shalnev, N. Petrova, I. Y. Lukianova
Antithrombotic therapy is a cornerstone of acute coronary syndromes treatment, preventing coronary artery thrombosis development and progression. Early administration of P2Y12 receptor antagonists to patients with acute coronary syndromes (ACS) at the prehospital stage is a common practice and has been supported by the European and Russian Societies of Cardiology guidelines for many years despite the lack of definite evidence for its benefit. Recent clinical trials and registers on ACS treatment have shown no benefit and higher prevalence of bleeding related to the early start of P2Y12 receptor antagonists in NSTE-ACS patients. The latest European and Russian Societies of Cardiology guidelines do not recommend prehospital administration of P2Y12 receptor antagonists. The article highlights the antithrombotic therapy in acute coronary syndromes setting, recent ESC guidelines and its possible implementation in common practice.
{"title":"Antithrombotic therapy in acute coronary syndromes setting: new clinical guidelines, controversial issues and the role of prehospital stage","authors":"V. Shalnev, N. Petrova, I. Y. Lukianova","doi":"10.24884/2072-6716-2021-22-4-4-11","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-4-4-11","url":null,"abstract":"Antithrombotic therapy is a cornerstone of acute coronary syndromes treatment, preventing coronary artery thrombosis development and progression. Early administration of P2Y12 receptor antagonists to patients with acute coronary syndromes (ACS) at the prehospital stage is a common practice and has been supported by the European and Russian Societies of Cardiology guidelines for many years despite the lack of definite evidence for its benefit. Recent clinical trials and registers on ACS treatment have shown no benefit and higher prevalence of bleeding related to the early start of P2Y12 receptor antagonists in NSTE-ACS patients. The latest European and Russian Societies of Cardiology guidelines do not recommend prehospital administration of P2Y12 receptor antagonists. The article highlights the antithrombotic therapy in acute coronary syndromes setting, recent ESC guidelines and its possible implementation in common practice.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87347821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-19DOI: 10.24884/2072-6716-2021-22-4-55-59
I. Y. Lukianova, A. V. Kuzneztov, V. Shalnev
The work demonstrates the possibility of effective and safe medical cardioversion in patients with atrial flutter at the pre-hospital stage.
这项工作证明了在院前阶段对心房扑动患者进行有效和安全的医疗转复的可能性。
{"title":"Medicinal cardioversion in patients with paroxysmal form of atrial flutter at the prehospital stage","authors":"I. Y. Lukianova, A. V. Kuzneztov, V. Shalnev","doi":"10.24884/2072-6716-2021-22-4-55-59","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-4-55-59","url":null,"abstract":"The work demonstrates the possibility of effective and safe medical cardioversion in patients with atrial flutter at the pre-hospital stage.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84618687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-19DOI: 10.24884/2072-6716-2021-22-4-70-75
A. V. Emelyanova, V. M. Shaytor, M. Revnova, D. I. Shaytor, E. Y. Airapetian
Objective: to evaluate the blood clotting system based on laboratory data in adolescent girls with uterine bleeding of the puberty period (MCPP). The study included 151 girls from 9 to 17 years old, of which 101 patients with MСPP and 50 patients with somatic pathology who do not suffer from MСPP. All patients underwent laboratory tests of blood coagulation parameters. The results of the study revealed lower values of the prothrombin index (PTI) and a tendency of compensatory increase in fibrinogen levels with a decrease in Duke bleeding time in the period of acute uterine bleeding in patients of the main group. In patients with MСPP, the threshold values of the blood clotting system parameters for the occurrence of uterine bleeding were determined, these are the level of PTI≤71.25%, fibrinogen ≤4.45 g/l, bleeding time according to Duque <2.38 min (p<0,05 according to the criterion χ2). The analysis of the obtained results indicates the presence of signs of insufficiency of the vascular-platelet hemostasis link in girls with MCPP.
目的:基于实验室资料评价青春期少女子宫出血(MCPP)的凝血系统。该研究包括151名9至17岁的女孩，其中101名患有MСPP, 50名患有躯体病理的患者没有MСPP。所有患者均接受了血液凝固参数的实验室检查。研究结果显示，主组患者急性子宫出血期间凝血酶原指数(PTI)值较低，纤维蛋白原水平有代偿性升高的趋势，同时Duke出血时间缩短。MСPP患者凝血系统参数发生子宫出血的阈值为PTI水平≤71.25%，纤维蛋白原≤4.45 g/l，出血时间按Duque值<2.38 min (χ2判定标准p< 0.05)。对所得结果的分析表明，在MCPP女孩中存在血管-血小板止血环节不足的迹象。
{"title":"Features of blood clotting system in girls with abnormal uterine bleeding of the puberty period","authors":"A. V. Emelyanova, V. M. Shaytor, M. Revnova, D. I. Shaytor, E. Y. Airapetian","doi":"10.24884/2072-6716-2021-22-4-70-75","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-4-70-75","url":null,"abstract":"Objective: to evaluate the blood clotting system based on laboratory data in adolescent girls with uterine bleeding of the puberty period (MCPP). The study included 151 girls from 9 to 17 years old, of which 101 patients with MСPP and 50 patients with somatic pathology who do not suffer from MСPP. All patients underwent laboratory tests of blood coagulation parameters. The results of the study revealed lower values of the prothrombin index (PTI) and a tendency of compensatory increase in fibrinogen levels with a decrease in Duke bleeding time in the period of acute uterine bleeding in patients of the main group. In patients with MСPP, the threshold values of the blood clotting system parameters for the occurrence of uterine bleeding were determined, these are the level of PTI≤71.25%, fibrinogen ≤4.45 g/l, bleeding time according to Duque <2.38 min (p<0,05 according to the criterion χ2). The analysis of the obtained results indicates the presence of signs of insufficiency of the vascular-platelet hemostasis link in girls with MCPP.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90361343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.24884/2072-6716-2021-22-3-38-47
A. Kazantsev, K. Chernykh, S. Artyukhov, L. Roshkovskaya, M. Janelidze, G. Bagdavadze, R. Lider, Ye. Yu. Kalinin, T. Y. Zaytseva, A. Y. Chikin, S. V. Sokolova, Y. Linets
Purpose. Analysis of the immediate results of emergency glomus-sparing auto-transplantation of the internal carotid artery (ICA) in the acute period of ischemic stroke, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg.Material and methods. In this prospective, single-center study from January 2017 to August 2020. 49 patients were included in the acute period of ischemic stroke with hemodynamically significant extended atherosclerotic lesions of the ICA. All patients underwent glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg (Kazantsev A. N., Zarkua N. E., Chernykh K. P. et al. Аrteries with extended atherosclerotic lesions of the internal carotid artery. Patent application No. 202.013.4151/14 (062595), filing date 10/16/2020). Glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg, was performed as follows. On the inner edge of the external carotid artery (ECA), adjacent to the carotid sinus, 2–3 cm above the orifice, depending on the spread of atherosclerotic plaque (ASB), arteriotomy was performed with the transition to the common carotid artery (CCA) (also 2–3 see below the mouth of the NSA). The ICA was cut off at the site formed by the sections of the wall of the NSA and the CCA. Then the ICA was cut off as distally as possible in front of the hypoglossal nerve, so that the artery was completely resected. In view of the presence of an intact carotid glomus on the resected area of the ICA, which connects it to the wound, endarterectomy from the ICA was performed inside the operating field by its complete eversion. Then, open endarterectomy from ECA and CCA was performed. At the next stage, the ICA was implanted in its previous place with the creation of proximal and distal end-to-end anastomoses, so that the continuing ASB above the endarterectomy zone was fixed with a circular vascular suture.Results. There were no complications in the postoperative period. No cases of restenosis / thrombosis of the reconstruction zone were identified in all the sample according to the color duplex scanning data. On the 7th day after the operation, all patients were diagnosed with regression of neurological symptoms according to the National Institute of Health Stroke Scale: on admission, the mean score was 10.5±3.5; at the moment of the control point — 6.5±1.5; p=0.001. This reflects the effectiveness of the chosen treatment strategy. According to the data on the dynamics of systolic blood pressure, stable systolic parameters were observed in the postoperative period against the background of antihypertensive therapy taken before the operation.Conclusion. Carotid endarterectomy in the acute period of ischemic stroke is safe in the presence of mild neurological deficits (up to 25 points on the National Institute of Health Stroke Scale) and the diameter of the ischemic focus in the brain not exceeding 2.5 c
目的。在圣彼得堡市亚历山德罗夫斯卡亚医院的基础上，对缺血性中风急性期紧急保留血管球的颈内动脉(ICA)自体移植的即时效果进行了分析。材料和方法。在这项2017年1月至2020年8月的前瞻性单中心研究中。49例急性期缺血性脑卒中患者伴有血流动力学上显著的动脉粥样硬化病变。所有患者都接受了保留血管球的ICA自体移植，该移植是在圣彼得堡市亚历山德罗夫斯卡亚医院(Kazantsev A. N.， Zarkua N. E.， Chernykh K. P.等人Аrteries)的基础上发展起来的，伴有颈内动脉粥样硬化病变。专利申请号:202.013.4151/14(062595)，申请日:2020年10月16日)。保留球囊的ICA自体移植是在圣彼得堡市亚历山德罗夫斯卡亚医院的基础上发展起来的，手术如下。在颈外动脉(ECA)的内缘，靠近颈动脉窦，在孔口上方2-3 cm处，根据动脉粥样硬化斑块(ASB)的扩散情况，进行动脉切开术，过渡到颈总动脉(CCA)(同样2-3见NSA口下方)。ICA被切断在由国家安全局和CCA墙的部分组成的地点。然后在舌下神经前面尽可能远端切断ICA，这样动脉就被完全切除了。由于在ICA切除区域存在完整的颈动脉血管球，将ICA与伤口连接起来，因此在手术视野内通过ICA的完全外翻进行ICA的动脉内膜切除术。然后行ECA和CCA动脉内膜切除术。下一阶段，将ICA植入原位，建立近端和远端端吻合器，用圆形血管缝合线固定动脉内膜切除术区上方的连续ASB。术后无并发症发生。根据彩色双工扫描数据，所有样本均未发现重建区再狭窄/血栓形成病例。术后第7天，所有患者均按照美国国立卫生研究院卒中量表诊断为神经系统症状消退:入院时，平均评分为10.5±3.5分;控制点瞬间- 6.5±1.5;p = 0.001。这反映了所选治疗策略的有效性。根据收缩压动态数据，在术前降压治疗的背景下，观察到术后收缩压参数稳定。根据计算机数据，在存在轻度神经功能缺损(美国国立卫生研究院卒中评分不超过25分)和脑缺血病灶直径不超过2.5 cm的情况下，在缺血性卒中急性期行颈动脉内膜切除术是安全的。断层扫描。在圣彼得堡Aleksandrovskaya医院的基础上开发的Glomussparing ICA自体移植不需要使用贴片，并且不存在由于动脉内膜切除术区后面的内膜脱离而导致ICA血栓形成的风险。在ICA重建干预期间保留颈动脉血管球可以防止术后不稳定动脉高血压和出血转化的发展。
{"title":"Emergency glomus-saving autotransplantation of the internal carotid artery in the acute period of ischemic stroke","authors":"A. Kazantsev, K. Chernykh, S. Artyukhov, L. Roshkovskaya, M. Janelidze, G. Bagdavadze, R. Lider, Ye. Yu. Kalinin, T. Y. Zaytseva, A. Y. Chikin, S. V. Sokolova, Y. Linets","doi":"10.24884/2072-6716-2021-22-3-38-47","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-3-38-47","url":null,"abstract":"Purpose. Analysis of the immediate results of emergency glomus-sparing auto-transplantation of the internal carotid artery (ICA) in the acute period of ischemic stroke, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg.Material and methods. In this prospective, single-center study from January 2017 to August 2020. 49 patients were included in the acute period of ischemic stroke with hemodynamically significant extended atherosclerotic lesions of the ICA. All patients underwent glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg (Kazantsev A. N., Zarkua N. E., Chernykh K. P. et al. Аrteries with extended atherosclerotic lesions of the internal carotid artery. Patent application No. 202.013.4151/14 (062595), filing date 10/16/2020). Glomus-sparing ICA autotransplantation, developed on the basis of the City Alexandrovskaya Hospital, St. Petersburg, was performed as follows. On the inner edge of the external carotid artery (ECA), adjacent to the carotid sinus, 2–3 cm above the orifice, depending on the spread of atherosclerotic plaque (ASB), arteriotomy was performed with the transition to the common carotid artery (CCA) (also 2–3 see below the mouth of the NSA). The ICA was cut off at the site formed by the sections of the wall of the NSA and the CCA. Then the ICA was cut off as distally as possible in front of the hypoglossal nerve, so that the artery was completely resected. In view of the presence of an intact carotid glomus on the resected area of the ICA, which connects it to the wound, endarterectomy from the ICA was performed inside the operating field by its complete eversion. Then, open endarterectomy from ECA and CCA was performed. At the next stage, the ICA was implanted in its previous place with the creation of proximal and distal end-to-end anastomoses, so that the continuing ASB above the endarterectomy zone was fixed with a circular vascular suture.Results. There were no complications in the postoperative period. No cases of restenosis / thrombosis of the reconstruction zone were identified in all the sample according to the color duplex scanning data. On the 7th day after the operation, all patients were diagnosed with regression of neurological symptoms according to the National Institute of Health Stroke Scale: on admission, the mean score was 10.5±3.5; at the moment of the control point — 6.5±1.5; p=0.001. This reflects the effectiveness of the chosen treatment strategy. According to the data on the dynamics of systolic blood pressure, stable systolic parameters were observed in the postoperative period against the background of antihypertensive therapy taken before the operation.Conclusion. Carotid endarterectomy in the acute period of ischemic stroke is safe in the presence of mild neurological deficits (up to 25 points on the National Institute of Health Stroke Scale) and the diameter of the ischemic focus in the brain not exceeding 2.5 c","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88089936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-30DOI: 10.24884/2072-6716-2021-22-3-71-78
A. Shchegolev, A. N. Gricaj, A. G. Klimov, V. Lapshin, V. Afonchikov, V. V. Shustrov, Е. U. Strukov
The article covers the principles of holding the infusion therapy at the prehospital stage with the ongoing uncontrolled bleeding. The scientific work shows the effectiveness of isoosmolar crystalloid solutions in conditions of low capillary pressure, which is typical for blood loss. The article shows that the concept of an acceptable hypotension is the most optimal approach to the infusion therapy if the ongoing bleeding is suspected in peacetime as well as in combat conditions. Recommendations are given for ensuring and maintaining venous access during short, long and delayed evacuation of victims with the suspected ongoing bleeding.
{"title":"Features of the infusion therapy at the prehospital stage with the ongoing bleeding","authors":"A. Shchegolev, A. N. Gricaj, A. G. Klimov, V. Lapshin, V. Afonchikov, V. V. Shustrov, Е. U. Strukov","doi":"10.24884/2072-6716-2021-22-3-71-78","DOIUrl":"https://doi.org/10.24884/2072-6716-2021-22-3-71-78","url":null,"abstract":"The article covers the principles of holding the infusion therapy at the prehospital stage with the ongoing uncontrolled bleeding. The scientific work shows the effectiveness of isoosmolar crystalloid solutions in conditions of low capillary pressure, which is typical for blood loss. The article shows that the concept of an acceptable hypotension is the most optimal approach to the infusion therapy if the ongoing bleeding is suspected in peacetime as well as in combat conditions. Recommendations are given for ensuring and maintaining venous access during short, long and delayed evacuation of victims with the suspected ongoing bleeding.","PeriodicalId":37398,"journal":{"name":"Sklifosovsky Journal Emergency Medical Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89555646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：