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ПРОФИЛАКТИКА ОСЛОЖНЕНИЙ, ОБУСЛОВЛЕННЫХ ИШЕМИЕЙ-РЕПЕРФУЗИЕЙ МИОКАРДА, ПРИ ЭКСТРАКАРДИАЛЬНЫХ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВАХ 预防缺血-心肌再灌注引起的并发症
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-07-01 DOI: 10.20538/1682-0363-2016-3-102-119
I. A. Kozlov
In the next 20 years, the aging population will be a major factor affecting the characteristics of perioperative anesthesia tactics. Domestic researchers have reported that the incidence of cardiac complications after general surgical procedures in patients with middle and old age is 9.1%, and mortality in these complications reached 45.5%. Analyzed current data on myocardial ischemia-reperfusion, the etiopathogenesis of perioperative cardiac complications, recurrence of their development and the possible consequences. It is concluded that prevention and timely treatment of complications resulting from ischemia-reperfusion of the myocardium, with noncardiac surgical interventions is an important tactical (prevention of perioperative myocardial infarction, arrhythmias, cardiac death) and policy (prevention of cardiac remodeling and post-hospital disability of patients) anaesthesiological tasks. Research carried out in the Nrgovsky Research Institute of General Reanimatology showed that in the real practice Detsky index, Lee index and echocardiographic left ventricular ejection fraction did not provide high accuracy prediction of cardiac events. More informative proved preoperative determination of blood N-terminal part of the pro-brain natriuretic peptide (NT-proBNP). In assessing the predictive ability of NT-proBNP area under the ROC-curve achieved 0.86. NT-proBNP value 358 pg/ml and above provided 77% sensitivity and 85% specificity. The comparative assessment and recommendations on the use to reduce the risk of cardiac complications of β-blockers, statins, calcium channel blockers, nitrates, clonidine, dexmedetomidine, levosimendan and phosphocreatine. Phosphocreatine, introduced in practice domestic cardiac surgery and transplantology more than 20 years ago, continues to be studied and used at the moment. Recently demonstrated that perioperative phosphocreatine usage appointment in older oncological patients with a high risk of cardiac complications reduces the incidence of acute ischemia and delirium, shortens the length of stay the intensive care unit and hospital stay. It was concluded that the reduction in the incidence of cardiac events has undoubted relevance with noncardiac operations.
未来20年,人口老龄化将是影响围手术期麻醉策略特点的主要因素。国内有研究报道,中老年患者普外科术后心脏并发症发生率为9.1%,并发症致死率达45.5%。分析心肌缺血再灌注、围手术期心脏并发症的发病机制、复发情况及可能的后果。结论:预防和及时治疗心肌缺血再灌注并发症,配合非心脏外科干预是预防围手术期心肌梗死、心律失常、心源性死亡的重要战术(预防围手术期心肌梗死、心律失常、心源性死亡)和政策(预防患者心脏重构和院后残疾)的麻醉学任务。Nrgovsky综合复活学研究所进行的研究表明,在实际操作中,Detsky指数、Lee指数和超声心动图左心室射血分数并不能准确预测心脏事件。更多的信息证实了术前测定血n端部分的前脑利钠肽(NT-proBNP)。在评估NT-proBNP预测能力时,roc曲线下的面积达到0.86。NT-proBNP值为358 pg/ml及以上,灵敏度为77%,特异性为85%。β-受体阻滞剂、他汀类药物、钙通道阻滞剂、硝酸盐、克拉定、右美托咪定、左西孟旦和磷酸肌酸降低心脏并发症风险的比较评价及建议磷酸肌酸早在20多年前就被引入国内心脏外科和移植学的实践中,目前仍在继续研究和使用。最近的研究表明,在心脏并发症高风险的老年肿瘤患者围手术期使用磷酸肌酸可减少急性缺血和谵妄的发生率,缩短重症监护病房和住院时间。结论:心脏事件发生率的降低无疑与非心脏手术相关。
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引用次数: 4
ЗАКОНОМЕРНОСТИ ФОРМИРОВАНИЯ ДВИГАТЕЛЬНОГО СТЕРЕОТИПА УПРАВЛЕНИЯ ТЕЛОМ В ФАЗЕ ПОЛЕТА У СПОРТСМЕНОВ 运动员在飞行阶段形成运动控制立体模型的模式
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-07-01 DOI: 10.20538/1682-0363-2016-3-87-94
A. V. Razuvanova, E. V. Koshelskaya, O. S. Smerdova, I. A. Karpova, E. V. Medvedeva, L. Kapilevich
Materials and methods. Regularities of movement patterns in the body control the flight phase of the athletes on the example of the long jump were studied by methods of Motion Tracking and electromyography. The findings suggest that a significant difference of motor stereotypes underlying the performance of motor actions – the long jump – in different skill athletes. Results. In the initial phase (phase jumping) differences between the groups are small - repulsion athletes perform in a similar manner, a core group of athletes with a more efficient use of the reserve of the work of the knee. The nature of the work the leg muscles in athletes of both groups in this phase is also not different. However, the further execution of motor actions in athletes of both groups occurs in different ways. Athletes of the control group did not perform virtually control the body in flight phase. This is evidenced primarily high tone muscles in the arms, back and neck throughout the flight phase. Movements are performed only in the knee and hip joints, and already in the phase of “hang-up” – the highest point of the flight path - these movements have focused on the preparation for landing. Conclusions. Athletes of the main group in the flight phase involve the full range of movements - flexion and extension are performed as in the shoulder and elbow joints, as well as in the neck and spine joints. All these movements are designed to increase the range of jumps - this contributes to the removal of the legs forward, and giving the body angular acceleration by the movement of legs and head. Preparation for landing is made directly before contact with the surface, but the very nature of the phase of flight allows the athlete to use the inertia of motion of the body as much as possible to lengthen the jump and thus facilitate shock absorption and retention of balance upon landing. Formation movement patterns in the body control the flight phase of the athletes in the performance of the long jump is caused first of all a transformation of the dominant, defining the objective of motor actions - from a safe landing at the beginning to a maximum distance of the jump from qualified athletes. The result is a motor stereotype that includes only foot traffic at beginners, is complemented by the involvement of the movements of hands and body, reducing the degree of fixation of joints in high-skilled athletes.
材料和方法。以跳远运动员为例,采用运动跟踪和肌电图方法研究了运动员身体控制飞行阶段运动模式的规律。研究结果表明,不同技术的运动员在跳远等运动动作的表现中,运动刻板印象存在显著差异。结果。在初始阶段(跳跃阶段)各组之间的差异很小——排斥力运动员的表现方式相似,核心组的运动员更有效地利用了膝盖的储备工作。在这一阶段,两组运动员腿部肌肉的工作性质也没有什么不同。然而,两组运动员进一步执行运动动作的方式不同。控制组的运动员在飞行阶段没有实际控制身体。在整个飞行阶段,这主要体现在手臂、背部和颈部的高张力肌肉。这些动作只在膝盖和髋关节处进行,并且已经处于“挂起”阶段——飞行路径的最高点——这些动作集中在为着陆做准备。结论。主力组的运动员在飞行阶段要进行全方位的动作——像在肩关节、肘关节、颈部和脊柱关节一样进行屈伸。所有这些动作都是为了增加跳跃的范围——这有助于腿部向前移动,并通过腿部和头部的运动给予身体角加速度。着陆的准备工作是在接触地面之前直接进行的,但飞行阶段的本质允许运动员尽可能多地利用身体的运动惯性来延长跳跃,从而促进着陆时的减震和保持平衡。形体运动模式的形成控制着运动员在表演跳远时的飞行阶段,首先是引起主导力量的转变,确定了运动动作的目标——从一开始的安全落地到跳远时达到合格运动员的最大距离。结果是一种运动刻板印象,在初学者中只包括步行,辅以手和身体的运动,降低了高技能运动员关节的固定程度。
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引用次数: 0
История развития хирургии височно-нижнечелюстного сустава 颞下颌手术的发展历史
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-06-04 DOI: 10.20538/1682-0363-2016-2-98-111
P. G. Sysolyatin, S. P. Sysolyatin, O. D. Baydik, O. V. Il’enok
The article presents the main stages of the historical development of the temporo-mandibular joint surgery. It was shown the evolution of treatments for diseases and injuries of joints. It summarizes the main work of domestic and foreign authors that influenced the development of surgery of the temporo-mandibular joint.
本文介绍了颞下颌关节外科历史发展的主要阶段。它展示了关节疾病和损伤治疗的演变。综述了影响颞下颌关节外科发展的国内外作者的主要工作。
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引用次数: 3
Сканирующая электронная микроскопия надпочечника крысы после воздействия хирургическим лазером 老鼠手术激光暴露后肾上腺扫描电子显微镜
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-06-03 DOI: 10.20538/1682-0363-2016-2-45-50
K. G. Kemoklidze, Y. K. Alexandrov, N. Tiumina, D. E. Pukhov
Aim. We studied via low vacuum scanning electron microscopy the effects of a surgical laser exposure to adrenal glands and results of regeneration processes after. Materials and methods.Purpose of this work is modeling of effects of the removal with a surgical laser a pathological focus in the adrenal glands. For this Wistar male rat (n = 19) adrenal glands were researched without the laser exposure, immediately after it and 1 month later. Results . Immediately after exposure occurs laser ablation crater with rough edges and melted surface penetrated by equidistant pores, which are footprints of blood vessels. Beneath of the surface are numerous vaporizationbubbles. Around the crater, the surface wrinkles and sags due to decreased ability to retain water. 1 month after the laser damage, the affected area tightened by a scar. Its coarse bundles of collagen fibers braid shapeless lumps of coal and caverns. Tissues with normal appearance are close to the scar, both outside and inside of the organ. The wrinkling and the sagging are absent. The undamaged organ part has retained the previous shape, without hypertrophies. The damaged part has shrunk. The nature of the regeneration processes indicates a low probability of a relapse after the destruction of a pathological focus via the surgical laser exposure.
的目标。我们通过低真空扫描电子显微镜研究手术激光照射肾上腺的影响和再生过程后的结果。材料和方法。本研究的目的是模拟手术激光去除肾上腺病理病灶的效果。对这只Wistar雄性大鼠(n = 19)在没有激光照射、激光照射后立即和1个月后的肾上腺进行了研究。结果。暴露后立即发生激光烧蚀坑,边缘粗糙,熔化表面被等距孔穿透,这些孔是血管的足迹。表面之下是许多汽化气泡。在陨石坑周围,由于保持水分的能力下降,表面起皱和凹陷。激光损伤1个月后,患处因瘢痕而收紧。它粗大的胶原纤维束编织着不规则的煤块和洞穴。外观正常的组织靠近疤痕,包括器官的外部和内部。没有褶皱和下垂。未受损的器官部分保持了原来的形状,没有肥大。损坏的部分缩小了。再生过程的性质表明,通过手术激光照射破坏病理病灶后复发的可能性很低。
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引用次数: 1
Роль фактора сезонности в формировании врожденных пороков развития 季节性因素在先天发展恶习形成中的作用
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-03-29 DOI: 10.20538/1682-0363-2012-3-135-138
O. V. Antonov, Ye. V. Bogachyova, A. Komarova, I. V. Antonova, A. A. Velmatova, G. A. Kovalyova, S. N. Maltsev, K. V. Mitrofanov
The results of prevalence, structure and timerisk study in children birth with malformations inOmskin the period of 1998—2008 are presented. Birth of children with congenital abnormality weight average index accounted for (47.72 ± 0.66)%. Musculoskeletal and cardiovascular malformations prevailed in birth abnormality total number structure. Accor­ding to ICD-10 the congenital malformations were united in groups and seasonal variation indices nave been determined for them. Study results indicated the predominance of children conception cases with high risk malformations forming in August, November and December.
本文对1998-2008年南京市出生畸形儿童的患病率、结构及时间风险进行了分析。出生先天性异常患儿体重平均指数占(47.72±0.66)%。出生畸形总数结构以肌肉、骨骼和心血管畸形为主。根据ICD-10对先天性畸形进行分组,并确定其季节变化指标。研究结果表明,高危畸形患儿以8月、11月和12月为主。
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引用次数: 13
К вопросу о целесообразности использования вибрации с частотой 100 Гц в лечении и реабилитации больных хронической обструктивной болезнью легких 关于使用100赫兹振动来治疗和恢复慢性阻塞性肺病患者的可取性
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-03-24 DOI: 10.20538/1682-0363-2016-1-22-29
T. N. Zaripova, M. A. Serebrova, I. I. Antipova
The aim of this research is study of feasibility of application of instrumental 100 Hz vibration of the thorax for rehabilitation of COPD patients. Materials and methods . This aim is achieved by clinical observation of 43 COPD patients of 1st and 2nd severity, 77.4 % from which were patients with low risk of exacerbations. Research has been carried out during the stable period of disease. The following parameters have been analyzed: dynamics of the clinical state, spirometry data, clinical - biochemical indicators of blood reflecting presence of the inflammatory process activity, a number of indicators of immune system. Two groups of patients, which were equivalent in an initial state on age, disease severity, expressiveness of functional violations, have been isolated. The 1st group contained 20 persons was the main one. It received 100 Hz vibration impact on the thorax on the background of exercises with physical therapy and inhalations of physiological solution. The 2nd group contained 23 persons obtained in addition sea-buckthorn paste. Results. It has been revealed that the course of 100 Hz vibration impact on the thorax is accompanied, mainly, with positive subjective dynamics in the form of decrease of frequency and expressiveness of complaints. At that it has been noted improvement of bronchial passability due to improved drainage of bronchial tubes, but only at the patients with initial violations of ventilation. Only additional reception of sea-buckthorn paste on the background of vibrotherapy contributes to decrease of subclinical inflammation activity and strengthening of immunological protection. Essential positive results of treatment have been reached only for a half of the surveyed patients that allows to speak about non-expediency or low expediency of use of 100 Hz vibration for CODT patients even 1st and 2nd severity in the stable period of course of the disease.
本研究的目的是研究100 Hz胸腔仪器振动在COPD患者康复治疗中的可行性。材料和方法。通过对43例1、2级COPD患者的临床观察,达到了这一目的,其中77.4%的患者急性加重风险较低。研究是在疾病稳定时期进行的。分析了以下参数:临床状态的动力学,肺活量测定数据,反映炎症过程活性的血液临床生化指标,免疫系统的一些指标。两组患者在年龄、疾病严重程度、功能侵犯的表达性等初始状态相等,已被分离。第1组20人是主力。在物理治疗运动和吸入生理溶液的背景下,胸腔受到100hz的振动冲击。第二组有23人,另外获得沙棘膏。结果。研究表明,100hz振动对胸腔的冲击过程主要伴随着积极的主观动力,表现为频率的减少和抱怨的表达。由于支气管引流的改善,支气管通过性有所改善,但仅适用于最初违反通气的患者。只有在振动治疗的背景下额外接受沙棘膏有助于降低亚临床炎症活性和增强免疫保护。在接受调查的患者中,只有一半的患者达到了治疗的基本积极结果,这就允许谈论对CODT患者使用100 Hz振动的非权宜之计或低权宜之计,即使是在疾病病程的稳定时期的第一和第二严重程度。
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引用次数: 0
ВЛИЯНИЕ НОВОЙ МАЗЕВОЙ КОМПОЗИЦИИ AG/ТАГА И ХИТОЗАН-ГЕЛЯ НА ЛЕЧЕНИЕ ЭКСПЕРИМЕНТАЛЬНЫХ РАН РАЗЛИЧНОЙ ЭТИОЛОГИИ 新的mazev构图AG/ tag和hitozan - gel对不同伦理的实验伤害的影响
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-03-24 DOI: 10.20538/1682-0363-2016-1-47-54
T. Popova, T. G. Tolstikova, A. Y. Letyagin, N. A. Zhukova, N. P. Bgatova, L. N. Rachkovskaya, A. A. Kotlyrova, V. A. Burmistrov
The purpose of the study – evaluation of the regenerating activity of two-component paste, consisting of silver containing finely particulate sorbent: chitosan gel. Material and methodologies. For the study we used novel excipient, consisting of two components: silver containing finely particulate sorbent: chitosan gel in ratio one-to-one. Novel sorbent agent, taken for study, consists of thermally activated silica containing aluminum hydroxide in the form of its modification silver. Experiment was conducted on 48 Wistar models in case of scalp (degloving) wound (abscission of skin area 30–40 mm2 in size on depilated side surface) and chemical burn (applying 1–2 drops of 70% sulfuric acid on the depilated surface side.  Regenerating activity was evaluated based on morphometry area of the wound surface, fixing the rate of scarring. Evaluation was made histologically on 4th - micrometers paraffin sections, stained with hematoxylin and eosin, and semithin sections, stained with toluidine blue. The results of study. Composition (paste) developed from silver containing finely particulate sorbent: chitosan gel sped up (for 3 days) the process of reparative regeneration of tissue on the model of chemical burns, helped to structuring formations in skin by the type of granuloma, at the same time there were no signs of perifocal inflammation. In case of scalp wound ointment composition wasn’t conducive to raising the rate of regeneration. Conclusion . Developed excipient (paste) is effective at the first phase of wound healing process, which was showed on scalped and burn wounds, as hydrophilic base had a large sorption capacity. Traumatic effect of dry sorbent powder (powder) on the surface of the wound was offset by connecting the sorption component and a hydrophilic ointment base.
研究目的:评价含银细颗粒吸附剂壳聚糖凝胶双组分浆料的再生活性。材料和方法。本研究采用新型赋形剂,由含银细颗粒吸附剂和壳聚糖凝胶两种组分组成,比例为1:1。以新型吸附剂为研究对象,采用热活化二氧化硅,以改性银的形式含有氢氧化铝。实验采用48只Wistar模型,分别对头皮(脱手套)创面(脱毛侧皮肤面积30 ~ 40mm2脱落)和化学烧伤(在脱毛侧涂抹1 ~ 2滴70%硫酸)进行实验。根据创面的形态测量面积评估再生活性,确定瘢痕形成率。4微米石蜡切片用苏木精和伊红染色,半薄切片用甲苯胺蓝染色,进行组织学评价。研究结果。由含银细颗粒吸附剂制成的成分(膏体):壳聚糖凝胶加速(3天)化学烧伤模型组织的修复再生过程,根据肉芽肿的类型帮助皮肤结构形成,同时没有局部炎症的迹象。对于头皮创面,药膏成分不利于提高创面的再生速度。结论。所研制的赋形剂(膏体)在创面愈合过程的第一阶段是有效的,这在头皮创面和烧伤创面上都表现出来,因为亲水性碱具有较大的吸附能力。干燥的吸收粉(粉)在伤口表面的创伤效应通过将吸收成分与亲水性软膏基连接来抵消。
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引用次数: 4
СОВРЕМЕННЫЕ ЛАБОРАТОРНЫЕ МЕТОДЫ ДИАГНОСТИКИ ПИЩЕВОЙ НЕПЕРЕНОСИМОСТИ 诊断食物不耐症的现代实验室方法
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-03-24 DOI: 10.20538/1682-0363-2016-1-69-78
М. Ю. Розенштейн, А.З. Розенштейн, С. Э. Кондаков, Наталья Анатольевна Черевко
Аn analytical review of modern methods of food intolerance diagnostics based on interpretation of markers used in the various tests is рresented. It is shown that tests based on observation of the reaction of specific antibodies of the immune system to food antigens tested, are the most accurate, reliable and representative for the diagnosis of food intolerance.
Аn基于对各种测试中使用的标记物的解释,对食物不耐受诊断的现代方法进行了分析综述。研究表明,基于观察免疫系统特异性抗体对食物抗原反应的检测,是诊断食物不耐受最准确、最可靠和最具代表性的方法。
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引用次数: 5
Реабилитация урологических больных 泌尿系统患者康复
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-03-19 DOI: 10.20538/1682-0363-2012-2-153-156
Валентин Николаевич Павлов, А. А. Загитов, Адель Альбертович Измайлов, Альберт Альфредович Казихинуров, В. З. Галимзянов, Р. И. Сафиуллин
According to the literature data, up to 30—40% of patients who underwent radical cysrectomy for cancer of the urinary bladder suffer from diverse types of urinary incontinence. The current methods of treatment of urinary incontinence are not very effective due to frequent recurrences requiring repeated and more complicated surgical interventions. The perspective method of rehabilitation of patients with urinary incontinence is doing physical exercises for the pelvic muscles.
根据文献资料,在接受根治性膀胱切除术治疗膀胱癌的患者中,高达30-40%的患者患有不同类型的尿失禁。目前治疗尿失禁的方法不是很有效,因为尿失禁经常复发,需要反复和更复杂的手术干预。尿失禁患者康复的透视方法是对盆腔肌肉进行体育锻炼。
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引用次数: 0
Эректильная дисфункция и психоэмоциональные аспекты больных ишемической болезнью сердца, подвергшихся коронарному шунтированию 冠状动脉搭桥引起的缺血性心脏病患者的勃起功能障碍和心理情感方面
IF 0.2 Q4 MEDICINE, GENERAL & INTERNAL Pub Date : 2016-03-18 DOI: 10.20538/1682-0363-2012-2-59-63
Евгений Владимирович Помешкин, А. И. Неймарк, С. А. Помешкина, Ольга Леонидовна Барбараш
The impact of erectile dysfunction on psychoemotional state of patients undergone coronary artery bypass graft surgery was evaluated. The International Index of Erectile Function, postcompression cavernous artery dilation test, nocturnal penile tumescence recording and psychophysiological exam were used. It was found that ischemic heart disease patients have higher incidence of associated psychoemotional and erectile dysfunctions.
探讨冠状动脉搭桥术患者勃起功能障碍对其心理情绪状态的影响。采用国际勃起功能指数、压缩后海绵动脉扩张试验、夜间阴茎肿胀记录和心理生理检查。发现缺血性心脏病患者有较高的相关心理情绪和勃起功能障碍发生率。
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引用次数: 2
期刊
Byulleten Sibirskoy Meditsiny
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