Anesteziologiia i reanimatologiia最新文献

58 patients who underwent urgent laparotomy were included in this randomized controlled study. The efficacy and safety of bilateral ultrasound rectus sheath block of ropivacaine with systemic analgesia in comparison with only systemic analgesia were assessed. Rectus sheath block reduces the pain intensity and the consumption of opioids and declines the incidence of the adverse effects, therefore improving the quality of analgesia and postoperative comfort ofpatient.

The Protocol isn't seen as directive. The goal of the Protocol is to define theframes ofdiagnostic criteria and therapeutic action, within which a doctor working in an intensive therapy children have freedom of choice. The Protocol takes into account that the critical and postagressive states are characterized by the features of malnutrition, particularly manifested in the period of intensive growth (first life year). The Protocol submitted by: contraindications to artificial nutricion in any form; indications for parenteral nutrition; components ofparenteral nutrition; calculation of water and energy needs; calculation of substrate requirements; the system of "two in one" and "three in one "; monitoring the effectiveness ofparenteral nutrition; the use of adjuvants and active additives to artificial nutrition, indications for early enteral nutrition, time of the beginning of enteral nutricion and tolerance to it: trial feeding; trophic nutricion; the technique ofprobe feeding; selection offormulas for enteral nutrition; monitoring the effectiveness of enteral nutrition. The Protocol does not discuss the issues of planned nutritional preparation for surgery, nutritional support in chronic malabsorption, sipping.

Background: The progress of surgery, the widespread use in the clinic of cardiac surgery and extended lymphadenectomy in thoracic surgery led to a greater incidence of the thoracic lymphatic duct ' trauma. That is why the actuality of treatment of chylothorax and chylorrhea is increased. The aim; improvement of diagnostics, prevention and treatment results ofpatients with chylothorax and chylorrhea.

Materials and methods: 37 patients (14 women and 23 men) with chylothorax had been treating with our participation in different hospitals from 2004 to 2014. The age of the patients was from 32 to 71 years. In 34 patients chylothorax occurred after surgery, in 3 patients - during the decompensation of the therapy diseases with the use of central venous catheterization, with an earlier clinic of thrombosis of the large veins of the neck.

Results: Conservative therapy had good clinical effect of 83.8%. 1 patient died due to pneumonia of the single lung on the background of chylothorax developed in the postoperative period after right-sided pneumonectomy. In other cases, chylothorax was eliminated and in the late period had no recurrence.

Conclusion: prevention of chylothorax depends on the experience of the operating surgeon. If there is doubt intact thoracic lymphatic duct, it has tightened with the stitching surrounding adipose tissue. Conservative therapy is the method of choice in the treatment of chylothorax. Surgery is indicated for failure of conservative therapy within the first two weeks, or when massive chylorrhea takes place.

Introduction: At present, no doubt enhanced by the attention of clinicians to monitor blood glucose and methods of its correction in ICU patients. Evidence of the effect of the expressed glycemic balance disorders on the results of treatment of such patients determine of the problem. Attempts to create a computer algorithm to determine the rate of insulin. The aim of the study was to investigate the efficacy and safety of the module Space glycemic control (SGC, "BBraun Germany) with intravenous insulin therapy in patients with thoracoabdominal surgery.

Material and methods: Single-center prospective observational study was conducted in the ICU in 50 patients in the early period after operations on the abdominal and thoracic cavity, mediastinum.

Results: The average duration of the monitoring group with SGC was 57 hours (17 to 280 hours). The average length of the period during which the patients were recorded in the target range glycemia was 80.4% of the total time of SGC monitoring. The average value of glucose in capillary blood proved to 7,6?1,58 mmol/l. The incidence of severe hypoglycemia was 2% (1 patient).

Conclusion: Application module SGC should expedient be used in patients after extensive thoracoabdiminal surgical procedures in which recorded postoperative hyperglycemia.

The article describes some characteristics of temperature homeostasis regulation while intraoperative period and its correction methods by infusions of balanced crystalloid solutions on the basis amino acids and the Krebs cycle substrates.

Materials and methods: 107 children of different ages were included into the study. All of them underwent surgery on thoracic or abdominal organs. The average age was 13 (7-16) years. All the operations were performed with total intravenous anesthesia and artificial lung ventilation. 0,9% sodium chloride solution, "Mafusol" "Infezol-40" and "Reamberin" were used in order to correct perioperative hypothermia. Results of the study. It was found that solutions based onfumarate (mafusol) and succinate (reamberin) have a significant positive effect on the temperature homeostasis. This fact means they can be recommendfor a broad usage in clinical practice for the purpose ofprevention and elimination of intraoperative hypothermia.

Realising for thefirst time in Russia the transportation of a patient with critical respiratory failure in conditions of EC-MO-therapy, the authors have accumulated great experience of its application at the stage of inter-hospital evacuation. This category ofpatients previously considered non-transportable by the severity of their condition. Having conducted a retrospective analysis of clinical experience in the use of high-tech medical care method, the authors received a zero mortality and questioned the possible new criteria and recommendations in assessing risk of death in patients with life-threatening conditions at the stage of inter-hospital transportation.

Background: The tracheal surgery is associated with opening of airways and historically used different methods of maintaining gas exchange: System "shunt-breathing", the injection ventilation, high frequency jet ventilation and even artificial circulation. In recent years increased the interest of use of apneic oxygenation (A 0).

The aim: to study the impact ofthe application ofA o on the gas exchange, acid-base balance of arterial blood, in patients undergoing reconstructive surgery on the trachea and bronchi with AO.

Materials and methods: The study included 130 patients with stenotic disease of the trachea, operated in the period from 2011 to 2014 usingAO.

Results: Application ofAO provides a high level of oxygenation and is accompanied by a moderate increase in pCO2 level and the development of acidosis. Hypercarbia and acidosis were not accompanied with hemodynamic disturbances on ECG, heart rate and invasive measurement of blood pressure at high values of Pa O₂.