[PREDICTORS OF UNFAVORABLE OUTCOME IN PATIENTS WITH ABDOMINAL SEPSIS.]

OBJECTIVE: The study focuses on identifying predictors of treatment outcome in abdominal sepsis (AS) in humans. SUBJECTS AND METHODS: 70 patients underwent determination of blood pressure, heart rate, SpO , the content of leu- kocytes, albumin, C-reactive protein, fibrinogen and TNF-a in arterial (femoral artery) and venous (subclavian vein) blood. Automatic biochemical analyzer Cobas-Integra 400 ('Roche", Switzerland), the test system Microlab STAR ELISA kit reagents "alpha TNF - ELISA - best" were used during the research. System statistical analysis included paired comparison of patients with favorable (n=27) and lethal (n=43) outcome, correlation, cluster; discriminating analysis, multidimensional scaling and plotting ROC curves with sensitivity and specificity indicators predictive value. RESULTS: Identfied predictors of outcome inpatients,from which to form a predictive model of CRP fibrinogen, albumin, and TNF-a arterial blood. It is established that if the basic treatment of the patient CRP <9,8 g/l,fibrinogen >3,43 g/l, albumin <28,9 gl and TNF-a <499,3 ng/ml, the probability of death was statistically significantly higher thanfavorable. CONCLUSION: It is assumed that therapeutic measures should be aimed at correction of the above mentioned indicators.

PREECLAMPSIA AND IRON EXCHANGE. ARE THERE ANY COMMON PATTERNS?

THE AIM: Detarmination of correlation between the level ofserm iron and hemoglobin with clinical symptoms ofpreeclampsia. MATERIALS AND METHODS: A prospective randomized controlled investigation of 62 women in the gestation of 30 to 39 weeks. Women were divided into 2 main groups. The first group included 38 nulliparous women with preeclampsia moderate degree (Io group) gestational age from 30 to 39 weeks, at the age of 26,8±2,7 years. The second main group included 24 nulliparous women with preeclampsia severe degree (II group) in gestational age from 30 to 39 weeks of similar age. The conditionfor inclusion in the main groups was iron supplementation in the period of total hemoglobin reducing < 115 g/l. The first control group (I) included 26 nulliparous women average 26,2±1,6 years, which admitted to a maternity hospital for planned Cesarean section. The second group (IQ included 22 healthy non-pregnant women at the age of 25,8±4,4 years. During hospitalization, before delivery and at 2 hours after delivery was investigated the concentration of total hemoglobin, serum iron, total bilirubin, creatinine, urea, endothelin-1 (immediately before delivery and after delivery). The total analyses of urine examined the number of red blood cells and white blood cells and protein concentration. RESULTS: It''s revealed that the serum iron level has a direct correlation with the level of blood preasure (r = 0,5412 and r = 0,6229) and concentration of endothelin- with total hemoglobin (r = 0,6446 in p < 0,03) and with serum iron concentration (r = 0,7841 in p < 0,02). Conclusuion. The analysis of conducted investigation allows to approve about the pathogenetic importance of iron in the development ofpreeclampsia and post-partum complications, that require new approaches of iron during gestation.

[PLACE REMAXOL AS A HEPATOPROTECTOR IN INTENSIVE THERAPY OF PERVASIVE PERITONITIS].

UNLABELLED: PERPOSE OF RESEARCH: to evaluate the effectiveness of Remaxol in patients with pervasive peritonitis. MATERIALS AND METHODS: assessed the effectiveness of a balanced infusion of the drug (Remaxol) in the treatment of 44 patients agedfrom 18 to 50 years. Patients were devided into 2 groups by the method of envelopes. All patients received a comprehensive differential therapy: 21 patient 1 group consisting of infusion therapy in the postoperative period received Remaxol at a dose of 800 mg/day for 7 days. RESULTS: the comporative assessment of indicators of systemic hemodinamics, oxygen transport, asid base status, glucose, lactose and free radical oxydation. Patients on the first background was used Remaxol have experiensed a more rapid relief of metabolic disorders, endotoxemia and hepatic dysfunction compared with the indices of the 2 group patients. Noted earlier stabilization of rudicators of systemic hemodynamics and oxygen transport. This has reduced the duration of respiratory and vasopressor suppot, early start ofparenteral intreduction in case the power (p < 0.05). CONCLUSIONS: this study shows that use of the drug for the purpose of relief Remaxol hepatic dysfunction and prevention of drug liver toxicity in conditions ofperitonitis, after 48 hours of operation, provides a positive dynamics and stabilization ofparameters of central hemodynamics, contributing to the abolition of vasopressor support, and contributes to the effective utilization of oxygen, while providing antioxidant effect.

[Correction of endotoxemia in patients with pancreatic necrosis]. / Korrektsiya svobodnoradikal'nykh protsessov i endotoksemii u bol'nykh pankreonekrozom.

AIM: To study the results of deferoxamine (Deferal) administration in intensive therapy program of 63 patients with severe acute pancreatitis to decrease effect of oxidative stress and endotoxemia. MATERIAL AND METHODS: In deferoxamine group (31 patients) there were decrease of serum iron's level and inhibition of free radical oxidation that led to early relief of endotoxemia, reducing periods of organs' dysfunction. It was not observed in comparison group (32 patients). RESULTS: Deferoxamine decrease risk of pancreatic necrosis and pancreatogenic sepsis. It allows reducing ICU- and hospital-stay and number of extended surgical procedures.

[Problem of intraoperative hemotransfusion].

MATERIALS AND METHODS: We studied 66 patients (males aged 39.5 +/- 5.3) with hemorrhagic shock II. Gas composition of arterial and venous blood and a detailed analysis of the blood were studied twice (before and after hemotransfusion). RESULTS: We found that a low-volume (up to 2 doses) transfusion of erythrocyte mass with terms of storage up to 3 days, held after bleeding stop and hypovolemia correction, is the most effective treatment for hemorrhagic shock II. CONCLUSIONS: Substitution therapy in operating room does not contribute oxygen transfering in tissues and inhibits stimulation of the bone marrow due to hypoxia. Thus the substitution therapy is an aggravating factor when the bleeding stopped, but hypovolemia not eliminated.

[Clinical effects of packed red blood cells transfusion according to storage life and time of transfusion].

It was studied 66 males aged 39.5±5.3 years with hemorrhagic shock II degree. Gas composition of arterial and venous blood was studied twice (before and after transfusion). It was revealed that succinct transfusion of packed red blood cells (to 2 doses) with storage life to 3 days after bleeding stop and hypovolemia filling is the most effective correction of hemorrhagic shock II degree. Replacement therapy in operating room in condition of stopped bleeding and unrepaired hypovolemia is burdening factor because it does not conducive to transfer of oxygen at the tissue level and inhibits stimulation of bone marrow in response to hypoxia.

[Iron metabolism and its role in traumatic disease].

The article reviews recent studies of iron exchange and its role in a traumatic disease and traumatic shock. The review stresses a relationship of iron metabolism disturbance with free radical oxidation, lipid peroxidation and multiple organ dysfunctions. The article deals with data of unbound iron collect mechanisms, ways of endotoxemia activation, haemostasis and haemodynamics disturbance proving the role of iron in a multiple organ dysfunctions during traumatic disease.

[Metabolic and organ protective properties of various infusion solutions and the choice of starting therapy in the pre-admission stage of acetic acid poisoning].

MATERIALS AND METHODS: We conducted an open prospective study in 60 patients (30 men and 30 women) with acetic acid poisoning. A randomization was performed on the groups, taking into account the tactics of infusion therapy: group I--15 patients who did not receive an infusion therapy at a pre-admission stage; group II--15 patients who received the infiusion therapy with solution of sodium chloride 0.9%; group III--15 patients who received the infusion therapy with modified gelatin (Gelofusinwn), group IV-15 patients who received the infusion therapy with reamberinum. RESULTS: We found that the most favorable results were noted in patients of group IV in the early posttraumatic period.

[Iron metabolism in women with anemia and eclampsia (Part I)].

The review deals with a modern view of iron exchange in general and during pregnancy, in particular Different views on the mechanisms of the development of anemia in pregnancy are reflected. The protective role of anemia is noted, and also the opinion of the review authors to the negative role of prophylactic supplementation of iron is reflected. Are numerous and compelling scientific evidence pointing to the large number of negative prevention of iron. That questioned the usefulness of routine appointments for pregnant women with iron. According to a large number of studies assigning pregnant iron on the one hand, contributes to excessive activation of free radical oxidation, the accumulation of lipid peroxidation products and demonstrations of eclampsia, and from the other potentiates the bacterial aggression and development of purulent-septic diseases that generally leads to the development of complications in pregnancy.

[Assessment of oxygen status in critical patients with systemic inflammatory reaction].

Diagnostic ability of alveolar-arterial oxygen gradient (A-aDO2 and respiratory index (RI) for acute respiratory distress syndrome was underestimated before recent time. 68 patients with severe inhomogeneous lung injure (severe concomitant trauma, pneumonia, and pancreonecrosis) were involved in the study. Patients were divided into two groups (basic group--34 patients and control group--34 patients). There were no differences in data of severity-of-disease by APACHE II and SOFA scales and J.F. Murrey lung injury score in both groups. Conventional volume controlled and pressure control respiratory techniques were used in patients of control group. Multi-level ventilation with three levels was used in patients of basic group. Blood gas containing, A-aDO2 and RI were studied. Gas status data improved both to gas exchange efficacy in patients of basic group. The data were significant different in the control group. Thus multilevel ventilation improves alveolar ventilation and arterial oxygenation, decreases pulmonary shunt and lung injury and improves respiratory lung functions.

[Opportunities of correction of rheological properties of blood in intensive therapy in patients with peritonitis and acute bowel obstruction].

An analysis of efficacy of 1.5% reamberin solution usage was made in 80 patients for correction of blood rheological properties disorder in the case of peritonitis and bowel obstruction. It was established, that reamberin, which was administered in the dose of 500 ml after 12 hours of the beginning of intensive care during 48 hours, efficiently corrected the rheological disorders. It was because the erythron and reticulocyte production were activated, the hyposmolarity was removed, the intensity of free radical oxidation and peroxide oxidation of lipids was decreased and the antioxidant status was restored. This facilitated the hydrophily and erythrocyte volume decrease, the haemolysis reduction and qualitative gas exchange at the level of tissues.

[Efficiency of succinic acid infusion solutions in minor surgery].

A group of 66 patients with purulent-septic surgical pathology on the background of type 2 diabetes mellitus (in the compensation phase) and atherosclerosis of vessels in lower extremities (in the decompensation phase) have been studied. The status of all patients has been determined by the syndrome of systemic inflammation reaction (rated 12.4 +/- 2.2 on the APACHE II scale). Group I (n = 30) included 19 men aged 53.7 +/-7.7 and 11 women aged 54.4 +/- 9.1, which were administered reamberin (single daily dose of 500 ml for three days after operation). Group II (n = 36) included 24 men aged 56.1 +/- 9.2 and 12 women aged 51.9 +/- 8.8 with analogous pathology and general status, which received infusion therapy without reamberin. It is established that the administration of reamberin in patients with purulent-septic surgical pathology on the background of type 2 diabetes mellitus and atherosclerosis of vessels in lower extremities is patho-. genetically justified and allows the reperfusion syndrome upon various operations to be prevented and the critical state in post-operation regime to be eliminated.

[Critical conditions as a logical and appropriate series of events in iron methabolism disorders (the summary of experimental studies)].

It is revealed that in all models of critical conditions will activate the free-radical oxidation, decreasing the total antioxidant activity, the concentration of transferrin decreases in the serum of the blood, increase of the concentration of ferritin, the theological properties of the blood are violated and the signs of endothelial dysfunction are identified. Pre-entered deferoxamine in the dose of 80 mg/kg reduced the intensity of free-radical oxidation processes, restoring the antioxidant potential, concentration of the transferrin, and a lower level of ferritin, contributed to the normalization of blood theological properties and a reduction of the extent endothelium destruction as a result of the reduction Fe2+ concentration in blood serum.

[Respiratory support using multi-level lung ventilation in patients in critical state with systemic inflammatory response syndrome].

PURPOSE: To prove the effectiveness of the method and improve lung gas exchange in patients with non-homogenous lung tissue damage with multi-level (3-level, MLV) ventilation. MATERIALS AND METHODS: Artificial lung ventilation (ALV) with MLV carried out in 13 patients with severe lung tissue damage (polytrauma, pneumonia and ARDS) treated at the unit of resuscitation and intensive care (for septic patients) SCH No 1 of Omsk since May 2011. The initial values of pO2 and oxygenation index were significantly reduced, the fraction of the intrapulmonary shunting - essentially increased. During the first day after the beginning of respiratory support with the use of MLV, was registered pO2, SaO2 and oxygenation index growth, there was a positive x-ray dynamics of improved lung tissue biomechanics. As a result of the ALV with MLV in 11 patients had achieved steady improvements of arterial oxygenation. The use of respiratory support with MLV in patients with severe lung damage leads to a significant improvement of the alveolar ventilation and arterial oxygenation, and to reduce the intrapulmonary shunting level. The use of this type of ventilation system versus traditional methods of respiratory therapy leads to respiratory failure solution, in reduce of duration of ALV terms and stay in the intensive care unit.

[Comparative study of infusion therapy options in patients with hemorrhagic shock].

This work presents the results of treatment of 60 patients with 2nd degree hemorrhagic shock at pre-hospital and hospital stages by different variations of infusion therapy. It is established that balanced infusion therapy in patients with 2nd degree hemorrhagic shock helps to stabilize the system hemodynamic and improve the general condition. The balanced infusion therapy does not lead to unfavorable changes in acid-alkaline and electrolyte balance.

[Effective use of third generation fat emulsion in total parenteral nutrition program in patients with severe sepsis].

The aim of the current research was to measure the clinical efficacy of 3rd generation fat emulsion in the program of complete parenteral nutrition of patients with severe sepsis. The work demonstrates the results of treatment of 25 patients with severe sepsis divided into 2 groups depending on the way of parenteral nutrition. In the 1st group (13 patients) the parenteral nutrition was carried out by 20% glucose, 15% solution of crystallic aminoacids and 20% of 2nd generation fat emulsion. In the 2nd group (12 patients) parenteral nutrition was carried out by 20% glucose, 15% solution of crystallic aminoacids and 20% of 3rd generation fat emulsion. The parenteral nutrition of Ist and 2nd group contributed to the correction of hypermetabolism syndrome and stabilization of the nutritive status parameters. It was observed that the parenteral nutrition used in the 2nd group showed statistically higher positive effect on the parameters of systemic inflammation and cellular part of immunity, rather than parenteral nutrition used in the 1st group. It is revealed that, the used methods of complete parenteral nutrition in patients with severe sepsis effectively eliminate the hypermetabolism syndrome. Parenteral nutrition of patients with severe sepsis by 3rd generation fat emulsion has a positive effect of parapeters of systemic inflammation.

[Systemic inflammation complication of acute coronary syndrome with diabetes mellitua type 2].

The basic indicators of systemic inflammatory reaction syndrome, as well as the dynamics of the content of low and medium molecular weight glycopeptides and in biological media in patients with acute coronary syndrome. Analysis of the results showed that the presence of background type 2 diabetes mellitus in patients with acute coronary syndrome is associated with higher non-infective resorbtion of necrotic syndrome. This is the rationale for inclusion in the complex intensive therapy of more active desintocsication activities and metabolically significant effects on myocarde and for type 2 diabetes with acute coronary syndrome.

[The homeostasis assessment by hemorrhagic shock].

The comparative analysis of different protocols of infusion therapy of the hemorrhagic shock stage III was performed. The infusion of the colloid solution of hydroxiethylstarch 200/0.5 and non-balanced crystalloid 0.9% solution of natrium chloride leads to the development of negative changes in homeostasis. Whereas infusion of the 4% solution of the modified gelatin and balanced crystalloid solition (sterofundin) allows to avoid the registered changes in electrolyte and alkaline balance.