[Coagulation profiles during cardiac surgery].

OBJECTIVE: To evaluate patients' hemostasis after cardiac surgery using thromboelastometric and impedance aggregometry. MATERIALS AND METHODS: 66 patients were examined intraoperatively. Comparison group included 45 blood donors. Hemostasis was tested for thromboelastometricRotem Gamma with the assessment of external (exTem) and internal (inTem) pathways of coagulation tests performed detection of heparin (hepTem) and cytochalasin-D-inactivation of platelets (fibTem) to assess the level of fibrinogen. Collagen-induced platelet aggregation was determined in an aggregometer CHRONO-LOG (USA). RESULTS: Significant deviations of the parameters of hemostasis were detected in 52 of the 66 studied patients. In group-1 (23 patients) revealed a residual effect of heparin. The effect manifested prolongation CT (clotting time) inTem to an average of 241 +/- 15 s, compared with CT hepTem--181 +/- 7. Patients in this group were in need of additional administration of protamine sulfate. Postoperative bleeding and resternotomia were observed in 3 patients of group-1. In group-2 (25 patients) CT inTem was 216 +/- 21 with significantly fewer CT hepTem (272 +/- 26). The data indicated excess of protamine sulfate. Platelets aggregation decreased compared to the norm. According to the obtained results, the addition of protamine sulfate is not required, however, in 7 cases the protamine sulfate was administered in a dose of 8.9 +/- 0.8 mg in 6 cases resternotomiya required. In the third group (n = 6) bleeding was observed in 4 patients. The difference in CT-hepCT was significant. Significant variations were revealed in the tests of the activity of the extrinsic pathway of coagulation and cytochalasin-D-induced inactivation of platelets: exMCF- 42 +/- 2 mm (normal 57 +/- 15 mm), fibMCF 5.0 +/- 0.3 mm (norm 12.8 +/- 4.3 mm). The concentration of platelets and their aggregation activity was sharply reduced. Disorders of hemostasis in the third group, designated as dilution coagulopathy. CONCLUSION: Turning thromboelastometric and impedance aggregometry in the study of the coagulation profile of patients undergoing cardiac surgery in postperfusion period brings valuable information and allows a differentiated treatment of hemostasis disorders.

[Mechanic reinfusion in emergency surgery].

The article highlights techniques and effects of intraoperative mechanic blood reinfusion in patients with trauma and intraabdominal bleeding in extend, exceeding the self circulating blood volume. The high efficacy of the self blood reinfusion during the emergency operation allowed the 2-fold decrease of the hospital and overall mortality. The mechanic blood reinfusion proved to be a safe and clinically effective method of the globular blood volume deficiency compensation, especially in emergency surgery.

[The intraoperative auto- and allohemotransfusion by massive bleeding in emergency abdominal surgery].

The results of intraoperative hemotransfusion of 112 patients with abdominal injuries, complicated with bleeding and the loss of more then 70% of the circulating blood. The aim of the study was to compare the efficacy of auto- and allohemotransfusion. The first method allowed to decrease both the overall lethality (p=0.039) and postoperative lethality (p=0.018). The odds ratio by the predominate autohemotransfusion was 1.385 (95% 1.101-1.741), where as the odds ratio by the predominate allohemotransfusion was 0.403 (95% 0.183-0.885; p=0.011).

[Role of pectins in the complex treatment in patients in neurointensive care units]. / Znachenie pektinov v komplekse lechebnykh meropriiatii u neiroreanimatsionnykh bol'nykh.

Clinical and laboratory estimation of the efficacy of pectins in complex treatment of patients with intracranial hematoma was performed. It was shown that in the group of the patients treated with pectins vs the control group development of pyo-inflammatory infections was less frequent, the indices of the immunity status improved and a more rapid decrease of the intoxication and a more rapid normalization of the composition of various biotopes in the patients were observed.

[Oral administration of pectins for prophylaxis and treatment of purulent septic complications in patients with burns]. / Peroral'noe primenenie pektinov dlia profilaktiki i lecheniia gnoino-septicheskikh oslozhnenii u ozhogovykh bol'nykh.

Clinical and laboratory evaluation of pectins application efficacy demonstrated that the patients treated with pectines has lower frequency of bacteriemia, intoxication, infectious complications and lethality. Pectins use per os resulted by acceleration of burns wounds healing and by lower microbial dissemination. Frequency of coagulase-positive staphylococci, streptococci and enterococci isolation was also lower in the treated group of patients when compared to the control group. Feces microbial profile also demonstrated positive trend--normal microflora (bifidobacteria and lactobacilli) enhanced, opportunistic bacteria diminished. Pectins application provided normalization of leucocytes, lymphocytes, B-lymphocytes, immunoglobulins A and G. The results of investigation demonstrated pectins efficacy at the complex treatment regimes of the patients with burns.

[Time course of toxic hypoxic encephalopathy during combined therapy including hyperbaric oxygenation]. / Dinamika toksikogipoksicheskoi éntsefalopatii pod vozdeistviem kompleksnogo lecheniia s primeneniem giperbaricheskoi oksigenatsii.

The mechanisms of action of hyperbaric oxygenation (HBO) in toxic hypoxic encephalopathy (THE) were studied using clinical psychopathological examinations, functional and laboratory tests in 268 patients with THE treated by a therapeutic complex including HBO and 75 patients with THE treated routinely (controls). The earliest possible addition of HBO to a complex of treatment of THE patients led to involution of signs of brain edema shown by computer tomography (CT) and improvement of its functional activity, while in patients exposed to HBO later the psychoorganic symptoms and CT signs of cerebral ischemia did not disappear. Detoxifying, neuroimmunomodulating, and neuroimmunostimulating effects of HBO in THE were demonstrated. Early HBO treatment decreased the dysfunction of various compartments of the brain characteristic of THE. The technology of HBO developed by the authors prevented the development of socially dysadapting psychoneurological disorders and reduced the mortality of THE patients.

[Hyperbaric oxygenation as a method of intensive therapy in acute exogenous poisoning]. / Giperbaricheskaia oksigenatsiia kak metod intensivnoi terapii pri ostrykh ékzogennykh otravleniiakh.

Hyperbaric oxygenation (HBO) was used in intensive care of patients with acute exogenous poisonings. Impaired oxygen homeostasis was pathogenetically significant, irrespective of the toxic agent. HBO added to a complex of intensive care measures was pathogenetically justified and promoted normalization of clinical and biochemical parameters of homeostasis.

[Role of hyperbaric oxygenation in the treatment of posthypoxic encephalopathy of toxic etiology]. / Rol' giperbaricheskoi oksigenatsii v lechenii postgipoksicheskoi éntsefalopatii toksicheskogo geneza.

Hyperbaric oxygenation (HBO) was used in the treatment of 475 patients with toxic encephalopathy (TE) developing as a result of exo- and endotoxicosis. HBO promoted correction of all components of homeostasis, decreased endotoxicosis, reduced psychopathological and neurological disorders, and promoted social adaptation.

[Blood reinfusion in injuries of the thorax and abdomen]. / Reinfuziia krovi pri povrezhdeniiakh grudi i zhivota.

The article is devoted to the assessment of efficiency of reinfusion of blood in patients with injured internal organs of the chest and abdomen and its influence upon the hemostasis system. The cavitary blood due to possessing a number of specific qualities has been shown to be a valuable transfusion medium. Its reinfusion does not aggravate abnormalities of the hemostasis system resulting from massive blood loss due to chest and abdominal traumas.