THE IMPACT OF CHRONIC HEART FAILURE ON BLOOD FLOW ENERGETICS IN CASE OF POLYTRAUMA.

OBJECTIVE: The aim: To study the influence of chronic heart failure of different origin on the energetics of blood circulation in case of polytrauma without myocardial damage. PATIENTS AND METHODS: Materials and methods: 32 patients with polytrauma without myocardial injury were examined that was assessed by the level of Troponin I not exceeding 0.3 ng/ml. The patients were divided into two groups: 1st group (n=15) without chronic heart failure (CHF), and the 2nd one - with CHF. The absence of CHF was proved by the level of NT-proBNP not exceeding 90 pg/ml. Circulatory reserve (CR) was an integral energy index. All measurements were made at the patients' admittance to the hospital, on the 3rd and the 7th day after admittance. RESULTS: Results: During admittance, CR in the groups was low without a significant difference (in the 1st group - 117±44, in the 2nd group - 99±39 mW/m2, p = 0.2). CR was increasing in the 1st group quicker than in the 2nd one; on the seventh day it reached 414±128 mW/m2 growing out of dangerous values, while the 2nd group showed only up to 295±96 mW/m2 (p = 0.005), which is lower than reference values. CONCLUSION: Conclusions: A severer disorder occurs in patients with initial CHF. The treatment requires the improvement of myocardium metabolism. An important prognosis criterium of severity can be represented by the level of circulatory reserve; its value below 100-120 mW/m2 is a worse outcome predictor.

5-HT3 SEROTONIN RECEPTOR BLOCKERS FOR INTENSIVE THERAPY OF TRAUMATIC DISEASE IN PATIENTS WITH MULTIPLE TRAUMA.

OBJECTIVE: The aim: To find the most rational choice of drugs that have anti-emetic effect in patients with polytrauma in acute and early periods. PATIENTS AND METHODS: Materials and methods: We examined 82 patients with polytrauma, 62 men and 20 women. The age of patients ranged from 19 to 50 years. Patients were divided into the main and control group with 36 and 46 people respectively, who did not differ significantly by sex, age, anthropometric data, the nature and severity of injuries, and the time from injury to admission to hospital. RESULTS: Results: Full antiemetic effect was achieved in 72.4% of patients, where metoclopramide was used. Сomplete antiemetic effect was achieved in 96.3% of patients, where sturgeon was used. Decrease of peristaltic activity does not increase postoperative intestinal paresis, and also prevents irritable bowel syndrome and diarrhea caused by dysbacteriosis on the background of antibiotic therapy. Anxiolytic effect without sedative effect and impairment of motor coordination, decrease of the somatic and psychopathological symptoms intensity in alcohol-toxic withdrawal syndrome contributes to the correct interpretation of the traumatic disease. CONCLUSION: Conclusions: Use of drugs with antiemetic effect is an important part of the complex of traumatic disease treatment in patients with polytrauma. The use of osetron is rational in patients with polytrauma with cranio-abdominal injuries.