[CLINICAL SIGNIFICANCE OF CARDIAC BIOMARKERS INCREASING AND THEIR INTERRELATIONS IN SURGERY WITH CARDIO-PULMONARY BYPASS.]

BACKGROUND: Levelfor cardiac troponin I (TrI) and MB-fraction of creatine kinase (CKMB) increases in cardiomyocyte necrosis, and B-type natriuretic peptide (of BNP) increasing reflects ventricular overload. THE AIM: to study the dynamics of BNP, TRI and CKMV in myocardial revascularisation with cardio-pulmonary bypass and to evaluate the clinical significance of these biomarkers elevated levels and establishing the relationship between BNP and markers of myocardial damage in the perioperative period Materials and methods. The study included 52 patients aged 62.5 (54.75; 70) years. Biomarkers concentrations was determined by immunofluorescence. RESULTS: The initial value of BNP were 57.9 (38.675;88.5) pg/ml, and then increased (p<0,01): at the end of the operation up to 91.75 (59.6;132.75) pg/ml, at 1st day following surgery - up to 260 (157;407) pg/ml, and at 2nd day - up to 184 (115.25;274.5) pg/ml. TrI and CKMV increased (p<0,01) up to 0.95 (0.4175;1.4525) ng/ml and up to 13.1 (5.575;15.525) U/L at the end of surgery, and up to 1,355 (0.76;3.8) ng/ml and 10.5 (5;18.325) U/L at thr Istpostoperative day. Preoperative BNP level and TrI level at the end of surgery were the predictors (p

[Prophylaxis of blood loss and allogenic blood transfusion with fibrinolysis inhibitors produced in Russian Federation in patients undergoing cardiac surgery].

Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Bleeding after cardiopulmonary bypass is related to multiple factors: endothelial dysfunction, thrombocytopenia, dilution coagulopathy. Hyperfibrinolysis is one of the important contributors to increased bleeding. To compare the effect of aprotinin with the effect of lysine analogues (aminomethylbenzoic acid and epsilon aminocaproic acid) examined 63 patients were divided into three equal groups depending on the product used for the prevention of activation of fibrinolysis. Data from rotational thromboelastometry measurements (Rotem Gamma Pentapharm, Germany), blood loss and transfusion were collected. The results confirm that used in the study antifibrinolytics: the lysine analogues aminomethylbenzoic acid and epsilon aminocaproic acid prevent hyperfibrinolysis after cardiopulmonary bypass as well as aprotinin.

[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.

[Effects of anesthetics on oxidative stress changes in patients with high anesthetic risk in the perioperative period of coronary bypass surgery].

The study included 44 patients who were divided into 3 groups according to the type of anesthesia. In group 1 patients (n = 15), initial anesthesia was accomplished by inhaled sevoflurane and intravenous fentanyl (2.5-3.5 microg/kg); basal anesthesia was performed with sevoflurane. In Group 2, midazolam, 0.1-0.15 mg/kg, fentanyl, 5.2 +/- 0.01 vg/kg, and ketamine, 0.85 +/- 0.13 mg/kg were given for induction. Basic anesthesia was carried out, by administering fentanyl in a dose of 4.71 +/- 0.4 microg/kg/hour, halothane, 0.5-1.5 ob %. In Group 3, midazolam, 1.2 +/- 0.01 mg/kg) and fentanyl, 7.8 +/- 0.6 microg/kg) were used to induce anesthesia. Basic anesthesia was effected with fentanyl, 5.31 +/- 0.5 microg/kg/hour, ketamine, and diprivan. Anesthetic management using halogen-containing inhalational anesthetics at coronary bypass surgery in patients at high anesthetic risk was ascertained to cause a significant reduction in the degree of manifestations of oxidative stress and facilitated a better intraoperative period. Sevorane was found to have the most significant effect on oxidative stress.

[Cardiac arrhythmias during coronary bypass surgery without extracorporeal circulation].

Ventricular arrhythmias are recorded in most patients at coronary bypass surgery without extracorporeal circulation. The stages, such as the pulling of the sternal edges apart, the opening of the pericardium, the revision and dislocation of the heart, and revascularization of coronary arteries, are most dangerous due to the fact that they may lead to the development of arrhythmias. The major proarrhythmogenic factors at coronary bypass surgery without extracorporeal circulation are mechanical irritation of reflexogenic areas and myocardial ischemia, the mechanical factors playing the leading role in the development of ventricular arrhythmias.

[The system of neurohumoral regulation during bypass surgery without extracorporeal blood circulation]. / Sostoianie sistemy neirogumoral'noi reguliatsii organizma vo vremia operatsii koronarnogo shuntirovaniia bez iskusstvennogo krovoobrashcheniia.

The activity of sympathyco-adrenal, and of serotonin-hystain-cholinergic systems was studied in 34 patients operated for the ischemic heart disease without extracorporeal blood circulation. A moderate increase of parameters characterizing the condition of sympathyco-adrenal, and of serotonin-hystain-cholinergic systems was noted in patients in the perioperative period. The activity of the studied systems reduced due to a total anesthetization. At the same time, the activation of the factors of the neurohumoral system was limited by the adaptation norms with sufficient reserves being preserved.