PREDICTORS OF FATAL OUTCOME IN PATIENTS WITH HEMORRHAGIC SHOCK IN GASTROINTESTINAL BLEEDING.

This work aimed to reveal the statistically reliable clinical and laboratory markers, which are associated with fatal outcomes in patients with hemorrhagic shock of the III degree on the stage of hospital treatment. It was stated that decrease of body temperature (till 35,9 °C), pH of venous blood (till 7,19) and content of ionized calcium (till 0,32 mmole/l) in venous blood and increase of lactate content (up to 4,1 mmole/l) in venous blood and rise of activated partial thromboplastin time (up to 59 sec) are connected with fatal outcomes.

[Case report of successful treatment of the patient with stab wound of the neck complicated with massive blood loss and shock].

The article deals with a case report of successful treatment of patient with massive blood loss and shock. The observation showed that use of balanced crystalloid solution and modified gelatin 4% in the program of infusion therapy effectively corrects systemic haemodynamics and effect on haemostasis, electrolyte and acid-base balance.

[Use of enteral immune mixture in program of intensive care for acute parenchimal lung injury].

The article deals with a case of successful acute lung injure syndrome treatment. Patient received enteral nutritive treatment with balanced polysubstrate mixture--immune liquid additionally to antibacterial, infusion, respiratory and symptomatic therapy. The case shows that immune liquid corrects hypermetabolic syndrome and effects on decreasing of organs dysfunctions especially lung dysfunction.

[Association of cardiovascular system and endothelial dysfunction indicators in patients with hemorrhagic shock].

UNLABELLED: Endothelial dysfunction is a universal mechanism of pathogenesis of many critical conditions. Goal of the study was to assess a relation of cardiovascular system and endothelial dysfunction indicators in patients with hemorrhagic shock. MATERIALS AND METHODS: 17 patients with hemorrhagic shock 3 were involved in the study. All patients received infusion therapy, artificial lung ventilation after tracheal intubation and symptomatic treatment in prehospital period. Common volume of blood loose was 2900 +/- 200 mL. The patients received infusion, transfusion, inotrope, antibacterial, respiratory and symptomatic therapy in ICU after surgical treatment. Cardio-vascular system parameters were assessed by Tischenko method of integral reography. Number of red cells, hemoglobin, lactate, endotelin-1 and Wb-factor of venous blood were studied before surgery, in 12 and in 24 hours after. Morphological study of the omentumbiopsy was carried out. RESULTS: Performed correlation analysis showed statistically significant relations of cardiovascular system and endothelial dysfunction indicators in patients with hemorrhagic shock. Endothelial dysfunction occurs in patients with hemorrhagic shock 3. The endothelial dysfunction correlates with parameters of cardio-vascular system and tissue perfusion.

[Acid-base status dynamics in patients after cesarean section with different types of infusion therapy].

The objective of the research was to estimate Cesarean section results during different types of infusion therapy. The article represents results of the simple blind perspective cohort randomized research which has been carried out in 54 women after planned Cesarean section. It is revealed that use of unbalanced solutions in infusion therapy causes statistically significant changes in acid-base balance status in comparison with control group receiving balanced ones.

[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.

[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.

[Evaluation of the efficiency of balanced and unbalanced crystalloid solutions used in the program of infusion therapy in patients with blood loss].

The authors present a comparative assessment of the efficiency of balanced and unbalanced crystalloid solutions used in the program of infusion therapy in patients with blood loss. It was found that infusion therapy with unbalanced crystalloid solution facilitated the appearance of electrolytic changes and decrease of pH of venous blood while infusion therapy with balanced crystalloid solution did not cause negative changes of the water-electrolytic and acid-base balance.

[Immunological parameters in diabetic patients with septic shock].

The paper describes early postoperative changes in the parameters of phagocytosis, cellular and humoral immunities in 33 patients with type 2 diabetes mellitus in the phase of decompensation along with diffuse purulent peritonitis and septic shock. Just on admission to an intensive care unit, the patients were found to have secondary immune deficiency and the performed therapy failed to correct the parameters of phagocytosis and cellular and humoral immunities. Impaired immunological responsiveness progressed to the maximum manifestations by the end of 7 days.

[Impact of postoperative early enteral feeding on hemodynamics, oxygen and nutritive status in patients with colonic malignancies concurrent with type 2 diabetes mellitus].

A hundred and one patients (51 males and 50 females) aged 66.2 +/- 5.0 years who had Stages II-III colonic malignancies concurrent with type 2 diabetes mellitus were examined. Two algorithms of postoperative management using the traditional diet and early enteral feeding were comparatively analyzed. The use of an early enteral feeding protocol improves central hemodynamics, oxygen and nutritive status, prevents moderate protein-energy deficiency in the early postoperative period, and reduces the number of complications and deaths in patients with colonic malignancies concurrent with type 2 diabetes mellitus.

[Effect of early post-resuscitation endotoxemia on the myocardial function]. / Vliianie rannei postreanimatsionnoi éndotoksemii na funktsiiu miokarda.

The impact made by serum (which was obtained in 30 minutes after resuscitation) on the cardiovascular system was studied in experiments with the total body as well as with isolated and isovolumetrically contracting hearts of white outbred male rats. A 5-minute clinical death was provoked by a severe blood loss. The "toxic" serum, when administered to the intact animals with the macrophage system blocked by trypan blue, was found to reduce the stroke and minute hearts volumes and to increase the general resistance of peripheral vessels. Lower force and velocity indices of the myocardium contractility, a higher consumption of glucose by the heart per a unit of a performed function, disassociation of the oxidation phosphorylation, activation of anaerobic glycolysis and increased discharges of cardiachystiocyte, lactate, pyruvate and of enzymes of different ultrasound localizations were detected in perfusion of the hearts isolated by Krebs-Henzelight solution containing the "toxic" serum.

[Effects of efferent therapy on the blood oxygen transporting function in diffuse suppurative peritonitis in patients with diabetes mellitus]. / Vliianie éfferentnoi terapii na kislorodtransportnuiu funktsiiu krovi pri razlitom gnoinom peritonite u bol'nykh sakharnym diabetom.

Twenty patients with non-insulin-dependent diabetes mellitus were treated in intensive care wards for diffuse purulent peritonitis developing during diabetes decompensation. Group 1 (10 pts) were treated by basic therapy after surgery, in group 2 (10 pts) basic therapy was supplemented by hemoquantum, efferent, and oxidative therapy with consideration for endotoxicosis phases. Basic therapy during the early postoperative period did not remove disorders in the blood oxygen-transporting function, while sessions of hemoquantum, efferent, and oxidative therapy supplementing basic therapy with consideration for the phases of endotoxicosis improved this function due to decrease of intoxication, diabetes compensation, and increase of cardiac output.