[Immunological indices of "drainage" blood used for compensation of blood loss]. / Immunologicheskie pokazateli "drenazhnoi" krovi, ispolzuemoi dlia vospolneniia krovopoteri.

The authors discuss experience in compensation for blood loss in patients with ischemic heart disease after aortocoronary shunting using drainage blood without or with donor blood (80 persons) and donor blood alone (60 persons). Mild changes of immunity cell factors were revealed and no differences in the concentration of class A, M, and G immunoglobulins and phagocytosis as compared to the indices recorded before the operation and 24 hours after it. Analysis of postoperative infectious-inflammatory complications showed their incidence to be less in patients who received drainage blood without or donor blood (23%) than in those given transfusion of only donor blood (55%). The results of the study allow drainage blood to be recommended for reinfusion.

[Current approaches to the prevention of infectious complications in heart surgery]. / Sovremennye podkhody k profilaktike infektsionnykh oslozhnenii v kardiokhirurgii.

Due to changes of humoral immunity, patients with rheumatic heart disease present, even before the operation, a high-risk group with regard to the development of infectious complications. Contamination of intraoperative material was revealed in 61.7% of cases during the operation. Extracorporeal circulation increases the cefotaxime half-life period which is in direct proportional dependence of the period of time between the beginning of the administration of the agent and the beginning of extracorporeal circulation. Immunocorrection by means of myelopid in the early postoperative period accelerates restoration of cellular and humoral immunity, and reduces the frequency of pneumonia occurrence and suppuration of the postoperative wound. Therefore, the prevention of infectious complications after operations on an open heart should be complex and should include broad-spectrum antibiotics and immunocorrective therapy.

[The prostacyclin-thromboxane system and platelet hemostasis following aortocoronary bypass with an uncomplicated postoperative course]. / Prostatsiklin-tromboksanovaia sistema i trombotsitarnyi gemostaz posle aortokoronarnogo shuntirovaniia pri neoslozhnennom techenii posleoperatsionnogo perioda.

Prostacyclin-thromboxane system and platelet hemostasis have been studied in 56 patients upon aortocoronary bypass surgery with uncomplicated early postoperative period. It has been established that cardiopulmonary bypass surgery leads to a considerable increase in 6-keto-PGF1 alpha and TXB2 levels per platelet, as compared to preoperative values. By hour 18 postoperatively 6-keto-PGF1 alpha to platelet number ratio returns to baseline, while TXB2 to platelet number ratio remains higher than preoperative values, which determines a shift in 6-keto-PGF1 alpha to TXB2 ratio towards TXB2, thus ensuring, probably, enhanced platelet aggregation properties. Thrombocytopenia, a decrease in platelet aggregation properties and elevated blood plasma level of beta-thromboglobulin were observed upon aortocoronary bypass surgery. By hour 18 postoperatively the number of platelets increased significantly, their aggregation properties were enhanced, beta-thromboglobulin blood plasma level was reduced, however, the parameters under study did not reach normal values at that time. Increased levels of 6-keto-PGF1 alpha and TXB2 per platelet in the early postoperative period are considered an important component of compensatory-adaptive body reactions directed to normalization of the damaged body functions, namely hemostasis and microcirculation.

[The role of lactate acidosis and enzyme hyperactivity in evaluating hypoxic organ disorders in patients following cardiopulmonary byøass]. / Rol' laktatatsidoza i giperfermentemii v otsenke gipoksicheskikh organnykh povrezhdenii u bol'nykh, operirovannykh na serdtse v usloviiakh iskusstvennogo krovoobrashcheniia.

One hundred and fifty patients after cardiopulmonary bypass surgery have been examined. It has been shown that overall enzyme activity should be taken into consideration when determining the genesis of postoperative hyperenzymemia and diagnosing the topical (organic) damage. High lactate level (6-8 mmol/l) reflects profound circulatory hypoxia and shows a great likelihood of secondary damage of parenchymatous organs in patients after cardiopulmonary bypass surgery. Marked lactatacidosis combined with a 5-10-fold increase in enzyme activity in the early postoperative period is an unfavourable prognostic sign. Prolonged antagosan (trasilol) administration during cardiopulmonary bypass surgery may be one of the techniques preventing and correcting hypoxic organ damage.

[The prostacyclin-thromboxane system and thrombocytic-vascular hemostasis in patients with ischemic heart disease in the preoperative period]. / Prostatsiklin-tromboksanovaia sistema i trombotsitarno-sosudistyi gemostaz u bol'nykh ishemicheskoi bolezn'iu serdtsa v dooperatsionnom periode.

Prostacyclin-thromboxane system (PTS) and platelet-vascular hemostasis have been studied in the preoperative period in 35 ischemic patients. A marked PTS disbalance with predominance of plasma thromboxane has been found. It has been established that in patients with postinfarction cardiosclerosis plasma prostacyclin content was significantly higher than in patients without myocardial infarction. The study of platelet function has demonstrated normal platelet aggregation rate and an increased level of beta-thromboglobulin in the blood of ischemic patients. Acetylsalicylic acid (250 mg/daily) was used for the correction of the disturbances observed, it reduced platelet aggregation, but had no effect on PTS and platelet release.

[Effect of hyperbaric oxygenation on central hemodynamics and oxygenating function of the lungs in open-heart surgery]. / Vliianie giperbaricheskoi oksiganatsii na tsentral'nuiu gemodinamiku i oksigeniruiushchuiu funktsiiu legkikh pri operatsiiakh na otkrytom serdtse.

The dynamics of some oxygenating pulmonary function (OPF) indices has been studied in 33 patients with coronary cardiac disease and rheumatic lesions of cardiac valves 4-6 hours after surgery in response to a single hyperbaric oxygenation (HBO) session (1.5 ata, 45 min) in the immediate postoperative period. It is found that in the presence of slight or, on the contrary, pronounced arterial hypoxemia, no significant negative OPF changes were observed. At the same time, a temporary increase in the alveolo-arterial gradient has been found in some patients. The comparison of data on the systemic blood flow with the OPF indices permits suggesting the prevalent role of the membrane component in a PaO2 decrease in patients after using assisted circulation.

[The status of the renin-angiotensin-aldosterone system in patients in the early period following aortocoronary bypass surgery]. / Sostoianie renin-angiotenzin-al'dosteronovoi sistemy u bol'nykh v rannie sroke posle operatsii aortokoronarnogo shuntirovaniia.

The state of renin-angiotensin-aldosterone system has been studied in 43 patients after aortocoronary bypass surgery. Renin activity, angiotensin II and aldosterone content have been studied, using radioimmunoassay, in comparison with hemodynamic findings and water-electrolyte balance parameters. The study was performed in patients with uncomplicated postoperative period and in patients with acute circulation disturbances just after surgery and 3, 6, 18 and 48 hours after surgical intervention. It has been shown that in uncomplicated postoperative period there is a 6-8-fold increase in plasma renin content and a 1.5-2-fold increase in aldosterone concentration. Despite an increase in aldosterone activity clinical signs of hyperaldosteronism became evident by the 18-48th hour postoperatively. A persistent increase in renin-angiotensin-aldosterone system activity in patients with acute circulation disturbances is considered as a compensatory body reaction directed at stabilization of the circulating blood volume and heart performance.

[Various aspects of the status of humoral immunity in patients after surgical correction of rheumatic heart defects under artificial circulation]. / Nekotorye aspekty sostoianiia gumoral'nogo immuniteta u bol'nykh posle khirurgicheskoi korrektsii revmaticheskikh porokov serdtsa v usloviiakh iskusstvennogo krovoobrashcheniia.

The serum concentrations of immunoglobulins A, M, and G were studied in 70 patients with rheumatic heart diseases and in 72 patients with spontaneous and pokeweed mitogen-induced production of these immunoglobulins and mononuclear peripheral blood cells. The investigations were done before and 1-2 and 7-8 days after surgery. Some patients received myelopid in the early postoperative period in addition to the conventional methods of therapy. With high serum IgA, IgM, and IgG levels, reduced humoral immunity was noted. Within the first two days after the operation, the capability of cells to produce IgA and IgG in response to pokeweed mitogen stimulation was lost, the induced IgM production was reduced considerably, and the serum IgA and IgM levels fell significantly. Eight days after surgery, the immune response was partially recovered. Myelopid facilitates complete restoration of humoral immunity and reduces the incidence of postoperative pneumonia more than threefold.

[Disorders of O2 transport and their correction in heart surgery patients]. / Narusheniia transporta O2 i ikh korrektsiia u kardiokhirurgicheskikh bol'nykh.

Basic factors of O2 transport disturbances and mechanisms of their compensation have been studied in 1200 patients after cardiac surgery. It has been shown that O2 transport decrease is induced by damages in oxygenating blood function, decreased cardiac performance and hemoglobin blood level, oxyhemoglobin dissociation curve deviation and changes in Hb affinity to O2 with regard to 2,3-DPG content. The causes of arterial O2 transport damage affect the treatment procedures, including oxygen therapy, controlled lung ventilation, erythrocyte mass transfusion, inotropic drug administration, hypothermia.

[Dynamics of the level of plasma vasopressin and its role in the regulation of water-electrolyte metabolism in patients following aortocoronary bypass]. / Dinamika urovnia plazmennogo vazopressina i ego rol' v reguliasii vodno-élekrolitnogo obmena u bol'nykh posle aortokoronarnogo shuntirovaniia.

Changes in plasma vasopressin, K+, Na levels, osmolality in blood and urine samples, as well as hemodynamic parameters, cardiac output and circulating blood volume including, have been assessed in 38 patients 3, 6, 18 and 48 hours after aortocoronary bypass surgery. It has been found that vasopressin blood level in the postoperative period is considerably (5-7 times) higher than physiological hormone level. The main reasons for vasopressin blood level increase are surgical stress, increase in blood plasma osmolality, hypokalemia, a drop of the arterial blood pressure and central venous pressure elevation. Despite a high vasopressin level and its pronounced impact on the renal excretory function, the first postoperative hours are marked by polyuria, mediated mainly by osmotic diuresis due to infusions of high amounts of osmotically active substances.

[Clinical use of tramal in patients in the early postoperative period]. / Klinicheskoe primenenie tramala u bol'nykh v rannem posleoperatsionnom periode.

Tramal was given to 204 patients who were operated on the lung, heart, abdomen. During pain therapy, good and satisfactory results were on average obtained in 75% patients operated on the lung, in 77%, on the heart, in 89%, on the abdomen, in 70%, on the great vessels. The absence of the inhibitory effect of the drug on the respiratory center and its slightly marked sedative effect allow one to recommend the agent for application in the early period following the surgery when narcotic analgesics still retain their effect and a real risk of their overdosage exists. During prolonged artificial pulmonary ventilation in the early postoperative period and in impaired adaptation of the patients to a respirator, tramal aids normalization of lung mechanics and hemodynamic parameters without eliminating and suppressing the patients' consciousness and results in cessation of muscular shivering. Adverse effects of tramal are of no decisive clinical significance and occur mainly when the drug is rapidly injected into the vein.

[Current methods of assessing hemodynamics in the intensive care unit (comparative aspects)]. / Sovremennye metody otsenki gemodinamiki v usloviiakh otdeleniia intensivnoi terapii (sravnitel'nyi aspekt).

The paper deals with comparative characterization of validity shown by current techniques for assessing hemodynamic parameters such as radiocardiography, echocardiography, Doppler cardiography, electroimpedance indicator separation, alveolar gas carbon dioxide concentration change technique, tetrapolar chest rheography and their potential role in the practice of intensive care and resuscitation units.

[Diagnostic value of laboratory indicators in various states of oxygen transport function of the blood in patients, operated on under conditions of cardiopulmonary bypass]. / Diagnosticheskaia tsennost' laboratornykh pokazatelei pri razlichnykh sostoianiiakh kislorodtransportnoì funktsii krovi u bol'nykh, operirovannykh v usloviiakh iskusstvennogo krovoobrashchenniia.

Changes in oxygen and acid-base balance have been studied in 86 patients with different oxygen transport function after cardiopulmonary bypass surgery. It has been shown that diagnostic value of such indexes as SO2 and pO2 in mixed venous blood, O2 consumption and transport, blood and erythrocyte acid-base balance, lactate concentration depends on the cardiac pump function, microcirculatory patterns, pulmonary oxygenation and cell metabolism. In case of acute circulatory disturbances in the early postoperative period the prognostic value of each laboratory finding is in close correlation with the degree of circulatory failure. The observation of changes in oxygen and acid-base balance in the first hours after the operation enables a more accurate diagnosis of disturbances in the inner body medium and a choice of pathogenetically verified methods of their correction in patients after cardiopulmonary bypass surgery to be made.