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1.
Artigo em Russo | MEDLINE | ID: mdl-31577269

RESUMO

OBJECTIVE: The aim of this study was to estimate the prognostic value of magnetic resonance imaging (MRI) classification of traumatic brain lesion localization and levels in patients with a brain injury of various severity in a few days to three weeks after the injury. MATERIAL AND METHODS: The cohort of 278 patients with traumatic brain injury (TBI) of various severity aged 8-74 y.o. (average -31.4±13.8, median - 29 (21.3; 37.0) was included in the analysis. The severity of TBI at admission varied from 3 to 15 Glasgow coma scores (GCS) (average - 8±4, median - 7 (5; 12). The main indications and conditions for MRI were: inconsistency between computed tomography (CT) data and neurological status, the necessity to clarify the location and type of brain damage, the absence of metal implants, the stabilization of the patient's vital functions, etc. MRI was performed during the first three weeks after the injury using T1, T2, T2-FLAIR, DWI, T2*GRE, SWAN sequences. The damage to the brain was classified according to 8 grades depending on the lesion levels (cortical-subcortical level, corpus callosum, basal ganglia and/or thalamus, and/or internal, and/or external capsules, uni- or bilateral brain stem injury at a different level). Outcomes were assessed by the Glasgow outcome scale (GOS) 6 months after injury. RESULTS: The significant correlations were found for the entire cohort between MRI grading and TBI severity (by GCS) and outcome (by GOS) of the injury (R=-0.66; p<0.0001; R=-0.69; p<0.0001, respectively). A high accuracy (77%), sensitivity (77%) and specificity (76%) of the proposed MRI classification in predicting injury outcomes (AUC=0.85) were confirmed using the logistic regression and ROC analysis. The assessment of MRI-classification prognostic value in subgroups of patients examined during the first, second, and third weeks after injury showed significant correlations between the GCS and the GOS as well as between MRI-grading and GCS, and GOS in all three subgroups. In the subgroup of patients examined during the first 14 days after the injury, the correlation coefficients were higher compared with those obtained in a subgroup examined 15-21 days after the injury. The highest correlations between MRI grading, TBI severity, and the outcome were found in the subgroup of patients who underwent MRI in the first three days after the injury (n=58). CONCLUSION: The proposed MRI classification of traumatic brain lesion levels and localization based on the use of different MR sequences reliably correlated with the clinical estimate of TBI severity by GCS and the outcomes by GOS in patients examined during the first three weeks after injury. The strongest correlation was observed for patients examined during the first three days after the injury.


Assuntos
Lesões Encefálicas , Imagem por Ressonância Magnética , Neuroimagem , Adolescente , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Lesões Encefálicas/diagnóstico por imagem , Criança , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
2.
Zh Vopr Neirokhir Im N N Burdenko ; 82(4): 109-116, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30137045

RESUMO

Subarachnoid hemorrhages due to rupture of cerebral aneurysms are characterized by high mortality. More than 25% of patients who have survived the first hours after aneurysmal SAH (aSAH) develop delayed cerebral ischemia that is one of the main causes of disability. The mechanisms underlying delayed ischemia have not yet been fully understood. Previously, the development of vasospasm was believed to be the only cause for development of delayed ischemia. In recent years, there has been evidence that hemostatic system disorders typical of this category of patients are the cause of cerebral artery thrombosis, which is one of the main pathophysiological mechanisms for the development of delayed cerebral ischemia. This review presents an analysis of published papers on hemostasis disturbances in patients with aSAH, their pathophysiological mechanisms, and their role in the development of cerebral ischemia.


Assuntos
Hemostasia/fisiologia , Aneurisma Intracraniano/sangue , Hemorragia Subaracnóidea/sangue , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Antifibrinolíticos/administração & dosagem , Antifibrinolíticos/efeitos adversos , Antifibrinolíticos/uso terapêutico , Isquemia Encefálica/sangue , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Hemostasia/efeitos dos fármacos , Humanos , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/etiologia , Vasoespasmo Intracraniano/sangue , Vasoespasmo Intracraniano/etiologia , Vasoespasmo Intracraniano/prevenção & controle
3.
Artigo em Russo | MEDLINE | ID: mdl-29927420

RESUMO

Autoregulation of cerebral blood flow (ACBF) is a system of mechanisms for maintaining stable adequate perfusion of the brain despite changes in systemic arterial pressure. In recent years, new data on the numerous metabolic and systemic mechanisms of cerebral blood flow regulation have been obtained, but the role of neurogenic regulation has not yet been fully understood and, therefore, not considered in clinical practice. AIM: The study aim was to assess the effect of anatomical injuries to deep brain structures on the extent and duration of ACBF abnormalities in a model of severe diffuse axonal injury (DAI). RESULTS: The study demonstrated that brain injury in the projection of a dopaminergic structure (substantia nigra) and a cholinergic structure (nucleus basalis of Meynert region) was more common in patients with impaired ACBF and was associated with a longer duration of the impairment. CONCLUSION: The obtained data may indicate the presence of central (neurogenic) pathways of cerebral vessel tone regulation; traumatic injury of the pathways leads to a more severe and prolonged period of impaired ACBF. Probably, injury to these regulatory structures in some patients has an indirect effect on the course of intracranial hypertension. Further experimental and clinical studies in this direction are needed to elucidate all elements of neurogenic regulation of cerebral vessel tone and ACBF mechanisms.


Assuntos
Lesões Encefálicas , Lesão Axonal Difusa , Pressão Sanguínea , Encéfalo , Circulação Cerebrovascular , Homeostase , Humanos , Pressão Intracraniana
4.
Artigo em Russo | MEDLINE | ID: mdl-29076469

RESUMO

PURPOSE: the study purpose was to evaluate the efficacy of the IntelliVent-ASV mode in maintaining the target range of PaCO2 in patients with severe TBI. MATERIAL AND METHODS: The study included 12 severe TBI patients with the wakefulness level scored 4-9 (GCS). This was a crossover design study. Two ventilation modes were consecutively used: IntelliVent-ASV and P-CMV, for 12 h each. When using the P-CMV mode, the ventilation parameters were set to maintain PaCO2 in a range of 35-38 mm Hg. The IntelliVent-ASV mode involved the Brain Injury ventilation algorithm. The target range of EtCO2 was set in accordance with the delta PaCO2-EtCO2 to maintain PaCO2 in a range of 35-38. At the beginning of each ventilation period and every 3 hours, the arterial blood gas composition was analyzed. When PaCO2 occurred out of the 35-38 range, appropriate adjustments were made to the ventilation parameters. In the P-CMV mode, the Pinsp and RR parameters were adjusted to achieve the target PaCO2 range. In IntelliVent mode, a shift of the target EtCO2 range was adjusted in accordance with a changed PaCO2-EtCO2 difference. In all patients, ICP, blood pressure, and EtCO2 were monitored; the arterial blood gas composition was analyzed every 3 h; the frequency of manual settings of ventilation parameters was recorded. RESULTS: The EtCO2 and PaCO2 parameters were found not to be significantly different in the P-CMV and IntelliVent modes, but the spread in these parameters was significantly lower in the IntelliVent ventilation mode. The PaCO2 parameter occurred out of the target range significantly less often in the IntelliVent mode than in the P-CMV mode. The mean frequency of manual respirator settings needed to maintain the target EtCO2 range was significantly lower in the IntelliVent-ASV mode than in the P-CMV mode. CONCLUSION: The IntelliVent-ASV mode provides more efficient maintenance of PaCO2 in the target range compared to traditional artificial ventilation using fewer manual settings of the ventilation parameters.


Assuntos
Algoritmos , Lesões Encefálicas Traumáticas/sangue , Lesões Encefálicas Traumáticas/terapia , Dióxido de Carbono/sangue , Respiração Artificial/métodos , Adulto , Gasometria/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/instrumentação
5.
Anesteziol Reanimatol ; 61(2): 100-4, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27468497

RESUMO

UNLABELLED: Transporting patients out of intensive care unit (ICU) in the acute period of TBI to perform diagnostic tests is an integral part of the treatment process and may be associated with the risk of secondary brain injury. Despite the large number of studies related to in-hospital transport ofpatients with TBI there are no clear recommendations on the required monitoring. OBJECTIVE: To provide safe transportation of the patient by multimodal monitoring in acute period of brain injury. MATERIALS AND METHODS: The study included 9 patients with severe TBI and loss of consciousness (Glasgow coma scale (GCS) 8 or less). The average GCS score was 5.5. The median age was 31 +/- 12 (21 to 54 years). There were 2 women and 7 men. Duration of the transportation was 52 +/- 7,4 min. Data collection was carried out every minute. All patients during transportation were monitoredfor the following parameters: HR, invasive ABP, ICE CPP EtCO2, SpO2. Before and immediately after the transportation sampling of arterial blood was performed for blood gas analysis. RESULTS: Statistically significant differences in ICP was noted in 5 main items (*p < 0.05). Mean ICP was mentioned in bed (12.5 +/- 5.3), on wheelchair (18.2 +/- 6.8*), in CT-scan (16.6 +/- 3.2**), on wheelchair after scan (18.4 +/- 4.1***), in bed again (15.8 +/- 2.9). Other parameters didn't differ significantly. CONCLUSIONS: Multimodal monitoring enables safe transportation ofpatients in acute period of TBI. There are 5 critical items associated with major complication during transportation (original ICE shifting patient from bed to transport wheelchair from wheelchair to CT-scanner table, from CT-scanner table to transport wheelchair from wheelchair to bed). The most unstable parameter is ICP


Assuntos
Lesões Encefálicas Traumáticas/enfermagem , Lesões Encefálicas Traumáticas/fisiopatologia , Transporte de Pacientes/métodos , Adulto , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Feminino , Escala de Coma de Glasgow , Humanos , Unidades de Terapia Intensiva , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Anesteziol Reanimatol ; 61(2): 108-12, 2016.
Artigo em Russo | MEDLINE | ID: mdl-27468499

RESUMO

The aim of the study was to assess the significance of NT-proBNP levels as a predictor of the severity of patients' condition after severe TBI and critical stress of the heart. In this prospective observational study 118 patients admitted on 1-4 day after severe TBI (GCS <8 points on admission) was supervised. The average age of patients was 32 +/- 16 years, 28 women and 90 men were in this group. 12 of the observed patients died within the first 10 days. NT-proBNP level was determined by immunochemiluminescent analyzer "Immulite 2000" (Siemens). Blood sampling was performed daily at 8:00 am during the acute period--an average for 7 days (5 to 10) from the date of admission. At the same time hemodynamic status was assessed by PiCCO. It has been shown that NT-proBNP level may be not only a marker of severity of condition and poor outcome in patients with severe TBI, but also can be used as a good predictor of exhaustion of compensatory myocardial capacity in these patients.


Assuntos
Biomarcadores/sangue , Lesões Encefálicas Traumáticas/sangue , Peptídeo Natriurético Encefálico/sangue , Adulto , Lesões Encefálicas Traumáticas/mortalidade , Lesões Encefálicas Traumáticas/fisiopatologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
7.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-27070262

RESUMO

Paradoxical air embolism (PAE) is a rare life-threatening complication when air emboli enter arteries of the systemic circulation and cause their occlusion. Here, we describe a clinical case of PAE developed during neurosurgery in a patient in the sitting position. PAE led to injuries to the cerebral blood vessels, coronary arteries, and lungs, which caused death of the patient. An effective measure for preventing PAE is abandoning surgery in the sitting position in favor of surgery in the prone position.


Assuntos
Lesões Encefálicas , Isquemia Encefálica , Embolia Aérea , Infarto do Miocárdio , Procedimentos Neurocirúrgicos/efeitos adversos , Posicionamento do Paciente/efeitos adversos , Complicações Pós-Operatórias , Lesões Encefálicas/etiologia , Lesões Encefálicas/patologia , Embolia Aérea/etiologia , Embolia Aérea/patologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Postura
8.
Anesteziol Reanimatol ; 60(4): 65-9, 2015.
Artigo em Russo | MEDLINE | ID: mdl-26596036

RESUMO

The clinical observation illustrates the role of screening of inflammatory markers and advanced hemodynamic monitoring in optimization of the treatment of the patient with severe traumatic brain injury (sTBI). The level of consciousness by the Glasgow Coma Scale at admission was 5 points. From the first day of stay the patient suffered hyperthermia to 39,0° C° The diagnosis of the aspiration pneumonia was determined by radiological signs, bronchoscopy and inflammatory blood markers, C-reactive protein, leukocytosis. From the second day the constant infusion of norepinephrine was necessary to maintain mean ABP above 80 mmHg. On the 10th day the patient's condition deteriorated sharply. Developed hyperthermia to 40, 2° and cardiovascular collapse (in spite of the high level of norepinephrine support a sharp decline in ABP up to 49/20 mmHg). Invasive advanced hemodynamic PiCCO monitoring (transpulmonary thermodilution) was started Septic shock was suspected. Standard laboratory tests did not meet the criteria for septic shock. Witnessed a slight increase in CRP and procalcitonin (PCT) was within normal limits. Diagnostic search was supplemented by a study of interleukins (IL-6 and IL-2R) in the blood plasma. The significant increase in their values, was regarded as the initial manifestations of the systemic inflammatory response. Sepsis was confirmed. The extended antibiotic therapy started Continuous Veno-Venous hemofiltration was used as part of treatment of the inflammatory-toxic condition. In two days of the therapy the patient's condition has stabilized, the patient recovered consciousness in the form of opening the eyes, simple instructions. At discharge, the patient's condition according to the Glasgow outcome scale was estimated at 4 points.


Assuntos
Hemorragia Cerebral Traumática/terapia , Traumatismos Craniocerebrais/terapia , Traumatismo Múltiplo/terapia , Choque Séptico/tratamento farmacológico , Adulto , Hemorragia Cerebral Traumática/complicações , Hemorragia Cerebral Traumática/diagnóstico , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/diagnóstico , Diagnóstico Diferencial , Bactérias Gram-Negativas/isolamento & purificação , Humanos , Masculino , Traumatismo Múltiplo/complicações , Traumatismo Múltiplo/diagnóstico , Choque Séptico/etiologia , Choque Séptico/microbiologia , Índices de Gravidade do Trauma , Resultado do Tratamento
9.
Zh Vopr Neirokhir Im N N Burdenko ; 78(1): 4-13; discussion 13, 2014.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-24761591

RESUMO

In this paper, the relationship between brain lesion localization (verified by magnetic resonance imaging (MRI)) and the severity of traumatic brain injury (TBI) and its outcomes is presented. Magnetic resonance studies in different modes (T1, T2, FLAIR, DWI, DTI, T2 * GRE, SWAN) were performed in 162 patients with acute TBI. Statistical analysis was done using Statistica 6, 8 software and R programming language. A new advanced MRI-based classification of TBI was introduced implying the assessment of hemispheric and brainstem traumatic lesions level and localization. Statistically significant correlations were found between the Glasgow coma and outcome scales scores (p < 0.001), and the proposed MRI grading scale scores, which means a high prognostic value of the new classification. The knowledge of injured brain microanatomy coming from sensitive neuroimaging, in conjunction with the assessment of mechanisms, aggravating factors and clinical manifestation of brain trauma is the basis for the actual predictive model of TBI. The proposed advanced MRI classification contributes to this concept development.


Assuntos
Lesões Encefálicas/diagnóstico , Coma Pós-Traumatismo da Cabeça/diagnóstico , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Lesões Encefálicas/classificação , Criança , Interpretação Estatística de Dados , Feminino , Escala de Coma de Glasgow , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Prognóstico
10.
Anesteziol Reanimatol ; (4): 44-50, 2013.
Artigo em Russo | MEDLINE | ID: mdl-24341042

RESUMO

The goal of the study was to assess frequency of plato waves, their influence on outcomes and define factors leading to plato waves. Ninety eight patients with severe traumatic brain injury (TBI) were included. Blood pressure (BP), intracranial pressure (ICP), cerebral perfusion pressure (CPP) and pressure reactivity index (Prx) were registered. Age was 34 +/- 13.6. There were 73 male and 25 female. Glasgow Coma Scale (GCS) was 6 +/- 1.4. Plato waves developed in 24 patients (group 1), 74 patients (group 2) did not have plato waves. Median of plato waves in the 1st group was 7[3.5; 7]. They developed on 3rd [2;4.5] day. Maximum level of ICP during plato waves was 47.5 [40;53] mmHg, its duration was 8.5 [7;27] minutes. In the group 1 Prx was significantly lower during first day, than in the group 2. Duration of ICP monitoring was longer in the group I due to presence of plato waves in these patients. CPP did not differ in groups, because CPP was strictly controlled. Patients of the group I had preserved autoregulation and less severe trauma (predominance of closed trauma and Marshall I, II type of brain damage). Plato waves did not predict bad outcomes.


Assuntos
Lesões Encefálicas/diagnóstico , Lesões Encefálicas/fisiopatologia , Pressão Intracraniana/fisiologia , Monitorização Neurofisiológica/métodos , Adulto , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Monitorização Neurofisiológica/instrumentação , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos
11.
Zh Vopr Neirokhir Im N N Burdenko ; 76(4): 26-30; discussion 30-1, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23033589

RESUMO

Aim of the study was to investigate the status of thyroid homeostasis and the relationship between severe traumatic brain injury (TBI) and thyroid disorders. The study included 56 patients. Protocol of the study concluded: noninvasive and invasive hemodynamic monitoring, including PICCO, transcranial Doppler ultrasonography, measurement of intracranial pressure (ICP), indirect calorimetry, levels of thyroid stimulating hormone (TSH), T3, T4 and free fractions. Patients were divided into three groups. Group 1--with normal thyroid hormones (n = 20), Group 2--with the low T3 (n = 23) and Group 3 with the low T3 and T4 (n = 13). Correlation between the Glasgow Coma Scale (GCS) and thyroid hormone levels was obtained: the first group between GCS and T4 (r = 0.50), GCS, and free fraction T4 (r = 0.51); between the GCS and TSH (r = 0.51), T3 (r = 0.48) and T4 (r = 0.57) in the second group, and the third--with TSH (r = 0.67). Poor outcomes in the first group compound 15%, in the second group--39.2%, and in the third group--62.5% of patients. Doses of vasopressors were significantly higher in groups 2 and 3 compared with a first group. ICP was significantly higher in the group with the low T3 and T4. Development of intracranial hypertension correlated with the formation of thyroid insufficiency. Deficiency of thyroid hormones, especially the simultaneous reduction and T3, and T4 is associated with poor outcome in patients with severe TBI. Doses of sympathomimetic drugs used to optimize the parameters of systemic hemodynamics in acute severe head injury were higher in patients with deficiency of thyroid hormones.


Assuntos
Lesões Encefálicas/sangue , Homeostase , Doenças da Glândula Tireoide/sangue , Hormônios Tireóideos/sangue , Lesões Encefálicas/complicações , Lesões Encefálicas/tratamento farmacológico , Feminino , Humanos , Masculino , Doenças da Glândula Tireoide/tratamento farmacológico , Doenças da Glândula Tireoide/etiologia , Índices de Gravidade do Trauma
12.
Zh Vopr Neirokhir Im N N Burdenko ; 76(4): 32-6; discussion 36, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23033590

RESUMO

Malnutrition leads to adverse effects and may worsen clinical outcome. Surgery as a stress factor activates pathological reactions changing metabolism structure. The aim of this study was to evaluate changes of protein metabolism in patients after elective neurosurgical operation. 24 patients were prepared for elective surgery and were enrolled in this study. Evaluation of each patient included: measurement of anthropometric indices--height, weight, arm circumference and the triceps skinfold thickness, the definition of protein loss by determining the loss of nitrogen in the urine, assessment of protein catabolism, determining the violations of nutritional status upon the base of laboratory parameters. During the course of the conducted investigation significant (p < 0.05) decrease in the indices of total protein, albumin, transferrin and the absolute numbers of lymphocytes in the postoperative period was revealed. All the patients developed severe protein catabolism. It became clear that uncomplicated elective surgical intervention, together with the adopted scheme of the nutritional therapy leads to severe protein catabolism in all patients.


Assuntos
Albuminas/metabolismo , Neoplasias Encefálicas/cirurgia , Nitrogênio/urina , Complicações Pós-Operatórias , Desnutrição Proteico-Calórica , Transferrina/metabolismo , Adulto , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/urina , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/urina , Desnutrição Proteico-Calórica/sangue , Desnutrição Proteico-Calórica/dietoterapia , Desnutrição Proteico-Calórica/etiologia , Desnutrição Proteico-Calórica/urina
13.
Zh Vopr Neirokhir Im N N Burdenko ; 76(6): 20-7; discussion 27, 2012.
Artigo em Russo | MEDLINE | ID: mdl-23379179

RESUMO

Mechanism of arterial hypotension (AH) in patients with sellar region tumors (SRT) and complicated postoperative period consists in decrease of systemic vascular resistance and relative hypovolemia. Therapeutic directions for blood pressure (BP) stabilization are clear. However criteria of optimal BP in these patients are absent. Object of the study was defining such criteria. Prospective study was conducted from January, 2011 to January, 2012. Inclusion criteria were: adults; SRT; early postoperative period. Thirty patients were included into the study. Patients were divided into three groups. Group I (n=11) consisted of patients with uncomplicated postoperative period; group II (n=12) - patients with complicated postoperative and with stable hemodynamics; group III (n=7) - patients with complicated postoperative period and AH. Median of central venous saturation (ScvO2) was normal in all groups. ScvO2 was significantly higher than jugular vein saturation (SjvO2) in all measurement. In group I SjvO2 was normal, and it was higher, than in group II. In group SjvO2 did not achieve normal level during three days of the study. Mean BP did not change during these days. In group III SjvO2 was decreased if mean BP was between 70 and 90 mmHg. This level of SjvO2 did not differ from SjvO2 in group II. When mean BP increased up to 100-110 mmHg SjvO2 significantly increased too in the group III and achieved level of the group I (normal level). Outcomes were favorable in all patients of the group I (GOS=4, 5). Median of length of stay (LOS) in the ICU was 1 day. In group II outcomes were favorable in 10 (83.3%) patients, 2 (16.7%) patients died. Median LOS in ICU was 7 days. In group III outcomes were favorable in 6 (85.7%) patients, unfavorable outcome (GOS=3) was in 1 (24.3%) patient. Median LOS in ICU was 12 days. There were no significant differences in all groups in the lactate levels both in central vein and in jugular vein. ScvO2 can not be a criterion for BP optimization in patients with SRT. In patients with uncomplicated postoperative period SjvO2 is normal. In patients with complicated postoperative period and normal BP SjvO2 remains decreased. In patients with complicated postoperative period and arterial hypotension normal level of SjvO2 can be achieved if mean BP is increased up to 100-110 mmHg. SjvO2 normalization can improve outcomes in patients with SRT and complicated postoperative period.


Assuntos
Pressão Sanguínea , Neoplasias Encefálicas/cirurgia , Hipotensão , Complicações Pós-Operatórias , Adulto , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/fisiopatologia , Feminino , Humanos , Hipotensão/sangue , Hipotensão/etiologia , Hipotensão/fisiopatologia , Hipotensão/terapia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Período Pós-Operatório , Estudos Prospectivos
14.
Ter Arkh ; 83(9): 25-9, 2011.
Artigo em Russo | MEDLINE | ID: mdl-22145384

RESUMO

AIM: To study long-term prognosis in patients with non-ST elevation acute myocardial infarction (AMI) with reference to changes in myocardial tissue dopplerography (MTD) in the course of treatment. MATERIAL AND METHODS: MTD echocardiography was conducted in 88 non-ST elevation AMI (mean age 58.0-9.8 years) and 34 healthy volunteers (mean age 58.0 +/- 9.8 years). Measurements were made of the velocity of systolic, early and late diastolic peaks at 4 levels of interventricular septum, anterior, lateral and inferior walls of the left ventricle (LV). MTD was repeated before the discharge from hospital. The patients were followed up for 10-18 months after the discharge. RESULTS: By MTD results the patients were divided into 3 subgroups: 1--an asymmetric decrease of MTD values--17(19.3%) patients who had a 20% reduction of the systolic and early diastolic peak velocity compared to healthy controls on one or two adjacent LV walls; subgroup 2--a diffuse decline of MTD values--61 (69.3%) patients. Their velocity of systolic and early diastolic peaks was subnormal on all the walls, all levels of estimation; subgroup 3--10 (11.4%) patients without MTD changes. These proportions changed in the course of treatment: the number of patients with a diffuse decrease of MTD values reduced to 31 (35.3%), the number of patients with an asymmetric MTD decrease rose to 37 (42%), and with unchanged MTD rose to 20 (22.7%) patients. The rate of development of congestive cardiac failure (CCF) and asymptomatic LV dysfunction in the long-term period was significantly higher in the subgroup with retained diffuse decrease of MTD values. CONCLUSION: The treatment of non-ST elevation AMI reduces the number of patients with a diffuse decrease of MTD values and elevates the number of patients with asymmetric decrease of MTD and unchanged MTD. Persistence of MTD diffuse changes is an unfavourable prognostic factor in relation to CCF and LV silent dysfunction.


Assuntos
Ecocardiografia/métodos , Infarto do Miocárdio/diagnóstico por imagem , Miocárdio/patologia , Ultrassonografia Doppler/métodos , Estudos de Casos e Controles , Diástole , Feminino , Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Sístole , Fatores de Tempo
15.
Anesteziol Reanimatol ; (4): 37-42, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21957619

RESUMO

The abdominal compartment syndrome (ACS) can lead to multiple organ dysfunction syndrome (MODS), sepsis and death. In neurosurgical patients ACS used to be interesting for specialists only in respect of its impact on ICP. However injury of diencephalic structures of the brain can theoretically cause ACS. The goal of the study is to assess the efficacy of conservative therapy and epidural anesthesia for ACS treatment in postoperative period in patients with tumors of the sellar region. 41 patients were enrolled in the study. The epidural anesthesia at T8-T9 level by bupivacaine was applied for three days in the case of ACS development and ineffective conservative therapy. Intra-abdominal hypertension (IAH) developed in 28 cases, ACS - in 9. IAN usually revealed itself on the second day after surgery, ACS - on the 3rd-6th day. Gastrointestinal tract paralysis developed earlier than IAH and continued longer than IAH. Conservative therapy was effective only in every third patient with ACS. Epidural anesthesia was used in 4 cases and appeared effective in all of them. All patients with ACS not provided by epidural anesthesia died. We conclude that conservative therapy is effective in IAH, but not in ACS cases. Epidural anesthesia is an effective method to treat ACS and should be used in all patients with ACS without sepsis.


Assuntos
Anestesia Epidural , Síndromes Compartimentais/terapia , Neoplasias do Nervo Óptico/cirurgia , Complicações Pós-Operatórias/terapia , Abdome , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Pressão , Sela Túrcica , Adulto Jovem
16.
Anesteziol Reanimatol ; (4): 42-5, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21957620

RESUMO

The study gives data on how to improve the way from mechanical to spontaneous breathing in patients with weakened respiratory drive after posterior fossa tumor removal. We compared the effectiveness of two methods of weaning from mechanical ventilation in these patients. The main group consisted of 6 patients weaned from ventilator with ASV mode. The control group was made up of 10 patients weaned from ventilator with SIMV or PS modes. The duration of weaning from ventilator using ASV mode was significantly shorter than with SIMV or PS modes. During ASV ventilation spontaneous breath rate gradually increased. In all patients the level of P0,1 index representing respiratory center activity was initially lower than normal. While spontaneous breath activity increased the level of P0,1 index also gradually normalized. Plmax index (respiratory effort index) measured once a day increased as well. Weakened respiratory drive is accompanied by P0,1 and Plmax indexes' decrease in patients after posterior fossa tumor removal. ASV mode in these patients allows quicker weaning from mechanical ventilation.


Assuntos
Fossa Craniana Posterior/cirurgia , Ventilação Pulmonar , Respiração Artificial , Neoplasias da Base do Crânio/cirurgia , Suspensão de Tratamento , Humanos
17.
Anesteziol Reanimatol ; (4): 46-50, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21957621

RESUMO

Capabilities and limitations of ASV mode in TBI patients are studied. 12 patients with severe TBI were enrolled in the study. ICP, MAP, CPP were monitored in all the patients. Cerebral regional blood flow was monitored by thermal diffusion in four patients. Hamilton G5 ventilator was used for mechanical ventilation and respiratory monitoring in all cases. Starting mode of mechanical ventilation was ASV with 100% mechanical substitution. The patient was regarded as ASV-nonresponder and switched to another mode when normoventilation was not possible with any percent of respiratory substitution. ASV mode provided normoventilation during all period of mechanical ventilation in 88 ou of 12 patients. In 4 out of 12 patients ASV mode led to hyperventilation with EtC02 decrease, cerebral regional blood flow slowing and P0,1 index increase. In three patients hyperventilation was induced by high rate of spontaneous breaths caused by brainstem irritation. Switching these patients to SIMV-VC led to normoventilation, normalization of etC02 and cerebral regional blood flow, and P0,1 index decrease. In one patient hyperventilation was caused by lung mechanics disorder when ventilator tried to achieve target minute volume by low tidal volume and high respiratory rate. ASV mode provides adequate lung ventilation during respiratory support period in most patients with severe TBI. It can prove ineffective for some patients with brainstem irritation or lung mechanics disorders.


Assuntos
Lesões Encefálicas/terapia , Ventilação Pulmonar , Respiração Artificial/métodos , Lesões Encefálicas/fisiopatologia , Escala de Coma de Glasgow , Humanos , Resultado do Tratamento
18.
Anesteziol Reanimatol ; (3): 62-6, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21851026

RESUMO

The purpose of the study was to estimate the drift of the zero value of "Codman" intracranial pressure sensors, compared with the duration of monitoring, location of intracranial pressure sensors, and also to assess the relationship of drift to the gauge number. 60 "Codman" intracranial pressure sensors were investigated. The analysis of zero drift were made depending on the length of monitoring and location of the intracranial pressure sensor, as well as on description of the gauge number. Data are presented as median, quartiles, minimum and maximum values. The gauge numbers of 499, 491 and 501, (475 and 513). The drift was 0 mm Hg. -1 And 0 (-2 to 3). In 43% of the ICP measurements of the drift of the zero value was absent. In 40% o the drift was within +/ - 1 mm Hg. The analysis showed no dependence of the drift of the zero value of the duration of monitoring, location of the sensor and gauge numbers. On two patients simultaneous recording of intracranial pressure in the ventricles and brain parenchyma was carried out. The high correlation between the measured values r = 0.94, p < 0.01. In one "in vivo" case the zero drift was detected, which amounted to 2 mm Hg and grew by 5th day of monitoring. The maximum value of the drift of the zero value was 3 mm Hg. The dependence of drift on the duration of monitoring, reference values of the calibration and sensor implant site was absent. This shows the accuracy and reliability of parenchymal ICP measurement.


Assuntos
Traumatismos Craniocerebrais/fisiopatologia , Pressão Intracraniana/fisiologia , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Calibragem , Falha de Equipamento , Feminino , Humanos , Masculino , Monitorização Fisiológica/normas , Valores de Referência , Fatores de Tempo , Transdutores de Pressão
19.
Anesteziol Reanimatol ; (2): 42-9, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21688659

RESUMO

Fever is a proven factor in secondary brain damage and worsens outcome in neuro intensive care patients. However, large randomized studies have shown neuroprotective effects of induced hypothermia only in patients with cardiac arrest and in neonates with perinatal hypoxic-ischemic brain damage. Nevertheless, now there is an active search for alternative modes of temperature correction, which would have been effective in other groups of patients with brain damage. Moreover, new management techniques of body temperature are being created. In this paper we presented a series of 10 observations when the used cooling system was CoolGard/CoolLine. 5 patients underwent hypothermia, 5 patients normothermia . Hypothermia was used for cerebroprotection in 1 case and for the correction of resistance to the therapy of intracranial hypertension in 4 cases. Normothermia was used for correction of resistance to pharmacological treatment of fever. In all cases the target temperature was achieved, and only for 1 patient to achieve hypothermia additional external cooling was used. Patients with normothermia did not need sedation, because they have not developed discomfort and muscle tremor. 2 patients died, in one case was due to intracranial hypertension and hemotamponade of brain ventricular system. Cause of second death was pulmonary embolism. Thus, the CoolGard system effectively lowers the body temperature to the target values for neuro intensive care patients. Application of this system is relatively safe. However, the most dangerous are the thromboembolic complications, thus the daily ultrasound scanning of lower limb veins and the possible early use of low molecular weight heparins is crucial.


Assuntos
Isquemia Encefálica/prevenção & controle , Febre/prevenção & controle , Hipotermia Induzida/métodos , Hipertensão Intracraniana/prevenção & controle , Procedimentos Neurocirúrgicos , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Isquemia Encefálica/etiologia , Criança , Cuidados Críticos/métodos , Feminino , Febre/etiologia , Humanos , Hipotermia Induzida/instrumentação , Hipertensão Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
20.
Zh Vopr Neirokhir Im N N Burdenko ; 75(1): 66-71; discussion 71, 2011.
Artigo em Russo | MEDLINE | ID: mdl-21698926

RESUMO

Currently problem of intraabdominal hypertension in patients with brain tumors is practically uninvestigated. Authors describe a case of complicated course of early postoperative period in the patient with craniopharyngioma due to secondary abdominal compartment-syndrome. Causes of intraabdominal hypertension in patients with CNS lesions requiring intensive care are analyzed. Risk factors of intraabdominal hypertension deserving attention in management of patients in neurolCU are determined.


Assuntos
Neoplasias Encefálicas/cirurgia , Hipertensão/etiologia , Hipertensão/terapia , Neoplasias Faríngeas/cirurgia , Complicações Pós-Operatórias/terapia , Neoplasias Encefálicas/diagnóstico por imagem , Humanos , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias Faríngeas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia
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