RESUMEN
The authors assessed the efficacy and safety of intravenous lomir used to treat arterial hypertension in 10 coronary patients early after aortocoronary shunting. The following parameters were monitored: systolic, diastolic, and mean arterial pressure, ECG, pressure in the pulmonary artery, blood gases, and minute volume obtained by thermodilution. Intravenous lomir was found to be a highly effective hypotensive agent in patients in the early periods after aortocoronary shunting, well tolerated by the patients, the infusions being easy to monitor and involving virtually no side effects. Lomir improved the coronary bloodstream, virtually did not influence the heart rate, atrioventricular conduction, and pumping function of the heart.
Asunto(s)
Antihipertensivos/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Puente de Arteria Coronaria , Hipertensión/tratamiento farmacológico , Isradipino/administración & dosificación , Complicaciones Posoperatorias/tratamiento farmacológico , Adulto , Antihipertensivos/efectos adversos , Bloqueadores de los Canales de Calcio/efectos adversos , Evaluación de Medicamentos , Hemodinámica/efectos de los fármacos , Humanos , Hipertensión/fisiopatología , Infusiones Intravenosas , Isradipino/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Factores de TiempoAsunto(s)
Ecocardiografía , Corazón/fisiopatología , Tetralogía de Fallot/diagnóstico por imagen , Adolescente , Niño , Ecocardiografía/métodos , Hemodinámica , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/fisiopatología , Periodo Posoperatorio , Pronóstico , Tetralogía de Fallot/complicaciones , Tetralogía de Fallot/fisiopatología , Tetralogía de Fallot/cirugíaRESUMEN
109 patients who underwent operation for formation of an aortocoronary shunt (ACS) were divided into 3 groups according to the method of introducing a cardioplegic solution and reperfusion. Thirty-five patients (group 1) underwent antegrade cardioplegia and direct reperfusion. Thirty-seven (group 2) were subjected to mixed antegrade-retrograde cardioplegia. Group 3 consisted of 37 patients with myocardial protection accomplished by the same method as in group 2, but retrograde perfusion was with warmed oxygenated blood through the right atrium was conducted before removing the clamp from the aorta. The effect of various types of pharmacocryocardioplegia on the appearance of new disorders of rhythm and conductivity in the early postoperative period after ACS formation was analysed. The frequency of sinus tachycardia was less in group 3 (24%) than in groups 1 and 2 (51 and 51%, respectively, p less than 0.05). We obtained no statistically significant differences in the frequency of other types of arrhythmias in these 3 groups. However, the number of transient bundle-branch blocks and disorders of intraventricular conductivity (8.1 and 10.8%, respectively) in group 3 was also less than that in groups 1 and 2 (p less than 0.05) and their regression was faster. We believe that combined anterograde-retrograde cardioplegia applied together with retrograde reperfusion with warmed oxygenated blood is most effective not only in protection of the conduction system of the heart but also in protection of the right- and left-ventricular myocardium.
Asunto(s)
Arritmias Cardíacas/cirugía , Paro Cardíaco Inducido/métodos , Reperfusión Miocárdica , Complicaciones Posoperatorias/cirugía , Taquicardia/cirugía , Arritmias Cardíacas/etiología , Soluciones Cardiopléjicas/administración & dosificación , Terapia Combinada , Humanos , Hipotermia Inducida/métodos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/cirugía , Taquicardia/etiología , Factores de TiempoRESUMEN
It has been shown that the course of the early postoperative period in cardiosurgical patients and its outcome is to a great extent related to adequate balance of adaptation hormones, whose levels and changes are determined by the functional state of compensatory-adaptive systems. Patients with favourable outcome of the complicated postoperative period along with synchronous activation of sympathoadrenal system (SAS), hypophyseoadrenal system (HAS) and an elevated somatotropic hormone (STH) level demonstrated adequately high blood insulin content, with the equilibrium in adrenalin/insulin and cortisol/insulin ratios retained, and moderate STH predominance over insulin. In 1/4 of patients with complicated postoperative period and unfavourable outcome an attenuated SAS response was accompanied by excessively high STH, ACTH, cortisol blood content and a lower insulin level, which determined relative insulin insufficiency.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Hormona del Crecimiento/sangre , Insulina/sangre , Complicaciones Posoperatorias/sangre , Adolescente , Adulto , Epinefrina/sangre , Femenino , Humanos , Hidrocortisona/sangre , Masculino , Persona de Mediana EdadRESUMEN
The article deals with a new method of treatment of the Wolff-Parkinson-White syndrome. The operation for epicardial destruction of Kent's bundle by pulsating current was developed by the authors. It is distinguished by its simplicity and the possibility to determine the efficacy of the procedures during the operation itself. The results of examination of 44 patients in the early postoperative period and in late-term periods after this operation are discussed. It was found that the electric factor does not cause structural changes of the underlying structures and does not affect the pumping function of the myocardium. The revealed changes were recorded by means of angiocardiography, coronarography, radionuclide ventriculography, and the enzyme spectrum.
Asunto(s)
Electrocirugia/métodos , Sistema de Conducción Cardíaco/cirugía , Síndrome de Wolff-Parkinson-White/cirugía , Adolescente , Adulto , Anciano , Niño , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pericardio/cirugía , Síndrome de Wolff-Parkinson-White/fisiopatologíaRESUMEN
It has been shown that the course and outcome of the early postoperative period in cardiosurgical patients are to a great extent related to the functioning of the adaptation systems under study and their interrelations. An essential role of sympathoadrenal system (SAS) in the control over hormonal body status has been established. It ensures, provided its activity is retained, interaction of other hormonal systems as a uniform functional mechanism in postoperative stress. Decreased activity and intrasystemic coordination of SAS combined with low activity of renin-angiotensin-aldosterone system and excessively activated hypophyseal-adrenal system in patients with postoperative complications are indicative of adaptation mechanism damage and are of negative prognostic value.