RESUMEN
One hundred and sixty-two patients operated on organs of lower part of abdominal cavity were studied. All the patients were divided into 3 groups depending on anesthesia method: general, epidural and spinal anesthesia. Efficacy of different methods of intrasurgical anesthesia for prevention of postoperative algetic syndrome and decrease of complications number was compared. It is demonstrated that spinal and epidural anesthesia ensure prophylaxis of postoperative algetic syndrome, but spinal anesthesia is the most simple, safe and cost-effective method.
Asunto(s)
Abdomen/cirugía , Anestesia/métodos , Dolor Postoperatorio/prevención & control , Analgesia/efectos adversos , Analgesia/economía , Analgesia/métodos , Anestesia/efectos adversos , Anestesia/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/terapiaRESUMEN
Prehospital care of victims with craniocerebral injuries and patients with cerebrovascular diseases is evaluated by means of retrospective analysis of emergency files and case histories of 258 patients with acute neurosurgical diseases treated in intensive neurosurgical care wards of N. V. Sklifosovsky Institute of Emergency Care. The results evidence that the majority of patients were hospitalized in a grave or extremely grave state. Prehospital care was inadequate: respiratory support was carried out in only 57% patients and oxygen therapy in but 23%, which resulted in pronounced disorders of blood gas composition and acid-base status. The highest mortality was observed among patients in whom intubation of the trachea was delayed. Prehospital infusion therapy was administered to 11% and inotropic support to only 1.1% patients. Oxygenation and active infusion therapy are recommended for all patients at the prehospital stage of care; indications for intubation of the trachea and sympathomimetic therapy should be extended.
Asunto(s)
Trastornos Cerebrovasculares/terapia , Traumatismos Craneocerebrales/terapia , Servicios Médicos de Urgencia , APACHE , Enfermedad Aguda , Adulto , Trastornos Cerebrovasculares/mortalidad , Traumatismos Craneocerebrales/mortalidad , Femenino , Humanos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Respiración Artificial , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/terapia , Hemorragia Subaracnoidea/mortalidad , Hemorragia Subaracnoidea/terapiaRESUMEN
Analgesic efficacy of nalbufine and buprenorphine is assessed in 86 patients with painful syndrome caused by unstable angina and acute myocardial infarction and in 72 patients with locomotor injuries, to whom urgent care was rendered by ambulance teams before hospitalization. By the velocity and depth of analgesic effect nalbufine is not inferior to morphine, and in patients with unstable angina and myocardial infarction is even superior to it. High analgesic activity of buprenorphine is compatible to that of morphine, but the rate of analgesia development is insufficient for urgent care.
Asunto(s)
Analgésicos Opioides/uso terapéutico , Buprenorfina/uso terapéutico , Servicios Médicos de Urgencia , Nalbufina/uso terapéutico , Dolor/tratamiento farmacológico , Anciano , Analgésicos Opioides/farmacología , Angina Inestable/tratamiento farmacológico , Buprenorfina/farmacología , Estudios de Evaluación como Asunto , Femenino , Hemodinámica , Humanos , Masculino , Morfina/farmacología , Morfina/uso terapéutico , Infarto del Miocardio/tratamiento farmacológico , Nalbufina/farmacología , Heridas y Lesiones/tratamiento farmacológicoRESUMEN
The mechanisms of antihypotensive action of antishock overalls (ASO) were studied on the basis of comparison of 30 patients with traumatic shock at the prehospital stage of medical care; in 15 of these ASO was used, in the other 15 traditional antishock intensive care. Use of a portable device for noninvasive measurement of cardiac stroke volume at the prehospital stage permitted us detect the principal mechanisms of liquidation of shock-induced arterial hypotension with the use of ASO: increase of cardiac output at the expense of autohemotransfusion from the lower part of the body to the upper vital organs with increase in the volume of venous blood restitution to the heart, the increase of total peripheral vascular resistance being negligible. Use of ASO in a complex of intensive care measures for the treatment of traumatic shock at the prehospital stage is physiological and conducive to optimization of medical care rendered to victims at the early stages of treatment.
Asunto(s)
Trajes Gravitatorios , Hipotensión/prevención & control , Choque Traumático/terapia , Adolescente , Adulto , Cuidados Críticos , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The efficacy of the early use of antishock overalls (ASO) as part of intensive care for traumatic shock is assessed in the clinical study performed in 15 patients with severe mechanical trauma complicated with shock. Hemodynamic parameters were compared in groups where ASO was and was not used as part of antishock procedures. High efficacy of ASO use for stabilization of hemodynamic parameters in patients with severe trauma complicated with shock has been demonstrated and the advisability of its use in the complex of intensive care procedures in traumatic shock at prehospital stage has been proved.
Asunto(s)
Trajes Gravitatorios , Choque Traumático/terapia , Hemodinámica , Humanos , Choque Traumático/fisiopatología , Factores de TiempoRESUMEN
On the basis of ten-year experience in theoretical studies and experimental tests mathematical models of hemodynamics were built for the follow-up of parameters of the cardiovascular system which cannot be determined by means of any other modern methods. Three years of clinical studies of the Hewlett-Pachard monitoring computer system and its modification helped to elaborate the mathematical backing, a bank of mathematical models, original automatic programs for measuring the cardiac index, the index of myocardial viability, etc. The automatic system provides for an individual approach in assessing the patient's condition in actual time and for control of the treatment.