The role of metabolic adaptation of the functional state of circulating erythron in determining the course of traumatic disease in patients with massive blood loss in polytrauma

Annotation. Metabolic adaptation of the functional state of circulating erythron is an important criterion for predicting the course of traumatic disease in patients with polytrauma, which is accompanied by heavy blood loss. The aim of the study was to increase the effectiveness of treatment of patients with polytrauma with hemorrhagic shock by developing and implementing a differentiated approach to infusion and transfusion therapy, based on elucidation of the mechanisms of systemic oxygen transport in the postoperative period. The index of erythrocyte transformation index, oxygen delivery index as a leading indicator of oxygen transport system in patients of group I who received intensive therapy according to the classical algorithm, in patients of group II who were additionally prescribed ceruloplasmin solution, in patients of group III who were additionally prescribed a solution of D-fructose-1,6-diphosphate sodium salt hydrate. To determine the functional state of erythrocytes and their ability to deform, we used the method of scanning electron microscopy. Statistical data processing was performed using Student’s t-test (for n<100) at a given level of reliability p=0.95. The statistical analysis of the obtained data revealed a probable reduction in the number of doses of heterogeneous erythrocytes received by patients with high blood loss in polytrauma in patients of group II on the background of maximum ability of erythrocytes to transform while maintaining the oxygen delivery index at a satisfactory level. In the future it is planned to study the morphofunctional parameters of erythrocytes in this group of patients.

Changes of indices of the oxygen-transport state, depending on periodization of the ischemic cerebral stroke

Objective. To elaborate a clinico-pathogenetic periodization of ischemic cerebral stroke, depending on changes of the oxygen-transport state indices in critically ill patents, suffering the ischemic cerebral stroke on background of conduction of complex intensive therapy. Materials and methods. Into the investigation 75 patients, suffering ischemic cerebral stroke, ageing 41 - 77 yrs, were included, in whom the indices of oxygen-transport state and severity of neurological symptoms on background of complex intensive therapy were studied. Depending on severity of neurologic symptoms, three similar groups of patients were formed (25 patients in every one), suffering mild, middle-severe and severe ischemic cerebral stroke, in which the disease severity was determined in accordance to the National Institute of Health Stroke Scale. Results. On background of the complex intensive therapy conduction the duration of the most acute period in mild ischemic stroke have constituted 3 days, in a middle-severe - 4 days, and in a severe one - 7 days. Tendency towards minimization of neurologic deficiency was noted, if parameters of central hemodynamics, the oxygen budget and the cognition level were stabilized during 2 days. Simultaneously the cardiac index values for all groups of patients have been situated in a range of (2.99 ± 0.20) l × min-1 × m-2, the oxygen delivery index have exceeded (509 ± 34) ml × min-1 × m-2. The restored level of neurological symptoms have not a tendency towards improvement or was stable during several days in accordance to data of the National Institute of Health Stroke Scale. The restored level of neurological symptoms had a tendency to improvement or staying during several days stable in accordance to indices of scales of National Institute of Health and Comas Glasgow, than a progressive staged improvement began. Conclusion. Normalization during 2 days of the oxygen-transport state indices without neurological symptoms progression constitutes a criterion of conclusion of the most acute period of the disease in patients, suffering mild, middle-severe and severe ischemic cerebral stroke. The restored due to intensive therapy during 48 h the oxygen-transport state without progressing of neurological symptoms in patients, suffering ischemic cerebral stroke, witnesses lowering of the cerebral tissue oedema and restoration of the autoregulation processes.

DOES ANEMIA AFFECT PERIOPERATIVE PAIN INTENSITY IN AGED PATIENTS WITH DIABETIC FOOT SYNDROME?

Background: As diabetes takes on pandemic proportions more than 500000 aged (over 50 years) patients undergo pedis amputation yearly. Anemia is very often accompanied diabetes mostly in aged patients. Anemia may influence somehow the pain severity in postoperative period. Objective: To investigate the possible anemia influence on severity of post surgery pain in aged diabetes patients with anemia. Design: A retrospective medical documentation analysis. Setting: Federal scientific centre. Patients: 58 diabetes patients aged from 50 to 75 with and without anemia after elective pedis surgery. Intervention. Patients were allocated to one of four groups: - 16 patients with anemia who received naropin combined with lidocaine for peripheral nerve blockades (I group), 14 patients with anemia who received only naropin (II group), 11 patients without anemia who received naropin combined with lidocaine (III group) and 17 11 patients without anemia who received only naropin. Main outcome measures: Levels of mean arterial pressure, oxygen delivery index, glycaemia and VAS scores were evaluated on four time points: 24 hours before surgery, in operating room, 12 and 24 hours after surgery respectively. Results. VAS scores and levels of mean pressure was higher in anemia groups postoperativly - 3,3±1,50 vs 0,6±0,82 and 101,7±7,81 mm Hg vs 87,9±12,08 mm Hg respectively. Glycaemia levels had no statistically significant differences neither in time points nor in groups. Oxygen delivery index levels also had no differences in time points but levels were significantly different between groups. Conclusion: Taking in account the results of the analysis it is obvious that anemia contributes to the severity of pain in postoperative period in aged diabetes patients somehow. More clinical investigations must be done to evaluate exact portion of anemia contribution.