Correction of lipid peroxidation disorders of patients in the acute period after craniocerebral trauma]

In sufferers at the acute period of mild and severe craniocerebral trauma, the processes of peroxide oxidation of lipids become essentially more active. The antioxidative function of an organism decreases. Changes in the metabolic processes are the most pronounced in patients under 44 years and in women of different age in severe craniocerebral trauma. The authors recommend to include into the complex of treatment in craniocerebral trauma the intensive antioxidant therapy together with surgical intervention.     

Cerebrospinal fluid sorption in the treatment of severe craniocerebral trauma in the acute period]

The effectiveness of the use of liquorosorption in treatment of 6 sufferers with severe craniocerebral trauma is shown.     

Hyperbaric oxygen therapy in acute trauma.

The usefulness of hyperbaric oxygen therapy in the treatment of acute trauma is described. The results in 71 such cases are given.     

Emergency medical aid to patients with craniocerebral trauma in the prehospital period]

On the basis of analysis of more than 5000 observations of the sufferers admitted to the Kiev Research Institute of Neurosurgery for acute craniocerebral trauma from 1975 to 1991, quality of giving medical aid at the prehospital period was studied. Of most importance, are the measures directed at struggle against respiratory disorders, disturbances in cardio-vascular activity, shock, hemorrhage.     

Surgical treatment of acute craniocerebral trauma]

Treatment of severe craniocerebral injuries is a multidisciplinary matter especially concerning anaesthesiology, neurology, neurosurgery and traumatology. A neurosurgical survey of this still controversial and complex subject is reported, failures are pointed out, which deteriorate postoperative outcome.     

Hyperbaric oxygenation in the combined treatment of acute kidney failure]

The paper presents the review of the treatment performed in 183 patients with acute renal failure caused by trauma, myorenal syndrome, surgical, obstetric and urological lesions. All the patients underwent hemodialysis. The majority of the patients manifested hypoxia due to pulmonary edema and abnormal central and visceral hemodynamics, anemia resultant from blood loss and suppression of hemopoiesis, impairment of tissue oxidation-reduction enzymes by uremic toxins. Hemodialysis aggravated hypoxia. A direct relationship existed between arterial hypoxemia and the degree of metabolic acidosis, electrolyte alterations and residual diuresis in oligoanuric stage of acute renal failure. The treatment of 48 relevant patients involved 5-10 sessions of hyperbaric oxygenation (1.5-2.2 atm for 60-90 min). The session usually followed hemodialysis. The response was achieved in arterial hypoxemia, central hemodynamics, peripheral blood, water-electrolyte balance, acid-base equilibrium, uremic intoxication. The frequency of hemodynamic reactions during hemodialysis and pyoseptic complications induced by uremia reduced as well as the need in urgent hemodialysis. The introduction of hyperbaric oxygenation diminished the lethality by 29%.     

右美托咪定对急性颅脑损伤患者围术期炎性反应的影响

目的 探讨右美托咪定对急性颅脑损伤患者围术期炎性反应的影响.方法 颅脑损伤的患者70例,性别不限,年龄20 ～ 68岁,ASA分级Ⅰ～Ⅳ级,受伤24 h内行去骨瓣减压术,采用随机数字表法,将患者随机分为2组(n=35)∶对照组(C组)和右美托咪定组(D组).静脉注射芬太尼、异丙酚、顺阿曲库铵行麻醉诱导,术中均以瑞芬太尼、七氟醚、异丙酚维持麻醉,间断追加顺阿曲库铵.D组麻醉诱导前经10 min静脉输注右美托咪定1μg/kg,继以0.4 μg· kg-1·h-1的速率静脉输注2h.于麻醉诱导前、手术开始2h、术毕、术后24 h(T1 ～T4)时抽取静脉血样,测定血清神经元特异性烯醇化酶(NSE)、IL-6和TNF-α浓度.结果 与C组比较,D组血清NSE、TNF-α和IL-6浓度降低(P＜0.05);与T1时比较,C组T2、T3时血清NSE、TNF-α和IL-6浓度升高,T4时血清TNF-α浓度降低,D组T2、T3时血清NSE和IL-6浓度升高,T4时降低,T3、T4时血清TNF-α浓度升高(P＜0.05).结论 右美托咪定可通过抑制急性颅脑损伤患者围术期全身炎性反应,从而产生脑保护作用.     

Hyperbaric oxygenation therapy for chronic occlusive arterial diseases of the extremities]

Therapeutic effects of hyperbaric oxygen therapy (HBO) in 50 patients with chronic occlusive arterial diseases were studied with determination of the transcutaneous oxygen pressure (TcPO2), plasma lipid peroxide level, and plasma superoxide dismutase (SOD) level. Necrosis or ulceration was present in 30 patients, rest pain without tissue loss in 6, infection and necrosis in 2, infection of the amputated stump in 2, delayed healing of the amputated stump wound in 8, and delayed union of bone fractures in 2. HBOs were carried out in 2-3 absolute atmospheres for 60 min for 3-40 times (mean, 12.7 times). In combination with HBO, sympathetic denervation was performed in 41 patients, and PGE1 infusions were administered in 46. Of patients with necrosis or ulceration, 16 were healed, 13 were improved, and one was unchanged. Of patients with rest pain, 5 had relief and one was unchanged. All patients with infection were cured. Of patients with delayed healing of amputation wounds, 7 were healed and one required reamputation. All patients with bone fractures obtained bone union. The TcPO2 markedly increased during HBO and remained at a high level for some time after HBO. The lipid peroxide and SOD levels were not changed significantly by HBO.     

Predictive value of the combined electro-, echo-, and rheoencephalographic studies in the acute period after severe craniocerebral trauma complicated by intracranial hemorrhage]

On the basis of the data of complex studies, the signs of changes in the bioelectrical activity of the brain, state of its middle structures and hemodynamics in favourable and lethal outcome of craniocerebral trauma complication by intracranial hemorrhage have been established. Early detection of the signs mentioned contributed to improvement in the results of treatment at the acute period.     

Surgical treatment of para-articular ossifications after craniocerebral trauma]

This article reports on 45 cases in which extra-articular ossifications were removed following cranial-cerebral traumata. Radiologically detectable relapses occurred in 6% of the patients only; however, in none of these cases did the relapses lead to reankylosis of the joint. In the sagittal plane, the average gain in mobility was an increase of 84 degrees in the hip joint and of 100 degrees in the elbow joint. Considerable complications were caused by four fractures in extremely osteoporotic bones. To reduce the fracture rate, surgery should be performed as soon as possible after bone maturation. In addition, treatment of patients with craniocerebral traumata and serious concomitant conditions requires an experienced rehabilitation team.     

Hyperbaric oxygenation in the treatment of crush syndrome]

Comparison of the results of treatment of 60 patients with the crush syndrome by applying a course of hyperbaric oxygenation (HBO) (the main group) with the results of treatment of 50 analogous patients not subjected to HBO (control group) showed the advantages of barotherapy. The latter contributed to reduction of tissue hypoxia, relative normalization of renal function, particularly in patients with acute renal failure, lessening of toxemia, and rapid reparative processes. This was manifested by alleviation of anemia and myoglobinemia, and diminished level of middle-mass molecules in the blood. In the control group the positive dynamics was less marked. The high efficacy of HBO allows the authors to recommend it as a measure in the complex treatment of the crush syndrome.     

Hyperbaric oxygenation in the treatment of bleeding gastroduodenal ulcers]

It is shown on the basis of analysis of the results of treatment of 179 patients that the use of hyperbaric oxygenation in the complex surgical management of ulcerative gastroduodenal bleeding reduced the number of postoperative complications by a factor of 3.3 and led to a decrease of mortality from 20 to 1%. The authors confirm the expedience of including hyperbaric oxygenation in the complex of therapeutic measures in patients with bleeding ulcers under conditions of accomplished hemostasis by conservative or surgical methods in one of three suggested variants: in preparation of the patients for operation in the postponed period; after operative interventions carried out at the peak of bleeding; before and after operations on patients with moderate and severe blood loss and concomitant diseases. The sessions should be conducted under pressure of 2 atm for 60 minutes.     

急性颅脑损伤后血清甲状腺素的变化及意义

目的　探讨急性颅脑损伤后血清甲状腺素水平的变化及意义。方法　应用磁性酶联免疫定量分析法检测１５６ 例急性颅脑损伤患者伤后２４～７２ 小时及存活者伤后２ 周血清Ｔ３ 、游离Ｔ３（ＦＴ３） 、Ｔ４ 、游离Ｔ４（ＦＴ４）及促甲状腺激素（ＴＳＨ）水平的变化，并与１００ 例正常对照组比较。结果　伤后早期血清Ｔ３ 、ＦＴ３ 水平显著降低（ Ｐ＜０ ．００１） ，而Ｔ４ 、ＦＴ４ 显著升高（ Ｐ＜ ０ ．０１） ；分组资料表明颅脑损伤愈重，昏迷程度愈深，上述指标变化愈明显；经治疗后存活者受伤２ 周后复测，上述指标值逐渐恢复正常。结论　急性颅脑损伤早期甲状腺功能有明显异常。