Влияние высокой эпидуральной блокады на функцию миокарда левого желудочка после аорто-коронарного шунтирования

Objective. To improve the outcomes of surgical treatment of coronary heart disease, by using high epidural block on the basis of evaluation of myocardial diastolic function in the preoperative and early postoperative periods. Materials and methods. 61 patients with coronary heart disease underwent coronary bypass surgery. According to the methods of analgesia, the patients were divided into 2 groups. A study group included 30 patients who had undergone high epidural block in the early postoperative period. A control group comprised 31 patients, wherein the conventional method for analgesia was applied through the parenteral administration of narcotic analgesics. Follow-up EchoCG was made, by examining the parameters of transmitral flow. The clinical course of a postoperative period and the length of stay in intensive care units were estimated. Results. Baseline diastolic dysfunction was detected in practically all patients. In the early postoperative period, the study group showed a significantly better myocardial diastolic function during high epidural block. In the control group, there was no improvement of the parameters characterizing left ventricular diastolic function. These patients longer stayed in a specialized intensive care unit. Conclusion. The postoperative employment of epidural block results in improved left ventricular diastolic function.Цель исследования : улучшить результаты хирургического лечения ишемической болезни сердца с помощью использования высокой эпидуральной блокады на основании оценки диастолической функции миокарда в предоперационном и раннем послеоперационном периодах.Материалы и методы: больные ишемической болезнью сердца (61 пациент), которым была выполнена операция коронарного шунтирования. В зависимости от методики анальгезии пациенты были разделены на 2 группы. Основную группу составили 30 больных, которым в раннем послеоперационном периоде проводилась высокая эпидуральная блокада. В группе контроля (31 пациент) использовался традиционный метод обезболивания парентеральным введением наркотических анальгетиков. В динамике выполнялось ЭХО-КГ-исследование, при котором исследовались показатели трансмитрального потока. Также оценивали клиническое течение послеоперационного периода и длительность пребывания в отделении реанимации.Результаты: наличие ди-астолической дисфункции исходно выявлено практически у всех больных. В раннем послеоперационном периоде в основной группе отмечено достоверное улучшение диастолической функции миокарда на фоне высокой эпидураль-ной блокады. В группе контроля улучшения показателей, характеризующих диастолическую функцию левого желудочка, не наблюдалось. Эти больные также требовали более длительного пребывания в специализированном реанимационном отделении.Заключение: использование эпидуральной блокады в послеоперационном периоде приводит к улучшению диастолической функции миокарда левого желудочка.

Респираторная терапия острого респираторного дистресс-синдрома у кардиохирургических больных

The purpose of the present investigation was to improve the outcomes of intensive care in patients with acute respiratory distress syndrome after cardiac surgery under extracorporeal circulation.Materials and methods. Respiratory therapy was analyzed in 43 patients with acute respiratory distress syndrome after surgery under extracorporeal circulation. According to the procedure of artificial ventilation (AV), the patients were divided into 2 groups: 1) those who had undergone routine tracheal intubation (n=23) AND 2) THOSE who had received noninvasive intubation through a nasal mask (n=20). The respiratory parameters, blood gas composition, central hemodynamic parameters, respiratory support time, and the pattern of complications were analyzed.Results. Noninvasive artificial ventilation permits one to make the patients active in earlier periods and take a spontaneous breath, recovers the respiratory index earlier, reduces the level of positive end-expiratory pressure, the frequency of infectious complications of the tracheobronchial tree, and length of stay in an intensive care unit as compared with endotracheal AV.Conclusion. The findings suggest that noninvasive AV is highly effective and yields better results of treatment in patients with acute respiratory distress syndrome.Целью настоящего исследования явилось улучшение результатов интенсивной терапии больных с острым респираторным дистресс-синдромом после кардиохирургических операций с искусственным кровообращением.Материалы и методы. Представлен анализ проведения респираторной терапии у 43 больных с острым респираторным дистресс-синдромом после операций с искусственным кровообращением. Больные разделены на 2 группы в зависимости от метода проведения ИВЛ: традиционная с интубацией трахеи (n=23) и неинвазивная, через назальную маску (n=20). Анализировались респираторные показатели, газовый состав крови, параметры центральной гемодинамики, время окончания респираторной поддержки, характер осложнений.Результаты. Использование НИВЛ позволяет в более ранние сроки активизировать больных и перевести их на самостоятельное дыхание, характеризуется более ранним восстановлением респираторного индекса и снижением уровня ПДКВ, меньшей частотой гнойно-инфекционных осложнений трахеобронхиального дерева, меньшими сроками нахождения в ОРИТ в сравнении с эндотрахеальной методикой ИВЛ.Заключение. Полученные данные свидетельствуют о высокой эффективности неинвазивной ИВЛ и улучшении результатов лечения больных с острым респираторным дистресс-синдромом

Educational robotics as an Innovative teaching practice using technology: minimization of risks

This research is focused on studying educational robotics, specifically robots which provide functions of educational activity. We have considered the questions of intelligent agents' behavior and have studied their educational opportunities. Educational robotics is a powerful tool of developing person's skills and abilities in various fields of technical creativity and professional activity. The evolutionary development of robotics is connected with development of artificial intelligence, where emotions play a great role in operations. Nowadays the main thing is to form the ability and skills of optimum interaction with social environment when a person, based on gained knowledge, is capable to put goals of the activity in strict accordance with laws and society conditions and using current technology

Educational robotics as an Innovative teaching practice using technology: minimization of risks

This research is focused on studying educational robotics, specifically robots which provide functions of educational activity. We have considered the questions of intelligent agents' behavior and have studied their educational opportunities. Educational robotics is a powerful tool of developing person's skills and abilities in various fields of technical creativity and professional activity. The evolutionary development of robotics is connected with development of artificial intelligence, where emotions play a great role in operations. Nowadays the main thing is to form the ability and skills of optimum interaction with social environment when a person, based on gained knowledge, is capable to put goals of the activity in strict accordance with laws and society conditions and using current technology

Respiratory Therapy for Acute Respiratory Distress Syndrome in Cardiosurgical Patients

The purpose of the present investigation was to improve the outcomes of intensive care in patients with acute respiratory distress syndrome after cardiac surgery under extracorporeal circulation.Materials and methods. Respiratory therapy was analyzed in 43 patients with acute respiratory distress syndrome after surgery under extracorporeal circulation. According to the procedure of artificial ventilation (AV), the patients were divided into 2 groups: 1) those who had undergone routine tracheal intubation (n=23) AND 2) THOSE who had received noninvasive intubation through a nasal mask (n=20). The respiratory parameters, blood gas composition, central hemodynamic parameters, respiratory support time, and the pattern of complications were analyzed.Results. Noninvasive artificial ventilation permits one to make the patients active in earlier periods and take a spontaneous breath, recovers the respiratory index earlier, reduces the level of positive end-expiratory pressure, the frequency of infectious complications of the tracheobronchial tree, and length of stay in an intensive care unit as compared with endotracheal AV.Conclusion. The findings suggest that noninvasive AV is highly effective and yields better results of treatment in patients with acute respiratory distress syndrome

Predictors of Cardiac Complications of Abdominal and Small Pelvic Surgery in Elderly and Senile Patients

In elderly and senile patients, extracardiac surgery frequently leads to cardiovascular complications. For their prevention, it is necessary to early detect patients with a potentially poor postoperative period. Routine preoperative examination is of limited prognostic value and instrumental techniques are inaccessible. Objective: to reveal the predictors of cardiac complications of abdominal and small pelvic surgery in elderly and senile patients. Subjects and methods. The study covered 82 patients (63 men and 19 women) aged over 60 years who had undergone at least one-hour open operations on the abdomen and small pelvis at the A. A. Vishnevsky Central Military Hospital Three in 2008—2011. In addition to routine procedures, the preoperative examination comprised the calculation of the Lee, Goldman, and Detsky scores and, in 35 patients, determination of NT-proBNP concentrations. Results. The logistic regression method applying the values routinely measured prior to surgery was used to make a cardiac complication-predicting model that included the Detsky index and blood glucose levels. Its dividing capacity proved to be satisfactory – AUC 0.75. Inclusion of echocardiographic data in the model failed to substantially improve its prognostic capacity. The cardiomarker NT-proBNP was the most effective predictor of postoperative complications. As its value became higher, there was an increase in the frequency of cardiac complications (p<0.001); AUC was 0.96. Conclusion. NT-proBNP is a highly effective predictor of postoperative complications in elderly and senile patients and may be included into preoperative screening. Key words: elderly and senile age, abdominal surgery, heart failure, surgery risk assessment, natriuretic peptides, Lee index, Goldman index, Detsky index, NT-proBNP

Increasing the resolution of ECG and EEG mapping equipment using nanosensors

The problem of a large number of people with cardiovascular diseases and brain diseases is relevant all over the world. The problem of mortality and the consequences of these diseases is particularly acute. Therefore, an important way in medical instrumentation is to improve and increase the amount of information with the help of external methods of diagnosing these diseases. Nanosensors have been developed at Tomsk Polytechnic University to significantly improve the quality of electrophysiological measurements. It is proposed to apply the developed nanosensors for ECG and EEG mapping