10 research outputs found
ΠΠΎΡΡΠ΅ΠΊΡΠΈΡ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΡΠ°ΡΡΠ²ΠΎΡΠΎΠΌ Ρ Π»ΠΎΡΠΈΠ΄Π° Π½Π°ΡΡΠΈΡ ΠΏΡΠΈ ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΡΡ
Objective: to assess the capabilities of small-volume hypertonic infusion in the context of early goal-directed therapy for critical conditions in surgical patients.Subjects and methods. Twenty-nine patients (SAPS II 47.5Β±6.81 scores) operated on for generalized peritonitis (n=24) or severe concomitant injury with damages to chest and/or abdominal organs (n=5) who had the clinical and laboratory signs of a systemic inflammatory reaction were intravenously injected 4 ml/kg of 7.5% of hypertonic sodium chloride solution (HS) and colloidal solution, followed by infusion and, if indicated, inotropic maintenance of hemodynamics for 6 hours in order to achieve the goal vales of mean blood pressure (BP), central venous pressure (CVP), central venous blood oxygen saturation (ScvO2), and diuresis. Plasma concentrations of sodium, chlorine, and lactate, acid-base balance, and osmotic blood pressure were monitored.Results. The patients were found to have infusion therapy-refractory critical arterial hypotension, low ScvO2, and oliguria before small-volume circulation maintenance. In all the patients, HS infusion originally caused a rapid rise in BP up to the goal value, with its further colloid infusion maintenance requiring additional dopamine infusion in 12 patients and red blood cell transfusion in 3. This could stabilize over 6 hours BP at the required level in 25 patients, in 9 of whom CVP only approximated the goal value. All the patients were found to have a significant increase in ScvO2 up to an average of 68% in response to HP infusion after 30β60 minutes; in 14 out of them ScvO2 exceeded 70%. By hour 6, ScvO2 stabilized at its goal level in 23 (79%) examinees. Administration of HS caused a significantly increased diuresis. In patients with recovered renal function, the observed hypernatremia, hyperchloremia with hyperchloremic acidosis were transient.Conclusion. The results of the study show it possible to include small-volume hypertonic infusion at the starting stage of early goal-directed therapy, the net result of which will be determined by the recovery of water-electrolyte homeostasis.Β Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ β ΠΎΡΠ΅Π½ΠΊΠ° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠ΅ΠΉ ΠΌΠ°Π»ΠΎΠΎΠ±ΡΠ΅ΠΌΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈΠ½ΡΡΠ·ΠΈΠΈ Ρ ΠΏΠΎΠ·ΠΈΡΠΈΠΉ ΡΠ°Π½Π½Π΅ΠΉ ΡΠ΅Π»Π΅Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠΎΡΡΠΎΡΠ½ΠΈΠΉ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. 29-ΠΈ Π±ΠΎΠ»ΡΠ½ΡΠΌ (SAPS II 47,5Β±6,81 Π±Π°Π»Π»ΠΎΠ²), ΠΏΡΠΎΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠΌ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠ°Π·Π»ΠΈΡΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΡΠΎΠ½ΠΈΡΠ° (24), ΡΡΠΆΠ΅Π»ΠΎΠΉ ΡΠΎΡΠ΅ΡΠ°Π½Π½ΠΎΠΉ ΡΡΠ°Π²ΠΌΡ Ρ ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΠ΅ΠΌ ΠΎΡΠ³Π°Π½ΠΎΠ² Π³ΡΡΠ΄ΠΈ ΠΈ/ΠΈΠ»ΠΈ ΠΆΠΈΠ²ΠΎΡΠ° (5), ΠΈΠΌΠ΅ΡΡΠΈΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠ΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ ΡΠΈΡΡΠ΅ΠΌΠ½ΠΎΠΉ Π²ΠΎΡΠΏΠ°Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠ΅Π°ΠΊΡΠΈΠΈ, Π΄Π»Ρ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΡΠ΅Π»Π΅Π²ΡΡ
Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ ΡΡΠ΅Π΄Π½Π΅Π³ΠΎ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ (ΠΠ), ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ (Π¦ΠΠ), Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄ΠΎΠΌ ΠΊΡΠΎΠ²ΠΈ Π² ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π²Π΅Π½Π΅ (ScvO2) ΠΈ Π΄ΠΈΡΡΠ΅Π·Π°, Π²Π½ΡΡΡΠΈΠ²Π΅Π½Π½ΠΎ Π²Π²ΠΎΠ΄ΠΈΠ»ΠΈ 4 ΠΌΠ»/ΠΊΠ³ 7,5% ΡΠ°ΡΡΠ²ΠΎΡΠ° Ρ
Π»ΠΎΡΠΈΠ΄Π° Π½Π°ΡΡΠΈΡ (ΠΠ ) ΠΈ ΠΊΠΎΠ»Π»ΠΎΠΈΠ΄Π½ΠΎΠ³ΠΎ ΡΠ°ΡΡΠ²ΠΎΡΠ° Ρ ΠΏΠΎΡΠ»Π΅Π΄ΡΡΡΠ΅ΠΉ ΠΈΠ½ΡΡΠ·ΠΈΠΎΠ½Π½ΠΎΠΉ ΠΈ, ΠΏΠΎ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΡΠΌ, ΠΈΠ½ΠΎΡΡΠΎΠΏΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΎΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ Π½Π° ΠΏΡΠΎΡΡΠΆΠ΅Π½ΠΈΠΈ 6 ΡΠ°ΡΠΎΠ². ΠΠΎΠ½ΠΈΡΠΎΡΠΈΡΠΎΠ²Π°Π»ΠΈΡΡ ΠΏΠ»Π°Π·ΠΌΠ΅Π½Π½Π°Ρ ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΡ Π½Π°ΡΡΠΈΡ, Ρ
Π»ΠΎΡΠ°, Π»Π°ΠΊΡΠ°ΡΠ°, ΠΊΠΈΡΠ»ΠΎΡΠ½ΠΎ-ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ ΠΈ ΠΎΡΠΌΠΎΡΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π΄Π°Π²Π»Π΅Π½ΠΈΠ΅ ΠΊΡΠΎΠ²ΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠΎ ΠΌΠ°Π»ΠΎΠΎΠ±ΡΠ΅ΠΌΠ½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Ρ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΈΡΡ ΠΊΡΠΈΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠΎΡΠ΅Π½Π·ΠΈΡ, ΡΠ΅ΡΡΠ°ΠΊΡΠ΅ΡΠ½Π°Ρ ΠΊ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠΌΠΎΠΉ ΠΈΠ½ΡΡΠ·ΠΈΠΎΠ½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, Π½ΠΈΠ·ΠΊΠ°Ρ ScvO2, ΠΎΠ»ΠΈΠ³ΡΡΠΈΡ. ΠΠ½ΡΡΠ·ΠΈΡ ΠΠ ΠΏΠ΅ΡΠ²ΠΎΠ½Π°ΡΠ°Π»ΡΠ½ΠΎ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΠ»Π° Ρ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΊ Π±ΡΡΡΡΠΎΠΌΡ ΠΏΠΎΠ΄ΡΠ΅ΠΌΡ ΠΠ Π΄ΠΎ ΡΠ΅Π»Π΅Π²ΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ Ρ Π΅Π³ΠΎ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅ΠΉ ΠΈΠ½ΡΡΠ·ΠΈΠΎΠ½Π½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΎΠΉ ΠΊΠΎΠ»Π»ΠΎΠΈΠ΄Π°ΠΌΠΈ, ΠΊ ΠΊΠΎΡΠΎΡΠΎΠΉ Ρ 12 Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΈΡΡ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½Π°Ρ ΠΈΠ½ΡΡΠ·ΠΈΡ Π΄ΠΎΠΏΠΌΠΈΠ½Π°, ΠΈ Ρ 3 β ΡΡΠ°Π½ΡΡΡΠ·ΠΈΡ ΡΡΠΈΡΡΠΎΡΠΈΡΠΎΠ². ΠΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ Π·Π° 6 ΡΠ°ΡΠΎΠ² ΡΡΠ°Π±ΠΈΠ»ΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ Π½Π° ΡΡΠ΅Π±ΡΠ΅ΠΌΠΎΠΌ ΡΡΠΎΠ²Π½Π΅ ΠΠ Ρ 25 Π±ΠΎΠ»ΡΠ½ΡΡ
, Ρ 9 ΠΈΠ· ΠΊΠΎΡΠΎΡΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΠΈ Π¦ΠΠ ΡΠΎΠ»ΡΠΊΠΎ ΠΏΡΠΈΠ±Π»ΠΈΠ·ΠΈΠ»ΠΈΡΡ ΠΊ ΡΠ΅Π»Π΅Π²ΠΎΠΌΡ Π·Π½Π°ΡΠ΅Π½ΠΈΡ. Π ΠΎΡΠ²Π΅Ρ Π½Π° ΠΈΠ½ΡΡΠ·ΠΈΡ ΠΠ Ρ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠ΅ΡΠ΅Π· 30β60 ΠΌΠΈΠ½ΡΡ ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΎΡΡ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΠ΅ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ScvO2 Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ Π΄ΠΎ 68%, ΠΏΡΠΈΡΠ΅ΠΌ Ρ 14 ΠΈΠ· Π½ΠΈΡ
ScvO2 ΠΏΡΠ΅Π²ΡΡΠΈΠ»Π° 70% . Π 6 ΡΠ°ΡΠ°ΠΌ ScvO2 ΡΡΠ°Π±ΠΈΠ»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π»Π°ΡΡ Π½Π° ΡΡΠΎΠ²Π½Π΅ ΡΠ²ΠΎΠ΅Π³ΠΎ ΡΠ΅Π»Π΅Π²ΠΎΠ³ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΡ Ρ 23 Π±ΠΎΠ»ΡΠ½ΡΡ
, Ρ. Π΅. Ρ 79% ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
. ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ ΠΠ Π²ΡΠ·ΡΠ²Π°Π»ΠΎ ΠΊ ΡΡΠΎΠΌΡ Π²ΡΠ΅ΠΌΠ΅Π½ΠΈ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΠ΅ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ Π΄ΠΈΡΡΠ΅Π·Π°. Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΠΎΠΉ ΡΡΠ½ΠΊΡΠΈΠ΅ΠΉ ΠΏΠΎΡΠ΅ΠΊ Π½Π°Π±Π»ΡΠ΄Π°Π²ΡΠΈΠ΅ΡΡ Π³ΠΈΠΏΠ΅ΡΠ½Π°ΡΡΠΈΠ΅ΠΌΠΈΡ, Π³ΠΈΠΏΠ΅ΡΡ
Π»ΠΎΡΠ΅ΠΌΠΈΡ Ρ Π³ΠΈΠΏΠ΅ΡΡ
Π»ΠΎΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ Π°ΡΠΈΠ΄ΠΎΠ·ΠΎΠΌ ΠΈΠΌΠ΅Π»ΠΈ ΡΡΠ°Π½Π·ΠΈΡΠΎΡΠ½ΡΠΉ Ρ
Π°ΡΠ°ΠΊΡΠ΅Ρ.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·ΡΠ²Π°ΡΡ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΡ ΠΌΠ°Π»ΠΎΠΎΠ±ΡΠ΅ΠΌΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΈΠ½ΡΡΠ·ΠΈΠΈ Π² ΡΡΠ°ΡΡΠΎΠ²ΡΠΉ ΡΡΠ°ΠΏ ΡΠ°Π½Π½Π΅ΠΉ ΡΠ΅Π»Π΅Π½Π°ΠΏΡΠ°Π²Π»Π΅Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΠΊΠΎΠ½Π΅ΡΠ½ΡΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°Ρ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ Π±ΡΠ΄Π΅Ρ ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΡΡΡΡ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΠ΅ΠΌ Π²ΠΎΠ΄Π½ΠΎ-ΡΠ»Π΅ΠΊΡΡΠΎΠ»ΠΈΡΠ½ΠΎΠ³ΠΎ Π³ΠΎΠΌΠ΅ΠΎΡΡΠ°Π·Π° ΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ°.
Modern Approaches to Continuous Professional Education of Specialists at Medical University
The article addresses the issues of transition of additional professional education to a qualitatively new system β continuous medical education, which requires updating the structure of the organization of the educational process, as well as the content of additional professional programs. In 2016β2019 more than 300 completely new development programs have been worked out, reviewed and approved on the educational portal of the Ministry of Public Health of the Russian Federation. In 2016 Yaroslavl State Medical University has joined the project βCreation of model lean clinicsβ for promoting the principles of lean-management in healthcare. The main emphasis in the additional professional programs aimed at training medical specialists in the sphere of lean management is made on using simulation technologies. As a result, the University has developed an educational project based on simulation technologies βProcess Factory PoLeanClinicβ entailing the total immersion of participants in typical process with the aim to reveal, minimize, and forecast the losses and to raise the efficiency of medical organization. Since 2017 the University implements the concept of continuous professional education of teachers. This concept includes three basic elements: 1) continuing education in research and pedagogical activities; 2) continuing medical (pharmaceutical) education; 3) self-education. The elaborated learning modules for teachersβ continuous education are based on the actual needs for acquisition or development of professional competences