ДІАГНОСТИЧНА ЗНАЧИМІСТЬ ПОКАЗНИКІВ ОПЕРАЦІЙНО-АНЕСТЕЗІОЛОГІЧНОГО РИЗИКУ В РОБОТІ МЕДИЧНОЇ СЕСТРИ.

The article analyzes and defines the dynamics and consequences of the postoperative period in 85 patients with acute and chronic abdominal pathology in the intensive therapy department depending on the severity of patients’ condition during the hospitalization and the postoperative risk. It has been found out that the increase in operative-anesthetic risk index and index of patients’ condition evaluation by APACHE ІІ scale during the hospitalization marks the increase in lethality during the postoperative period.У статті визначено і проаналізовано динаміку і наслідок перебігу післяопераційного періоду в 85 пацієнтів із гострою і хронічною абдомінальною патологією у відділенні реанімації та інтенсивної терапії залежно від тяжкості хворого при госпіталізації та операційно-анестезіологічного ризику. Виявлено, що зі збільшенням балів операційно-анестезіологічного ризику і оцінки тяжкості хворого за шкалою APACHE ІІ при госпіталізації, достовірно збільшується летальність хворих у післяопераційний період

Biological tissues high-frequency electric welding in biliodigestive anastomoses formation in the experimental and clinical conditions

O.O. Shalimov National Surgery and Transplantology Institute of National Academy of Medical Sciences of Ukraine, Kyiv, Odessa National Medical University, Ivano-Frankivsk National Medical UniversityThe aim of the study - to improve the treatment results of patients with main bile duct disturbances, using the modern method of tissues high-frequency electric welding (HFEW) for the hepaticojejunic anastomoses formation. Material and methods. The formation of 15 models of termino-lateral hepaticojejunic anastomoses were performed experimentally. The modelings were done using “bioimitators” in the form of both hepaticocholedochus and small intestine fragments, removed during pancreatoduodenal resections. The HFEW method was used in 14 patients with the main biliary outflow disturbances for hepaticojejunic anastomoses formation: 6 patients were operated as the result of a periampular zone malignant tumor complicated by mechanical jaundice, 2 patients with chronic pancreatitis presented tubular stenosis of the distal part of the common bile duct, 6 patients presented scars and bile ducts iatrogenic lesions. The control group consisted of 60 patients in whom hepaticojejunic anastomoses was formed traditionally. Results. Hepaticojejunic anastomoses formed by biological tissues radio-frequency (RF)-welding method were passable, completely sealed and had sufficient strength (706.9±70.0 H2O mm). The primary narrowing of anastomoses lumen, formed by the HFEW method, was smaller (13.6±2.1%), compared to the same in the anastomoses formed by the suture method (49.1±3.4%). It was proved histologically that a coagulation suture was formed during electrowelding, and tissue joining was due to changes in the protein conformation of the intercellular substance and the destructed cells. The comparative analysis of clinical and laboratory data in patients of both main and control groups, provided during the postoperative period, revealed better results in the main group patients compared to the control group – the duration of anastomoses formation in case of RF-welding was averagely by 19 minutes (43.2%) shorter comparing to the duration in case of ligature use; the total bilirubin level throughout the postoperative period decreased quicker in the main group (40.4±6.2 μmol/l) comparing to the decrease in the control group (55.0±8.0 μmol/l); one could register both AlAT and AsAT levels quicker. Ultrasound investigation and Magnetic Resonance Cholangiopancreatography, performed at different times of the postoperative period, also proved HFEW anastomoses good patency and tightness. Conclusions. HFEW method for soft biological tissues in clinical practice allows to create reliable biodigestive anastomoses, especially in conditions of inflammation. One could see decrease in early postoperative complications frequency and both bilirubin and transaminases levels faster normalization while using HFEW methods, which indicates liver function rapid recovery

GOSPEL TEXT IN THE STRUCTURE OF THE POEM "JESUS IS A FRIEND TO SINNERS" BY M. M. HERASKOV

In this article the author analyses a little-known poem by Mikhail Kheraskov and comes to the conclusion that the Gospel text is a structural and semantic center of Kheraskov's lyrical utterance that determines its religious, philosophical and artistic value

THE ROLE OF THE INTENSIVE THERAPY AND RESUSCITATION DEPARTMENT NURSE IN THE EVALUATION OF THE CONDITION DYNAMICS IN PATIENTS OPERATED ON ACUTE AND CHRONIC ABDOMINAL PATHOLOGY

The reason for staying patients with abdominal pathology at the department of intensive therapy and resuscitation is the somatic severity of the initial state of the patient, complicated postoperative period, severe concomitant pathology and the need for constant qualified supervision and care. The aim of the study – to determine and analyze the dynamics of the severity of the condition of patients operated on acute and chronic abdominal pathology in the reanimation and intensive care unit on the basis of APA CHE II scoring, in the modification of A. P. Radzykhovskyi. Materials and Methods. A retrospective analysis of medical records of 85 patients who were in inpatient treatment in the intensive care unit for acute and chronic abdominal pathology was conducted. The severity of patients with postoperative periodic dynamics was determined using the APA CHE II grade scoring grade in the APA CHE II modification (1997) based on a set of clinical and laboratory data. Statistical processing of data was carried out by means of general statistics for calculating averages, comparing the mean values by means of non-parametric statistics using the MedCalc for Windows program. They found that the score of the APA CHE II score in the patient's assessment of severity was sufficiently informative for a quick and adequate assessment of the patient's condition in the work of another medical nurse. Results and Discussion. In the patients under study, there were various symptoms that indicate acute and chronic problems in the abdominal cavity. Among the most common symptoms there are: abdominal pain, vomiting with food remains, stagnant gastric contents, intestinal contents, with bile admixture, positive symptoms of peritoneal irritation (symptom of Shchotkin-Blumberg, muscle tension of the abdominal wall), paresis of the intestine, body temperature, tachycardia of shortness of breath, low blood pressure, neurological disorders, dry mouth, liver function, kidney function, changes in skeletal system, system of hemograms, etc. Our study showed that ball scoring of the status of patients under study APA CHE II, allows the nurse quickly and objectively assessing the severity of the atient's condition at a particular moment, as well as to see the objective dynamics of the severity of the condition of the patients. Conclusions. This monitoring allows you to accurately predict the further course of the disease, and the main timely detection of the deterioration of the patient. All these indicators can be used by another nurse in any period, in a short period of time and in any hospital, since they do not require special equipment and special laboratory tests and analyzes

Biological tissues high-frequency electric welding in biliodigestive anastomoses formation in the experimental and clinical conditions

The aim of the study – to improve the treatment results of patients with main bile duct disturbances, using the modern method of tissues high-frequency electric welding (HFEW) for the hepaticojejunic anastomoses formation. Material and methods. The formation of 15 models of termino-lateral hepaticojejunic anastomoses were performed experimentally. The modelings were done using “bioimitators” in the form of both hepaticocholedochus and small intestine fragments, removed during pancreatoduodenal resections. The HFEW method was used in 14 patients with the main biliary outflow disturbances for hepaticojejunic anastomoses formation: 6 patients were operated as the result of a periampular zone malignant tumor complicated by mechanical jaundice, 2 patients with chronic pancreatitis presented tubular stenosis of the distal part of the common bile duct, 6 patients presented scars and bile ducts iatrogenic lesions. The control group consisted of 60 patients in whom hepaticojejunic anastomoses was formed traditionally. Results. Hepaticojejunic anastomoses formed by biological tissues radio-frequency (RF)-welding method were passable, completely sealed and had sufficient strength (706.9±70.0 H2O mm). The primary narrowing of anastomoses lumen, formed by the HFEW method, was smaller (13.6±2.1%), compared to the same in the anastomoses formed by the suture method (49.1±3.4%). It was proved histologically that a coagulation suture was formed during electrowelding, and tissue joining was due to changes in the protein conformation of the intercellular substance and the destructed cells. The comparative analysis of clinical and laboratory data in patients of both main and control groups, provided during the postoperative period, revealed better results in the main group patients compared to the control group – the duration of anastomoses formation in case of RF-welding was averagely by 19 minutes (43.2%) shorter comparing to the duration in case of ligature use; the total bilirubin level throughout the postoperative period decreased quicker in the main group (40.4±6.2 μmol/l) comparing to the decrease in the control group (55.0±8.0 μmol/l); one could register both AlAT and AsAT levels quicker. Ultrasound investigation and Magnetic Resonance Cholangiopancreatography, performed at different times of the postoperative period, also proved HFEW anastomoses good patency and tightness. Conclusions. HFEW method for soft biological tissues in clinical practice allows to create reliable biodigestive anastomoses, especially in conditions of inflammation. One could see decrease in early postoperative complications frequency and both bilirubin and transaminases levels faster normalization while using HFEW methods, which indicates liver function rapid recovery