111 research outputs found
Prevention Program of Internet Addiction in Adolescents: Implementation Aspects
The Article is devoted to the development of a project for the prevention of Internet addiction among young people (a social group most susceptible to Internet addiction due to the specifics of age characteristics). The design is based on ANSI PMI PMBOK Guide 3 Edition, 2004.Π‘ΡΠ°ΡΡΡ ΠΏΠΎΡΠ²ΡΡΠ΅Π½Π° ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ΅ ΠΏΡΠΎΠ΅ΠΊΡΠ° ΠΏΠΎ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΠΈΠ½ΡΠ΅ΡΠ½Π΅Ρ-Π·Π°Π²ΠΈΡΠΈΠΌΠΎΡΡΠΈ ΡΡΠ΅Π΄ΠΈ ΠΌΠΎΠ»ΠΎΠ΄Π΅ΠΆΠΈ (ΡΠΎΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΡΡΠΏΠΏΠ° Π² Π½Π°ΠΈΠ±ΠΎΠ»ΡΡΠ΅ΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΏΠΎΠ΄Π²Π΅ΡΠΆΠ΅Π½Π½Π°Ρ ΠΈΠ½ΡΠ΅ΡΠ½Π΅Ρ-Π°Π΄Π΄ΠΈΠΊΡΠΈΠΈ Π² ΡΠΈΠ»Ρ ΡΠΏΠ΅ΡΠΈΡΠΈΠΊΠΈ Π²ΠΎΠ·ΡΠ°ΡΡΠ½ΡΡ
ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠ΅ΠΉ). ΠΡΠΎΠ΅ΠΊΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΎ Π½Π° ΠΎΡΠ½ΠΎΠ²Π΅ ΡΡΠ°Π½Π΄Π°ΡΡΠ° ANSI PMI PMBOK Guide 3 Edition, 2004
Effects of exposure of rat erythrocytes to a hypogeomagnetic field
The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Background:Hypomagnetic fields can disrupts the normal functioning of living organisms by a mechanism thought to involve oxidative stress. In erythrocytes, oxidative stress can inter alia lead to changes to hemoglobin content and to hemolysis. Objective:To study the effects of hypomagnetism on the state of rat erythrocytes in vitro. Methods:Rat erythrocytes were exposed to an attenuated magnetic field (AMF) or Earthβs magnetic field (EMF), in the presence of tert-butyl hydroperoxide (TBHP) as inducer of oxidative stress. Determinations: total hemoglobin (and its three forms β oxyhemoglobin, methemoglobin, and hemichrome) released from erythrocytes, spectral data (500β700 nm); oxygen radical concentrations, electron paramagnetic resonance. Results:AMF and EMF exposed erythrocytes were compared. After 4 h incubation at high TBHP concentrations (>700 ΞΌM), AMF exposed erythrocytes released significantly more (p<0.05) hemoglobin (Hb), mostly as methemoglobin (metHb). Conversely, after 24 h incubation at low TBHP concentrations (β©½350 ΞΌM), EMF exposed erythrocytes released significantly more (p<0.001) hemoglobin, with metHb as a significant proportion of the total Hb. Erythrocytes exposed to AMF generated more radicals than those exposed to the EMF. Conclusion:Under particular conditions of oxidative stress, hypomagnetic fields can disrupt the functional state of erythrocytes and promote cell death; an additive effect is implicated
Analytical derivation of DC SQUID response
Β© 2016 IOP Publishing Ltd.We consider voltage and current response formation in DC superconducting quantum interference device (SQUID) with overdamped Josephson junctions in resistive and superconducting state in the context of a resistively shunted junction (RSJ) model. For simplicity we neglect the junction capacitance and the noise effect. Explicit expressions for the responses in resistive state were obtained for a SQUID which is symmetrical with respect to bias current injection point. Normalized SQUID inductance (where Ic is the critical current of Josephson junction, L is the SQUID inductance, e is the electron charge and β is the Planck constant) was assumed to be within the range l β€ 1, subsequently expanded up to using two fitting parameters. SQUID current response in the superconducting state was considered for arbitrary value of the inductance. The impact of small technological spread of parameters relevant to low-temperature superconductor (LTS) technology was studied, using a generalization of the developed analytical approach, for the case of a small difference of critical currents and shunt resistances of the Josephson junctions, and inequality of SQUID inductive shoulders for both resistive and superconducting states. Comparison with numerical calculation results shows that developed analytical expressions can be used in practical LTS SQUIDs and SQUID-based circuits design, e.g. large serial SQIF, drastically decreasing the time of simulation
Adiabatic Superconducting Artificial Neural Network: Basic Cells
We consider adiabatic superconducting cells operating as an artificial neuron
and synapse of a multilayer perceptron (MLP). Their compact circuits contain
just one and two Josephson junctions, respectively. While the signal is
represented as magnetic flux, the proposed cells are inherently nonlinear and
close-to-linear magnetic flux transformers. The neuron is capable of providing
a one-shot calculation of sigmoid and hyperbolic tangent activation functions
most commonly used in MLP. The synapse features by both positive and negative
signal transfer coefficients in the range ~ (-0.5,0.5). We briefly discuss
implementation issues and further steps toward multilayer adiabatic
superconducting artificial neural network which promises to be a compact and
the most energy-efficient implementation of MLP.Comment: 5 pages, 2 figure
ΠΠΠ’ΠΠΠΠΠΠ§ΠΠ‘ΠΠΠ― Π’ΠΠ ΠΠΠΠ― ΠΠ Π ΠΠ¨ΠΠΠΠ§ΠΠ‘ΠΠΠ ΠΠΠ‘Π£ΠΠ¬Π’Π
The article shows the world experience of metabolic therapy use in the treatment of ischemic stroke. The issue still remains prominent. The reasonability of prescribing metabolic drugs is not completely clear, its effectiveness has not been fully proved, despite numerous studies which show only trends. The article presents an overview of the most popular drugs of different pharmacological groups with a metabolic effect which affect different parts of the ischemic cascade. Ethylmethylhydroxypyridine succinate and cytoflavin have predominantly antihypoxic effect, improve functional outcome and neurological functions, and normalize overall well-being and adaptation. Cerebrolysin is a complex of low molecular weight biologically active peptides derived from the pigβs brain. It has a multimodal effect on the brain, helps to reduce the volume of cerebral infarction, restores neurologic functions and improves the functional outcome. Cortexin is a mixture of cattle brain polypeptides, also has a complex action that provides the most complete reversion of neurological deficit, improves cognitive functions and the functional outcome, reduces the level of paroxysmal convulsive readiness and improves bioelectric activity of the brain. Citicoline is a precursor of cell membrane key ultrastructures, contributes to significant reduction in the volume of cortical brain damage, improves cholinergic transmission, which results in better clinical outcome, even despite the questionable impact on the neurological status. Choline Alfoscerate is a precursor of choline, and the use of the drug significantly limits the growth of the cerebral infarction area starting from the first day of therapy, leads to reversion of neurological symptoms and achievement of rehabilitation goals. Actovegin is deproteinized derivative of calf blood, activates metabolism in tissues, improves trophism and stimulates regeneration. In a large study, it was shown that Actovegin improved cognitive function in patients who had experienced a stroke,. The drug does not significantly improve the neurological status of patients after a stroke, but it reduces the risk of the stroke development in the next 10 years. Thus, we analyzed mechanisms of medical substances action and data of experimental and clinical studies, including ones after thrombolytic therapy and with inclusion of drugs for primary and secondary prevention of ischemic stroke. The reasonability and effectiveness of prescribing a combination of drugs of different pharmacological groups affecting brain metabolism remains controversial, since the excessive drug treatment may have complications. The safety of metabolic therapy is in doubt, and some of authors views presented confirm the need for additional large independent studies.Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π½ ΠΌΠΈΡΠΎΠ²ΠΎΠΉ ΠΎΠΏΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°. ΠΠΎΠΏΡΠΎΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½ΡΠΌ. Π¦Π΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎΡΡΡ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² Π΄ΠΎ ΠΊΠΎΠ½ΡΠ° Π½Π΅ ΡΡΠ½Π°, ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΎΠΊΠΎΠ½ΡΠ°ΡΠ΅Π»ΡΠ½ΠΎ Π½Π΅ Π΄ΠΎΠΊΠ°Π·Π°Π½Π°, Π½Π΅ΡΠΌΠΎΡΡΡ Π½Π° ΠΌΠ½ΠΎΠ³ΠΎΡΠΈΡΠ»Π΅Π½Π½ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΠΎΠΊΠ°Π·ΡΠ²Π°ΡΡ ΡΠΎΠ»ΡΠΊΠΎ ΡΠ΅Π½Π΄Π΅Π½ΡΠΈΠΈ. Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΎΠ±Π·ΠΎΡ ΡΠ°ΠΌΡΡ
ΠΏΠΎΠΏΡΠ»ΡΡΠ½ΡΡ
Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² ΠΈΠ· ΡΠ°Π·Π½ΡΡ
ΡΠ°ΡΠΌΠ°ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π³ΡΡΠΏΠΏ Ρ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠΌ Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ΠΌ, ΠΎΠΊΠ°Π·ΡΠ²Π°ΡΡΠΈΡ
Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° ΡΠ°Π·Π½ΡΠ΅ Π·Π²Π΅Π½ΡΡ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠ°ΡΠΊΠ°Π΄Π°. ΠΡΠΈΠ»- ΠΌΠ΅ΡΠΈΠ»Π³ΠΈΠ΄ΡΠΎΠΊΡΠΈΠΏΠΈΡΠΈΠ΄ΠΈΠ½Π° ΡΡΠΊΡΠΈΠ½Π°Ρ ΠΈ Π¦ΠΈΡΠΎΡΠ»Π°Π²ΠΈΠ½ ΠΎΠ±Π»Π°Π΄Π°ΡΡ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ Π°Π½ΡΠΈΠ³ΠΈΠΏΠΎΠΊΡΠ°Π½ΡΠ½ΡΠΌ Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ΠΌ, ΡΠ»ΡΡΡΠ°ΡΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΉ ΠΈΡΡ
ΠΎΠ΄, ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΡΡ Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΡΠ½ΠΊΡΠΈΠΉ, Π° ΡΠ°ΠΊΠΆΠ΅ Π½ΠΎΡΠΌΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ ΠΎΠ±ΡΠ΅Π³ΠΎ ΡΠ°ΠΌΠΎΡΡΠ²ΡΡΠ²ΠΈΡ ΠΈ Π°Π΄Π°ΠΏΡΠ°ΡΠΈΠΈ. Π¦Π΅ΡΠ΅Π±ΡΠΎΠ»ΠΈΠ·ΠΈΠ½ β ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡ Π½ΠΈΠ·ΠΊΠΎΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΡΡ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈ Π°ΠΊΡΠΈΠ²Π½ΡΡ
ΠΏΠ΅ΠΏΡΠΈΠ΄ΠΎΠ², ΠΏΠΎΠ»ΡΡΠ΅Π½Π½ΡΡ
ΠΈΠ· Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° ΡΠ²ΠΈΠ½ΡΠΈ, ΠΎΠ±Π»Π°Π΄Π°Π΅Ρ ΠΌΡΠ»ΡΡΠΈ-ΠΌΠΎΠ΄Π°Π»ΡΠ½ΡΠΌ Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ΠΌ Π½Π° Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠΉ ΠΌΠΎΠ·Π³, ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΈΠ½ΡΠ°ΡΠΊΡΠ° Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°, Π²ΠΎΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½ΠΈΡ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΡΠ½ΠΊΡΠΈΠΉ ΠΈ ΡΠ»ΡΡΡΠ΅Π½ΠΈΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π°. ΠΠΎΡΡΠ΅ΠΊΡΠΈΠ½ β ΠΏΠΎΠ»ΠΈΠΏΠ΅ΠΏΡΠΈΠ΄Ρ ΠΊΠΎΡΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° ΡΠΊΠΎΡΠ°, ΡΠ°ΠΊΠΆΠ΅ ΠΎΠ±Π»Π°Π΄Π°ΡΡ ΠΊΠΎΠΌΠΏΠ»Π΅ΠΊΡΠ½ΡΠΌ Π΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ΠΌ, ΡΡΠΎ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠΈΠ²Π°Π΅Ρ Π½Π°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΏΠΎΠ»Π½ΡΠΉ ΡΠ΅Π³ΡΠ΅ΡΡ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π΄Π΅ΡΠΈΡΠΈΡΠ°, ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΡΡ
ΡΡΠ½ΠΊΡΠΈΠΉ ΠΈ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΡΡΠ½ΠΊΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΈΡΡ
ΠΎΠ΄Π°, ΠΏΡΠ΅ΠΏΠ°ΡΠ°Ρ ΡΠ°ΠΊΠΆΠ΅ ΡΠ½ΠΈΠΆΠ°Π΅Ρ ΡΡΠΎΠ²Π΅Π½Ρ ΠΏΠ°ΡΠΎΠΊΡΠΈΠ·ΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΡΡΠ΄ΠΎΡΠΎΠΆΠ½ΠΎΠΉ Π³ΠΎΡΠΎΠ²Π½ΠΎΡΡΠΈ ΠΈ ΡΠ»ΡΡΡΠ°Π΅Ρ Π±ΠΈΠΎΡΠ»Π΅ΠΊΡΡΠΈΡΠ΅ΡΠΊΡΡ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°. Π¦ΠΈΡΠΈΠΊΠΎΠ»ΠΈΠ½ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠ΅Π΄ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΈΠΊΠΎΠΌ ΠΊΠ»ΡΡΠ΅Π²ΡΡ
ΡΠ»ΡΡΡΠ°ΡΡΡΡΠΊΡΡΡΠ½ΡΡ
ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΠΎΠ² ΠΊΠ»Π΅ΡΠΎΡΠ½ΠΎΠΉ ΠΌΠ΅ΠΌΠ±ΡΠ°Π½Ρ, ΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΡΠ΅Ρ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΌΡ ΡΠΌΠ΅Π½ΡΡΠ΅Π½ΠΈΡ ΠΎΠ±ΡΠ΅ΠΌΠ° ΠΊΠΎΡΡΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°, ΡΠ»ΡΡΡΠ°Π΅Ρ Ρ
ΠΎΠ»ΠΈΠ½Π΅ΡΠ³ΠΈΡΠ΅ΡΠΊΡΡ ΠΏΠ΅ΡΠ΅Π΄Π°ΡΡ, ΡΡΠΎ ΡΠΎΠΏΡΡΠΆΠ΅Π½ΠΎ Ρ Π»ΡΡΡΠΈΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΡΡ
ΠΎΠ΄ΠΎΠΌ, Π΄Π°ΠΆΠ΅ Π½Π΅ΡΠΌΠΎΡΡΡ Π½Π° Π½Π΅ΠΎΠ΄Π½ΠΎΠ·Π½Π°ΡΠ½ΠΎΠ΅ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΠ°ΡΡΡ. Π₯ΠΎΠ»ΠΈΠ½Π° Π°Π»ΡΡΠΎΡΡΠ΅ΡΠ°Ρ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΡΠ΅Π΄ΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΈΠΊΠΎΠΌ Ρ
ΠΎΠ»ΠΈΠ½Π°, ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ° ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎ ΠΎΠ³ΡΠ°Π½ΠΈΡΠΈΠ²Π°Π΅Ρ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ Π·ΠΎΠ½Ρ ΠΈΠ½ΡΠ°ΡΠΊΡΠ° ΠΌΠΎΠ·Π³Π° Ρ ΠΏΠ΅ΡΠ²ΡΡ
ΡΡΡΠΎΠΊ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΠ΅Π³ΡΠ΅ΡΡΡ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΠΊΠΈ ΠΈ Π΄ΠΎΡΡΠΈΠΆΠ΅Π½ΠΈΡ ΠΏΠΎΡΡΠ°Π²Π»Π΅Π½Π½ΡΡ
ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΡΠ΅Π»Π΅ΠΉ. ΠΠΊΡΠΎΠ²Π΅Π³ΠΈΠ½ β Π΄Π΅ΠΏΡΠΎΡΠ΅ΠΈΠ½ΠΈ- Π·ΠΈΡΠΎΠ²Π°Π½Π½ΡΠΉ Π³Π΅ΠΌΠΎΠ΄Π΅ΡΠΈΠ²Π°Ρ ΠΊΡΠΎΠ²ΠΈ ΡΠ΅Π»ΡΡ, Π°ΠΊΡΠΈΠ²ΠΈΠ·ΠΈΡΡΠ΅Ρ ΠΎΠ±ΠΌΠ΅Π½ Π²Π΅ΡΠ΅ΡΡΠ² Π² ΡΠΊΠ°Π½ΡΡ
, ΡΠ»ΡΡΡΠ°Π΅Ρ ΡΡΠΎΡΠΈΠΊΡ ΠΈ ΡΡΠΈΠΌΡΠ»ΠΈΡΡΠ΅Ρ ΠΏΡΠΎΡΠ΅ΡΡ ΡΠ΅Π³Π΅Π½Π΅ΡΠ°ΡΠΈΠΈ. Π ΠΊΡΡΠΏΠ½ΠΎΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ Π΄ΠΎΠΊΠ°Π·Π°Π½ΠΎ, ΡΡΠΎ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΏΠ΅ΡΠ΅Π½Π΅ΡΡΠΈΡ
ΠΈΠ½ΡΡΠ»ΡΡ, ΠΠΊΡΠΎΠ²Π΅Π³ΠΈΠ½ ΡΠ»ΡΡΡΠ°Π΅Ρ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΡΠ΅ ΡΡΠ½ΠΊΡΠΈΠΈ. ΠΡΠ΅ΠΏΠ°ΡΠ°Ρ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎ Π½Π΅ ΡΠ»ΡΡΡΠ°Π΅Ρ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΡΠ°ΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΠΎΡΠ»Π΅ ΡΠΎΡΡΠΎΡΠ²ΡΠ΅Π³ΠΎΡΡ ΠΈΠ½ΡΡΠ»ΡΡΠ°, ΠΎΠ΄Π½Π°ΠΊΠΎ ΡΠΌΠ΅Π½ΡΡΠ°Π΅Ρ Π΄Π΅ΡΡΡΠΈΠ»Π΅ΡΠ½ΠΈΠΉ ΡΠΈΡΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈΠ½ΡΡΠ»ΡΡΠ°. Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΡΠ°Π·ΠΎΠ±ΡΠ°Π½Ρ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΡ Π΄Π΅ΠΉΡΡΠ²ΠΈΡ Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
Π²Π΅ΡΠ΅ΡΡΠ² ΠΈ Π΄Π°Π½Π½ΡΠ΅ ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΠΏΠΎΡΠ»Π΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ ΡΡΠΎΠΌΠ±ΠΎΠ»ΠΈΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΈ Ρ Π²ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅ΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ ΠΈ Π²ΡΠΎΡΠΈΡΠ½ΠΎΠΉ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠΈ ΠΈΡΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΡΡΠ°. Π¦Π΅Π»Π΅ΡΠΎΠΎΠ±ΡΠ°Π·Π½ΠΎΡΡΡ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΡ ΠΈ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² ΡΠ°Π·Π½ΡΡ
ΡΠ°ΡΠΌΠ°ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΡ
Π³ΡΡΠΏΠΏ, Π²Π»ΠΈΡΡΡΠΈΡ
Π½Π° ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΠ·ΠΌ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°, ΠΎΡΡΠ°Π΅ΡΡΡ ΡΠΏΠΎΡΠ½ΠΎΠΉ, ΡΠ°ΠΊ ΠΊΠ°ΠΊ ΠΏΠΎΠ»ΠΈΠΏΡΠΎΠ³ΠΌΠ°Π·ΠΈΡ ΠΌΠΎΠΆΠ΅Ρ ΠΈΠΌΠ΅ΡΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ. ΠΠΎΠ΄Π½ΠΈΠΌΠ°Π΅ΡΡΡ Π²ΠΎΠΏΡΠΎΡ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎΡΡΠΈ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½Ρ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΡΠ΅ ΡΠΎΠΌΠ½Π΅Π½ΠΈΡ Π½Π΅ΠΊΠΎΡΠΎΡΡΡ
Π°Π²ΡΠΎΡΠΎΠ², ΡΡΠΎ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π°Π΅Ρ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎΡΡΡ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΊΡΡΠΏΠ½ΡΡ
Π½Π΅Π·Π°Π²ΠΈΡΠΈΠΌΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ
Π‘Π ΠΠΠΠΠΠΠ ΠΠΠ£Π₯ ΠΠΠ’ΠΠΠΠ ΠΠΠ’ΠΠ’ΠΠ ΠΠΠΠ¦ΠΠ ΠΠ£Π§ΠΠΠΠ ΠΠ Π’ΠΠ ΠΠ: ΠΠΠΠ¬ΠΠΠ’ΠΠ ΠΠΠ Π Π‘ Π£ΠΠ¬Π’Π ΠΠΠΠ£ΠΠΠΠ«Π ΠΠΠΠ’Π ΠΠΠΠ
Anatomical landmarks and palpation are traditionally used for radial arterial catheterization in emergency units. Despite the successful use ofΒ ultrasound monitoring for central venous access, there is a lack of evidence about the benefits of the ultrasound guidance for peripheral arterial cannulation.The objective:Β to compare two methods of radial arterial catheterization (the traditional one based on palpation and the method under ultrasound guidance) in the patients undergoing planned surgery.Subjects and methods.Β 40 patients participated in the prospective cohort study, all of them had planned surgeries. In Group 1, the traditional method was used for arterial catheterization (the palpation group), and in Group 2 it was done under ultrasound guidance (the ultrasound group). The following parameters were recorded for both groups: number of attempts, number of puncture sites, complications and their type, time of catheterization. The number of cannulation attempts was taken as a primary endpoint.Results.Β The statistically significant correlation was found between the method of catheterization and the number of attempts (Pearson's chi-squared testΒ =Β 29.562, dfΒ =Β 6,Β pΒ <Β 0.001), places of puncture (Pearson's chi-squared testΒ =Β 10.365, dfΒ =Β 3,Β pΒ =Β 0.015). In the ultrasound group, the first attempt of cannulation was a success in 19 cases (95%;Β CIΒ 73β99%), while in the palpation group, the first attempt was a success in 2 cases (10%;Β CIΒ 2β33%). The one catheterization site was used in 95% of cases in the ultrasound group (CIΒ 73β99%; 1 observation). While in Group 2 (the palpation group), two sites of cannulation and more were required in 50% of patients (CIΒ 30β17%; 10 observations). Among complications there were hematomas, and no statistically significant correlations were found between the method of puncture and their number in the groups (Pearson's chi-squared testΒ =Β 2.7706, dfΒ =Β 1,Β pΒ =Β 0.09601). The time spent on catheterization in the ultrasound group was shorter versus the palpation group (WΒ =Β 344,Β pΒ <Β 0.001) and it made 101 sec. (51; 144) and 194 sec. (153; 311) respectively.Conclusion:Β Compared to the traditional (palpation) method, the radial arterial catheterization guided by ultrasound possesses such benefits as high chances of successful cannulation with the first attempt, fewer sites required to provide arterial access and total time required for the manipulation.Π’ΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎ Π΄Π»Ρ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠΈ Π»ΡΡΠ΅Π²ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΡΡ
Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΎΠ»ΠΎΠ³ΠΈΠΈ-ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΈΡΠΏΠΎΠ»ΡΠ·ΡΡΡ Π°Π½Π°ΡΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠΈΠ΅Π½ΡΠΈΡΡ ΠΈ ΠΏΠ°Π»ΡΠΏΠ°ΡΠΈΡ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΡΠΏΠ΅Ρ
ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ° ΠΏΡΠΈ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΠΈ ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π²Π΅Π½ΠΎΠ·Π½ΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ°, Π΄Π°Π½Π½ΡΡ
Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ ΠΏΠΎΠ»ΡΠ·Ρ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ° ΠΏΡΠΈ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΊΠ°Π½ΡΠ»ΡΡΠΈΠΈ Π°ΡΡΠ΅ΡΠΈΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ.Π¦Π΅Π»Ρ:Β ΡΡΠ°Π²Π½ΠΈΡΡ Π΄Π²Π΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠΈ Π»ΡΡΠ΅Π²ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ (ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΡΡ Π½Π° ΠΏΠ°Π»ΡΠΏΠ°ΡΠΈΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΡ ΠΈ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ°) Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠΈ ΠΏΠ»Π°Π½ΠΎΠ²ΡΡ
ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΡΡ
Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°Ρ
.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ.Β Π ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΌ ΠΊΠΎΠ³ΠΎΡΡΠ½ΠΎΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠ°ΡΡΠ²ΠΎΠ²Π°Π»ΠΎ 40 ΡΠ΅Π»ΠΎΠ²Π΅ΠΊ, ΠΊΠΎΡΠΎΡΡΠΌ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΠΏΠ»Π°Π½ΠΎΠ²ΡΠ΅ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΈΠ΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π°. ΠΒ 1-ΠΉΒ Π³ΡΡΠΏΠΏΠ΅ ΠΏΠ΅ΡΠ΅Π΄ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ΅ΠΉ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΡ Π°ΡΡΠ΅ΡΠΈΠΈ Π²ΡΠΏΠΎΠ»Π½ΡΠ»ΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΡΠΌ ΡΠΏΠΎΡΠΎΠ±ΠΎΠΌ (Π³ΡΡΠΏΠΏΠ° Β«ΠΏΠ°Π»ΡΠΏΠ°ΡΠΈΠΈΒ»), Π²ΠΎΒ 2-ΠΉΒ β Ρ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΡΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ (Π³ΡΡΠΏΠΏΠ° Β«ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ°Β»). Π ΠΎΠ±Π΅ΠΈΡ
Π³ΡΡΠΏΠΏΠ°Ρ
ΡΠΈΠΊΡΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΠΎΠΏΡΡΠΎΠΊ, ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΌΠ΅ΡΡ Π΄Π»Ρ ΠΏΡΠ½ΠΊΡΠΈΠΈ, ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ ΠΈ ΠΈΡ
Ρ
Π°ΡΠ°ΠΊΡΠ΅Ρ, Π²ΡΠ΅ΠΌΡ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠΈ. ΠΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ ΠΊΠΎΠ½Π΅ΡΠ½ΠΎΠΉ ΡΠΎΡΠΊΠΎΠΉ ΡΡΠΈΡΠ°Π»ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΏΠΎΠΏΡΡΠΎΠΊ ΠΊΠ°Π½ΡΠ»ΡΡΠΈΠΈ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ.Β ΠΡΡΠ²Π»Π΅Π½Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠ°Ρ ΡΠ²ΡΠ·Ρ ΠΌΠ΅ΠΆΠ΄Ρ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠΈ ΠΈ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎΠΌ ΠΏΠΎΠΏΡΡΠΎΠΊ (Ρ
ΠΈ-ΠΊΠ²Π°Π΄ΡΠ°Ρ ΠΠΈΡΡΠΎΠ½Π°Β =Β 29,562, dfΒ =Β 6,Β pΒ <Β 0,001), ΠΌΠ΅ΡΡΠ°ΠΌΠΈ Π΄Π»Ρ ΠΏΡΠ½ΠΊΡΠΈΠΈ (Ρ
ΠΈ-ΠΊΠ²Π°Π΄ΡΠ°Ρ ΠΠΈΡΡΠΎΠ½Π°Β =Β 10,365, dfΒ =Β 3,Β pΒ =Β 0,015). Π Π³ΡΡΠΏΠΏΠ΅ Β«ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ°Β» Π² 19 ΡΠ»ΡΡΠ°ΡΡ
(95%;Β ΠΠΒ 73β99%) ΠΊΠ°Π½ΡΠ»ΡΡΠΈΡ Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° Ρ ΠΏΠ΅ΡΠ²ΠΎΠΉ ΠΏΠΎΠΏΡΡΠΊΠΈ, ΡΠΎΠ³Π΄Π° ΠΊΠ°ΠΊ Π² Π³ΡΡΠΏΠΏΠ΅ Β«ΠΏΠ°Π»ΡΠΏΠ°ΡΠΈΡΒ» Π»ΠΈΡΡ Π² 2 ΡΠ»ΡΡΠ°ΡΡ
(10%;Β ΠΠΒ 2β33%). Π Π³ΡΡΠΏΠΏΠ΅ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ° Π² 95% ΡΠ»ΡΡΠ°Π΅Π² (ΠΠΒ 73β99%; 1 Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅) Π΄Π»Ρ ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΡ ΠΏΡΠΈΠΌΠ΅Π½ΠΈΠ»ΠΈ ΠΎΠ΄Π½ΠΎ ΠΌΠ΅ΡΡΠΎ. ΠΠΎΒ 2-ΠΉΒ ΠΆΠ΅ Π³ΡΡΠΏΠΏΠ΅ (Β«ΠΏΠ°Π»ΡΠΏΠ°ΡΠΈΠΈΒ») ΡΒ 50%Β ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (ΠΠΒ 30β17%; 10 Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠΉ) Π΄Π»Ρ ΡΡΠΏΠ΅ΡΠ½ΠΎΡΡΠΈ ΠΌΠ°Π½ΠΈΠΏΡΠ»ΡΡΠΈΠΈ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»ΠΎΡΡ Π΄Π²Π° ΠΌΠ΅ΡΡΠ° ΠΊΠ°Π½ΡΠ»ΡΡΠΈΠΈ ΠΈ Π±ΠΎΠ»Π΅Π΅. Π‘ΡΠ΅Π΄ΠΈ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π²ΡΡΡΠ΅ΡΠΈΠ»ΠΈΡΡ Π³Π΅ΠΌΠ°ΡΠΎΠΌΡ, ΠΏΡΠΈ ΡΡΠΎΠΌ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠΉ ΡΠ²ΡΠ·ΠΈ ΠΌΠ΅ΡΠΎΠ΄Π° ΠΏΡΠ½ΠΊΡΠΈΠΈ ΠΈ ΠΈΡ
ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° Π² Π³ΡΡΠΏΠΏΠ°Ρ
Π½Π΅ Π²ΡΡΠ²ΠΈΠ»ΠΈ (Ρ
ΠΈ-ΠΊΠ²Π°Π΄ΡΠ°Ρ ΠΠΈΡΡΠΎΠ½Π°Β =Β 2,7706, dfΒ =Β 1,Β pΒ =Β 0,09601). ΠΡΠ΅ΠΌΡ, Π·Π°ΡΡΠ°ΡΠ΅Π½Π½ΠΎΠ΅ Π½Π° ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΡ Π°ΡΡΠ΅ΡΠΈΠΈ Π² Π³ΡΡΠΏΠΏΠ΅ Β«ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ°Β», Π±ΡΠ»ΠΎ ΠΌΠ΅Π½ΡΡΠ΅, ΡΠ΅ΠΌ Π² Π³ΡΡΠΏΠΏΠ΅ Β«ΠΏΠ°Π»ΡΠΏΠ°ΡΠΈΡΒ» (WΒ =Β 344,Β pΒ <Β 0,001), ΠΈ ΡΠΎΡΡΠ°Π²ΠΈΠ»ΠΎ 101 Ρ (51; 144) ΠΈ 194 Ρ (153; 311) ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ.ΠΡΠ²ΠΎΠ΄.Β Π ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ Ρ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠΉ (ΠΏΠ°Π»ΡΠΏΠ°ΡΠΎΡΠ½ΠΎΠΉ), ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ° ΠΊΠ°ΡΠ΅ΡΠ΅ΡΠΈΠ·Π°ΡΠΈΠΈ Π»ΡΡΠ΅Π²ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ ΠΏΠΎΠ΄ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΡΠ»ΡΡΡΠ°Π·Π²ΡΠΊΠ° ΠΎΠ±Π»Π°Π΄Π°Π΅Ρ ΡΠ°ΠΊΠΈΠΌΠΈ ΠΏΡΠ΅ΠΈΠΌΡΡΠ΅ΡΡΠ²Π°ΠΌΠΈ, ΠΊΠ°ΠΊ Π²ΡΡΠΎΠΊΠ°Ρ Π²Π΅ΡΠΎΡΡΠ½ΠΎΡΡΡ ΡΡΠΏΠ΅ΡΠ½ΠΎΡΡΠΈ ΠΊΠ°Π½ΡΠ»ΡΡΠΈΠΈ Ρ ΠΏΠ΅ΡΠ²ΠΎΠΉ ΠΏΠΎΠΏΡΡΠΊΠΈ, ΠΌΠ΅Π½ΡΡΠ΅Π΅ ΡΡΠ΅Π±ΡΠ΅ΠΌΠΎΠ΅ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²ΠΎ ΠΌΠ΅ΡΡ Π΄Π»Ρ ΠΎΠ±Π΅ΡΠΏΠ΅ΡΠ΅Π½ΠΈΡ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΎΡΡΡΠΏΠ° ΠΈ ΠΎΠ±ΡΠ΅Π΅ Π·Π°ΡΡΠ°ΡΠ΅Π½Π½ΠΎΠ΅ Π½Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΠ΅ ΠΌΠ°Π½ΠΈΠΏΡΠ»ΡΡΠΈΠΈ Π²ΡΠ΅ΠΌΡ
ΠΠΠΠ―ΠΠΠ ΠΠΠ£ΠΠΠΠΠ ΠΠΠΠ‘Π’ΠΠΠΠ ΠΠ ΠΠΠΠΠΠΠΠΠΠΠΠΠ ΠΠΠ‘ΠΠΠΠΠΠ ΠΠ¦ΠΠΠΠΠΠ ΠΠΠΠΠΠ’ΠΠΠΠΠ ΠΠΠ‘Π€Π£ΠΠΠ¦ΠΠ
The profound deepening of medicamentous sleep down to the burst-suppression electroencephalography pattern is used to provide medication-based protection of brain during preventive temporary clipping of the major arteries when performing surgery due to cerebral aneurysms. There is no consensus about the effect of profound suppression of electrobiological activity on the development of post-operative cognitive dysfunction. The goal: to evaluate the impact of anesthesia with the burst-suppression electroencephalography pattern on the post-operative cognitive status of the patients with no cerebral disorders. Subjects and methods. 30 patients were enrolled into the prospective randomized study, they all had surgeries due to degenerative spinal diseases. All patients were divided into two groups. Anesthesia in the main group (Group 1) differed from the one in the control group (Group 2); it included administration of propofol till achieving suppression of the electrobiological activity of burst-suppression electroencephalography pattern during 15 minutes. Prior to the surgery and in 4 days after it, all patients had neuro-psychological tests using Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB) and numbers memorization techniques (NMT). Results. When testing in 4 days after surgery, results in the patients from Group 1 did not differ from pre-operative results of MoCA (Mebefore =Β 28, Meafter= 28, Z = 0.714, p = 0.476), FAB (Mebefore = 18, Meafter = 18, Z = 0.592, p = 0.554), memorization of numbers in the direct order (Mebefore = 18, Meafter = 18, Z = 0.178, p = 0.859) and in the reverse order (Mebefore = 18, Meafter = 18, Z = 0.548, p = 0.583). The results of the post-operative testing in Group 2 were compatible with pre-operative results of (Mebefore = 18, Meafter = 18, Z = 0.459, p = 0.646), FAB (Mebefore = 18, Meafter = 18, Z =Β 1.348, p =Β 0.178), memorization of numbers in the direct order (Mebefore = 18, Meafter = 18, Z = 0.21, p = 0.843) and in the reverse order (Mebefore =Β 18, Meafter =Β 18, Z = 0.809, p = 0.418). None of the tests detected significant differences between the Groups (U = 88, p = 0.319, Z = 0.995 for MoCA; UΒ =Β 102.5, p = 0.644, Z = 0.394 for FAB; U = 92.0, p = 0.407, Z = -0.829 for memorization of numbers in the direct order, and U = 33.5, p = 0.62, ZΒ =Β 0.572 for memorization of numbers in the reverse order). Conclusion. Anesthesia with burst-suppression electroencephalography pattern as a model of medication-based cerebral protection during temporary clipping of the major arteries does not cause the deterioration of cognitive status in the patients who had no cerebral pathology initially.Β ΠΠ»Ρ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ Π·Π°ΡΠΈΡΡ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΏΡΠ΅Π²Π΅Π½ΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΊΠ»ΠΈΠΏΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΌΠ°Π³ΠΈΡΡΡΠ°Π»ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ ΠΏΡΠΈ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΡΡ
ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΡΠ΅ΡΠ΅Π±ΡΠ°Π»ΡΠ½ΡΡ
Π°Π½Π΅Π²ΡΠΈΠ·ΠΌ ΠΏΡΠΈΠΌΠ΅Π½ΡΡΡ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΡΠ³Π»ΡΠ±Π»Π΅Π½ΠΈΠ΅ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠ³ΠΎ ΡΠ½Π° Π΄ΠΎ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΡ Π½Π° ΡΠ»Π΅ΠΊΡΡΠΎΡΠ½ΡΠ΅ΡΠ°Π»ΠΎΠ³ΡΠ°ΠΌΠΌΠ΅ ΠΏΠ°ΡΡΠ΅ΡΠ½Π° Β«Π²ΡΠΏΡΡΠΊΠ° β ΠΏΠΎΠ΄Π°Π²Π»Π΅Π½ΠΈΠ΅Β». ΠΠ΅Ρ Π΅Π΄ΠΈΠ½ΠΎΠ³ΠΎ ΠΌΠ½Π΅Π½ΠΈΡ Π² ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠΈ Π²Π»ΠΈΡΠ½ΠΈΡ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΠ³ΠΎ ΡΠ³Π½Π΅ΡΠ΅Π½ΠΈΡ Π±ΠΈΠΎΡΠ»Π΅ΠΊΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π½Π° Π²ΠΎΠ·Π½ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ. Π¦Π΅Π»Ρ: ΠΎΡΠ΅Π½ΠΈΡΡ Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΈ Ρ ΡΠ»Π΅ΠΊΡΡΠΎΡΠ½ΡΠ΅ΡΠ°Π»ΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠ°ΡΡΠ΅ΡΠ½ΠΎΠΌ Β«Π²ΡΠΏΡΡΠΊΠ° β ΠΏΠΎΠ΄Π°Π²Π»Π΅Π½ΠΈΠ΅Β» Π½Π° ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΉ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΡΠΉ ΡΡΠ°ΡΡΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΏΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΌ ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΌ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠ°ΡΡΠ²ΠΎΠ²Π°Π»ΠΈ 30 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ Π²ΡΠΏΠΎΠ»Π½ΠΈΠ»ΠΈ Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ Π΄Π΅Π³Π΅Π½Π΅ΡΠ°ΡΠΈΠ²Π½ΡΡ
Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠΉ ΠΏΠΎΠ·Π²ΠΎΠ½ΠΎΡΠ½ΠΈΠΊΠ°. ΠΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ Π±ΡΠ»ΠΈ ΡΠ°Π·Π΄Π΅Π»Π΅Π½Ρ Π½Π° Π΄Π²Π΅ Π³ΡΡΠΏΠΏΡ. ΠΠ½Π΅ΡΡΠ΅Π·ΠΈΡ Π² ΠΎΡΠ½ΠΎΠ²Π½ΠΎΠΉ Π³ΡΡΠΏΠΏΠ΅ (1-Ρ Π³ΡΡΠΏΠΏΠ°) ΠΎΡΠ»ΠΈΡΠ°Π»Π°ΡΡ ΠΎΡ ΠΊΠΎΠ½ΡΡΠΎΠ»ΡΠ½ΠΎΠΉ (2-Ρ Π³ΡΡΠΏΠΏΠ°) Π²Π²Π΅Π΄Π΅Π½ΠΈΠ΅ΠΌ ΠΏΡΠΎΠΏΠΎΡΠΎΠ»Π° Π΄ΠΎ ΠΏΠΎΡΠ²Π»Π΅Π½ΠΈΡ Π² Π±ΠΈΠΎΡΠ»Π΅ΠΊΡΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΠΈ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π° ΠΏΠ°ΡΡΠ΅ΡΠ½Π° Β«Π²ΡΠΏΡΡΠΊΠ° β ΠΏΠΎΠ΄Π°Π²Π»Π΅Π½ΠΈΠ΅Β» Π² ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ 15 ΠΌΠΈΠ½. ΠΠ΅ΡΠ΅Π΄ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ΅ΠΉ ΠΈ Π½Π° 4-Π΅ ΡΡΡ ΠΏΠΎΡΠ»Π΅ Π²ΠΌΠ΅ΡΠ°ΡΠ΅Π»ΡΡΡΠ²Π° Π²ΡΠ΅ΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌ ΠΏΡΠΎΠ²ΠΎΠ΄ΠΈΠ»ΠΈ Π½Π΅ΠΉΡΠΎΠΏΡΠΈΡ
ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΠΎΠ½ΡΠ΅Π°Π»ΡΡΠΊΠΎΠΉ ΡΠΊΠ°Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ ΠΏΡΠΈΡ
ΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΡΠ½ΠΊΡΠΈΠΉ (MoCA), Π±Π°ΡΠ°ΡΠ΅ΠΈ ΡΠ΅ΡΡΠΎΠ² Π΄Π»Ρ ΠΎΡΠ΅Π½ΠΊΠΈ Π»ΠΎΠ±Π½ΠΎΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ (FAB) ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ Π·Π°ΠΏΠΎΠΌΠΈΠ½Π°Π½ΠΈΡ ΡΠΈΡΡ. Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΡΠΈ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ Π½Π° 4-Π΅ ΡΡΡ ΠΏΠΎΡΠ»Π΅ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΈ Π² 1-ΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π½Π΅ ΠΎΡΠ»ΠΈΡΠ°Π»ΠΈΡΡ ΠΎΡ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΡΠ΅ΡΡΠΎΠ² MoCA (MeΠ΄ΠΎ = 28, MeΠΏΠΎΡΠ»Π΅ = 28, Z = 0,714, p = 0,476), FAB (MeΠ΄ΠΎ = 18, MeΠΏΠΎΡΠ»Π΅ = 18, Z = 0,592, p = 0,554), Π·Π°ΠΏΠΎΠΌΠΈΠ½Π°Π½ΠΈΡ ΡΠΈΡΡ Π² ΠΏΡΡΠΌΠΎΠΌ (MeΠ΄ΠΎ = 18, MeΠΏΠΎΡΠ»Π΅ = 18, Z = 0,178, p = 0,859) ΠΈ ΠΎΠ±ΡΠ°ΡΠ½ΠΎΠΌ ΠΏΠΎΡΡΠ΄ΠΊΠ΅ (MeΠ΄ΠΎ = 18, MeΠΏΠΎΡΠ»Π΅ = 18, Z = 0,548, p = 0,583). ΠΠΎ 2-ΠΉ Π³ΡΡΠΏΠΏΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π±ΡΠ»ΠΈ ΡΠΎΠΏΠΎΡΡΠ°Π²ΠΈΠΌΡ Ρ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠΌΠΈ Π΄Π°Π½Π½ΡΠΌΠΈ ΡΠ΅ΡΡΠΎΠ² MoCA (MeΠ΄ΠΎ = 18, MeΠΏΠΎΡΠ»Π΅ = 18, ZΒ =Β 0,459, p = 0,646), FAB (MeΠ΄ΠΎ = 18, MeΠΏΠΎΡΠ»Π΅ = 18, Z = 1,348, p = 0,178), Π·Π°ΠΏΠΎΠΌΠΈΠ½Π°Π½ΠΈΡ ΡΠΈΡΡ Π² ΠΏΡΡΠΌΠΎΠΌ (MeΠ΄ΠΎ = 18, MeΠΏΠΎΡΠ»Π΅ = 18, Z = 0,21, p = 0,843) ΠΈ ΠΎΠ±ΡΠ°ΡΠ½ΠΎΠΌ ΠΏΠΎΡΡΠ΄ΠΊΠ΅ (MeΠ΄ΠΎ = 18, MeΠΏΠΎΡΠ»Π΅ = 18, Z = 0,809, p = 0,418). ΠΠ΅ΠΆΠ΄Ρ 1-ΠΉ ΠΈ 2-ΠΉ Π³ΡΡΠΏΠΏΠ°ΠΌΠΈ Π·Π½Π°ΡΠΈΠΌΡΡ
ΠΎΡΠ»ΠΈΡΠΈΠΉ Π½Π΅ Π²ΡΡΠ²Π»Π΅Π½ΠΎ Π½ΠΈ ΠΏΠΎ ΠΎΠ΄Π½ΠΎΠΉ ΠΈΠ· ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊ (U = 88, p = 0,319, Z = 0,995 Π΄Π»Ρ MoCA; U = 102,5, p = 0,644, Z = 0,394 Π΄Π»Ρ FAB; U = 92,0, p = 0,407, Z = -0,829 Π΄Π»Ρ Π·Π°ΠΏΠΎΠΌΠΈΠ½Π°Π½ΠΈΡ Π² ΠΏΡΡΠΌΠΎΠΌ ΠΈ U = 33,5, p = 0,62, Z = 0,572 Π΄Π»Ρ Π·Π°ΠΏΠΎΠΌΠΈΠ½Π°Π½ΠΈΡ Π² ΠΎΠ±ΡΠ°ΡΠ½ΠΎΠΌ ΠΏΠΎΡΡΠ΄ΠΊΠ΅). ΠΡΠ²ΠΎΠ΄. ΠΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠ΅ Π°Π½Π΅ΡΡΠ΅Π·ΠΈΠΈ Ρ ΡΠ»Π΅ΠΊΡΡΠΎΡΠ½ΡΠ΅ΡΠ°Π»ΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΏΠ°ΡΡΠ΅ΡΠ½ΠΎΠΌ Β«Π²ΡΠΏΡΡΠΊΠ° β ΠΏΠΎΠ΄Π°Π²Π»Π΅Π½ΠΈΠ΅Β» ΠΊΠ°ΠΊ ΠΌΠΎΠ΄Π΅Π»ΠΈ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ Π·Π°ΡΠΈΡΡ ΠΌΠΎΠ·Π³Π° Π½Π° ΠΏΠ΅ΡΠΈΠΎΠ΄ Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ³ΠΎ ΠΊΠ»ΠΈΠΏΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΌΠ°Π³ΠΈΡΡΡΠ°Π»ΡΠ½ΡΡ
Π°ΡΡΠ΅ΡΠΈΠΉ Π½Π΅ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΡ
ΡΠ΄ΡΠ΅Π½ΠΈΡ ΠΊΠΎΠ³Π½ΠΈΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π±Π΅Π· ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ Π³ΠΎΠ»ΠΎΠ²Π½ΠΎΠ³ΠΎ ΠΌΠΎΠ·Π³Π°.
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