Rationale. Knee join replacement is accompanied by intensive pain syndrome. Prolonged blocks of branches of sciatic and femoral nerves are the most effective. Apart from sensory block and analgesia some types of blocks cause motor block of lower extremities, particularly quadriceps muscle of thigh which may prevent patients mobilization. In this connection, the choice of anesthesia strategy is significant concerning the use of prolonged blocks of the branches of sciatic and femoral nerves maintaining the motor function of the lower extremities with adequate analgesia. The goal of the study is to select a method of pain relief after knee replacement that provides adequate analgesia while maintaining the motor function of the lower limb muscles. Material and methods. The investigation was carried out in patients undergone knee join replacement according to standard procedure. The operation was performed under combined anaesthesia: spinal anaesthesia plus prolonged block of tibial nerve and femoral nerve or femoral triangle block with perineural space catheterization. The block with the use of local anesthetic in the analgesic concentration for postoperative analgesia during 3 postoperative days. All participants were divided into four groups according to the combinations of the blocks. Results. The combination of block of branches of sciatic and femoral nervessignificantly improves the quality of postoperative analgesia on the first postoperative day. The block in femoral triangle (subsartorial) in comparison with the block of femoral nerve is accompanied by significantly less weakness of quadriceps muscle of thigh at the equal analgesic potency. Conclusions. Maintaining the motor function of quadriceps muscle of thigh with the use of the prolonged block in femoral triangle for analgesia can be of certain advantage for patients mobilization in the early postoperative period (fast track).

Коррекция гемодинамических нарушений при критических состояниях неонатального периода является одной из главных задач интенсивной терапии. Цель исследования - оценить эффективность гемодинамической поддержки у новорожденных в критическом состоянии на основе неинвазивного мониторинга сердечного выброса. Материалы и методы. В исследование включено 323 ребенка: 133 доношенных и 190 недоношенных новорожденных. Для оценки гемодинамического статуса и эффективности назначения катехоламинов использовали ультразвуковой монитор для оценки сердечного выброса USCOM. Оценивали частоту сердечных сокращений, сердечный выброс, сердечный индекс, ударный объем, индекс ударного объема, системное сосудистое сопротивление и расстояние в минутах. Результаты исследования. Установлено, что гипердинамический тип кровообращения (СИ >5 л/мин/м2) при поступлении в ОРИТ имел место у 32 (30%) новорожденных; гиподинамический (СИ <2,5 л/мин/м2) - у 42 (40%) и нормодинамический (СИ = 2,5-4 л/мин/м2) - у 31 (30%) ребенка. После коррекции медикаментозной поддержки количество пациентов с гипердинамическим типом кровообращения уменьшилось на 14,3%, с гиподинамическим - на 15,2%, а число пациентов с нормодинамическим типом кровообращения возросло на 29,5%. Средняя длительность инфузии вазоактивных препаратов на фоне оценки сердечного выброса составила 54±9,75 часов, в то время как при эмпирическом назначении она достигала 79,03±11,5 часов (р <0,05). Использование неинвазивного мониторинга сердечного выброса позволило снизить потребность в медикаментозной поддержке гемодинамики на 44% и сократить финансовые затраты стационара на 52%. Заключение. Патогенетически обоснованная цель ориентированная терапия гемодинамических нарушений неонатального периода, основанная на неинвазивном мониторинге сердечного выброса, позволяет сократить финансовые затраты стационара и улучшить исходы заболеваний. Correction of hemodynamic disorders in critical conditions of the neonatal period is one of the main tasks of intensive care. The aim of the study is to evaluate the effectiveness of hemodynamic support in newborns in critical condition based on non invasive cardiac output monitoring. Materials and methods. The study included 323 babies: 133 full term and 190 premature newborns. To assess the hemodynamic status and efficacy of catecholamine administration, an ultrasound monitor was used to assess cardiac output USCOM. Heart rate, cardiac output, cardiac index, stroke volume, stroke volume index, systemic vascular resistance and distance in minutes were evaluated. Study results. It was established that the Hyperdynamic type of blood circulation (CI >5 l/min/m2) at admission to ICU occurred in 32 (30%) newborns; hypodynamic (CI <2.5 l/min/m2) - in 42 (40%) and normodynamic (CI = 2.524 l/min/m2) - in 31 (30%) children. After correction of medical support, the number of patients with hyperdinamic blood circulation type decreased by 14.3%, with hypodynamic - by 15.2%, and the number of patients with normodynamic blood circulation type increased by 29.5%. The average duration of vasoactive infusion during cardiac output assessment was 54±9.75 hours, while with empirical prescription it reached 79.03±11.5 hours (p <0.05). The use of non invasive cardiac output monitoring reduced the need for medical hemodynamic support by 44% and reduced the financial costs of the hospital by 52%. Conclusion. Pathogenetically justified target oriented therapy of hemodynamic disorders of the neonatal period, based on non invasive monitoring of cardiac output, allows to reduce the financial costs of the hospital and improve the outcomes of diseases.

Проблемам длительной искусственной вентиляции легких (ИВЛ) у детей первого года жизни, имеющих диагноз бронхолегочной дисплазии (БЛД), по данным литературы, уделено недостаточно внимания. В связи с улучшением оказания помощи на перинатальном уровне число таких детей неизменно растет, данная группа пациентов является определяющей в развитии инвалидизации и младенческой смертности. Нами были изучены 79 пациентов грудного возраста с БЛД, находящихся на длительной ИВЛ. Для проведения ИВЛ применяли режим SIMV-VC с нисходящей формой кривой потока. Выявлены параметры ИВЛ: Vt 11(8-13) мл/кг, РIP 29(25-32) Н2О, PEEP 8(729), частота дыхания - 24(20-30) циклов/мин, которые выходят за границы допустимых безопасных значений, но хорошо переносятся детьми данной группы. Применяемый режим проведения ИВЛ можно считать эффективным и безопасным для детей, находящихся на длительной вентиляции легких. According to the literature, not enough attention is paid to the problems of long term ventilation in infants with bronchopulmonary dysplasia. As perinatal care has improved, the number of such children has steadily increased, this group of patients is decisive in the development of disability and infant mortality. We studied 79 infants who retrospectively, with bronchopulmonary dysplasia on a long term ventilation. We used SIMV-VC mode with a downward form of flow waveform. The ventilator parameters: Vt 11(8-13) ml/kg, РIP 29(25-32) cm Н2О, PEEP 8(7-9) cm Н2О, ventilator rate - 24(20-30) inflation/min, that go beyond the limits of acceptable safe values, but are well tolerated by children of this group, we identified. The applied ventilator mode can be considered effective and save for children with bronchopulmonary dysplasia and are on long term ventilation.

The article deals with the problem of early neonatal and infant mortality. It is pointed out that recent advances in emergency and intensive care therapy have provided decline in early neonatal and infant mortality. Hemodynamic disorders are reported to be associated with any severe pathology in patients of all age groups including newborns, significantly influence quality of life of patients having experienced a critical condition. Clinical manifestations of hemodynamic disorders in infants are not considered to be specific; they are critically delayed and are not timely recognized. The article describes peculiarities of the cardio-vascular system of newborns that are responsible for the necessity of thorough hemodynamic profile monitoring in order to provide detection of vital function alterations at the early stages, ensure timely onset of intensive therapy and its qualitative performance. Special attention is paid to current methods of determination of central hemodynamic parameters, which are stated to be divided into invasive and non-invasive. The paper also highlights some peculiarities of evaluation of hemodynamic findings using specific monitoring methods and factors influencing the outcome. The article specifies increased interest towards non-invasive monitoring tools of hemodynamic profile in recent years; their relevance is stated to be doubtless in both pediatric and neonatal practice. The main task of any monitoring procedure is reported to be hemodynamic findings analysis, “trend tracking” in the process of monitoring a patient and intensive therapy performance.

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