Самарский государственный медицинский университет (ректор-акад. ран Г.п. Котельников) минздрава рФ, Самара, россия Ключевые слова: портальная гипертензия, эндоваскулярная хирургия, тромбофилия. Complex endovascular treatment of Budd-Chiari syndrome A.G. SOniS, v.v. SukhOrukOv, yu.L. kEtSkO, i.v. kOLESnik, B.d. GrAChEv, i.v. kurtOv, t.A. GritSEnkO, O.v. tErEShinA Samara State medical university (rector-academician of rAS G.p. kotelnikov) health ministry of the russian Federation,

The aim of the study was to determine the comparative significance of basal metabolism indicators and inflammatory process markers for the closest prognosis of patients in ICUs with systemic inflammation syndrome caused with infectious genesis. The paper presents the results of a retrospective analysis of the plan of treatment of 198 patients with confirmed clinical and laboratory signs of bacterial infection. The number of leukocytes, platelets, the percentage of lymphocytes, the concentration of procalcitonin, creatinine, bilirubin, C-reactive protein, acid-base balance values were determined in patients. Patients were assessed on a SOFA scale. The type of biomaterial for microbiological research was determined depending on the intended source of infectious inflammation. Identification of the isolated microorganisms was carried out using the MALDI ToF mass spectrometry method, followed by determination of antibiotic resistance. Empirical antibiotic therapy was prescribed upon admission of the patient to the ICU. Patients were switched to etiotropic antibacterial therapy after 48 hours, taking into account the results of a microbiological study. Determination of basal metabolic rate was carried out using the method of indirect calorimetry (CCM Express, Medical Graphics) with the calculation of basal metabolism, respiratory coefficient, absolute and relative amount of macronutrients. The calculation of the protein was made on the basis of the nitrogen level of the daily urine urea. Logistic analysis (ROC analysis) revealed that the antibacterial therapy strategy used, age, gender of patients, tinctorial properties of microorganisms isolated from patients, do not affect the nearest prognosis of the disease. On the contrary, SOFA score, the concentration of procalcitonin in the blood, and such parameters of the metabolic status as the need for kilocalories per kilogram of actual body weight and the percentage of protein calories significantly affect the nearest prognosis of the disease. The percentage of calories derived from protein metabolism, in the main exchange has a high reliable predictive value. The results of the study confirm the importance of adequate nutritional therapy in the treatment of patients with infectious inflammatory syndrome, including the calculation and correction of protein loss and total daily calorie.

Hyperlactatemia is a dangerous metabolic shift, manifested in an increase in the blood lactate content above 2.2 mmol / l. Changes in the content of lactate affect the function of vital organs and systems, disrupting the course of biochemical processes. This condition accompanies a large number of clinical situations, also it is a major factor, worsening the clinical outcome and the patient’s condition. The study of the characteristics of its occurrence and metabolic relationships helps to fulfill the diagnostic criteria for assessing the likelihood of an adverse outcome. The purpose of this study is to assess the variability of the content of lactate and glucose, as well as the glucose/lactate ratio, depending on the group of blood in the ABO system and the nosology of patients. 250 patients with various diseases whose condition required intensive care were examined, the middle age was 61.08 ± 13.6 years, and 446 practically healthy individuals who did not have acute somatic and infectious diseases, the middle age was 26.83 ± 1.46 years . We investigated the content of lactate and glucose, the glucose/lactate ratio, determined the belonging of the blood to ABO system. Statistical processing of the results was performed in the IBM SPSS Statistica 23.0. The data obtained indicate that patients with B (III) blood group have the highest lactate content in venous blood compared to the general population, and patients with AB (IV) blood group have the highest blood glucose level. In the group of patients with the highest median lactate content, the lowest glucose content was observed. The data presented demonstrate the importance of measuring and monitoring glucose, lactate, and their ratio in the management of patients in a life-threatening condition. Evaluation of metabolic variability depending on the different blood grouping of the ABO system in critical conditions involving hyperlactataemia can serve as an important tool in modeling a personalized approach to the patient.

Aim. To determine the effectiveness of thromboelastometry (TEM) and echocardiography for anticoagulant therapy monitoring in patients with COVID-19.Material and methods. We analyzed treatment regimen of 92 patients with COVID-19. The patients were divided into two groups. In the control group (n=30), anticoagulant therapy with unfractionated heparin (UFH) was carried out under laboratory control of coagulation parameters. In the experimental group (n=62), anticoagulation was maintained by intravenous UFH under control of coagulation, echocardiography (Philips, Epiq 5) and TEM (ROTEM® delta). Echocardiography determined the pulmonary artery acceleration time (AT), mid-systolic notching (SN). The TEM method was used to study external (EXTEM) and internal (INTEM) pathways, differential tests (FIBTEM, HEPTEM) of coagulation. Statistical analysis was performed by calculating non-parametric statistics parameters, comparisons of differences in groups (Mann-Whitney test), area under the curve (AUC), and regression equations.Results. A high correlation level between echocardiographic and TEM parameters was determined. Their levels associated with a positive prognosis were calculated (AT>113,5 ms., AUC 0,979; p<0,0001; no SN, AUC 0,931; p<0,0001; FIBTEM ML (60 min) >1,12%, AUC 0,971, p<0,0001; INTEM ML (60 min) >2,01%, AUC 0,941, p<0,0001, EXTEM ML (60 min) >1,4%, AUC 0,934, p<0,0001; MCFfib not >26 mm, AUC 0,954; p<0,0001; MCFin not >56,6 mm, AUC 0,938; p<0,0001; MCFex not >47,9 mm, AUC 0,838, p<0,0001). In 33,9% of patients in the experimental group, heparin resistance was detected. In this connection, combined therapy with UFH and direct oral anticoagulants (DOACs) was used, followed by the switch to DOACs. In the control group, artificial ventilation was used in 50% of patients, mortality — 36,6%, myocardial infarction — 13,3%, deep vein thrombosis — 6,6%, pulmonary embolism — 6,6%, while in the experimental group, mechanical ventilation — 12,9%, myocardial infarction — 4,8%, mortality — 8,1%.Conclusion. The dynamic assessment of echocardiography and TEM parameters made it possible to monitor pulmonary thrombosis processes, significantly reduce complications, the use of artificial ventilation and mortality in COVID-19 patients.

Цель. Изучение распространенности и антибиотикорезистентности Pseudomonas aeruginosa в струк туре микрофлоры, выделенной от пациентов, находящихся на стационарном лечении с оценкой влияния внедрения системы микробиологического мониторинга и мероприятий стратегии контроля антимикробной терапии. Материалы и методы. В 2013 г. проведена первичная оценка этиологии и антибиотикорезистент ности при инфекциях у пациентов, госпитализированных в многопрофильный стационар. В 2014 г. в данном стационаре внедрена система микробиологического мониторинга и мероприятия стратегии контроля антимикробной терапии. Проведена оценка частоты выделения и распространенности резистентных штаммов P. aeruginosa за период с 2013 по 2017 гг.