Complicated injury of the cervical spine is accompanied by a violation of blood circulation. This condition requires maintaining adequate perfusion pressure in order to prevent secondary damage to the spinal cord and multiple organ failure. The authors did not evaluate the effect of the urgency of spinal decompression on the severity and duration of systemic hypotension in this category of patients previously, as well as the presence of a connection between systemic hypotension and the outcome of the injury. Objective. To determine the effect of early decompression of the spinal cord on the duration and characteristics of adrenomimetics use in the bundle of intensive care measures in the acute period of complicated injury to the cervical spine. Material and Methods. A retrospective analysis of the treatment outcomes in 27 patients with complicated ASIA A cervical spine injury was conducted. Two groups were identified: Group I included 13 patients operated on within the first eight hours from the moment of injury; and Group II - 14 patients operated on within the period from eight to 72 hours. The analyzed parameters were: age, hemodynamic parameters, severity of organ dysfunction, duration of hemodynamic support, neurological status, time spent in intensive care unit, and length of hospital stay. Central hemodynamic parameters were registered using the impedance cardiography technique. To assess organ dysfunction, the SOFA score was used. Results. Complicated injury of the cervical spine is accompanied by a decrease in systemic vascular resistance and cardiac index. Hemodynamic parameters and duration of hemodynamic support in groups were not statistically different. Statistically significant differences in the SOFA score between groups were obtained on the third and 10^th day of the follow-up. Neurogenic shock was recorded in 70.4 % of cases. Positive dynamics of neurological deficit was observed only in two (15.4 %) patients of Group I. Conclusion. The urgency of spinal decompression does not affect the duration of hemodynamic support, but reduces the severity of organ dysfunction and increases the risk of neurological disorder regression.

Objective. To evaluate the effectiveness of dalargin and polyoxidonium as neurovegetative protection components, when performing decompression and stabilization operations in patients in the late period of spine and spinal cord injury. Material and Methods. Perioperative parameters of central hemodynamics and stress hormone levels were analyzed in 68 patients operated on using technology of multi-stage treatment in one surgical session under three variants of general anesthesia with mechanical ventilation: sevoflurane, fentanyl, and rocuronium bromide in Group I (n = 23); sevoflurane, fentanyl, dalargin, and rocuronium bromide-in Group II (n = 21); and sevoflurane, fentanyl, polyoxidonium, and rocuronium bromide-in Group III (n = 24). Results. The duration of operation was: 385.7 ± 54.8 min in Group I, 391.5 ± 43.5 min in Group II, 399.2 ± 51.2 min in Group III, and blood loss was 1008.7 ± 89.2 ml, 968.3 ± 71.8 ml, 1001.4 ± 80.3 ml, respectively. Statistically significant differences in cardiac output parameter from initial values were recorded during anterior spinal fusion procedure and at the stage of spinal deformity correction. There were no significant differences in hemodynamics between the groups. The greatest deviations in stress hormone levels were recorded in Group I at stages of anterior spinal fusion, deformity correction, and on the first day after surgery. The level of endogenous intoxication in Group I corresponded to high severity, in Groups II and III-to moderate severity. The need for opioid analgesics was significantly lower in Groups II and III (p < 0.05). Conclusion. Inclusion of dalargin and polyoxidonium into the anesthesia program allows achieving a required level of anesthetic protection of patients during operation, while maintaining adequate reactivity of the patient's body defenses.

Objective. To analyze the role of the functional state of the diaphragm in patients with cervical spinal cord injury at the stages of respiratory support and to substantiate additional criteria for their readiness to transfer to spontaneous breathing.Material and Methods. The state of the diaphragm was assessed by ultrasound in 24 patients with spinal cord injury. The excursion of the diaphragm during quiet breathing, the excursion and thickness of the diaphragm during forced breathing, and the change in forced expiratory volume from the moment of admission till the end of mechanical ventilation were analyzed.Results. On the first day, on the background of mechanical ventilation, there was a significant decrease in the excursion and thickness of the diaphragm during forced breathing (p = 0.002; p = 0.008) which persisted up to 3 days (p < 0.001; p < 0.001); by the fifth day of mechanical ventilation, the indicators increased to the initial levels (p = 0.112; p = 0.433); and by the 10th day they exceeded the initial values (p < 0.001). When comparing the excursion and thickness of the diaphragm during the transfer of patients to spontaneous breathing with the data on their admission, a significant difference was obtained (p < 0.001; p < 0.001). The dynamics of forced expiratory volume indicators was similar to those of diaphragm excursion during forced breathing.Conclusion. A peculiarity of the functional state of the diaphragm in patients with cervical spinal cord injury in the acute period was a significant decrease in diaphragm excursion and the development of ventilator-induced diaphragm dysfunction (VIDD) associated with mechanical ventilation in replacement modes. The tactics of early tracheostomy and the use of auxiliary ventilation modes determined the absence of progression of VIDD during prolonged mechanical ventilation. The presence of a strong correlation between the diaphragm excursion during forced breathing and the forced expiratory volume allows concluding that these indicators can be additional objective criteria for the  readiness of patients with cervical SC injury to transfer to spontaneous breathing, since they reflect not only the functional state of the diaphragm, but also the state of the lung tissue.

Проблема обезболивания после операции эндопротезирования тазобедренного сустава остается актуальной задачей. Эффективным методом послеоперационного обезболивания является продленная эпидуральная анальгезия местными анестетиками. Целью исследования было изучение эффективности и безопасности эпидуральной анальгезии левобупивакаином в сравнении с ропивакаином у пациентов после эндопротезирования тазобедренного сустава. Материалы и методы. Исследованы 50 пациентов после первичной тотальной артропластики тазобедренного сустава. Они были рандомизированы на 2 группы. В первой группе послеоперационное эпидуральное обезболивание проводили инфузией левобупивакаина, во второй-инфузией ропивакаина. Исследованы динамика болевого синдрома после операции, необходимость дополнительной анальгезии, стабильность гемодинамических показателей. Результаты исследования. Полученные данные свидетельствуют о лучшем контроле болевого синдрома в группе левобупивакаина в первые часы после операции. Средние баллы оценки боли по 10-балльной визуально-рейтинговой шкале в группе левобупивакаина были 4,36 ± 2,46 против 5,84 ± 1,46 в группе ропивакаина. В дальнейшем контроль болевого синдрома в исследуемых группах был сопоставим. Количество эпизодов гипотонии и потребность в наркотических анальгетиках в обеих группах значимо не отличались. Заключение. Использование продленной эпидуральной анальгезии левобупивакаином может быть рекомендовано для обезболивания после эндопротезирования тазобедренного сустава. Ключевые слова: левобупивакаин, ропивакаин, эндопротезирование тазобедренного сустава, эпидуральная анестезия, эпидуральная анальгезия.

To identify the incidence and severity of acute kidney injury (AKI) in patients after replacement of large joints with infectious complications. Materials and methods. The object of study: 54 patients with infectious complications after replacement of large joints. The severity of AKI was determined by the RIFLE classification. Three groups of observation were singled out: I-18 patients (33.3%) with AKI in stage R (risk); II-11 patients (20.3%) with AKI in stage I (injury); III-25 patients (46.3%) with AKI in stage F (failure). AKI developed in 0.2% of cases. Results. In most cases, the clinical picture of AKI developed 2-4 days after surgery, and 2-5 days after onset of AKI, the signs of infectious endotoxicosis with the development of various infectious complications were noted. The analysis of the intraoperative period established that most patients in groups II and III had hypotension with MBP [mean blood pressure] 55-70 mm Hg, 87.5% of patients with intraoperative blood loss greater than 20% of blood volume were included in the study groups II and III. The calculation of odds ratios (OR) showed that low MBP levels, intraoperative blood loss greater than 20% of blood volume and sepsis are statistically significant factors of the risk of severe AKI (p˂0.05). Conclusions. Risk factors for the development of AKI and its severity after replacement of large joints were the presence of arterial hypertension, MBP level of less than 75 mm Hg, blood loss greater than 20% of blood volume, and sepsis. Manifestation of the clinical picture of AKI after such operations may be a warning sign of the development of postoperative infection and sepsis.