О р и г и н а л ь н ы е и с с л е д о в а н и я Цель исследования. Изучить влияние различных концентраций кислорода, применяемых во время сбалансирован ной многокомпонентной эндотрахеальной анестезии на основе севофлурана, на структурно функциональные пара метры эритроцитов. Материал и методы. В проспективное, рандомизированное исследование было включено 20 человек (52,7±16,2 лет), которым выполнялось однотипное хирургическое вмешательство. Пациенты были разде лены на две группы в зависимости от используемой интраоперационно концентрации кислорода во вдыхаемой сме си (с FiO 2 50% (группа 1) и 21% (группа 2). Проводили морфодифрактометрический анализ эритроцитов пациен тов на трех этапах (до начала операции, во время нее и после анестезии). Результаты. В группе, где использовали FiO 2 равное 50%, наблюдалась статистически значимая тенденция эритроцитов к макроцитозу (82,4±23,3 фл до на чала общей анестезии, по сравнению с 85,1±20,6 фл после анестезии; р=0,02), в сравнении с группой с FiO 2 равным 21%, где изменений объема эритроцитов не наблюдалось. Боковое светорассеивание статистически значимо снизи лось после анестезии в 1 группе (146,2±17,7 ед. в сравнении с 162,9±23,0 ед. до анестезии (р<0,005) и 156,4±16,3 ед. во время операции (р<0,05). Коэффициент вариации полувысоты бокового светорассеивания эритроцитов так же статистически достоверно увеличивался на последнем этапе наблюдения в 1 группе (26,3±3,1 ед. в сравнении с 22,1±5,0 ед. во время операции (р<0,05) и 20,8±3,9 ед. до анестезии (р<0,005). Во второй же группе статистически значимых изменений этих двух признаков не наблюдалось. Заключение. Нами установлено, что во время оператив ных вмешательств в условиях гипероксии происходит изменение формы и свойств эритроцитов, что связано, веро ятно, с ростом уровня прооксидантов. Ключевые слова: эритроциты, гомеостаз, общая анестезия, гипероксия, мор фодифрактометрия. Objective: to study the effect of different concentrations of oxygen on structural and functional parameters of red blood cells during balanced multicomponent sevoflurane based endotracheal anesthesia. Subjects and methods. The prospective, randomized trial enrolled 20 persons (aged 52.7±16.2 years) who underwent the same surgical proce dure. The patients were divided into 2 groups, which differed inintraoperatively used oxygen concentration in the inspired mixture,50% FiO 2 (group 1) and 21% FiO 2 (Group 2). A morphological difractometric analysis of patients' red blood cells was performed preoperatively, intraoperatively, and after anesthesia. Results. In Group 1, red blood cells demonstrated statistically significant trend towards macrocytosis (82.4±23.3 fl before general anesthesia versus 85.1±20.6 fl after anesthesia; р=0.02); in group 2, there were no statistically significant changes in red blood cell vol umes. Lateral light scattering was ignificantly decreased after anesthesia in Group 1 (146.2±17.7 U versus 162.9±23.0 U prior to anesthesia (р<0.005) and 156.4±16.3 U during the surgery (р<0.05)). The coefficient of variation in half height ...

Objective: to determine the feasibility of using C-reactive protein (CRP) and cholesterol levels as biochemical screening markers for multiple organ dysfunction syndrome (MODS) in patients after abdominal surgery.Materials and methods. A prospective case-control study was performed in 192 patients who receivedtreatment at the Intensive Care Unit (ICU) after abdominal surgery. Patients were classified into two groups: Group 1 (n=95) of patients without MODS and Group 2 (n=97) of patients with MODS. The signs of MODS were identified based on 2001 SCCM/ACCP consensus conference criteria. During the first three post-operative days, total cholesterol and CRP levels were measured, and severity was assessed using prognostic scoring systems (SOFA and Apache III). Logistic regression analysis was used to evaluate five MODS prediction models based on total cholesterol levels, CRP levels, a combination of cholesterol and CRP levels as well as SOFA and Apache III scores.Results. Cholesterol levels in Group 2 were found to be significantly lower than those in Group 1 (3.13 (2.6–3.74) mmol/l vs 4.09 (3.26–5.01) mmol/l; P0.05). Significantly increased CRP levels in Group 2 compared to Group 1 were found (168.7 (90.2–247.2) mg/l vs 85.9 (35.6–172.6) mg/l; P0.05). AUC, sensitivity, and specificity values were determined for the study models and scales based on total cholesterol levels (AUC 0.679; 95% confidence interval (CI) 0.625–0.732), CRP levels (AUC 0.67; 95% CI 0.6–0.74), a combination of cholesterol and CRP levels (AUC 0.819; 95% CI 0.721–0.917), SOFA score (AUC 0.786; 95% CI 0.744–0.829), and Apache III score (AUC 0.631; 95% CI 0.582–0.68). The optimal threshold was 3.4 mmol/l and 96.5 mg/l for cholesterol and CRP levels, respectively.Conclusion. Total cholesterol and CRP monitoring revealed them as screening biomarkers informative for predicting MODS within the first three days after abdominal surgery. Using all these models, the probability of MODS development in a patient can be calculated as a function of the numerical value of the biomarker.

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Objective : to analyze our own experience and literature data on the use of targeted antibacterial therapy in a patient with severe pneumonia and multiple organ dysfunction syndrome (MODS). Materials. The work presents a clinical case of successful treatment of a patient with community-acquired pneumonia, sepsis, and MODS, caused by multidrug resistant pathogens. Targeted antibiotic therapy was used during the treatment of the patient. Discussion . We have done a review of the literature and our own data on the antibiotic therapy for community-acquired pneumonia. The targeted antibacterial therapy in severe patients having a multidrug-resistant flora and MODS has the following features: it includes several drugs, is administered by courses, is often combined with antimycotic drugs, antibacterial drugs can be used via inhalation. The evaluation of clinical data, blood counts, as well as indicators of procalcitonin, C-reactive protein, and cholesterol provide substantial assistance during the monitoring of the therapy effectiveness. Conclusion. Among all the components of intensive care in a patient with community-acquired pneumonia, sepsis, and MODS, etiotropic therapy plays a leading role.