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Biomedical subjects

R N Lebedeva

Publications and source records attributed to R N Lebedeva.

87 records · Page 5Linked to original sources
PubMedDate not supplied

[Methodological approaches to studies of the functional state of lungs under conditions of intensive care].

Algorithms for automated processing of curves reflecting respiratory function of the lungs (pneumotachygram, psyrogram, transthoracic pressure) in grave patients were developed. A system of monitoring the parameters characterizing real time pulmonary ventilation, gas exchange, respiratory mechanics and aerodynamics was created. The described algorithms for calculating the curves of respiratory functions permit examination of pulmonary function during spontaneous respiration of a patient.

Critical Care↗
PubMedDate not supplied

[Right ventricular insufficiency in patients in the early periods after orthotopic transplantation of donor heart].

The function of transplanted heart in the early postoperative period is analyzed in 20 patients operated on at the Research Center of Surgery of the Russian Academy of Medical Sciences. Cardiac function was assessed by a complex of hemodynamic parameters, among which were the ratio between the ventricular stroke index and end diastolic pressure in the ventricle. Right-ventricular dysfunction of varying severity was detected in all the patients in the immediate postoperative period. Three variants of right-ventricular insufficiency were singled out: isolated right-ventricular insufficiency with increased (20%) and normal (45%) total vascular resistance and right-ventricular insufficiency combined with left-ventricular insufficiency (35%). Isolated right-ventricular insufficiency could be, as a rule, treated by combined intensive care including sympathomimetics and vasodilators. A combination of right-ventricular and left-ventricular insufficiency, which may be caused by incompatability between the sizes of the donor and recipient, as well as hypoxic and metabolic cardiac injury in donor body, is prognostically infavorable, for it requires intensive inotropic therapy and is associated with a high mortality.

Adult↗
PubMedDate not supplied

[The evaluation of the efficacy and safety of using nalbuphine hydrochloride (Nubain) in patients in the early postoperative period].

Nubaine (N) was used in 92 patients operated on the lungs, heart and major vessels, abdominal organs. N at a dose of 0.3 mg/kg caused adequate analgesia in 62-85% of cases on days 1-3 after surgery; it is an effective analgesic among those used in patients with acute postoperative pain. The effect of N on circulation, respiration, gas exchange, metabolism, and hormonal status was studied. It has been shown that N is a safe agent which has no considerable effect on respiration, hemodynamics, blood gas composition, and metabolism. In patients at high risk analgesia with N caused no serious side effects.

Adult↗
PubMedDate not supplied

[The use of isolated ultrafiltration for the treatment of congestive circulatory failure].

Clinical and hemodynamic efficacy of isolated ultrafiltration (IUF) has been assessed during treatment of congestive coronary failure in 11 patients. Forty IUF sessions have been performed. High therapeutic efficacy of the technique has been established. It has been shown that during IUF a decrease in volumic heart overload is accompanied by an increase in heart performance and O2 consumption. In terminal stages of heart failure IUF may lead to an imbalance between higher oxygen consumption and the capacity of cardiorespiratory system to deliver O2, which might cause the onset of circulatory hypoxia in the course of IUF.

Adult↗
PubMedDate not supplied

[Lomir in the treatment of arterial hypertension after angioplastic surgery].

Isradipine (lomir) is a new highly selective arteriolar vasodilator of the dihydropyridine group, characterized by a slight cardiodepressive effect. The drug effect on the central hemodynamics and oxygen transport was studied after cardiovascular surgery. Arterial pressure and total peripheral vascular resistance were reliably reduced at the peak of the drug action, as was the left-ventricular stroke work and oxygen consumption. A tendency to increase of cardiac output and cardiac index was observed. Pulmonary vascular resistance and pressure in the pulmonary artery did not reliably change. The drug increased the intrapulmonary shunt.

Adult↗
PubMedDate not supplied

[Clinical use of sublingual buprenorphine hydrochloride for analgesia in the early postoperative period].

Analgesic efficacy and safety of sublingual buprenorphine was assessed in 31 patients aged 20 to 79 (20 women) in the postoperative period. Moderate and intensive pain during the first hours after the patients were brought from the operation room were indications for administering the drug. It was used in 26 patients after abdominal surgery (15 through the laparoscopic access and 11 through the laparotomic one) and 5 after other operations. A single dose of buprenorphine was 0.2 to 0.4 mg; if the effect was insufficient during an hour, the dose was repeated. Maximal daily dose was 1.8 mg. If analgesia was insufficient or null, other analgesics were injected. Clinical status was assessed by the intensity of the painful syndrome (according to 4 score scale) before analgesia and during 6 h after drug administration, by the duration of analgesia, daily dose, need in other analgesics, and parameters of systemic hemodynamics (arterial and partial pressure, heart rate, monitoring of HbO2 in capillary blood). The incidence, pattern, and severity of side effects were assessed. Adequate analgesia with buprenorphine was attained in 25 (81%) patients: in 7 (64%) with intensive pain and in 17 (89%) with moderate pain. The mean duration of analgesic effect of buprenorphine was 6.6 +/- 0.6 hours. Side effects (nausea and vomiting) were observed in 2 (6.6%) patients. The drug did not appreciably affect the hemodynamics, nor did it depress respiration. Hence, sublingual buprenorphine is an effective and safe analgesic for postoperative analgesia.

Administration, Sublingual↗
PubMedDate not supplied

[Extrarenal purification of blood in patients with multiple organ failure: results and prognostic criteria].

Acetate hemodialysis (HD) with an artificial kidney an continuous hemofiltration were used in the treatment of 49 patients with the multiple organ failure syndrome (MOFS) developing as a complication of aortocoronary and mammary-coronary shunting and heart valve replacement. MOFS involved failure of the function of 3.5 +/- 0.2 vital organs on average. Acute circulatory disorders were observed in 100% of patients, acute renal failure in 75.5%, and perioperative myocardial infarction in 34.7%. In 93.9% of patients HD and HF were combined with forced ventilation of the lungs, in 97.9% with catecholamine infusion, in 26.5% with assisted circulation, and in 57.1% with the Swan-Ganz monitoring of the central hemodynamics and of oxygen transporting function of circulation. Multiple-modality intensive care resulted in survival of 21 (42.8%) patients. The survival of patients with MOFS depended on the number of involved organs, method of extracorporeal detoxication, and monitoring of central hemodynamics and oxygen-transporting function of the blood. Acute renal failure, respiratory distress syndrome, and shock deteriorated the prognosis for patients with MOFS.

Acute Kidney Injury↗
PubMedDate not supplied

[Pharmacological correction of low cardiac output syndrome in hemofiltration].

Low cardiac output was corrected by catecholamines in the course of hemofiltration (HF) administered to 37 patients with multiple organ failure after surgery. Catecholamines (adrenaline hydrochloride, noradrenaline hydrotartrate, dopamine hydrochloride, and dobutamine hydrochloride) were used as monotherapy or in various combinations (two, three, or four drugs). Ninety percent of patients with low cardiac output subjected to HF were administered combined catecholamine therapy. Catecholamines provided the hemodynamic stability of HF in patients with low cardiac output. The frequency of noradrenaline administrations and its mean doses were reliably decreased in the course of HF, whereas the mean doses of adrenaline, dopamine, and dobutamine remained virtually the same.

Cardiac Output, Low↗
PubMedDate not supplied

[Methods of the use of ketorolac tromethamine in patients during the early postoperative period].

Analgesia with nonsteroid antiinflammatory drugs (NSAID) becomes a pressing problem today. One such drug is ketorolak tromethamine (KT), characterized by expressed analgesic activity comparable with that of opioid analgesics morphine or promedol. Our purpose was to assess KT efficacy in analgesia performed by different methods, including analgesia controlled by the patient (ACP) after surgery. In medium severe and strong pain KT was used in group I (n = 60) "as needed" in a dose of 30 mg up to 3-4 times a day, in group 2 (n = 12) by the ACP method, in group 3 (n = 16) KT was incessantly infused in a daily dose of up to 120 mg, and in group 4 (n = 11) KT was injected 3-4 times a day in a dose of 30 mg in combination with morphine ACP. The results indicate a high efficacy of KT: 83% after a single injection. Combined use of KT and promedol decreased the dose by 40-50%. Side effects were observed in 15% of patients: most often it was a sense of fever and sweating (in 4% of patients), nausea and vomiting (in 2%), insomnia (in 2%). ACP and planned injections in a daily dose of 90-120 mg is the optimal method of analgesia in patients after extensive surgical interventions.

Adolescent↗
PubMedDate not supplied

[Use of tramal for prevention of motor hyperactivity during r fiber bronchoscopy in patients in the postoperative period].

The efficacy of tramal for preventing motor hyperactivity is assessed in patients on spontaneous respiration after surgery during fiber bronchoscopy under a short-acting hypnotic ethomidate. Group 1 consisted of 22 patients to whom 100 mg of tramal was injected intravenously 30 min before fiber bronchoscopy, group 2 of 10 patients subjected to fiber bronchoscopy without preliminary tramal. Ethomidate caused manifest 20-45-sec myoclonus in the distal parts of the upper and lower limbs in 80% of cases. Pretreatment with tramal (100 mg intravenously) decreased the severity and incidence of myoclonus to 18.2%, did not affect gas exchange, and stabilized hemodynamics during fiber bronchoscopy.

Adolescent↗
PubMedDate not supplied

[Comparative evaluation of the use of nalbuphine and buprenorphine in prehospital care].

Analgesic efficacy of nalbufine and buprenorphine is assessed in 86 patients with painful syndrome caused by unstable angina and acute myocardial infarction and in 72 patients with locomotor injuries, to whom urgent care was rendered by ambulance teams before hospitalization. By the velocity and depth of analgesic effect nalbufine is not inferior to morphine, and in patients with unstable angina and myocardial infarction is even superior to it. High analgesic activity of buprenorphine is compatible to that of morphine, but the rate of analgesia development is insufficient for urgent care.

Aged↗