卷 18, 编号 6 (2012)

The treatment of patients with pancreatonecrosis continues to be one of the most actual issues of surgical gastroenterology in spite of that during the last decades certain significant successes in its therapy have been achieved. The progressive endogenic intoxication is both key pathogenic unit determining the severity of pathologic processes among patients of this category and the main cause of their deceases. The methods of prolonged replacing renal therapy are successfully applied to correct this condition in recent surgical practice. The study was organized to assess the effectiveness of methods of prolonged replacing renal therapy in patients with destructive pancreatitis. The sample of study included 154 patients aged from 25 to 94 years (median age was 41 years) including 39 females (25.3%) and 115 males (74.7%). The diagnosis was established on the basis of sum total of clinical laboratory data, ultrasonography, computerized axial tomography and the results of laparoscopy and/or laparotomy. At reception into hospital department the severity of patient condition was determined using APACHE II, SAPS II, Glasgow and Ransom scales. The velocity of glomerular filtration was calculated using MDRD 2 formula. The analysis was made every day of the indicators of acid-base balance of venous and arterial blood, oxygenation index, clinical and biochemical analysis of blood (hemoglobin, erythrocytes, leucocytes, hematocrit, thrombocytes, lactate, total protein, albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, α-amylase, urea, creatinine, fibrinogen, procalcitonin, electrolytes) and urine. The monitoring of vitally important functions (arterial blood pressure, electrocardiogram and O2 saturation) was applied daily. The statistical analysis considered the worst indicator of elapsed day. The syndrome of multiple organ failure was diagnosed in case of failure of functions of two and more system organs. To control the conditions of patients and to evaluate the effectiveness of applied therapy the technique of transpulmonic termo-dilution was used. The prolonged replacing renal therapy was applied using hemoprocessors "Prismaflex" within volume of veno-venous hemodiaphiltration with velocity of replacement more than 35 ml/h in post-dilution mode. The duration of procedure made 32.4 hours on average. After application of prolonged replacing renal therapy procedures the reliable positive dynamics of main clinical and biochemical indicators was observed. The reliable positive dynamics of all indicators of volumetric monitoring of hemodynamics is confirmed by improvement of myocardium function, systemic decrease of vascular resistance, reduction of vascular wall permeability and decrease of volume of extravascular fluid in lungs. The analysis of effectiveness of comprehensive treatment of patients with pancreatonecrosis demonstrated that in the group of 72 patients without application of extracorporeal hemocorrection the lethality consisted 13.9% while in the group with prolonged replacing renal therapy lethality consisted 9.5%. The study of application of prolonged replacing renal therapy in comprehensive treatment of patients with pancreatonecrosis and the indicators of clinical laboratory control allow considering the extracorporeal disintoxication as an effective technique. This method makes it possible not only to ameliorate clinical condition of patients but to decrease the indicators of lethality of patients with this sever pathology.

The article presents the results of study of character of variations of parameters of the peroxidation-antioxidant protection system. The experimental sample included 38 fertile women taking complex oral contraceptive pills against the background ща iatrogenic anovulation and 33 women with infertility against the background of anovulation conditioned by functional hyperprolactinemia. In fertile women taking contraceptive pills and in female patients with infertility conditioned by functional hyperprolactinemia the unilaterality ща changes in peroxidation - anti-oxidant protection system is established. The established qualitative changes of parameters of the peroxidation - anti-oxidant protection system are discussed in connection with high redox-capacity of glutathione buffer and poly-functional role of retinol as an anti-oxidant and pro-hormone.

The article deals with the results of studying the clinical characteristics and detection of changes of microelement composition of blood serum in children with juvenile rheumatoid joint inflammation residing in city of Chelyabinsk, the industrial metropolis of South Ural. The microelement composition was determined using the technique of atomic absorption spectrophotometry. The characteristic of clinical signs of juvenile rhematoid joint inflammation is given depending of its variant. The characteristics content of essential and toxic microelements in children with different variants of juvenile rheumatoid joint inflammation are established.

The implementation of algorithm of control of higher once-only and day doses in case of prescription of medications is supported by two significant conditions: 1) availability of officially registered higher once-only and day doses included into relevant reference book of medical information system; 2) differentiation of interpretation of values of dose size in drug formulation unit relative to its size and volume units of measurement in reference book of doses as compared with mentioned units of measurement in medication prescription. The algorithm universality makes it possible to apply it in the control of similar kind but concerning tentative day dose and equivalent course dose indicated in medical care standards.