No abstract

No abstract

Based on the analysis of literature and their own data the authors presented modern aspects of the etiology and pathogenesis of preeclampsia from the perspective of intra-abdominal hypertension syndrome. The data are collected from a large representative sample of 647 patients at various stages of gestation. It was shown that elevated levels of intra-abdominal pressure at 20-24 weeks of pregnancy in some cases preceded the development of preeclampsia. The level of intra-abdominal pressure, preceding the development of preeclampsia in pregnant women with obesity, was significantly higher than that of normal-weight patients (p <0.001). Along with the level of intra-abdominal pressure, the rate of its increase plays an important role in the preeclampsia development, with a greater degree than the absolute value of the intra-abdominal pressure. Pregnant women with a rapid and substantial increase in intra-abdominal pressure (more than 4 mm Hg for 2 weeks of gestation) are more likely to have complications of pregnancy than patients with an increase in intra-abdominal pressure less then 2 mm Hg in a given time interval (p <0.001), while the higher the increase in intra-abdominal pressure, at the earlier stages complication develops. The article also provides information about the dynamics of intra-abdominal pressure during pregnancy, relationships of intra-abdominal hypertension with parameters of utero-placental blood flow, renal hemodynamics, intestinal perfusion and permeability, level of endotoxemia in pregnant women. Based on the results of their own investigations, the authors suggest a model of preeclampsia development as a consequence of intra-abdominal hypertension syndrome.

No abstract

No abstract

No abstract

Синдром гиперстимуляции яичников (СГЯ) -системное заболевание, развивающееся в результате активации продукции вазоактивных медиаторов яичниками на фоне стимуляции суперовуляции. СГЯ характеризуется повышением проницаемости стенки капилляров, что приводит к выходу внутрисосудистой жидкости во внесосудистое пространство, ее накоплению в третьем пространстве и гемоконцентрации. Тяжелая степень СГЯ характеризуется риском развития тромбозов, нарушением функции печени, почек и возникновением респираторного дистресс-синдрома взрослых (РДСВ). В настоящих клинических рекомендациях представлены основные положения по прогнозу, диагностике, профилактике и интенсивной терапии СГЯ, включающие принципы лечения синдрома внутрибрюшной гипертензии (ВБГ).• Ключевые слова: синдром гиперстимуляции яичников, интенсивная терапия, профилактика СГЯ Для корреспонденции: Маршалов Дмитрий Васильевич -д-р мед. наук, доцент кафедры симуляционных технологий и неотложной медицины ФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России,

Introduction. Over the past decade, there has been increased attention to ketamine, which is associated with the identification of its new effects when using low (less than 1 mg/kg for bolus administration and less than 20 μg/kg/min for prolonged infusion) doses of the drug. In pregnant women, the pharmacokinetics of most drugs change, so the results of studies of low doses of ketamine obtained in other categories of patients may not be reproduced in the obstetric population. Objectives. Assessment of the clinical effects of various doses and regimens of ketamine administration, within the subanesthetic range, in the perioperative period of cesarean section. Material and Methods. Publications were searched in the electronic databases PubMed, MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) by four reviewers independently. The date of the last search query was December 31, 2019. Results. A total of 18 randomized controlled trials (RCTs) involving 2703 patients were included in the review. The results of this systematic review showed that the administration of low doses of ketamine (in the range of 0.15-0.5 mg/kg) in the perioperative period of cesarean section performed under spinal anesthesia can reduce the intensity of pain and the need for analgesics in the postoperative period. The use of low doses of ketamine under these conditions can also be useful to reduce the severity of chills, itching, and the prevention of postoperative nausea and vomiting, post-puncture headache, and postpartum depression. Doses of less than 0.5 mg/kg appear to be safer and comparatively effective in the prevention of the above complications. However, the small number and high heterogeneity of research does not allow us to draw unambiguous conclusions. The effectiveness of low doses of ketamine in the prevention of these complications with general anesthesia also remains unclear. Conclusion. Further research and a meta-analysis of the data are necessary to obtain final conclusions.