РезюмеЦель исследования. Выявление клинических и параклинических признаков, учет которых у пациентов с преходящим неврологическим дефицитом в виде симптомов поражения затылочной доли, ствола или мозжечка повышает возможность диагностики транзиторной ишемии в вертебрально-базилярной системе. Материал и методы. Получены и проанализированы клинико-анамнестические и инструментальные данные 126 пациентов, госпитализированных в первичный сосудистый центр с диагнозом острого нарушения мозгового кровообращения в вертебрально-базилярной системе, в том числе те, у кого этот диагноз предполагался при поступлении и в дальнейшем был снят. Результаты и заключение. Выявлены клинические и параклинические признаки, значимые для дифференциальной диагностики транзиторных ишемических синдромов в вертебрально-базилярной системе, и синдромов, имитирующих острую ишемию в этой системе.Ключевые слова: транзиторная ишемическая атака, вертебрально-базилярная система, острое нарушение мозгового кровообращения, транзиторная ишемическая атака.
Сведения об авторах:Хасанов Ильдар Акрамович -
Aim: to study the state of lipid metabolism, hemostasis, inflammatory reaction and the potential for their correction after indirect revascularization in patients with distal steno-occlusion of arteries and critical ischemia of lower extremities (critical ILE).Material and methods. Changes in hemostasis and dynamics of its parameters during the complex surgical treatment in 131 patients with critical ILE and distal arterial stenoocclusion were analyzed. To achieve the targeted goals, patients were divided into the following groups: 34 patients had traditional care (control group); 32 patients had intravenous laser blood irradiation in combination with standard therapy (Group I); 32 patients had cytokine therapy with roncoleukin in combination with standard therapy (Group II); 33 patients had intravenous laser blood irradiation combined with cytokine therapy and standard therapy (Group III). Parameters of lipid metabolism were studied in dynamics (total cholesterol, very low density lipoproteins, high density lipoproteins, triglycerides); products of lipid peroxidation (malondialdehydes, conjugates, superoxide dismutase); inflammatory mediators (C-reactive protein, sialic acids, seromucoids, fibrinogen A, circulating immune complexes); hemostatic parameters (fibrinogen, fibrinolytic activity, fibrin degradation products, antithrombin III activity). Hemostatic indices were compared with identical parameters of 48 apparently healthy individuals (reference group).Results. On admission, patients with critical ILE and distal wall occlusion had sharp changes in their lipid metabolism, inflammatory reaction, and hemostasis. Conclusion. The inclusion of intravenous laser blood irradiation and cytokine therapy separately and in combination in a set of therapeutic measures led to the leveling of the studied homeostasis indicators. The best results were obtained in the group where patients had combined perioperative intravenous laser blood irradiation with cytokine therapy in indirect revascularization.
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