ÂñòóïОсновними напрямками консервативної терапії постраждалих із тяжкою черепно-мозковою трав-мою (ЧМТ) є респіраторна підтримка, корекція гемодинаміки та інфузійна терапія, діагностика та корекція внутрішньочерепної гіпертензії. Інфузійна терапія є одним з основних методів інтенсивної те-рапії при тяжкій черепно-мозковій травмі [6]. У пе-реважній більшості випадків пацієнти з пригнічен-ням свідомості до сопору та коми при надходженні у відділення інтенсивної терапії перебувають у ста-ні гіповолемії. У більшості пацієнтів з ізольованою ЧМТ артеріальний тиск (АТ) у перші години піс-ля травми, як правило, підвищений, незважаючи на існуючий дефіцит об'єму циркулюючої крові, що становить приблизно 25-30 % [2]. Саме тому Îðèãèíàëüíûå èññëåäîâàíèÿ Original ResearchesАдреси для листування з авторами: Крамарева Ольга Геннадіївна E-mail: doctorolchi@e-mail.ua Згржебловська Леся Володимирівна E-mail: lesyavz@ukr.net © Крамарева О.Г., Згржебловська Л.В., Малиш І.Р., 2016 © «Медицина невідкладних станів», 2016 © Заславський О.Ю., 2016 на цьому етапі лікування постраждалих із тяжкою ЧМТ інфузійна терапія розв'язує проблему віднов-лення об'єму циркулюючої крові та, як результат, забезпечує подальшу стабільність гемодинаміки [3]. Не менш важливим напрямком у лікуванні тяжкої ЧМТ є боротьба з набряком і набуханням головно-го мозку. Набряк мозку являє собою універсальну УДК 617. 51-001-036.882 DOI: 10.22141/222451-001-036.882 DOI: 10.22141/ -0586.4.75.2016
Introduction Infusion therapy is an integral part of intensive care patients with severe traumatic brain injury, addressing such important issues as to replenish the deficit blood volume in the first day of treatment, thereby providing hemodynamic stability and as a result, adequate perfusion of the damaged brain that is essential to avoid secondary ischemic damage. The most widely used at present as a basic solution for volemic support in patients with severe TBI, sodium chloride 0.9%. The main advantages of crystalloid solutions-low reactogenicity, no effect on renal function and immune system, and no significant effect on the hemostatic system. The main disadvantage is their rapid crystalloid redistribution of the vascular bed in the intercellular space, 75-80% of the drug after one or two hours after the infusion is found in the interstices. Significantly affect the degree of edema syndrome in these patients possibly by influencing the osmotic pressure, as well as through volemic support of solutions that are as close in their ionic composition to blood plasma. Any infusion liquid which contains a physiological buffer HCO3-, will always create dilution acidosis, such as infusion solution reduces the concentration of HCO3-throughout the extracellular space, while the partial pressure of CO2 (buffer acid) remains constant. When the extracellular fluid volume expands with a solution without bicarbonate, there is hyperhydration. Materials and Methods The study involved 60 patients with severe TBI, aged 18 to 65 years, with the level of consciousness 5-11 points for the Glasgow Coma Scale at admission and 12 hours after the initial resussitation and severity on a scale APACHE II-21 ± 2,7 points, which were divided into two groups: control and research. Victims in the control group performed volemic support solution NaCl 0,9%, by the conventional method. The group conducted research volemic support a balanced crystalloid solution. In both groups monitoring indicators increasing the thickness of solid tissue in the frontal area, the rear foot and the circumference over radiocarpal joint. Results As shown by our study in both groups, patients with severe traumatic brain injury occurred edema syndrome manifested the thickness of solid tissue of the periosteum to the line skin measured sonographic method in constant point on the rear foot and in the frontal area and the increase dynamics circumference of the radiocarpal joint. However, the group suffered from severe traumatic brain injury where volemic support held sodium chloride 0.9% growth increase in the thickness of the array of tissues in the studied areas significantly higher than in the group, which held volemic support a balanced crystalloid solution. In the control group edema syndrome observed during all ten days of treatment, whereas in the study group observed regression edema syndrome since 8 days of treatment. In general, the maximum increase in solid tissue increasing the thickness of the control group was observed in the frontal part of 10 days of trea...
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