This study was undertaken to determine the general regularities of hemodynamic disorders in relation to the severity of brain damage for the subsequent development of pathogenetically warranted methods for their correction in the complex of intensive care for severe brain injury. Studies were made in 67 victims, by using neurophysiological studies (electroencephalography, studies of acoustical stem evoked potentials and somatosensory stem evoked potentials), computed tomography and magnetic resonance imaging. Central hemodynamics was studied by a Sirecust 1260 moni toring system using Swan Ganz catheters and thermodilution. The overall condition of the victims was regarded as very bad. Loss of consciousness was 8 4 scores by the Glasgow coma scale. The studies have indicated that the victims in whose clinical picture the signs of compression of the cerebral hemispheres dominate over those of the latter's contu sion develop a hemodynamic reaction by the normodynamic type. The hyperdynamic type of hemodynamic disorder develops in cerebral hemispheric and diencephalic lesions with a parallel increase in oxygen transport and uptake; and in severe brain injury, lower brain stem damages are accompanied by hemodynamic disorder by the hypodynamic type with a reduction in oxygen transport and uptake. Key words: severe brain injury; hyperdynamic, hypodynamic, and normodynamic types of circulation, brain injury.
The study focuses on breathing disorders in 119 patients with central nervous system (CNS) injuries that needed artificial lung ventilation for more than 1 day. 65% of patients had apneic, hypopneic and hyperpneic types of regulation of respiration (TRR). The normopneic type was the most favorable for survival, while the apneic one was unfavorable. It was established that a brain injury at hemispherical, diencephalic levels and low brain stem leads to the development of all TRR, while the apneic type occurs only in patients with the diffuse lesions of CNS and spinal injuries at the C <sub>1</sub>-C <sub>5</sub> level, with complications developing in the main disease. The hypopneic type occurs more often in patients with injuries of the spinal cord and cerebrovascular disease. The hyperpneic TRR does not occur in patients with spinal cord lesions at the C <sub>1</sub>-C <sub>5</sub> level. An algorithm for correction of respiratory disorders is proposed.
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