Проведено дослідження показників гемодинаміки, маркерів стресу та рівня болю у травматологічних хворих молодого віку, оперованих в умовах провідникової, провідникової із седацією (пропофол) та внутрішньовенної (пропофол, фентаніл) анестезії. Виявлено, що всі методи анестезії демонструють гемодинамічну стабільність, а провідникова анестезія із седацією та внутрішньовенна анестезія мають високий рівень антистресорної активності при операціях металоостеосинтезу Ключові слова: гемодинаміка, провідникова анестезія, загальна анестезія, травма кінцівок, маркери стресу, рівень болю Aim of research. Study of the hemodynamic state, evaluation of the pain level, stress markers and its correlations in traumatologic patients of the young age in conditions of the different kinds of anesthesia. Materials and methods. The research includes 102 patients: 72 men (70,6 %), 30 women (29,4 %) 18-45 years old (33,5±0,7 years), who underwent osteosynthesis because of traumatic injure of limbs. Patients were separated into 3 groups depending on the kind of anesthesia: I group (n=32)-underwent surgery in conditions of conduction anesthesia without sedation (average age 31,9±1,3 years), II group (n=44)-underwent surgery in conditions of conduction anesthesia with sedation (35,0±1,0 years), III group (n=26)-underwent surgery in conditions of intravenous anesthesia (32,7±1,4 years). Results of research. MAPB level at the surgery stages didn't exceed the output values in patients of all groups. As for HR it must be noticed its increase in patients of the 1 and II groups at the traumatic stage and at the end of surgery that can be explained by an effect of adrenaline added to the local anesthetic. The pain level was the lowest in the group of patients who underwent an anesthesia with sedation in first postsurgical day. Hyperglycemia was noticed in patients of the 1 group in first postsurgical day, and in patients of the III group-the tendency to hypercortisolemia. The cortisone-insulin ratio at the surgery stages was maximal in patients of the 1 group and in postsurgical day-in the III group. НОМА index at the surgery stages was within norm in patients of all groups and only in postsurgical day it had a tendency to increase in patients of the I group. Conclusions. Conduction anesthesia without sedation, conduction anesthesia with sedation (propofol) and intravenous anesthesia (propofol, fentanyl) demonstrate hemodynamic stability at osteosynthesis in young patients. The conduction anesthesia with sedation (propofol) and intravenous anesthesia (propofol, fentanyl) have a high level of anti-stress activity at osteosynthesis in young patients
1 Õàðê³âñüêà ìåäè÷íà àêàäåì³ÿ ï³ñëÿäèïëîìíî¿ îñâ³òè 2 Íàö³îíàëüíèé àåðîêîñì³÷íèé óí³âåðñèòåò ³ì. Í.ª. AEóêîâñüêîãî «Õàðê³âñüêèé àâ³àö³éíèé ³íñòèòóò» 3 ÄÓ « ²íñòèòóò ìåäè÷íî¿ ðàä³îëî㳿 ³ì. Ñ.Ï. Ãðèãîð'ºâà ÍÀÌÍÓ» Ñüîãîäí³ ³ñíóº áàãàòî ñïîñîá³â áîðîòüáè ç ï³ñëÿîïåðàö³éíèì áîëüîâèì ñèíäðîìîì. Ïðîòå, íåçâàaeàþ÷è íà øâèäê³ òåìïè ðîçâèòêó ìåäè÷íî¿ ãàëóç³, çà äàíèìè íàóêîâö³â 30-75% õâîðèõ ñòðàaeäຠâ³ä ï³ñëÿîïåðàö³éíîãî áîëþ ñåðåäíüî¿ òà âèðàaeåíî¿ ³íòåíñèâíîñò³. Çàâäÿêè ìàë³é âàðòîñò³, øâèäêîñò³ âèêîíàííÿ òà âèñîê³é êë³í³÷í³é åôåêòèâíîñò³, â³ò÷èçíÿí³ ³ ñâ³òîâ³ ã³íåêîëîãè â³ääàþòü ïåðåâàãó ìàëî³íâàçèâíèì îïåðàòèâíèì âòðó÷àííÿì, ñåðåä ÿêèõ íàéïîøèðåí³øèì º âèøêð³áàííÿ ïîðîaeíèíè ìàòêè (ÂÏÌ). Îäíàê ïèòàííÿ ï³ñëÿîïåðàö³éíîãî áîëþ, ñïðè÷èíåíîãî íèì, äîñ³ ëèøàºòüñÿ íåäîñòàòíüî âèâ÷åíèì. Íåâ³äîìà ³íòåíñèâí³ñòü áîëüîâîãî ñèíäðîìó, ÿêèé âèíèêຠó ï³ñëÿîïåðàö³éíîìó ïåð³îä³ ÂÏÌ, ÷àñîâ³ õàðàêòåðèñòèêè éîãî ðîçâèòêó, âïëèâ âèêîðèñòàíîãî ìåòîäà àíåñòå糿. Ìåòà: äîñë³äèòè âïëèâ ð³çíèõ êîìá³íàö³é òà äîçóâàíü ïðåïàðàò³â, ÿê³ âèêîðèñòîâóþòüñÿ äëÿ çàáåçïå÷åííÿ àíåñòåç³îëîã³÷íîãî ñóïðîâîäó ÂÏÌ, íà ³íòåíñèâí³ñòü òà ÷àñîâ³ õàðàêòåðèñòèêè ï³ñëÿîïåðàö³éíîãî áîëüîâîãî ñèíäðîìó. Ìàòåð³àëè ³ ìåòîäè: ó äîñë³äaeåí³ ïðèéíÿëè ó÷àñòü 128 ae³íîê, ÿêèì ç ä³àãíîñòè÷íîþ àáî ë³êóâàëüíîþ ìåòîþ â àìáóëàòîðíèõ óìîâàõ áóëî ïðîâåäåíî ÂÏÌ. Àíåñòåç³îëîã³÷íå çàáåçïå÷åííÿ ïðîâîäèëè ³ç âèêîðèñòàííÿì ð³çíèõ ìåäèêàìåíòîçíèõ êîìá³íàö³é òà ¿õ äîçóâàíü. ²íòåíñèâí³ñòü ï³ñëÿîïåðàö³éíîãî áîëüîâîãî ñèíäðîìó ðåºñòðóâàëàñÿ çà äîïîìîãîþ âèì³ðþâàííÿ òà àíàë³çó ïîêàçíèê³â â³òàëüíèõ ôóíêö³é, âèçíà÷åííÿ ð³âí³â êîðòèçîëó, ³íñóë³íó òà ãëþêîçè ñèðîâàòêè êðîâ³ ïàö³ºíòîê, ìàòåìàòè÷íîãî ðîçðàõóíêó êîðòèçîë-³íñóë³íîâîãî ³íäåêñó, îö³íêè ð³âíÿ áîëþ çà ÂÀØ òà îïèòóâàëüíèêàìè ÿêîñò³ aeèòòÿ, ÿê³ ì³ñòèëè ïèòàííÿ ùîäî ³íòåíñèâíîñò³ áîëüîâèõ â³ä÷óòò³â, ïðîâîäèëàñü ñòàòèñòè÷íà îáðîáêà îòðèìàíèõ äàíèõ. Ðåçóëüòàòè: âèÿâëåíî, ùî ïðè ïðîâåäåíí³ âèøêð³áàííÿ ïîðîaeíèíè ìàòêè â óìîâàõ êëàñè÷íî¿ âíóòð³øíüîâåííî¿ àíåñòå糿 òà ç äîäàòêîâèì çíåáîëåííÿì íåñòåðî¿äíèì ïðîòèçàïàëüíèì çàñîáîì (ÍÏÂÇ) ðîçâèòîê áîëüîâîãî ñèíäðîìó ìຠïðîãðåñèâíèé âåêòîð âïðîäîâae 3 ãîäèí ï³ñëÿ çàê³í÷åííÿ îïåðàòèâíîãî âòðó÷àííÿ. Çìåíøåííÿ äîçóâàíü ïðåïàðàò³â äëÿ íå³íãàëÿö³éíîãî íàðêîçó ïîäîâaeóº ðåãðåñèâíèé åòàï ïåðåá³ãó ï³ñëÿîïåðàö³éíîãî áîëüîâîãî ñèíäðîìó. Âèêîíàííÿ ³íòðàîïåðàö³éíî¿ àïë³êàö³éíî¿ àíåñòå糿 ðîç÷èíîì áóï³âàêà¿íó ìຠçíà÷íèé ïðåâåíòèâíèé àíàëãåòè÷íèé åôåêò òà ñêîðî÷óº ÷àñ ðîçâèòêó áîëüîâîãî ñèíäðîìó ìàêñèìóì äî 1 ãîäèíè. Òàêèé âèä àíàëãå糿 ï³ñëÿîïåðàö³éíîãî ïåð³îäó ÂÏÌ íàäຠïîçèòèâíèé ïñèõî-åìîö³éíèé òà ñîö³àëüíèé åôåêò äëÿ ïàö³ºíò³â â³ää³ëåíü àìáóëàòîðíî¿ ã³íåêîëî㳿. Âèÿâëåíî ³ñíóâàííÿ ïñèõîëîã³÷íîãî ôàêòîðó, ïîâ'ÿçàíîãî ç ìàéáóòí³ì ³íâàçèâíèì âòðó÷àííÿì òà ìîaeëèâèìè áîëüîâèìè â³ä÷óòòÿìè, ÿêèé çíèêຠâïðîäîâae ïåðøî¿ ãîäèíè ï³ñëÿîïåðàö³éíîãî ïåð³îäó ÂÏÌ. Êëþ÷îâ³ ñëîâà: ï³ñëÿîïåðàö³éíèé á³ëü, âèøêð³áàííÿ ïîðîaeíèíè ìàòêè, àìáóëàòîðíà àíåñòåç³îëîã³ÿ, àìáóëàòîðíà ã³íåêîëîã³ÿ
ÄÓ «²íñòèòóò ïàòîëî㳿 õðåáòà òà ñóãëîá³â ³ì. ïðîô. Ì.². Ñèòåíêà ÍÀÌÍ Óêðà¿íè» 2 Õàðê³âñüêà ìåäè÷íà àêàäåì³ÿ ï³ñëÿäèïëîìíî¿ îñâ³òè ÌÎÇ Óêðà¿íè Âñòóï. Ìóëüòèìîäàëüíà àíàëãåç³ÿ (ÌÌÀ) ó õ³ðóð㳿 õðåáòà ëèøå ïî÷èíຠâïðîâàäaeóâàòèñü ÷åðåç ïðîòèð³÷÷ÿ ùîäî âïëèâó ÍÏÇÏ íà ðîçâèòîê ñïîíä³ëîäåçó. Íåìຠºäèíî¿ äóìêè é ùîäî âïëèâó ìåòîäó àíåñòå糿 íà ï³ñëÿîïåðàö³éíèé á³ëü ïðè îïåðàö³ÿõ íà õðåáò³. Ìåòà äîñë³äaeåííÿ: îö³íèòè âïëèâ ìåòîäó àíåñòå糿 òà ðåaeèìó ï³ñëÿîïåðàö³éíîãî çíåáîëåííÿ ï³ñëÿ îïåðàòèâíèõ âòðó÷àíü íà ïîïåðåêîâîìó â³ää³ë³ õðåáòà.
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