Some aspects of systemic and cerebral hemodynamics with intrahospital transport in patients after clipping aneurysm of the brain
https://doi.org/10.24884/1682-6655-2018-17-1-45-49
Abstract
Goal. Evaluate cerebral hemodynamics in the patient after clipping of saccular aneurysms of the brain during nosocomial transportation, in the early postoperative period. Material and methods. A study was conducted in 86 patients divided into four groups, where the first group of patients was transported without additional sedation, the second - with additional sedation with solutions of morphine hydrochloride 1 % - 1.0 and a bit of diazepam 0.5 % - 2.0, in the third group, patients were sedated with propofol solution at a dose of 1 mg/kg in the 3rd group, and a solution of sodium thiopental at a dose of 4 mg/kg was administered in the 4th group for sedation prior to transport. Results. In the first group, a significant increase in the average velocity of blood flow through the cerebral vessels was found to be 23.5 % on the side of operational combat. The use of any of the three proposed schemes for additional sedation of a significant level of salary increase, but in the 3 rd and 4 th groups the blood pressure is statistically significantly lower. Conclusion. An increase in the indices of cerebral angiospasm during intra-hospital transportation was revealed. Justification of the use of additional sedation, transported with the use of artificial ventilation. It has been proved that during sedation and analgesia morphine and diazepammental shifts of systemic hemodynamics do not occur, however, the increase in the indices of cerebral angiospasm is significantly lower than in the first group of patients.
About the Authors
V. I. Gorbachev
Irkutsk State Medical Academy of Postgraduate Education - a branch of the federal budget of the budgetary educational institution of additional professional education «Russian Medical Academy of Continuing Vocational Education» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
A. V. Lokhov
Irkutsk State Medical Academy of Postgraduate Education - a branch of the federal budget of the budgetary educational institution of additional professional education «Russian Medical Academy of Continuing Vocational Education» of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
References
1. Агаджанян В. В., Шаталин А. В., Кравцов С. А. и др. Основные аспекты межгоспитальной транспортировки пациентов с политравмой, находящихся в критическом состоянии // Общая реаниматология. - 2006. - № 56. - С. 35-39 [Agadzhanyan VV, Shatalin AV, Kravtsov SA, Skopintsev DA, Vlasov SV Karlova OA. Basic Aspects of Interhospital Transportation of Critically Ill Patients with Polytrauma. General Reanimatology. 2006;5-6:35-39. (In Russ).] doi: 10.15360/1813-9779-2006-6-35-39.
2. Власов А. Ю., Щеголев А. В., Курсансеитов М. М. и др. Первый опыт транспортировки больного с тяжелой дыхательной недостаточностью в условиях экстракорпоральной мембранной оксигенации // Военно-медицинский журнал. - 2015. - № 4. - С. 22 [Vlasov AYu, Shchegolev AV, Kurmanseitov MM et al. The first experience of transporting a patient with severe respiratory failure in conditions of extracorporeal membrane oxygenation. Voenno-medicinskij zhurnal. 2015;4:22. (In Russ).]
3. Горбачев В. И., Ковалев В. В., Петров С. И. и др. Актуальные вопросы интенсивной терапии тяжелой черепно-мозговой травмы на догоспитальном этапе // Скорая медицинская помощь. - 2010. - № 2. - С. 18-23 [Gorbachev VI, Kovalev VV, Petrov SI et al. Questions of intensive therapy cerebral trauma at a prehospital stage. Emergency medical care. 2010;2:18-23. (In Russ).]
4. Горбачев В. И., Лохов А. В., Горбачева С. М. и др. Влияние внутригоспитальной транспортировки на церебральную гемодинамику у пациентов с сосудистой патологией головного мозга // Журнал неврологии и психиатрии им. С. С. Корсакова. - 2017. - № 117 (3). - С. 35-40. doi: 10.17116/jnevro20171173235-40 [Gorbachev VI, Lokhov AV, Gorbacheva SM et al. An effect of cerebral hemodynamics in patients with cerebrovascular disorders on the in-hospital transportation. S. S. Korsakov Journal of Neurology and Psychiatry. 2017;117(3):35-40. (In Russ).] doi: 10.17116/jnevro 20171173235-40.
5. Крылов В. В., Гусев С. А., Гусев А. С. Сосудистый спазм при разрыве аневризм головного мозга // Нейрохирургия. - 2000. - № 3. - С. 4-13 [Gusev SA, Gusev AS. A vascular spasm in rupture of brain aneurysms. The Russian Journal of Neurosurgery. 2000;3:4-13. (In Russ).].
6. Крылов В. В., Природов А. В. Факторы риска хирургического лечения аневризм средней мозговой артерии в остром периоде кровоизлияния // Нейрохирургия. - 2011. - № 1. - С. 31-41 [Krylov VV, Prirodov AV. Risk factors of surgical treatment for middle cerebral artery aneurysms in acute period of subarachnoid hemorrhage. The Russian Journal of Neurosurgery. 2011;1:31-41. (In Russ).]
7. Свистов Д. В. Неотложные состояния в нейрохирургии // Лекции по нейрохирургии; под ред. В. Е. Парфенова, Д. В. Свистова. - СПб.: Фолиант, 2004. - 336 с. [Svistov DV Neotlozhnye sostojanija v nejrohirurgii / Lekcii po nejrohirurgii; pod red. V.E. Parfenova, D.V. Svistova. - SPb. : OOO «Izdatel'stvo Foliant», 2004. - 336 p. (In Russ).]
8. Greenberg MS. Cerebral abscess. In: Handbook of neurosurgery. 6th ed. New York: Thieme. 2006. P. 217-223. doi: 10.1056/NEJMra1301635.
9. Hop JW, Rinkel GJ, Algra A et al. Case-fatality rates and functional outcome after subarachnoid hemorrhage. Stroke. 1997;28:660-664.
10. Jinkins RJ, Salvolini U, Scarabino T. Emergency Neuroradiology. Springer Berlin Heidelberg, 2006.
11. Lokhov A, Gorbachev V. The hospital transportation of patients with subarachnoid hemorrhage. European Stroke Journal, vol. 2, 1 suppl. p. 490.
12. Parmentier-Decrucq E, Poissy J, Favory R. et al. Adverse events during intrahospital transport of critically ill patients: incidence and risk factors. Ann Intensive Care. 2013;3:10. doi: 10.1186/2110-5820-3-10.
13. Raaymakers TW, Rinkel GJ, Limburg M et al. Mortality and morbidity of surgery for unruptured intracranial aneurysms. Stroke. 1998;29:1531-1538.
14. Schievink WI. Intracranial aneurysms. New England Journal of Medicine. 1997;336:28-40.
15. Shahlaie K, Boggan JE, Latchaw RE, et al. Posttraumatic vasospasm detected by continuous brain tissue oxygen monitoring: treatment with intraarterial verapamil and balloon angioplasty. Neurocritical care. 2009;10(1):61-69. doi: 10.1007/s12028-008-9138-z.
Review
For citations:
Gorbachev V.I., Lokhov A.V. Some aspects of systemic and cerebral hemodynamics with intrahospital transport in patients after clipping aneurysm of the brain. Regional blood circulation and microcirculation. 2018;17(1):45-49. (In Russ.) https://doi.org/10.24884/1682-6655-2018-17-1-45-49
Views:
688
Email this article 
