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Objective. To elaborate the intensive therapy tactic in patients, suffering ischemic cerebral insult (ICI) depending on changes in the systemic hemodynamics indices and the oxygen-transportation status.Маterials and methods. In 42 patients, suffering the ICI of middle severity, ageing 45 - 88 years old, the integrative monitoring of the neurological state severity, systemic hemodynamics indices and the oxygen-transportation status on background of targeted intensive therapy was conducted. Results. In the patients, suffering initial hypoxemia, a hypokinetic heart index (HI) - (2,0±0,1) l×min-1×m-2 and the lowered systemic delivery of oxygen (DO2) - (356±21) ml×min-1×m-2were revealed. Prophylactic oxygenation is needed if the value of the oxygen content in arterial blood (SаO2) exceeds 95% and DO2 is lesser than 520 ml×min-1×m-2. Aiming the achievement of eukinetic values of the HI, correction of vascular spasm and antihypertensive therapy was conducted, using alpha-adrenoblocking agent (urapydil) up to stabilization of the DO2 indices on the level of 520-600 ml×min-1×m-2. In hyperoxidal state a hyperkinetic HI - (3.6±0.1) l×min-1×m-2 and a raised DO2 - (699±14) ml×min-1×m-2 were revealed. Prophylactic oxygenation is not indicated if the value of the SаO2 index exceeds 95% and DO2 exceeds 600 ml×min-1×m-2. Aiming to achieve eukinetic values of HI it is mandatory to conduct antihypertensive therapy, using therapy with аlpha-beta-аdrenoblocking agent (labetalol). Conclusion. Targeted intensive therapy, oriented towards balance with general oxygenation of the organism tissues, normalizes the oxygen-transport homeostasis in shortest terms, what impacts the results of treatment in patients, suffering ICI, immediately.

klìnìčna hìrurgìâ/klìnìčna hìrurgìâ

Integrative monitoring of systemic hemodynamics and the oxygen-transport status and the choice of the intensive therapy tactics in patients, suffering an ischemic cerebral insult