Purpose of the study - to assess the level of cognitive disorders in gerontological patients of the urological profile, depending on the use of sedation in the intraoperative period. A prospective cohort study was performed on 60 gerontological patients diagnosed with BPH II-III stages. Two groups were formed: conscious patients and patients using sedation. Operation - bipolar transurethral enucleation of the prostate (BTUEP). Determination of the depth of sedation with propofol was carried out according to the Ramsey sedation scale in the BIS-monitoring mode. Registration of cognitive status was carried out on the basis of the Montreal Cognitive Function Scale and the Hamilton Depression Scale. The level of cognitive functions of patients in both study groups before surgical treatment indicated the presence of mild impairments according to the Montreal Cognitive Function Scale and the Hamilton Depression Scale. In the group using sedation in patients, a statistically significant decrease (p<0,005) in the score for three items of the Hamilton depression scale was determined in comparison with the group with preserved consciousness in patients: average insomnia (χ2=5,07), working capacity and activity (χ2=4,17), mental anxiety (χ2=4,43). Anesthesia, including spinal anesthesia and sedation controlled by BIS-monitoring, in gerontological patients during BTUEP provides a positive effect on the cognitive functions of patients and reduces the manifestations of depressive symptoms according to the results of clinical interviews using the Montreal Cognitive Assessment Scale and the Hamilton Depression Scale.

Цель исследования - оценка эффективности использования транексамовой кислоты в профилактике интраоперационных геморрагических осложнений у пациентов геронтологического профиля с биполярной трансуретральной резекцией простаты (БТУРП). Пациенты методом конвертов были разделены на две группы. Пациентам 1-й группы (контрольная, n =42) не проводили инфузию транексамовой кислоты. Пациентам 2-й группы (основная, n =42) прединтраоперационно проводили инфузию транексамовой кислоты в дозе 2 мг/кг. Всем пациентам была выполнена БТУРП на эндоскопическом оборудовании по стандартной методике под спинальной анестезией. Сравнение групп проводили по следующим критериям: объём интраоперационной кровопотери, уровень эритроцитов, тромбоцитов и гемоглобина, показатели гемостаза, тромбоэластография до и после операции. Установлено, что периоперационное применение транексамовой кислоты позволило достоверно уменьшить объем кровопотери при БТУРП. Метод тромбоэластографии за счет количественно-качественных характеристик способен выявить, почему достигается эффективность применения ингибитора фибринолиза. The aim of the study was to evaluate the effectiveness of the use of tranexamic acid in the prevention of intraoperative hemorrhagic complications in geriatric patients with bioply transurethral resection of the prostate (BTURP). The patients were divided into 2 groups by the envelope method. Patients of the first group (control group, n =42) did not receive tranexamic acid infusion. Patients of the second group (main group, n =42) received pre-intraoperative infusion of tranexamic acid at a dose of 2 mg/kg. All patients underwent BTURP on endoscopic equipment according to the standard technique under spinal anesthesia. The groups were compared according to the following criteria: the volume of intraoperative blood loss, the level of erythrocytes, platelets and hemoglobin, indicators of hemostasis, thromboelastography before and after surgery. It was established that the perioperative use of tranexamic acid allowed to significantly reduce the volume of blood loss in BTURP. The method of thromboelastography, due to quantitative and qualitative characteristics, is able to assess how the effectiveness of the use of a fibrinolysis inhibitor is achieved.

Preservation of reproductive function in women with uterine myoma, after surgery for its removal, is of great social significance. One of the pathological processes in the body of a woman who develops in this category of patients before and after surgery is anemia, which arises from pathological hemorrhage from a diseased organ. Therapy of anemia in this category of patients, in practice, is a difficult task, because against a background of recurrent menometrorrhagia, a vicious circle is formed, because of the severity of the patient's condition there are no conditions for conservative myomectomy, and the treatment of anemia, for a short period before the next bleeding - Ineffective. Within the framework of this work, the efficacy of iron carboxymethyltosate and tranexamic acid has been evaluated in organ-saving operations in gynecological practice. It has been established that the therapy of iron deficiency anemia in the preoperative period with iron carbomethyltosate in combination with intraoperative administration of fibrinolysis inhibitors allows avoiding transfusions of homologous donor blood.

Aim. To estimate immunobiochemical markers of the stress response during uterine artery embolization (UAE), and to assess the connection of the endocrine and immune response with pain severity Materials and мethods: 62 patients (ages 31 to 56) with a diagnosis of multiple symptomatic uterine body fibroids were made EMA, and analgesia was achieved by intravenous injection of narcotic and non-narcotic analgesics. Immunobiochemical profile of the stress reaction was investigated (IL-1, IL-6, TNFα, IL-4, IL-10, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH), cortisol, blood glucose) at four (I ONLY SEE 3-SMT) time points (baseline at 2 hours after occlusion of the uterine arteries, and 24 and 48 hours after surgery). Pain syndrome was assessed using a visual analogue scale (VAS) by means of hemodynamic profile.Results. The occlusion of the uterine arteries and ischemia myoma nodes lead to the development of the stress response, as anincrease in the serum concentration of pro-inflammatory (IL-1, IL-6, TNFα) and anti-inflammatory (IL-4, IL-10) cytokines, CRP, stress hormones (ACTH, cortisol) levels of glucose was observed. Pain of various intensity was recorded in all cases, and 18% of patients experienced marked pain (7 to 10 points on the VAS).Conclusion. The maximum increase in immunobiochemical stress markers coincides with the highest manifestations of pain. The necessity of optimization methods of analgesia when performing EMA with the use of immunobiochemical stress markers as a control reaction taking into account hemodynamic profile and VAS data was observed.

The definition of operational risk is key to determining the tactics of surgical treatment, anesthesia and preventive measures, as well as to prove the real severity of the patients' condition.

The aim of the study was to examine the effectiveness of renal replacement therapy (RRT) in the treatment of sepsis as an example of severe destructive forms of pancreatitis. During the course of treatment was a significant positive trend of laboratory parameters and course of the main pathological process in the group of patients who were conducted RRT together with basic therapy sessions. Ultrahemodiafiltration inclusion in complex intensive sepsis and septic shock therapy helps to stabilize hemodynamics faster and renounce the use of agonists as well as greatly reduces the laboratory hypoxia and endotoxemia presentations.

One of the major pathogenetic factors in developments lymphedima of the lower extremity is infringement haemo-and lymphocirculation. Considering presence of changes haemoand lymphocirculation in region of the amazed limb lymphostasis, and also deterioration detoxication possibilities of the given area, inclusion in complex treatment of patients with limb lymphoedema lymphostimulation techniques and efferent methods is represented justified to therapy.