Objective: to study whether reamberin and hydroxyethyl starch may be used to correct dyslipoproteinemia in gestosis. Subjects and methods: Twenty-two patients with early postoperative gestosis were examined. Group 1 patients (n=8) received the standard treatment. In addition to the standard treatment, Group 2 patients (n=7) were given 6% hydroxyethyl starch solution infusion at concentrations of 5-6 ml/kg body weight at a rate of 3 ml/ml. Just after hydroxyethyl starch infusion, Group 3 patients (n=7) were additionally injected 1.5% reamberin by the above scheme. The results of examinations were compared with the data obtained on examination of 8 puerperas after pregnancy and normal delivery (Group 4). The plasma concentration of triglycerides, total cholesterol (TC), and the cholesterols of high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very low-density lipoprotein (VLDL) were measured. Results and discussion. All the puerperas with gestosis were found to have hypertriglyceridemia and elevated levels of VLDL cholesterol with decreased concentrations of HDL cholesterol. The moderately higher levels of triglycerides and TC were also observed in patients without gestosis. Hydroxyethyl starch lowered the concentration of triglycerides by postpartum days 3—4. When hydroxyethyl starch was used in combination with reamberin, there was a significant reduction in the concentrations of triglycerides and VLDL and LDL cholesterols and a substantial rise in the level of HDL cholesterol. By postpartum days 3 and 4, Group 1 showed a considerable increase in the atherogenicity coefficient, which was significant as compared with the baseline level. Hydroxyethyl starch alone prevented an increase in the atherogenici-ty coefficient while its use in combination with reamberin significantly lowered this index and normalized it by postpartum days 3—4. Conclusion. Hydroxyethyl starch alone and in combination with reamberin shows an antiatherogenic effect in the treatment of gestosis in the early postpartum period, the action of hydroxyethyl starch in combination with reamberin was much more pronounced. Key words: gestosis, blood lipoproteins, atherogenicity coefficient, reamberin.

Цель исследования — изучить возможность коррекции дислипопротеинемии при гестозе с помощью реамберина и гид< роксиэтилкрахмала. Материал и методы. Обследовали 22 больных с гестозом в раннем послеродовом периоде. Боль< ные группы 1 (8 человек) получали стандартное лечение. Больным группы 2 (7 человек) дополнительно к стандартно< му лечению в 1<е сутки после родов проводили инфузию гидроксиэтилкрахмала в виде 6% раствора в количестве 5—6 мл/кг массы тела со скоростью 3 мл/мин. Больным группы 3 (7 человек) дополнительно вводили 1,5% реамберин, по вышеуказанной схеме непосредственно после инфузии гидроксиэтилкрахмала. Результаты обследования сопоставля< ли с данными, полученными при обследовании 8 родильниц после беременности и родов без патологии (4<я группа). В плазме крови определяли концентрацию триглицеридов, общего ХС и холестерина ЛПВП, ЛПНП и ЛПОНП. Резуль� таты и обсуждение. У всех родильниц с гестозами обнаружили гипертриглицеридемию и повышенный уровень ХС ЛПОНП при сниженной концентрации ХС ЛПВП. Умеренно повышенный уровень триглицеридов и общего ХС наблю< дали и у пациенток при отсутствии гестоза. Действие гидроксиэтилкрахмала снижало концентрацию триглицеридов к 3—4<м суткам послеродового периода. В присутствии комплекса гидроксиэтилкрахмала с реамберином наблюдали до< стоверное снижение концентрации триглицеридов, ХС ЛПОНП и ХС ЛПНП и существенный рост уровня ХС ЛПВП. К 3—4<м суткам после родов в группе 1 наблюдали значительный рост коэффициента атерогенности, достоверный по сравнению с исходным уровнем. Действие гидроксиэтилкрахмала предотвращало возрастание коэффициента атеро< генности, комплекс гидроксиэтилкрахмала с реамберином достоверно снижал величину этого показателя и нормализо< вал его к 3—4<м суткам после родов. Заключение. Гидроксиэтилкрахмал и комплекс гидроксиэтилкрахмала с реамбе< рином проявляют антиатерогенный эффект при лечении гестозов в раннем послеродовом периоде, причем действие комплекса гидроксиэтилкрахмала с реамберином более выражено. Ключевые слова: гестозы, липопротеиды крови, ко< эффициент атерогенности, реамберин. Objective: to study whether reamberin and hydroxyethyl starch may be used to correct dyslipoproteinemia in gestosis. Subjects and methods: Twenty

Objective: to define the specific features of the course of acute respiratory distress syndrome (ARDS) in puer-peras with a complicated postpartum period. Subjects and methods. Sixty-seven puerperas with ARDS were examined. Group 1 included 27 puerperas with postpartum ARDS; Group 2 comprised 10 puerperas who had been treated in an intensive care and died; Group 3 consisted of nonobstetric patients with ARDS of various genesis (a control group). Results. In obstetric patients, the baseline oxygenation index was significantly lower than that in the control group. However, Group 1 patients showed a rapid increase in PaO2/FiO2 on days 3—4 of treatment. In the control group, the changes occurred later — on days 5—6. The baseline alveolar-arterial oxygen difference was significantly higher in the obstetric patients than that in the controls. In Group 1, AaDpO2 drastically decreased on days 3—4, which took place in parallel with an increase in the oxygenation index. At the beginning of the study, pulmonary shunting was high in the group of survivors, deceased, and controls. In Group 1, the shunting decreased on days 3—4 whereas in the control group this index normalized later — only by days 6—7. In Group 1, compliance remained lower throughout the observation, but on day 7 there was a significant difference in this index between the deceased, survivors, and controls. Conclusion. Thus, more severe baseline pulmonary gas exchange abnormalities are observed in obstetric patients than in general surgical and traumatological patients; the oxygenation index, alveolar-arterial oxygen difference, and pulmonary shunting index more rapidly change in patients with severe obstetric disease in its favorable course than in general surgical and traumatological patients; throughout the observation, thoracopulmonary compliance was less in obstetric patients than in the controls. Key words: acute respiratory distress syndrome, puerperium.

Цель исследования. Изучить профиль водных секторов у родильниц, страдающих преэклампсией и определить целесообразность включения растворов коллоидов в программу инфузионной терапии у данной категории больQ ных. Материалы и методы. Обследовано 42 родильницы с преэклампсией средней и тяжелой степени, родоразQ решенных путем операции кесарева сечения. Все исследуемые родильницы разделены на 2 группы: группа 1 (n=22) — родильницы, получавшие в составе инфузионной терапии растворы хетаQгидроксиэтилированного крахQ мала (ГЭК); группа 2 (n=20) — родильницы, которым в состав инфузионной терапии не включены растворы ГЭК. Результаты. Выявлено, что в обеих группах в начале исследования отмечалось увеличение общей воды организQ ма, объемов внеклеточной и интерстициальной жидкости по сравнению с показателями нормы. На фоне проводиQ мой инфузионной терапии в 1Qй группе по сравнению со 2Qй группой отмечено: уменьшение общей воды организQ ма со 123,8% в 1Qе сутки исследования до 106,7% к 5Qм суткам; уменьшение интерстициальной гипергидратации со 141,5 до 110,1%; уменьшение внеклеточной жидкости со 139,7 до 108,6%. Во 2Qй группе к концу исследования соQ храняются значительные нарушения баланса водных секторов. Заключение. Включение хетаQГЭК (Стабизол) в состав инфузионной терапии больным с преэклампсией на 1—2Qе сутки после родоразрешения приводит к более быстрой нормализации нарушений водного баланса. Ключевые слова: преэклампсия, водноQсекторальные наруQ шения, инфузионная терапия. Objective: to study the profile of water sectors in puerperas with preeclampsia and to determine whether it is expediQ ent to include colloidal solutions into an infusion therapy program for this category of patients. Subjects and methods. FortyQtwo puerperas with moderate and severe preeclampsia, whose delivery was made by cesarean section, were examined. All the study puerperas were divided into 2 groups: 1) 22 puerperas who received hetaQhydroethylized starch (HES) solutions as part of infusion therapy; 2) 20 puerperas who did not. Results. At the beginning of the study, both groups had increased systemic water and higher extracellular and interstitial fluid volumes as compared with the norQ mal values. With infusion therapy, Group 1 exhibited a decrease in systemic water from 123.8% on day 1 of the study to 106.7% by day 5 and reductions in interstitial hyperhydration from 141.5 to 110.1% and in extracellular fluid from 139.7 to 108.6% as compared with Group 2. By the end of the study, significant impairments in the balance of water secQ tors preserved in Group 2. Conclusion. Inclusion of hetaQHES (Stabisole) into infusion therapy in patients with

Objective: to study the profile of water sectors in puerperas with preeclampsia and to determine whether it is expedient to include colloidal solutions into an infusion therapy program for this category of patients.Subjects and methods. Forty-two puerperas with moderate and severe preeclampsia, whose delivery was made by cesarean section, were examined. All the study puerperas were divided into 2 groups: 1) 22 puerperas who received heta-hydroethylized starch (HES) solutions as part of infusion therapy; 2) 20 puerperas who did not.Results. At the beginning of the study, both groups had increased systemic water and higher extracellular and interstitial fluid volumes as compared with the normal values. With infusion therapy, Group 1 exhibited a decrease in systemic water from 123.8% on day 1 of the study to 106.7% by day 5 and reductions in interstitial hyperhydration from 141.5 to 110.1% and in extracellular fluid from 139.7 to 108.6% as compared with Group 2. By the end of the study, significant impairments in the balance of water sectors preserved in Group 2.Conclusion. Inclusion of heta-HES (Stabisole) into infusion therapy in patients with preeclampsia on days 1—2 after delivery leads to a rapider normalization of impaired water balance.

Objective: to study the regularities of postpartum blood biochemical changes in varying severity gestosis. Subjects and methods: thirty-five females were examined in the puerperium. Blood was taken on postpartum days 1 and 3—4. The parameters of hepatic and renal function and lipid parameters were determined. Results. Higher levels of creatitine and urea and a more pronounced increase in the concentration of triglycerides and very low-density lipoproteins were observed in moderate gestosis than in normal physiological pregnancy. All the examinees were recorded to have low total protein levels within the first 24 hours after labor. Parturient women with moderate gestosis showed negative changes in protein concentrations throughout the study. Severe gestosis was characterized by multiple increases in bilirubin concentrations and, in case of death, these are also added by higher alanine aminotransferase and aspartate aminotransferase activities. Conclusion. Hypoproteinemia, hypocalcemia, elevated levels of triglycerides and very low-density lipoproteins and a simultaneous decrease in high-density lipoproteins are preserved in moderate gestosis in the early puerperium.

Objective: to study the regularities of postpartum blood biochemical changes in varying severity gestosis.Subjects and methods: thirty-five females were examined in the puerperium. Blood was taken on postpartum days 1 and 3—4. The parameters of hepatic and renal function and lipid parameters were determined.Results. Higher levels of creatitine and urea and a more pronounced increase in the concentration of triglycerides and very low-density lipoproteins were observed in moderate gestosis than in normal physiological pregnancy. All the examinees were recorded to have low total protein levels within the first 24 hours after labor. Parturient women with moderate gestosis showed negative changes in protein concentrations throughout the study. Severe gestosis was characterized by multiple increases in bilirubin concentrations and, in case of death, these are also added by higher alanine aminotransferase and aspartate aminotransferase activities.Conclusion. Hypoproteinemia, hypocalcemia, elevated levels of triglycerides and very low-density lipoproteins and a simultaneous decrease in high-density lipoproteins are preserved in moderate gestosis in the early puerperium.

The critical states occurring during pregnancy, labor, and early puerperium were analyzed. Seventy puerperas treated at intensive care units (ICU) were examined. The patients were divided into 5 groups: 1) those with preeclampsia (n = 15); 2) eclampsia (n = 22); 3) massive blood loss (n = 17); 4) pyoseptic complications (n = 10); 5) acute respiratory failure (n = 6). The APACHE II scale severity was 22 +/- 5.3 scores. The mean age of puerperas is 29.2 +/- 7.2 years. Total mortality was 14.3%. Parametric and non-parametric statistic methods were used to analyze the reasons for referral of the patients to ICU, their age composition, the association of an outcome to the time of their referral to ICU, the duration of stay there and at hospital, mortality, the time of controlled ventilation, the incidence of multiorgan failure. The common reasons for referral of the puerperas from maternity homes to ICU were eclampsia, preeclampsia, and massive blood loss. Acute respiratory distress syndrome (52.9%), encephalopathy (44.3%), coma (47.1%), and intestinal insufficiency (38.6%) were predominant in the pattern of multiorgan failure in intensive care obstetric patients. When emergencies occurred in puerperas, earlier referral from maternal homes to ICU caused a reduction in mortality from 33.% at referral on day 3 after their occurrence to 23.5% at referral on day 2, and to 11.5 at referral on day 1.

The effects of the solutions of hydroethyl starch (HES) and reamberin on hemodynamics, metabolism, and water-sector disorders were studied in patients with severe gestosis. The study covered 42 puerperas who were divided into 3 groups: 1) 10 patients with severe gestosis and normal acid-alkali balance (AAB); 2) 10 with severe gestosis and metabolic acidosis; 3) 22 pueperas with physiological single pregnancy (a control group). Group 1 patients were given infusions of 6% HES solution, 5-6 ml/kg; Group 2 received in addition to 6% HES solution in the above dose infusions of 1.5% reamberin solution, 5 ml/kg. In patients with severe gestosis, hemodynamic, water-sector, and metabolic monitoring on puerperal days 1-5 were found to identify changes in oxygen supply and consumption, water balance, and AAB. In Group 1 patients, HES infusion on days 1-2 after delivery decreased the content of systemic water, extracellular and interstitial fluid, increased oxygen supply; in Group 2, combined infusion therapy with GES and reamberin on puerperal days 1-2 led to an increase in oxygen supply and consumption and a reduction in interstitial hyperhydration and to normalization of AAB.

The water-sector misbalance was studied in 53 puerperants. The method of bio-impedance spectrometry was made use of to determine the total body water, extra-cellular- cellular- and interstitial water as well as the circulating blood volume. The levels of extra-cellular and interstitial water were found to be reliably higher in patients with moderate gestosis on day 1 after delivery versus healthy subjects. Stable trends towards normalizing the volumes of extra-cellular and interstitial water were registered by day 5. As for patients with sever gestosis, a reliably increasing total body water as well as extra-cellular and interstitial water persisted in them by day 5 after delivery versus the controls.

The paper contains the results of a study involving an inclined body positioning (45 degrees orthostasis) under the conditions of artificial pulmonary ventilation applied to patients with acute parenchymatous pulmonary lesion of different etiologies. The impact of the method produced on pulmonary gas exchange, hemodynamics, transport and consumption of oxygen as well as its efficiency and disadvantages, indications and contraindications are in the focus of attention.

The paper presents the results of a study of the impact of autoPEEP (positive end-expiratory pressure) on gas exchange in the lungs, their biomechanical characteristics, the transport and consumption of oxygen by inverting the inspiration/expiration ratio under the volume-controlled mechanical ventilation of the lung (VCMVL) in patients with acute parenchymatous lung lesion, as well as how to choose the optimum inspiration/expiration ratio in VCMVL by analyzing the pattern of total PEEP (the sum of positioning and autoPEEP) in this group of patients.

Signs of oxygen debt were studied in 28 patients with systemic inflammatory response and polyorgan failure. The parameters of oxygen debt, oxygen consumption, saturation of mixed venous blood, and heart rate can be used as criteria of therapy efficiency. The probability of a favorable outcome is increased if the mean 24-h oxygen debt is less than 30 ml/min x m2, oxygen consumption more than 158 ml/min x m2, mixed venous blood saturation less than 64%, and heart rate less than 114 stroke/min.

Mechanical ventilation of the lungs (MVL) with positive end expiratory pressure (PEEP) is difficult in patients with unilateral lung damage because of uneven distribution of volumes and pressures in the involved and intact lungs. Harmful effects are easier manifested under such conditions. Selective MVL with selective PEEP is widely used abroad for optimizing MVL, but this method is rather expensive and is not devoid of shortcomings. Our study carried out in 32 patients with unilateral lung involvement showed that traditional MVL with general PEEP can effectively (in 75% cases) regulate gaseous exchange and decrease its untoward effects if MVL is performed with the patient lying on the healthy side and not supine. MVL in patients with unilateral lung injury lying on the healthy side can be a simpler and cheaper alternative to selective MVL with selective PEEP.