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Objective: to define the types and specific features of hemodynamic responses in miners with a service length of 10 years or more in the early posttraumatic period after severe mechanical injury.Subjects and methods. Noninvasive central hemody-namic studies using tetrapolar rheography were conducted in 55 injured miners with an underground service length of 10 years or more (a study group) and in 54 victims without underground service (a control group). Major hemodynamic parameters, such as mean blood pressure, heart rate, cardiac index, stroke index, vascular resistance index, were measured over time: on admission and on days 3, 5, and 7. The victims with severe concomitant injury were matched by age and the nature and severity of mechanical injuries.Results. The study has shown that in the early posttraumatic period from days 3 to 7, the miners with an underground service length of 10 years or more had hypodynamic, hyperdynamic, and normodynamic circulations in 37.2, 50.5, and 12.3%, respectively. Unlike the miners, the controls exhibited in this period a hyperdynamic type in 96.0% and only 4.0% were found to have a hypodynamic type.Conclusion. The miners and the victims without underground service were observed to have the similar hemodynamic responses to severe mechanical injuries within the first 24 hours posttraumatically. Beginning with the 3rd-to-7th day, the ratio of hemodynamic circulatory types changed in the miners, by increasing hypodynamic responses. This may be accounted for by the diminished reserve capacities of the circulatory system due to long-term exposure to poor industrial factors.

This study was undertaken to determine the general regularities of hemodynamic disorders in relation to the severity of brain damage for the subsequent development of pathogenetically warranted methods for their correction in the complex of intensive care for severe brain injury. Studies were made in 67 victims, by using neurophysiological studies (electroencephalography, studies of acoustical stem-evoked potentials and somatosensory stem-evoked potentials), computed tomography and magnetic resonance imaging. Central hemodynamics was studied by a Sirecust 1260 monitoring system using Swan-Ganz catheters and thermodilution. The overall condition of the victims was regarded as very bad. Loss of consciousness was 8-4 scores by the Glasgow coma scale. The studies have indicated that the victims in whose clinical picture the signs of compression of the cerebral hemispheres dominate over those of the latter’s contusion develop a hemodynamic reaction by the normodynamic type. The hyperdynamic type of hemodynamic disorder develops in cerebral hemispheric and diencephalic lesions with a parallel increase in oxygen transport and uptake; and in severe brain injury, lower brain stem damages are accompanied by hemodynamic disorder by the hypodynamic type with a reduction in oxygen transport and uptake.

Objective: to evaluate the states of microcirculation, cerebral perfusion intracranial pressures in patients with isolated severe brain injury (SBI) and to determine their possible relationships. Subjects and methods. 148 studies were performed in 16 victims with SBI. According to the outcome of brain traumatic disease, the patients were divided into two groups: 1) those who had a good outcome (n=8) and 2) those who had a fatal outcome (n=8). Microcirculation was examined by skin laser Doppler flowmetry using a LAKK-01 capillary blood flow laser analyzer (LAZMA Research-and-Production Association, Russian Federation). All the victims underwent surgical interventions to remove epi-, subdural, and intracerebral hematomas. A Codman subdural/intraparenchymatous intracranial pressure (ICD) sensor (Johnson & Johnson, United Kingdom) was intraoperatively inserted in the victims. Cerebral perfusion pressure (CPP) was calculated using the generally accepted formula: CPP = MBP (mean blood pressure) — ICD. ICD, CPP, and microcirculation were studied on postoperative days 1, 3, 5, and 7. Their values were recorded simultaneously. Ninety and 58 studies were conducted in the group of patients with good and fatal outcomes, respectively. Results. No correlation between the changes in MBP, ICD, and microcirculatory parameters suggested that the value of ICD was determined by the nature of brain damage and it was the leading and determining indicator in the diagnosis and treatment of secondary cerebral lesions. The amplitude of low-frequency fluctuations directly correlated with ICD, which indicated that they might be used to evaluate cerebral perfusion and impaired cerebral circulation indirectly in victims with severe brain injury. Conclusion. The laser Doppler flowmetric technique makes it possible not only to qualitatively, but also quantitatively determine changes in the tissue blood flow system in severe brain injury. With this technique, both the local and central mechanisms which are responsible for changes in tissue blood flow autoregulation suffer, with a preponderance of the latter mechanisms. Key words: microcirculation, intracranial pressure, cerebral perfusion pressure, severe brain injury.

Objective: to study the specific features of central hemodynamic function in the acute phase of severe thermal injury (STI) in miners who had a length of service of 10 years or more. Subjects and methods. A noninvasive study of central hemodynamics was conducted in 33 miners with severe thermal injury (a study group) and 34 patients without a length of underground work who had the same condition (a control group). Both groups were matched by age and the nature and severity of thermal injuries. Central hemodynamics was evaluated by the following parameters: mean arterial blood, heart rate, stroke index (SI), cardiac index (CI), cardiac output (CO), specific vascular peripheral resistance (SVPR) determined by Cubichek tetrapolar rheography. Results. The study indicated that on posttraumatic days 3—7, as compared with victims without a length of underground service, the miners had more pronounced central hemodynamic changes: decreases in CI, SI, and CO and an increase in SVPR. In the control group, from day 3, the hemodynamic changes were the following: increases in SI, SI, and CO and a decrease in SVPR. In the miners, the above features were attributable to the baseline central hemodynamic function. Conclusion. Thus, unlike the victims without a length of underground service, the miners with severe thermal injury develop more significant and prolonged central hemodynamic disorders. The detected differences during thermal injury are determined by the lowered reserve capacities of the cardiovascular system in miners due to the long-term exposure to poor working conditions, i. e. an underground service length of 10 years or more. Key words: thermal injury, miner, hemodynamics, type of circulation.

Objective: to study external respiration in patients with damage to the spinal cord of various genesis (compression myelopathy) at the lower cervical and thoracic levels depending on the degree of its conduction disturbances in order to select an analgesic mode as part of postoperative intensive care. Subjects and methods. Before and 1—3, and 5—7 days after surgery, 30 patients with spinal cord damage at the lower cervical and thoracic levels were examined, by determining external respiratory function (vital capacity (VC), forced VC (FVC), forced expiratory volume in 1 second (FEV1), Gaenslar index, average forced expiratory volume velocity (AFEVV25—75%); by performing cliniconeuro-logical and neurophysiological (electromyography (EMG), needle EMG, and somatosensory evoked potentials (SSEP)) studies; according to these indices, the gender- and age-matched patients were divided into 2 groups: 1) those who had complete spinal cord conduction disturbances and 2) those who had incomplete one. According to the postoperative analgesia mode, the following groups were identified: A) conventional systemic administration of opioid analgesics (promedol); B) prolonged epidural blockade with anecaine solution at the Th2—3 level. External respiration was studied after disconnecting the patient from a respirator before and after analgesia. A control group comprised 18 apparently healthy volunteers. Results. Before surgery, restrictive respiratory disorders were observed in Group 1 and they were absent in Group 2. In the postoperative period, all the patients were found to have mixed disorders that were most pronounced in Group 1. In Group A, the postoperative duration of artificial ventilation was significantly greater and it was 160.0±21.0 minutes whereas it was 90.0±25.0 minutes in Group 2 (p

Objective: to study pulmonary hemodynamics, cerebral oxygenation, intracranial and perfusion pressures in pulmonary complications in victims with severe brain injury (SBI). Subjects and materials. Retrospective studies were conducted in 47 victims with isolated brain injury. Of them, 30 patients made up a study group with poor prognosis (death, vegetative state, and severe disability). In the presence of negative clinical and neurological changes, they developed pneumonia, acute respiratory distress syndrome (ARDS) of different stages, ARDS concurrent with pneumonias. All the victims underwent invasive dynamic studies of pulmonary hemodynamics, intracranial pressure (ICP), by calculating cerebral perfusion pressure (CPP) and cerebral oxygenation (CO). Results. The studies have shown that pulmonary pressure, pulmonary vascular resistance, and pulmonary capillary wedge pressure increase and heart failure develops in the SBI victims with evolving pulmonary complications. Along with cardiopulomonary changes, ICP elevates and CPP and CO decrease. Conclusion. In traumatic brain lesions, it is very important to have information pertaining to the cardiopulmonary system and an estimation of ICP, CPP, and CO. Only comprehensive monitoring allows one to avoid the narrowness of evaluating the condition of a patient with SBI, to timely detect the development of secondary brain lesions, and to control the efficiency of intensive care. Key words: severe brain injury, pulmonary hemodynamics, intracranial and cerebral perfusion pressures, cerebral oxygenation.