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КЛИНИЧЕСКАЯ МЕДИЦИНА КАЗАХСТАНА №3,4 (22,23) 2011
One of the most informative integral indexes of environment influence on human health is health condition of exposed descendants. Depositing of "mutagenic load" and decreasing of individual heterozygosity leads to limitation of organism abilities to answer by adaptation and compensatory protection reactions on external influence, leading to development of the multifactorial diseases.
Aim of our research is conducting of complex epidemiological and clinical-laboratory monitoring among offspring of people who had been exposed in consequence of nuclear testing at Semipalatinsk proving ground, in order to identify risk groups of vascular pathology, induced by endothelial dysfunction, their early diagnosis and elaboration of rehabilitation programs. On the basis of creation of system of the individual forecasting of risks of development CVD for persons born from exposed parents and following generation, lies principle of determination of genetically conditioned predisposition. For every member of patient's family ill by IHD, including of his parents, brothers, sisters and children, created individual chart of CVD development risk on the basis of determination of genes-candidates of development and also in accordance with SCORE scale.
Performed evaluation of diagnostic and prognostic significance of determination of nitrogen oxide metabolites in blood and urine, and also condition of endothelial dysfunction at patients with high risk factors. Also we had conducted patient's life quality as prognostic factor with the help of sociologic research with evaluation of nosological, syndromal and individual aspect in CVD formation. Results of conducted work are bases in elaboration of program of revealing, monitoring, adherence of patients with CVD to the treatment and creation of recommendations for rehabilitation measures in ambulatory conditions.
PROTOCOL-GUIDED DIURETIC MANAGEMENT IN CARDIAC SURGERY INTENSIVE CARE UNIT: COMPARISON OF FUROSEMIDE BY CONTINUOUS INFUSION AND INTERMITTENT BOLUS
Tojiboyev R, Zhanturganov M, Albazarov A, Mendykulov S, Kulchukov R.
National Scientific Medical Research Center, Astana, Kazakhstan.
Objective: To evaluate the safety and relative effectiveness of two diuretic protocols in the intensive care unit (ICU).
Design: Prospective, randomized comparative study.
Patients: Fourty-five post cardiac surgery intensive care unit patients with fluid overload for which aggressive diuresis were intended.
Interventions: Enrolled patients were randomized to fluid management strategies combining fluid restriction and individually adjusted diuretic therapy by either continuous or bolus infusions of furosemide, titrated to achieve negative hourly fluid balance.
Measurements and main results: Cumulative intake minus output (primary endpoint); change in serum creatinine, and length of ICU and hospital stay (secondary endpoints). Diuresis by continous infusion protocol was more reliable, safe, and effective.
Conclusions: Protocol-guided diuretic management, with individualized titration of dosage to defined physiologic endpoints can be readily and safely implemented in the Cardiac Surgery intensive Care Unit. Continuous diuretic regimens appear more effective in achieving negative fluid balance. Larger studies with a randomized control arm are needed before these protocols can be recommended as routine practice.
ПЕРВЫЙ КЛИНИЧЕСКИЙ ОПЫТ ПРИМЕНЕНИЯ АЛЛОГЕННЫХ МОНОНУКЛЕАРНЫХ
СТВОЛОВЫХ КЛЕТОК ПРИ ОСТРОМ КОРОНАРНОМ СИНДРОМЕ
Джолдасбекова А.У., Абсеитова С.Р., Ешмуратов Б.К., Князова Г.Ж., Габдуллина Г.Н.
Национальный научный медицинский центр, Астана, Казахстан
Идея регенеративной терапии с использованием своих или чужих стволовых клеток, а также использование специфических факторов роста, которые стимулируют выход стволовых клеток в периферический кровоток, на сегодняшний день уже стала реальностью. Лечение ишемической болезни сердца (ИБС), инфаркта миокарда (ИМ), сердечной недостаточности прошло большой путь - от медикаментозной коррекции и хирургического вмешательства до регенерационной терапии стволовыми клетками (клеточной кардиомиопластики).
Целью данного исследования явилось изучение возможности применения мононуклеарных клеток костного мозга (МККМ) для улучшения состояния миокарда у больных с острым коронарным синдромом с систолической дисфункцией левого желудочка с EF<45%, направленных на реваскуляризацию миокарда.
Материалы и методы: 11 пациентам с острым коронарным синдромом (ОКС), поступившим экстренно в кардиологическое отделение ННМЦ, после проведения чрескожных коронар-
НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ
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