What is hypovolemia (definition)
Hypovolemia is a condition characterized by a decrease in the total volume of blood and, as a rule, a violation of the ratio of its formed elements and plasma. There are normocythemic, oligocythemic and polycythemic hypovolemia.
The volume of blood in our body is quite static, changing only slightly under the influence of various factors.
However, in certain cases, the blood level can decrease quite strongly. This condition is called hypovolemia.
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There are many factors that can provoke its development, and their timely identification and subsequent correction play a very important role. Let's try to understand in more detail the reasons that can provoke hypovolemia, and also determine the symptoms of this pathological condition, and consider the methods used for its correction.
hypovolemia thyroid gland- a diagnosis that is made in cases where the body significantly reduces not only the level of fluid, but also the production of thyroid hormones. Usually observed after prolonged blood loss.
Causes (etiology) of hypovolemia
Normocythemic hypovolemia is a condition manifested by a decrease in the total blood volume while maintaining Ht within the normal range.
The most common causes of normocythemic hypovolemia: acute blood loss, shock conditions, vasodilatation collapse. In the last two cases, normocythemic hypovolemia develops as a result of the deposition of a large volume of blood in the venous (capacitive) vessels and a significant decrease in the BCC in connection with this.
Manifestations of normocythemic hypovolemia are determined by the nature of the cause that caused it (blood loss, shock, collapse), as well as the inclusion of compensation mechanisms aimed at eliminating acute hypoxia.
Oligocythemic hypovolemia
Oligocythemic hypovolemia is a condition characterized by a decrease in the total blood volume with a predominant decrease in the number of its formed elements. Ht is below normal.
The most common causes of oligocythemic hypovolemia.
Conditions after acute blood loss (at the stage when the transport of fluid from the tissues and the release of deposited blood into the vascular bed still do not eliminate hypovolemia, and the flow of blood cells from the organs of hematopoiesis does not eliminate the deficiency of red blood cells).
Erythropenia as a result of massive hemolysis of erythrocytes (for example, with burns of a large surface of the body, when hemolysis is combined with the loss of the body's liquid part of the blood due to plasmorrhagia) and suppression of erythropoiesis (for example, with aplastic or regenerative conditions).
Polycythemic hypovolemia
Polycythemic hypovolemia is a condition in which a decrease in the total volume of blood in the body is mainly due to a decrease in plasma volume. The Ht index in this condition is above the normal range.
The most common causes of polycythemic hypovolemia.
Conditions that cause increased body fluid loss: repeated vomiting (eg, in pregnant women or as a result of exogenous intoxication), prolonged diarrhea (eg, in violation of membrane digestion, intestinal toxic infections), polyuria (eg, in renal failure), increased and prolonged sweating ( for example, in hot climates or in hot workshops in production) and extensive skin burns (accompanied by plasmorrhagia).
Conditions that prevent sufficient fluid intake in the body (water "starvation"): lack of drinking water and the inability to drink water (for example, as a result of muscle spasm in tetanus or rabies).
Pathogenesis
Hypovolemia of any type leads to a compensatory hemodynamic response. The resulting deficiency of BCC causes a decrease in plasma volume and venous return, since fixation of the cardiac and pulmonary veins occurs and sympathetically mediated vasoconstriction occurs. The defense mechanism allows you to maintain blood circulation for brain and heart activity.
Pronounced hypovolemia reduces cardiac output and thus reduces systemic blood pressure. This reduces the blood supply to tissues and organs.
Blood pressure is normalized due to an increase in venous return, cardiac contractility and frequency of its contractions, as well as an increase in vascular resistance due to an increase in the secretion of renin by the kidneys and a sympathetic effect.
With a slight degree of decrease in BCC, activation of the sympathetic nervous system accompanied by slight tachycardia.
In severe hypovolemia, vasoconstriction is more pronounced due to the influence of the hormone angiotensin II and the activity of the sympathetic nervous system. This hormone helps to maintain blood pressure in the supine position, but hypotension (manifested by dizziness) may appear when the position changes.
Continued fluid loss in severe hypovolemia leads to severe hypotension even in the supine position. Shock may develop.
Symptoms (clinical picture) of hypovolemia
Manifestations of oligocythemic hypovolemia.
A decrease in the oxygen capacity of the blood (as a result of erythropenia).
Signs of hypoxia (for example, a decrease in the oxygen content in the blood, acidosis, a decrease in p02 of venous blood, etc.).
Disorders of organ tissue circulation and microcirculation of varying degrees, due, among other factors, to a decrease in BCC.
Manifestations of polycythemic hypovolemia.
Violations of organ tissue microcirculation due to hypovolemia and polycythemia.
Increased blood viscosity, aggregation of blood cells in microvessels of organs and tissues, and disseminated microthrombosis.
Signs of an underlying pathology causing polycythemic hypovolemia (for example, shock, diabetes insipidus, renal failure, burn disease, etc.).
With normocythemic hypovolemia, symptoms appear depending on the amount of blood lost:
Mild hypovolemia is observed with an average degree of blood loss (from 11 to 20% of BCC).
At the same time, there is a decrease in blood pressure by 10%, moderate tachycardia, slightly increased pulse and respiration.
The skin becomes pale, the limbs become cold, there is dizziness, a feeling of weakness, dry mouth and nausea. Possible inhibited reaction, fainting and a sharp decline in strength.
Hypovolemia of moderate severity is observed with a large degree of blood loss (from 21 to 40% of the BCC). Blood pressure drops to 90 mm Hg. Art., the pulse quickens, breathing is arrhythmic, superficial and rapid.
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The presence of cold sticky sweat, cyanosis of the nasolabial triangle and lips, pointed nose, progressive pallor, drowsiness and yawning as a sign of lack of oxygen are noted.
There may be obscuration of consciousness, apathy, increased thirst, vomiting is possible, the appearance of a bluish coloration of the skin and a decrease in the amount of urine.
Severe hypovolemia is observed with massive blood loss (up to 70% of BCC). Arterial pressure in this case does not exceed 60 mm Hg, the threadlike pulse reaches 150 beats/min.
There is a sharp tachycardia, complete apathy, confusion or lack of consciousness, delirium and deathly pallor, anuria. The features are sharpened, the eyes become dull and sunken, convulsions are possible.
Breathing becomes periodic (Cheyne-Stokes type).
Hypovolaemia in newborns
One of the causes of shock in children may be a relative or absolute lack of fluid in the vascular system.
The main clinical symptoms of hypovolemic shock: decreased blood pressure, rapid pulse, pallor skin, cold sweat, cold upper and lower extremities, oliguria.
However, not all patients have severe hypotension and oliguria, and this must be taken into account when diagnosing shock.
When shock occurs due to hypovolemia, urgent measures should be taken, since it subsequently causes severe metabolic disorders, the functions of the central nervous system and almost all internal organs.
Treatment begins with intravenous administration of fresh whole blood at the rate of 5-30 ml / kg or blood plasma in the same amounts or blood substitutes (polyglucin, polyvinylpyrrolidone, etc.).
If these solutions are not available, then intravenously administered not a large number of hypertonic sodium chloride solution (10-25 ml), then Ringer's solution with sodium lactate and 5% glucose solution is immediately injected at the rate of 10-30 ml / kg of this mixture of solutions (1: 1).
In the future, the type and amount of transfused fluids depend on the course of the disease, clinical and laboratory data. Repeated transfusions of the above fluids are acceptable.
Assign parenterally vasopressors: adrenaline, norepinephrine in the age dosage; drinking plenty of water, to which one teaspoon is added table salt, half a teaspoon of baking soda and three teaspoons granulated sugar(for 250 ml of water).
The patient is given complete rest. oxygen therapy. Warming. Intensive treatment of the underlying cause of shock.
In the treatment of dehydration in children with transfusions of various saline solutions, complications may occur, the main of which are hypokalemia, alkalosis, acidosis, hypocalcemia, hypoxemia, and water intoxication.
It is necessary to ensure that fresh air is constantly supplied to the ward, and any cooling of a sick child is unacceptable.
Diagnosis of hypovolemia
For diagnostics it is used:
- clinical picture.
- In rare cases, the determination of plasma osmolality and biochemical analysis urine.
- Hypovolaemia is suspected in patients at risk, most often with a history of insufficient fluid intake, excessive fluid loss, diuretics, or kidney and adrenal disease.
Diagnosis is based on symptoms. If the cause is clear and correctable, laboratory research optional; in other cases, determine the content of electrolytes in the serum, urea nitrogen and creatinine. When metabolic alkalosis is detected, the content of C1 in the urine is also determined.
Invasive diagnostic procedures sometimes have to be performed on patients in whom even a small additional volume increase can be dangerous.
The following should be kept in mind when interpreting urinary electrolyte levels and osmolality.
- With hypovolemia healthy kidneys retain the ability to retain Na.
- With a combination of hypovolemia with metabolic alkalosis, the concentration of Na in the urine may increase, since a large amount of HCO3 enters the urine and excretion of Na is necessary to maintain its electrical neutrality. In such cases, a more reliable indicator of volume reduction is the concentration of C1 in the urine.
Hypervolemia causes, symptoms, treatment. Directory of diseases symptoms of hypervolemia Hypervolemia
Hypervolemia
Hypervolemia is an increase in the size of the circulating blood and plasma.
Root causes of origin
This position will be able to spin because:
Signs of pervolemia
Typical severe manifestations of hypervolemia: weight gain, damage to urination and separation of the trace, flabby eunuchoidism, slightly hypertensive eunuchoidism, dry skin, dry mouth, shortness of breath, impotence, headaches, shortness of breath.
Normocythemic hypervolemia is revealed by an equivalent increase in the size of the purest parts and a weak fraction of the size of the circulating blood. The hematocrit (Ht) is about the generally accepted standards. Oligocythemic hypervolemia is characterized by an increase in the total blood volume. The Ht indicator is below the generally accepted standards.
Polycythemic hypervolemia is also revealed by an increase in the total size of the blood, an increase in the number of its purest parts. Ht is above conventional standards.
Diagnostics
Diagnosis of hypervolemia is based on the effects of a selective survey of the patient, laboratory blood tests (to determine the proportion of red blood cells and plasma), urine analysis.
Disease options
The following variants of hypervolemia are distinguished:
Patient's efforts
When signs specific to hypervolemia appear, you need to proceed to a hematologist or anesthesiologist.
Treatment of hypervolemia
Treatment is determined by the reason that caused hypervolemia. When the situation is caused by a hitch of sodium in the body, you need to limit the intake of sodium with food. On the recommendation of the doctor, use diuretics, hormones to improve the condition of the kidneys, substances to maintain mental function.
Weights
The increase in hypervolemia threatens with lightweight edema. Hypervolemia is very dangerous in the perspective of full parenteral administration. medical preparations, intravenous or probing feeding. Evidence is shown that hypervolemia has a toxic effect on the functions of internal organizations and contributes to an increase in the mortality of seriously ill patients.
Pharmacoprophylaxis of hypervolemia
Pharmacoprophylaxis of hypervolemia is based on the appropriate treatment of diseases of the cardiovascular system. To reduce the risk of hypervolemia, forego excess water intake and limit the use of food that retains the element (sharp foods, fast food, seasoning (includes baking soda), hard cheese, etc.).
Hypervolemia
Hypervolemia
The main reasons for downtime hypervolemia
Polycythemia
For hypervolemia
Treatment is symptomatic
Hypervolemia
Hypervolemia- conditions characterized by an increase in total blood volume and usually a change in Ht. There are normocythemic, oligocythemic and polycythemic hypervolemia.
What causes Hypervolemia:
Normocythemic hypervolemia(simple) - a state manifested by an equivalent increase in the volume of shaped elements and the liquid part of the bcc. Ht remains within the normal range.
The main reasons for downtime hypervolemia: transfusion of a large volume of blood, acute hypoxic conditions, accompanied by the release of blood from its depot, as well as significant physical activity, leading to hypoxia.
Oligocythemic hypervolemia
Oligocythemic hypervolemia(hydremia, hemodilution) - a condition characterized by an increase in the total volume of blood due to an increase in its liquid part. The Ht index is below the norm.
The main causes of oligocythemic hypervolemia.
- Excessive intake of fluid in the body with pathological thirst (for example, in patients with diabetes) and the introduction of a large amount of plasma substitutes or blood plasma into the vascular bed.
- Decreased excretion of fluid from the body as a result of insufficiency of the excretory function of the kidneys (for example, in renal failure), hyperproduction of ADH, hyperosmolality of blood plasma.
Polycythemic hypervolemia- a condition manifested by an increase in the total volume of blood due to a predominant increase in the number of its formed elements. In this regard, Ht exceeds the upper limit of normal.
The main causes of polycythemic hypervolemia.
- Polycythemia (erythrocytosis) is a group of pathological conditions characterized by an increase in the number of red blood cells (regardless of the number of white blood cells, platelets).
- Polycythemia vera (polycythemia vera, Wakez's disease) is a chronic leukemia with a lesion at the level of the myelopoiesis progenitor cell with an unlimited proliferation of this cell characteristic of a tumor, retaining the ability to differentiate into four germs, mainly red. Erythremia is accompanied by significant erythrocytosis and, as a consequence, elevated Ht.
- Chronic hypoxia of any type (hemic, respiratory, circulatory, tissue, etc.).
Polycythemia at the same time, it reflects the hyperregenerative state of the bone marrow, which is accompanied by increased proliferation of blood cells, mainly erythrocytes, and their release into the vascular bed.
Polycythemic hypervolemia is detected in chronic circulatory failure, alveolar hypoventilation, a decrease in the oxygen capacity of the blood and the efficiency of biological oxidation, and in exogenous (normal and hypobaric) hypoxia.
Hypervolemia symptoms:
For hypervolemia characterized by an increase in cardiac output and an increase in blood pressure.
- An increase in cardiac output is the result of compensatory hyperfunction of the heart due to an increase in blood volume. However, with decompensation of the heart and the development of its insufficiency, cardiac output, as a rule, decreases.
- The increase in blood pressure is mainly due to an increase in cardiac output, as well as BCC and resistance vascular tone.
- Polycythemia vera is also characterized by a significant increase in blood viscosity, aggregation and agglutination of blood cells, disseminated thrombosis, and microcirculation disorders.
Hypervolemia Treatment:
Treatment is symptomatic
Which doctors should you contact if you have Hypervolemia:
Anesthesiologist
Hypervolemia: causes of the disease, main symptoms, treatment and prevention
A pathological condition caused by an increase in the volume of circulating blood and plasma, which can be caused by various reasons.
Causes
An increase in circulating blood volume can be observed for various reasons. Hypervolemia develops against the background of excessive fluid intake, edema, fluid retention in the vascular bed, transfusion of significant volumes of blood, acute hypoxic conditions, lesions of the cardiovascular system, impaired renal function and respiratory system, heavy physical activity.
Symptoms
This pathological condition is manifested by an increase in body weight, impaired urination and sweating, edematous syndrome, hypertensive syndrome, dry skin, dry mouth, shortness of breath, weakness, headaches, shortness of breath.
Normocythemic hypervolemia is manifested by an equivalent increase in the volume of formed elements and the liquid part of the volume of circulating blood. In this condition, the hematocrit is within the normal range. Oligocythemic hypervolemia is characterized by an increase in total blood volume, while the hematocrit in such patients is below normal.
Polycythemic hypervolemia is also manifested by an increase in the total blood volume, an increase in the number of its formed elements and is characterized by hematocrit values above normal.
Diagnostics
Diagnosis of hypervolemia occurs against the background of a general examination of the patient, the collection of an anamnesis of the disease and a thorough analysis of the patient's complaints.
During a physical examination, it is necessary to establish by palpation whether the patient has peripheral edema.
In addition, the patient without fail means carrying out general and biochemical blood tests, as well as general analysis urine.
Treatment
The result of the treatment of this pathological condition largely depends on the willingness of the patient to perform all medical recommendations, as well as follow the diet prescribed by the specialist. Also, for the duration of treatment, such patients are advised to limit the amount of fluid consumed.
Treatment is aimed at removing excess fluid from the patient's body. The treatment regimen for the disease is selected taking into account the reasons that caused this pathological condition.
If the condition is due to sodium retention in the body, it is necessary to limit the intake of sodium from food.
As prescribed by the doctor, use diuretics, hormones to improve the condition of the kidneys, drugs to maintain cardiac function.
Prevention
Prevention of hypervolemia is based on the timely treatment of diseases of the cardiovascular and urinary systems. To reduce the risk of hypervolemia, you will need to abandon excessive fluid intake and limit the intake of foods containing sodium, as well as smoked meats and preservatives.
Hypovolemia of the thyroid gland - what is it
Hypovolemia of the thyroid gland (hypovolemia) is a decrease in the organ of the endocrine system, an extremely rare pathology diagnosed by endocrinologists. The disease is characterized by a change in the size of a vital organ. The thyroid gland decreases in size.
Change in size leads to weak production of hormones. Insufficient levels of trace elements cause pathological diseases.
The thyroid gland has a fixed size. Data on normal volumes of the thyroid gland can be found in medical sources, endocrinology textbooks.
Normal size of the thyroid gland (healthy organ):
- weight - from 20 to 40 grams;
- height - 20 mm;
- width - 40 mm;
- thickness - 20 mm;
- the volume of the isthmus connecting the lobes of the thyroid gland is 20 mm (4 * 5).
The size and volume of the thyroid gland correlate with the weight of the human body. In some periods, there is a change in volumes that is not associated with diseases.
These are the following periods:
When these processes are completed, the thyroid gland returns to normal.
Medical data suggests several reasons for the development of pathology:
- hypoplasia;
- atrophy;
- damage to the pituitary gland;
- age.
The most common cause is hypoplasia. A reduced thyroid gland cannot produce the norm of hormonal elements. Their deficiency provokes diseases.
Underdevelopment of the thyroid gland in a child often occurs due to disorders in the mother's body. In women with iodine deficiency and untreated pathologies that entered the period of gestation, there is a decrease in hormone production. The child does not receive necessary trace elements. hypoplasia begins to develop.
It is dangerous for the baby with the consequences:
- mental retardation;
- deviations from the physical norms of maturation and growth;
- neurological disorders.
Pathology of a hypovolemic nature is explained by a decrease in the normal amount of fluid in the cells of thyroid tissue formations. The rate of hormone synthesis decreases. Usually, the detection of the disease is preceded by profuse blood loss and a violation of the functionality of the thyroid gland.
Causes of hypovolemia:
- dehydration of the body;
- big blood loss;
- loss of plasma on the background of extensive burns;
- osmotic diuresis;
- diabetes insipidus;
- bleeding;
- vomit;
- diarrhea.
There are three types of hypovolemia:
- normocythemic;
- oligocythemic;
- polycythemic.
The first type is a reaction to blood loss, misuse of medical devices, severe infectious intoxication, shock injuries, excess histamine intake.
The oligocythemic type is diagnosed with blood loss at the stage of untreated hypovolemia during the period of blood output, but before it enters new cells. This species is the result of plasmorrhagia, erythropoiesis.
The polycythemic form is a consequence of dehydration. It can occur after repeated vomiting processes (toxicosis), prolonged diarrhea and polyuria, increased sweating. Such a course develops with spasmodic contractions of the muscles: tetanus, rabies. Fluid loss can cause hypovolemic shock.
Symptoms of pathology
Hypovolemia occurs against the background of a number of unpleasant changes that worsen the state of human health:
For children, pathology is dangerous due to the appearance of an incorrect reaction to stimuli, a lag in development compared to peers.
Symptoms of the disease depend on the quantitative indicator of blood loss:
Treatment of hypovolemia
The main task of the therapeutic complex is to increase hormones. Doctors seek to normalize the production of hormones necessary for correct operation organism. The specialist will conduct diagnostics, laboratory tests. A nutritionist will select the right food.
The endocrinologist will select medications, determine the dose and prescribe a course of treatment. The course involves the duration of medication. Often it will continue throughout life.
Medical advances cannot find a development or technology capable of returning lost thyroid cells. Neither the pharmaceutical industry nor medical professionals have the means to restore gland tissue. Only blocking the development of pathology is possible.
Endocrinologists seek to stop the development of diseases of the gland, which lead to a decrease in its size.
Hypervolemia: types, causes, symptoms and treatment
Hypervolemia - the main symptoms:
- Headache
- mood swings
- Lower back pain
- Weakness
- Dizziness
- Cardiopalmus
- Dyspnea
- Fainting
- Heartache
- Dry mouth
- Dry skin
- Insomnia
- High blood pressure
- Hard breath
- Decreased performance
- Obesity
- General swelling
- Weight loss
- Accumulation of fluid in the abdominal cavity
- Urination disorder
Hypervolemia is a violation of the circulating blood volume by blood vessels in the direction of increase. In medicine, this condition is divided into simple, oligocythemic and polycythemic. They differ depending on the level of hematocrit. There is also hypervolemia in the pulmonary circulation - this is an isolated type of hypervolemia, which is also called pulmonary hypertension.
Etiology
The reasons for the development of this condition differ depending on the type of pathology.
In a simple view, they are as follows:
- transfusion of too much blood - this process is called transfusion;
- too hot climate;
- lack of oxygen in the body.
In the first case, this happens because too much blood enters the body from the outside. In the other three cases, because blood enters the vessels from the "reserves" of the body itself.
Oligocythemic appearance has the following etiology of development:
- The period of bearing a baby is the norm, since an increased volume of blood contributes to normal metabolism between the fetus and the woman.
- Increased volume of fluid entering the body. The first is excessive drinking. Also, fluid can flow from the tissues into the vessels. In other words, when there is a violation of the water balance in the body.
- Violation of the fluid withdrawal process. Occurs with renal failure, sodium retention in the body.
The polycythemic appearance is manifested for such reasons:
- Chronic lack of oxygen in the body. Occurs in chronic diseases of the upper respiratory tract, heart defects. It can also happen during a long stay in a mountainous area.
- Blood diseases are neoplasms of a different nature, congenital pathologies in which many cells are formed in the blood.
One or another type of pathology is determined during diagnostic procedures.
Hypervolemia of the small circle has its own etiology of development:
- chronic bronchitis, emphysema, silicosis and other pathologies;
- increased pressure in the airways - occurs during improper ventilation of the lungs and with a strong cough;
- poor work of the left ventricle with arrhythmia and heart attack;
- chronic drug poisoning;
- apnea that occurs at night.
What is apnea
In some cases, it is not possible to determine the cause of the development of the disease.
Classification
As mentioned earlier, there are three types of hypervolemia:
- Simple. This type of pathology is extremely rare. It differs in that the volume of circulating blood increases proportionally. That is, the number of cells and the liquid part remains within acceptable limits.
- Oligocythemic. This species is characterized by an increase in only the liquid part of the blood, and the hematocrit level decreases. This condition is called hydremia.
- Polycythemic. Occurs with an increase in the cellular component of the blood and the level of hematocrit.
Since the etiology of each species is different, the method of diagnosis and treatment methods are also selected on an individual basis.
It should be noted that a violation of the circulating blood volume can also occur in the direction of decrease: this condition is called hypovolemia. It also has three main types.
Symptoms
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If the symptoms are short-term, and the changes do not exceed the norm, then the body can independently cope with such a situation. In the case when hypervolemia was caused by a chronic or acute disease, the treatment is selected to eliminate it.
In general, this pathology is manifested by various non-specific signs, namely:
- increased blood pressure;
- rapid heart rate;
- obesity;
- swelling;
- dyspnea;
- dryness of the oral mucosa and skin;
- violation of urination;
- hard breath;
- weakness;
- pain in the head and in the lumbar region;
- decrease in performance.
Separately, it should be noted the signs of such a state of the respiratory system. At the initial stage of development, the clinical picture is absent, which leads to a belated diagnosis.
In general, as the pathological process worsens, the clinical picture will be supplemented by the following signs:
- mood swings;
- a sharp decrease in body weight;
- insomnia;
- dizziness;
- fainting physical activity;
- heartache;
- accumulation of fluid in the abdominal cavity;
- pain in the liver;
- disruption of the heart.
Since the symptoms of this disease manifest themselves in different ways, it is better to consult a doctor when they appear.
Diagnostics
To date, it is difficult to diagnose such a condition, because there are no methods for determining the circulating blood volume. Be sure to set the level of hematocrit. It is he who can indicate the type of developing pathology and its cause.
Held initial inspection at the doctor's appointment, which includes:
- visual examination of the patient;
- medical history taking.
Additionally, the following procedures are prescribed:
- general and detailed biochemical blood test;
- general urine analysis;
- determination of hematocrit;
- determination of blood group and Rh factor.
Pulmonary pathology is diagnosed through instrumental diagnostics:
- electrocardiogram - will indicate the presence of a heart attack, arrhythmia and much more;
- x-ray - will show dilated vessels, especially in the later stages of the disease;
- computed tomography - if it is carried out with the help of contrast, then the result can say more than an x-ray;
- ultrasound examination of the heart - will show congenital pathologies, the speed and volume of blood flow in the vessels.
How is an ECG performed?
Diagnosis of this condition is carried out in a complex. A thorough examination makes it possible to accurately diagnose, and on the basis of this, prescribe an effective treatment.
When hypervolemia is detected, treatment is carried out in two directions:
- Etiotropic, that is, eliminate the cause of the development of the pathological process. Therapy of kidney diseases, operations of heart defects, therapy of thyroid diseases, the fight against blood neoplasms are carried out. Also treat chronic and acute illnesses lungs and strictly control the volume of intravenous infusions.
- Symptomatic - helps to cope with the signs of the disease. For example, high blood pressure is reduced by antihypertensive drugs. Diuretics are also prescribed. Angina pectoris, which was caused by this particular pathology, is treated with antianginal drugs, but only after a decrease in cardiac load.
Treatment is carried out in a hospital. Most often, the pathological process is eliminated through conservative measures, but it is not excluded. surgical intervention followed by a period of rehabilitation.
In addition, traditional medicine in the treatment of such a disease can also be used.
The doctor may prescribe:
- Hirudotherapy - the use of leeches. They will help reduce blood volume. In addition, its viscosity and the number of formed elements will decrease. Thus, the hematocrit level is normalized.
- herbal diuretics. These are dill, fennel, viburnum, horsetail and many others.
But it must be taken into account that diuretics will not help with severe kidney disease. In this situation, hemodialysis and hemofiltration should be performed.
Possible Complications
This pathological process can cause the development of serious complications if therapy is not started in a timely manner:
- pulmonary edema with an increase in blood volume;
- toxic effect on the work of internal organs.
In seriously ill patients, this disease increases the risk of death.
Prevention
Preventive measures of this pathology are as follows:
- diagnosis and timely treatment of cardiovascular pathologies;
- a decrease in the amount of fluid consumed, especially its amount should be monitored in children, the elderly and hypertensive patients, because fluid stagnation affects the functioning of many organs and systems;
- proper nutrition;
- exclusion of excessive alcohol consumption.
It is also worth giving up bad habits and excessive physical activity.
Hypovolemia - what is it? Causes, symptoms and treatment of the disease
Thyroid hypovolemia is a rare diagnosis in endocrinology. This is a disease characterized by a decrease in blood volume, which is a pathological condition.
Hypovolemia, by definition, is a discrepancy between the volume of blood needed by the body, a decrease in the level of fluid in the thyroid tissue and the amount of hormones synthesized by it.
Blood problems are dangerous with serious consequences.
Among the many diseases of the blood, its pathologies associated with plasma volume are also common.
The essence of hypovolemia
The thyroid gland has importance in the activities of the body. With its participation, metabolism takes place, iodine is produced, bone tissue grows. Under the influence of various factors, thyroid diseases are becoming more common.
Hypovolemia is a disease that occurs due to large blood loss and disruption of the thyroid gland.
Its dimensions correspond to the parameters of 20-40-20 mm, but the organ depends on body weight and changes in volume at certain stages of life: it increases during pregnancy, puberty and decreases upon reaching old age.
Causes of hypovolemia
The thyroid gland does not necessarily decrease due to age.
Causes of hypovolemia:
- diseases of the pituitary gland;
- underdevelopment of the thyroid gland (hypoplasia);
- organ atrophy;
- vasodilatory collapse (vasodilation that does not correspond to the mass of circulating blood);
- high vascular permeability;
- increase in hydrostatic pressure in arterioles;
- increased venous pressure;
- insufficient intake of fluid in the body;
- prolonged significant blood loss;
- blood loss from burns;
- states of shock.
The most common cause of hypovolemia is hypoplasia: the gland synthesizes less hormones, which causes disturbances in the body.
It happens that with a decrease in blood volume, the content of thyroid hormones decreases. This type of hypovolemia is accompanied by weight gain, deterioration of hair, dry skin, menstrual irregularities among women. If left untreated, there is a risk of infertility.
A fetus that receives less thyroid hormones and iodine during the period of development will suffer from hypovolemia of the thyroid gland, a congenital disease is not excluded.
A baby predisposed to the disease is characterized by increased body weight, it is characterized by lethargy and calmness, slow weight gain, and preservation of infant jaundice.
Hormone deficiency will affect the development of the fetus, both mentally and physically. Therefore, monitoring and timely treatment of the disease is necessary.
Autoimmune thyroiditis is a disease on the basis of which hypovolemia is possible; this manifests itself as a cessation of thyroid hormone production and is used as the main indicator in diagnosing the extent of the disease.
The prerequisites for the development of the disease are: chronic stress, physical overwork, poor quality products nutrition (the presence of carcinogens), iodine deficiency, unfavorable ecology, genetic features.
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Symptoms
Signs of hypovolemia are not identified with the disease in everyone, patients explain it with fatigue and normal condition. The disease has similar symptoms to dehydration.
Symptoms of hypovolemia are:
- swelling of the face and body;
- low temperature and pressure;
- tachycardia;
- decrease in diuresis;
- instability of the nervous system;
- apathy, lethargy, fainting;
- disorder of the digestive system;
- metabolic disease;
- dry skin;
- low hemoglobin;
- voice change;
- compaction in the thyroid gland;
- weakened immunity and frequent illnesses;
- decreased sexual desire, infertility;
- slowdown in child development.
Additional signs of hypovolemia can be: cyanosis of the mucous membranes and skin, cramps of the limbs, dizziness, weak pulse.
Kinds
Depending on the proportionality of the elements and plasma, they speak of several types of disease.
Hypovolemia is acute, which occurs in the process of blood loss, and chronic, which develops after the provision of medical assistance to the victim.
Degrees of hypovolemia
The highest degree of manifestation of hypovolemia is replaced by hypovolemic shock. Distinguish the following degrees disease exacerbation:
- Easy. Blood loss is about 15% of the total volume. There is a drop in blood pressure, rapid pulse, tachycardia, pale skin, insufficient blood supply to the extremities, dry mouth, weakness.
- Average. Blood loss approaches 40%, the condition is severe, blood pressure is up to 90 mm, the pulse is rapid, breathing is irregular, sweating, cyanosis, pallor, drowsiness, and the need for high-quality fresh air are pronounced. Sometimes - vomiting, fainting, a decrease in the amount of urine.
- Heavy. Blood loss is up to 70%, pressure is up to 60 mm, the pulse is poorly audible, tachycardia is pronounced, impaired consciousness, convulsions, and heavy breathing. The condition is unsafe for life, can lead to death.
Diagnosis
Diagnostics is based on data clinical picture. The list of studies is assigned depending on the characteristics of the pathology that led to a drop in the volume of blood circulating in the body.
The basis of diagnosis involves:
- determination of hematocrit;
- blood chemistry;
- general blood analysis;
- determination of the blood group.
If hypovolemia provoked by internal bleeding is confirmed, diagnostic laparoscopy is performed.
Treatment
In the diagnosis of hypovolemia, hormone therapy in combination with diet and iodine intake to stabilize the condition. Patients will have a long-term treatment, and if it is impossible to improve thyroid function, it persists throughout life.
The primary goal of treating hypovolemia is to restore the norm of the circulating blood volume with proteins, electrolytes, and donated blood. To do this, produce an infusion of dextrose solutions, saline, polyionic solutions. If there is no sustainable effect, apply intravenous administration plasma substitutes (dextran, gelatin, hydroxyethyl starch).
With a non-critical loss of fluid, oral medication is prescribed, and with a severe degree of hypovolemia, intravenous. Usually, the patient is given an isotonic saline solution appropriate for shock and hypotension.
Further measures to restore blood volume are carried out independently by preparing sugar-salt solutions, providing access to fresh air and maintaining an acceptable temperature in the room.
To stop the subsequent destruction of the organ, it is necessary to concentrate treatment on autoimmune thyroiditis, the hypothalamic-pituitary system, and iodine deficiency.
If there is a source of bleeding, surgical hemostasis is performed. If a state of shock has become the cause of insufficient blood volume, anti-shock therapy is carried out. In case of respiratory failure, the patient is provided with artificial ventilation of the lungs.
Therapy problems
In the course of treatment, patients are forced to face problems such as the consequences of drug therapy, and improvement is accompanied by the development of other diseases or side effects.
An equally difficult circumstance is the short-term effect of drugs of considerable cost, as well as the peculiarity of the effect of the drug: the drug taken orally violates the microflora of the gastrointestinal mucosa.
Regarding the patient's condition, due to instability hormonal background his mood does not allow him to relax in fully to enjoy life.
Consequences
Severe hypovolemia in the absence of medical intervention turns into hypovolemic shock, which poses a threat to life.
A decrease in blood volume entails a disruption in the activity of internal organs, which, in the presence of diseases, complicates the patient's condition and treatment.
Prevention
To prevent hypovolemia, it is necessary to control the condition of the heart, blood vessels, and kidneys. Properly rendered assistance in case of profuse blood loss is of great importance. It must be borne in mind that incorrect actions can lead to the death of the patient.
As a preventive measure, one can indicate the prevention of injuries, the timely detection of intestinal diseases, compliance with the water regime and control of water intake when the environment changes, the use of diuretics only on the recommendation of a doctor.
Hypervolemia is a condition in which there is too much fluid in the blood. Despite the need for a large amount of fluid for the health of the body, its excess can seriously harm.
As a rule, hypervolemia is a consequence of disorders in the body. Also mild degree hypervolemia can develop as a result of eating foods high in salt or changes in hormonal levels. If there are no other health problems, mild hypervolemia goes away on its own.
With timely diagnosis, hypervolemia is successfully treated, but in order to prevent its recurrence, it is necessary to deal with the underlying disease that caused it.
Causes
Very often, hypervolemia is caused by excess sodium (salt) in the body, as the body accumulates fluid to restore the water-salt balance. In addition to dysregulation of sodium and water, certain medications or medical interventions can cause hypervolemia.
Congestive heart failure
This condition is characterized by a violation of the pumping function of the heart, in which the heart is not able to deliver blood to all organs of the body. At the same time, kidney function decreases, which leads to fluid retention in the body. In chronic heart failure, hypervolemia occurs quite often, and in some it does not disappear completely even during treatment.
kidney failure
The kidneys play a role in regulating the amount of sodium and water, therefore, with kidney failure, the risk of hypervolemia increases. In severe stages of renal failure in patients in the departments intensive care, hypervolemia occurs quite often. The doctors of these patients are very careful about the amount of fluid in their body, since hypervolemia can lead to congestive heart failure, impaired wound healing, and disorders of the digestive system. There is also evidence indicating the possibility of developing sleep apnea due to hypervolemia, which developed against the background of heart failure or terminal stage kidney disease.
Cirrhosis of the liver
Hypervolemia can develop due to a violation of the functions of the liver: the storage of nutrients and the filtration of toxins. Liver problems most often cause fluid retention in the abdominal region(the so-called ascites - fluid in the abdominal cavity, which develops as a complication of cirrhosis of the liver) and limbs.
Intravenous infusions
When dehydration or oral flooding is not possible, intravenous infusions save lives. As a rule, solutions for intravenous infusion contain sodium and water to maintain fluid and electrolyte balance. But too much IV fluid can lead to hypervolemia, especially with other comorbidities. In one study, a large amount of intravenous fluid in patients after surgery was shown to cause hypervolemia and an increase in the risk of postoperative mortality. The study examined the data of patients after surgical treatment of esophageal cancer.
Hormones
Premenstrual syndrome (PMS) and pregnancy can cause fluid and salt retention in the body. Often this is manifested by moderate swelling, puffiness and discomfort. Pregnant women who notice puffiness or pastosity should consult a doctor, as this may indicate high blood pressure.
Medications
Drugs that affect hormones can also cause hypervolemia through water and salt retention in the body. This contraceptives, hormone replacement therapy, some antidepressants, drugs that affect blood pressure, and non-steroidal anti-inflammatory drugs (NSAIDs).
Eating a lot of salt
A large amount of salt leads to water retention in the body. It is unlikely that hypervolemia will occur after one salty meal, but be aware that large amounts of salt can be very dangerous, especially for children, older people and those who have health problems. Many people with congestive heart failure, liver disease, or kidney disease must eat a salt-restricted diet to avoid or minimize the risk of hypervolemia.
Symptoms
Symptoms of hypervolemia depend on the area of fluid accumulation and the presence of other health problems. The most frequent of them:
Sudden or unexplained weight gain
Bloating (often with liver disease)
Shortness of breath caused by fluid in the lungs
Diagnostics
The doctor can identify hypervolemia when examining for edema. He may also hear wheezing in the lungs with fluid. May need laboratory analysis blood and urine for sodium. Since hypervolemia is often the result of other diseases, the doctor may prescribe additional extended studies to identify diseases of the heart, kidneys and liver.
Treatment
There are several approaches to the treatment of hypervolemia. One of them is diuretics. These are diuretics that increase the amount of urine. It is also important to treat the underlying disease, since diuretics are ineffective in severe renal impairment. In this case, dialysis and hemofiltration procedures should be performed.
In case of diseases of the heart, liver or kidneys that cause hypervolemia, you need to follow a low-salt diet, in case of heart failure, limit fluid intake. Your doctor will help you calculate the individual amounts of salt and liquid.
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Hypervolemia- a condition in which the volume of blood circulating in the vascular bed increases. There are simple, oligocythemic and polycythemic hypervolemia, which differ in hematocrit.
Isolated hypervolemia the small circle of blood circulation is called.
The experience accumulated over the entire period of the development of medicine has established certain limits for various laboratory parameters, beyond which it is regarded as a disease. The same framework defines the amount of blood at one time inside our vessels.
The norm for an adult is such a condition when a total amount of blood circulates inside the vessels of the whole organism, equal by weight from 6 to 8 percent of body weight or 1/13 of it. That is, a person weighing 75 kilograms contains about 5 liters of blood at a time inside the vessels.
Causes and types of hypervolemia
An increase in the volume of blood circulating in the vascular bed at a time is called hypervolemia. This condition is not an independent disease and is regarded as a syndrome - a complex of manifestations (symptoms) of a disease. Blood is represented by two main components: plasma (the liquid part) and formed elements (the totality of all blood cells). The ratio of the total volume of blood cells to the total blood volume is called hematocrit and normally it is 36% - 48%, that is, in one liter of blood from 360 to 480 milliliters of cells, and the rest is plasma.
Depending on the change in the number, hypervolemia is divided into three types:
- Simple hypervolemia;
- Oligocythemic hypervolemia;
- Polycythemic hypervolemia.
blood in polycythemic hypervolemia
Each of the listed types of hypervolemia has its own separate cause, which is the reason for the different approaches to treatment and diagnosis.
Simple hypervolemia
Simple hypervolemia - such a state when there is a proportional increase in the amount of circulating blood, that is, the ratio of all cells and the liquid part in a unit volume of blood remains within normal values. This condition is observed quite rarely, its causes are:
- (transfusion) of excessive amounts of blood;
- Heat environment;
- Acute lack of oxygen (hypoxia).
In the first case, hypervolemia develops as a result of the intake of an excessive amount of blood that is normal in terms of hematocrit from the outside, in the rest, the same blood corresponding to the norm enters the vascular bed from the depot (reserves) of one's own body.
Oligocythemic hypervolemia
In a situation oligocythemic hypervolemia an increase in the amount of circulating blood is associated with an increase in the amount of the liquid component of the blood, while the hematocrit becomes below normal. This condition is called hydremia, it leads to:
- Pregnancy - hydremia during childbearing is the norm and contributes to an adequate metabolism between the body of the mother and child;
- Increasing the flow of fluid into the vascular bed (excessive drinking, transfusion of plasma and its substitutes, fluid transfer during edema from tissues to vessels);
- Decreased fluid excretion from the body (acute and chronic kidney failure, increased formation of antidiuretic hormone, sodium retention).
Polycythemic hypervolemia
Polycythemic hypervolemia - develops in cases where an increase in blood volume in the vascular bed is achieved due to the cellular component, which is accompanied by an increase in hematocrit. Lead to this state:
- Chronic hypoxia: heart defects, chronic lung diseases with insufficient lung function, prolonged stay in high altitude conditions, etc.;
- Blood diseases are malignant and benign tumors, hereditary anomalies accompanied by advanced education blood cells.
Clinical manifestations, diagnosis and treatment of hypervolemia
Signs of hypervolemia and medical tactics largely depend on its type and the causes that caused this condition.
In the case of physiological and functional causes that do not go beyond the adaptive abilities of our body, the manifestations are short-term and without any special medical manipulations the body will restore its normal state on its own.
If hypervolemia is caused by any chronic or acute illness therapeutic tactics are aimed primarily at the disease itself, causing an increase in the amount of intravascular blood, and also, if necessary, at stopping the immediate symptoms of hypervolemia, which manifests itself in a variety of and non-specific ways:
- Increased blood pressure;
- An increase in the load on the heart can lead to manifestations of heart failure, angina pectoris;
- unexplained weight gain;
- swelling;
- Dyspnea;
- Feeling of dry skin and dry mouth;
- urination disorders;
- Increased respiratory rate and a feeling of heaviness when breathing;
- General weakness;
- Headache;
- Pain in the lumbar region;
- Increased fatigue.
Diagnosis of a hypervolemic state in practical medicine is difficult, due to the lack of objective, reliable, and most importantly safe methods for determining the volume of circulating blood in clinical practice. In other words, those methods that are used have proven themselves well in experimental science, explained this pathological process and laid the scientific foundations for the treatment of hypervolemia. Only hematocrit remains available for practical use., which is of great importance in determining the type of hypervolemia and the causes that caused it.
Therapeutic tactics is based on two directions:
Etiotropic (aimed at the cause of the pathology) treatment: 
- Fight against kidney diseases;
- Operative, as early as possible, treatment of heart defects;
- Treatment of endocrine diseases;
- Fight against tumors and congenital diseases of the blood system;
- Treatment of acute and chronic lung diseases;
- Careful control of the volume of intravenous infusions.
Symptomatic (aimed at combating the manifestations of pathology) treatment:
- High blood pressure is stopped by the use of antihypertensive drugs with an emphasis on diuretics;
- Angina pectoris caused by hypervolemia requires, first of all, a decrease in the load on the heart and only then the use of antianginal drugs;
- One of the leading elements of helping with hypervolemia is placing the patient in comfortable conditions with normal ambient temperature and a sufficient amount of oxygen in the inhaled air.
Also effective and gentle methods of treatment can be considered folk medicine:
- (the use of leeches) has a direct effect directly on the volume of blood, reducing it, and also reduces blood viscosity and slightly reduces the number of formed elements, which can normalize hematocrit in polycythemic hypervolemia;
- Vegetable: fennel, dill, viburnum, bearberry, horsetail and others.
The treatment and especially the diagnosis of hypervolemia requires a careful integrated approach from qualified doctor,
because behind the apparent simplicity and harmlessness of this condition, the initial manifestations of serious illness, early and timely diagnosis of which can save the health and even life of a person.
Hypervolemia of the pulmonary circulation
The blood inside the vascular bed is unevenly distributed: approximately 70% of all blood is constantly in the veins, about 15% in the arteries, 12% is in the thinnest vessels that perform the direct function of metabolism - capillaries, 3% inside the heart. The entire circulatory system is divided into large (includes the vessels of all organs and tissues with the exception of the vessels of the lungs) and small (captures only the vessels of the lungs) circulation circles.
About 75-80% of the total volume of circulating blood is simultaneously in the systemic circulation, and only 20-25% is in the small one.
Isolated hypervolemia of the pulmonary circulation, or hypervolemia of the lungs, is called in medicine, since signs of high pressure in the vessels of the lungs come to the fore in the clinic.
Causes of hypervolemia of the small circle
Hypervolemia of the lungs has a fairly large number of various factors in its causes, and not all of them are well studied, and some have not yet been established. Known reasons include:
- Long-term insufficient oxygen content (hypoxia) inside the terminal sections of the respiratory tract - the alveoli. Chronic bronchitis (including smoker's bronchitis), emphysema, bronchiolitis, bronchiectasis, chronic obstructive pulmonary disease, silicosis, anthracosis and other diseases of the lungs and respiratory tract lead to it.
- Acute reflexogenic narrowing of the small arteries of the lungs. It develops with a strong emotional shock, pulmonary embolism (even small branches), mitral valve stenosis.
- Increased pressure within the airways. Occurs with intense coughing, increased external barometric pressure, errors artificial ventilation lungs.
- Lack of function of the left ventricle, which occurs with a heart attack, arrhythmia, myocarditis.
- Increased blood viscosity.
- Increased ejection of blood from the right ventricle.
- Narrowing of the blood vessels that carry blood from the lungs. It can be caused by a tumor, aneurysm, adhesions, malformations, and more.
- Chronic intoxication - psychostimulant drugs (cocaine, amphetamine).
- Hereditary diseases and defects in enzyme systems.
- Portal hypertension is an increase in blood pressure portal vein liver (cirrhosis, disease and Budd-Chiari syndrome).
- HIV infection.
- Sleep apnea is a relatively short-term stoppage of breathing during sleep, more common with snoring.
Also, do not discount idiopathic - unknown causes that lead to primary pulmonary hypervolemia.
Signs of pulmonary hypervolemia
On early stages of its course, pulmonary hypervolemia does not have any pronounced manifestations, which is its danger - being undiagnosed, it slowly progresses and manifests itself only at the stages of an advanced and, alas, already irreversible pathological process:
- Asthenization - increased fatigue, mood lability, weight loss, sleep disturbances, etc.;
- Shortness of breath, up to suffocation, aggravated by physical exertion;
- Frequent bouts of dizziness;
- Unexplained fainting, especially during physical exertion;
- Severe, unproductive cough, sometimes, in advanced cases, with an admixture of streaks of blood;
- Pain in the region of the heart;
- Cyanosis (cyanosis) of the skin at the beginning of the disease is barely distinguishable, with the progress of the disease it becomes more pronounced;
- Edema, in severe cases, ascites (fluid in the abdominal cavity);
- Pain in the right hypochondrium (in the region of the liver);
- Heart rhythm disorders.
Diagnosis of hypervolemia of the small circle
The diagnosis of pulmonary hypervolemia is based on the above clinical manifestations and a number of laboratory and instrumental methods:
Treatment of pulmonary hypervolemia
Medical tactics for hypervolemia of the lungs is primarily aimed at treating the pathology that caused it, since by her own pulmonary hypertension only manifestation of the underlying disease. The greatest difficulty, or rather the almost complete ineffectiveness of therapeutic measures, is primary (with an unknown cause) pulmonary hypertension, since the primary source of the disease is not known.
For the treatment of hypervolemia of the pulmonary circulation, all drugs and methods that are used to treat the usual are effective. A feature is a more pronounced effectiveness of aminophylline and oxygen therapy against the background of a slightly reduced effectiveness of antihypertensive therapy.
a condition characterized by an increase in the total volume of blood and most often a violation of the ratio of formed elements and plasma.
Simple (normocythemic) hypervolemia- an increase in the total blood volume while maintaining a normal percentage of plasma and formed elements. Occurs for a short time when transfusing large amounts of donor blood, with great physical exertion, with acute hypoxia, at the onset of action high temperature environment, when deposited blood enters the bloodstream from the depot, and intercellular fluid from the tissues. This condition can lead to a decrease in vascular tone, heart overload, and the development of heart failure.
Oligocythemic hypervolemia (hydremia)- an increase in blood volume due to the predominant increase in its liquid part, while the hematocrit is below 36%. Occurs when there is a violation of the excretory function of the kidneys and fluid retention in the bloodstream, pathological thirst, excessive administration of saline or blood substitutes, with hyperproduction of antidiuretic hormone. As a result, circulatory disorders may occur due to overstretching of blood vessels, heart cavities and microcirculation disorders.
Polycythemic hypervolemia- a condition in which the volume of circulating blood increases mainly due to formed elements (erythrocytes), in connection with which the hematocrit exceeds 48%. It occurs with heart defects, chronic circulatory failure, alveolar hypoventilation, a decrease in the oxygen capacity of the blood and the efficiency of biological oxidation, exogenous (hypo- and normobaric) hypoxia, as well as in erythremia (Vakez's disease) - leukemia with a primary lesion of the red germ of the bone marrow. The disease is accompanied by an increase in blood viscosity, blood pressure, an increase in the load on the heart, followed by left ventricular hypertrophy, etc.
hypovolemia
a condition characterized by a decrease in the total blood volume and a violation of the ratio of formed elements and plasma.
Simple (normocythemic) hypovolemia characterized by a decrease in BCC with normal hematocrit. The causes are acute bleeding, shock conditions, vasodilatory collapse. In the last two cases, a significant amount of blood is deposited in the venous (capacitive) vessels and a significant decrease in BCC, the hematocrit has not yet changed. The danger of the condition lies in a decrease in blood pressure, impaired peripheral blood flow, leading to hypoxia and metabolic disorders in tissues.
Oligocythemic hypovolemia characterized by a decrease in the total blood volume with a predominant decrease in the number of formed elements and a decrease in hematocrit below 36%. It is observed immediately after the loss of blood, when its intake from the depot and tissue fluid does not yet eliminate hypovolemia, and the release of blood cells from the hematopoietic organs is a deficiency of red blood cells. It is manifested by a circulatory disorder in various vessels, an excess of the need for organs and tissues in blood supply above its level, a decrease in the oxygen capacity of the blood due to erythropenia.
Polycythemic hypovolemia(anhydremia) is observed with a decrease in total blood volume due to a predominant decrease in plasma volume, while the hematocrit level exceeds normal. The most common causes of this condition are various forms dehydration: indomitable vomiting, profuse diarrhea, polyuria, increased sweating, extensive burns, water starvation, hyperthermia, diabetes insipidus, etc. Disorders of the central, organ tissue and microcirculation are observed.
Dissertation abstractin medicine on the topic Hypervolemia of the pulmonary circulation and methods of its compensation in patients with coronary heart disease, hypertension and heart defects
On the ground of the manuscript
^ ^ EVDOKIMOVA ANNA GRIGORIEVNA
UDC 616.11-009.72; 615.835.12
HYPERVOLEMIA OF THE SMALL CIRCULATION AND METHODS OF ITS COMPENSATION IN PATIENTS WITH CORONARY HEART DISEASE, HYPERTENSION AND HEART DEFECTS.
MOSCOW - 1995
The work was performed at the Moscow Medical Dental Institute. Scientific consultant:
Doctor medical sciences, Professor A.E. Radzevich Official opponents:
Doctor of Medical Sciences, Professor V.M. Panchenko Doctor of Medicine, Professor MA Gurevich Doctor of Medicine, Professor A.L. Syrkin Lead Institution:
Peoples' Friendship University of Russia
meeting of the specialized Council D.084.08.01 at the Moscow Medical Dental Institute (Dolgorukovskaya st., 4).
The dissertation can be found in the library of the institute (Vuchetich str., 10-a).
// ¿¿/<¿>¿-<4 1995 г.
Scientific Secretary of the Specialized Council Doctor of Medical Sciences, Professor
LL. Kirichenko
RELEVANCE OF THE PROBLEM
Treatment of pulmonary edema in patients with cardiovascular pathology is still one of the urgent tasks of modern cardiology.
A lot of works are devoted to the study of the state of hemodynamics in the development of pshervolemia of the pulmonary circulation in patients with ischemic heart disease, hypertensive disease and heart defects, and the treatment of these conditions (Gratiansky NA et al., 1979; Topolyansky V.D., 1982; Ruda M.Ya. , 1982; Gasilsh! B. C., 1987; Ryabov G., 1988; Golikov A. P. et al., 1989; Radzevich A. E., 1990;<ин АЛ., 1991; WaUcenstein M.D. etal, 1985; Forrester J. etal, 1977).
In acute left ventricular failure, measures are aimed at unloading the pulmonary circulation by improving the pumping function of the left ventricle and reducing the flow of blood to the heart. For these purposes, cardiac glycosides, peripheral vasodilators, ganglioblockers, diuretic drugs are most often trimmed (Panchenko V.M. 1977, 1981; Golikov A.P. et al., 1978; Malaya L.T. 1981; Chazov E. I., 1982; Mgasailovnch D.A., 1990; Forrester J. etal, 1977). However, not all types of hemodynamics can be used with the above groups of drugs. In addition, their action begins to appear only after 10-15 minutes, various complications are possible: overdose, excessive hypotension, cletrolite disorders, etc.
It is known that the rate of development of the alveolar stage of pulmonary edema is sometimes so rapid that it often does not leave time for the implementation of therapeutic measures. Increasing asphyxia with protein foam quickly leads to fatal lpoxemia, and artificial lung ventilation in the mode of increased ventilation at the end of exhalation requires time, specialized hardware and anesthetic support. Mortality is 30-50% (Ryabov G.A., 1988).
This determines the relevance of creating a model of pschervolemia of the pulmonary circulation, when it is possible to study the pathophysiological [mechanisms that occur in the body of a patient with cardiovascular pathology, this situation, in particular, to determine changes in hemodynamics, hemostasis, microcirculation, function external respiration, acid-base state.
On the basis of the identified violations, to develop an effective, fast-acting and technologically accessible method for the practical cardiological service, a method for stopping pulmonary edema and fatal hypoxemin, which allows solving the problem of lack of time required for complex therapy.
hypervoleshsh of a small circle. In this regard, the use of the method of breathing under excess pressure is of particular interest (Murakhovsky K.I., 1979; Fomin I.O., 1985; Radzevich A.E., 1990; Tompson L., 1987; Hunt N., 1987), which will reduce the effects of centralization of blood circulation.
PURPOSE OF THE STUDY
To study the state of central and peripheral hemodynamics, plasma, platelet and vascular hemostasis, microcirculation, function of external respiration, acid-base state in simulated hypervalemia of the pulmonary circulation under conditions of "dry" immersion; to develop a method for correcting the identified disorders by the method of breathing under excessive pressure and to determine the clinical effectiveness of this method in the complex therapy of cardiogenic pulmonary edema.
1. To study the effect of "dry" immersion, as a model of hypervalemia of the pulmonary circulation, on the state of central and peripheral hemodynamics in healthy individuals with borderline arterial hypertension.
2. Determine the state of plasma, platelet and vascular hemostasis, microcirculation, acid-base state and external respiration function under "dry* immersion" conditions.
3. Compare the results of invasive and non-invasive research methods during dry-air immersion in an immersion medium.
4. To study the effect of overpressure breathing as a way to correct hypereoemia of the pulmonary circulation, to evaluate its impact on central and peripheral hemodynamics, hemostasis, microcirculation, acid-base balance, and external respiration function.
5. To evaluate the clinical effectiveness of the use of the method of breathing under excessive pressure in the complex therapy of pulmonary edema in patients with cardiovascular pathology.
The studies were carried out from 1980 to 1995 on the basis of the 52nd City Clinical Hospital (Chief Physician Mishutin V.I.) together with the Institute of Biomedical Problems of the Ministry of Health of the Russian Federation and the Research Institute of Transplantation and Artificial Organs of the Ministry of Health of the Russian Federation (in the department of X-ray functional diagnostics, head - Dr. M.Sc. Chestukhin V.V.).
The study was a fragment of the planned scientific topic "Arterial hypertension, atherosclerosis, non-chemic (coronary) heart disease" (state registration number 01920017874).
SCIENTIFIC NOVELTY
For the first time, a comprehensive study of central and peripheral hemodynamics was carried out, the state of plasma, vascular and thrombocytic hemostasis, microcirculation, the function of external respiration, acid-base co-compression in conditions of "bitch" cimmeria, as a model of hapervolemia of the pulmonary circulation, were studied. It has been proven that the method of dry-air immersion in a water-immersed medium makes it possible to simulate hypervolemia of the pulmonary circulation in order to study pathogenetic mechanisms, especially in the first three days of its application.
A method of adaptation in the "dry" immersion mode has been developed (author's certificate No. 1352690, DSP).
To correct the revealed violations in the mode of "dry" immersion, the method of breathing with excessive pressure was applied.
For the first time, the effect of breathing under excessive pressure on hemodynamics, hemostasis, microcirculation, acid-base balance, and the function of external respiration in patients with borderline arterial pterthesia aged 45-55 years under conditions of simulated hypervolemia of the pulmonary circulation was studied in a comprehensive manner for the first time.
It is shown that the revealed pathophysiological changes are successfully compensated by the method of breathing under excessive pressure.
A method has been developed for the prevention of pathological reactions in "dry" immersion (invention certificate No. 1531269) and a method for the prevention of circular disorders with a decrease in gravity (invention certificate No. 1724182).
Optimal modes of breathing under excess pressure +! 0 cm of water column were worked out for use in ball rooms with cardiovascular pathology, complicated by pulmonary edema.
It has been proven that the method of breathing under excess breathing is highly effective, highly effective and technologically available for the relief of cardio-purulent pulmonary edema and fatal hypoxemia and allows solving the problem of time deficiency, which is necessary for the complex treatment of acute heart failure.
PRACTICAL VALUE
Conducted klshshko-experimental studies have shown that the method of "dry" immersion allows you to simulate the state of hypervolemia of the pulmonary circulation of the day, the study of pathogenetic mechanisms and the development of effective methods for their correction.
Hyperemia of the pulmonary circulation in model studies is accompanied by hypercoagulability syndrome, deterioration of microcirculation, changes in acid-base balance and respiratory function.
The results of the studies showed that the minute volume of the heart under conditions of "dry" immersion can be determined using integral rheography using a coefficient that matches the MOS indicators obtained by methods of integral rheography and thermodilution.
It has been proven that for the correction of disorders developing under conditions of simulated hypervolemia of the pulmonary circulation, the method of breathing under excess pressure of +10 cm of water column can be used with high efficiency.
The use of breathing under excess pressure +10 cm of the water column in the complex therapy of pulmonary edema in patients acute infarction myocardium, hypertension, heart defects, allows you to stop the alveolar stage of pulmonary edema in 10-20 minutes without the use of penogsitsley.
The positive pressure breathing method is highly effective in preventing impending cardiogenic pulmonary edema.
This method can be used in hospitals, in an ambulance using the apparatus "NIMB-1", produced by the domestic industry, and the apparatus "Exhalation", developed on the basis of the results of this study.
IMPLEMENTATION INTO PRACTICE
Practical recommendations on the therapeutic tactics of intensive therapy of pulmonary edema in patients with acute myocardial infarction, hypertension, heart defects using the method of breathing under excessive pressure have been developed and implemented. ■
On the basis of the received data, applications for 3 inventions were filed, for which copyright certificates were obtained: "A method for assessing the adaptation of the body when simulating the state of weightlessness in immersion conditions" ed.
6 1352690, 1988; "Method of preventing pathological reactions in case of reduced gravitation", ed. certificate No. 1531269, 1989; "A method for the prevention of circulatory disorders with reduced gravity", ed.svi. N° 1724182, 1991
The results of the study are used in scientific work and pedagogical process at the Department of Therapy of the Faculty of Education and Science of the Moscow Medical Institute.
WORK APPROBATION
The main provisions of the dissertation are presented at: All-Union Conference Actual? Problems of Space Biology and Medicine" (Moscow, 1980); XVIII Congress of Therapists (Leningrad, 1981); MMSI Science and Park Conference Human Health and the Environment" (1983); IBMP Coordinating Council Moscow, 1987); XVIII Gagarin Honors, 1988; scientific and practical conferences of the MMSI (1988, 1990, 1993).
A school-seminar was held on the implementation of the results of the study for doctors in Moscow and the Moscow region (1988) on the topic "Non-traditional methods of treatment".
SCOPE AND STRUCTURE OF THE THESIS
The dissertation consists of an introduction, 5 chapters, a conclusion, conclusions, practical >recommendations and a list of references, including 230 works by domestic and 211 >works by foreign authors. Volume is typewritten,
|includes tables and_ drawings.
GENERAL CHARACTERISTICS OF THE MATERIAL AND RESEARCH METHODS
In the first clinical and experimental part, 15 healthy men aged 32 to 41 years and 42 men with borderline arterial hypertension aged 35 to 54 years were examined. Depending on the objectives of the study, the entire contingent of the examined persons was divided into 4 groups.
In group I, practically healthy individuals in age were examined; ; from 32 to I years (9 people). We studied the comparability of the results of measuring the minute volume of the heart under the conditions of "dry" immersion by the method of thermodnelution and integrally?!
rheography. MOS" was measured before the "dry" immersion regime and from the 2nd to the 6th day of immersion.
Group II included 22 patients with borderline arterial hypertension aged 45 to 53 years. We studied the influence of immersic, as a model of hypervolemin in the pulmonary circulation, on indicators of central and peripheral hemodynamics; plasma, vascular and thrombotic hemostasis, microcirculation-lyatsgao, acid-base state, respiratory function. The control group consisted of 6 healthy men aged 30 to 40 years.
In group III, 20 patients were examined: borderline arterial hypertension aged 45 to 54 years and 6 healthy men aged from? 30 to 41 years.
In this group, study the effect of breathing under excessive pressure (DID + 10 cm of water column).
Hemodynamic studies were performed before the start of immersion, before the DID session, at 15 and 30 minutes of the DID session, immediately after the session, and 30 and 60 minutes after the end of the DID session.
In the second part of the work in clinical conditions, the studies were carried out in 4 groups of patients.
Group I included 102 patients with acute myocardial infarction; of these, 52 patients amounted to! axis group (aged 40 to 73 years, of which men - 3E, "he; pdin - 14).
The diagnosis of MI was made on the basis of anamnesis data, clinical map, changes in the MCG to the increase in the activity of special fermentoses.
In 46 patients the Son. NKSh, bchgpovzk made bslnyz with NKGU (according to the classification "Sh1tsr). Esgalgym is": groups in the complex therapy of pulmonary edema used the DID method.
The control group for evaluation of the DID method consisted of patients (50 people) with acute myocardial infarction, complicated by pulmonary edema, treated with peripheral vasodilators and diuretics; means.
Prior to the start of the study, patients with AMI received conventional therapy: narcotic and non-arcotic analgesics, vasodilators, diuretics, intravenous glucose-potassium-insulinose polarizing mixture and heparin at doses up to 200-300 units/kg/day. According to the indications, antimicrobial drugs (lidocaine, trimekash), intranasalco-oxygen were used. In ASNHUst, catghalamines, glucocorticoids (or cardiac glycosides in extreme cases) were additionally used.
Group II consisted of patients with mitral stenosis, 28 people aged 22 to 63 years (8 men and 29 women).
All patients from the moment of detection of pulmonary edema were treated with antipsychotics, in some cases, narcotic analgesics, peripheral drugs, lasix, oxygen therapy, if indicated, cardiac glycosides and positive instrop drugs for low blood pressure.
In 19 patients with mitral stenosis against the background of conventional therapy, the DID method was used. ,
In group III, 41 patients with aortic stenosis aged 25 to 59 years (15 men and 26 women), of which 19 patients with developed pulmonary edema underwent complex therapy with the use of DID.
In group IV, 22 patients with hypertension aged 44 to 69 years (women - 12, men - 8) were examined, who developed pulmonary edema in the background of a hypertensive crisis.
All patients with ARF underwent antihypertensive therapy with pggloblockers, ceirsgptichemi, diuretics, and zadklgtators; oxygen intranasally.
In 12 patients in complex therapy hypertensive crisis and pulmonary edema, the DID method was used.
MEANS USED: modeling of hypervalence of the pulmonary circulation was carried out by the method of "dry" immersion, i.e. by immersion in water, however, skin contact with water was completely eliminated by using a soft waterproof fabric. This allowed any clinical researches in full (E.B. Shuyazhenkho, ¡975).
Determination of cardiac output by the thermodynamic method was carried out using a Swan-Ganz catheter with a thermistr and balloon (Edwards Lab. Model 93A-131-7F). It was positioned in such a ravine that the main ophthalmic opening (and thermistor) were in the trunk of the pulmonary artery, and the proximal one was in the region of the right .l. Gas counting was carried out on a special computer Edwards Lab (USA) with registration on micogogrfg-32 (Siemens, Sweden).
A special catheter with thermistors (W. W. Lab., Calif, model CCS-7F-90A) was implanted into the coronary sinus.
A constant rate of introduction of the thermoindicator was provided by an omp "Sfgeínst., Orion Res.Mzs (model 351), the volumetric blood flow velocity was measured by an LF-300 flowmeter (W.W.Lab) and recorded on an Omnisíriblí recorder (Hcmtcn Jnä.).
The performance of the left ventricle was determined by probing the radial id of the femoral artery using Odkaa-Gans catheters from Eickatg (USA) No. 7324067 or No. 73-2067 with a diameter of 7G and a length of 110 cm.
Daale:- and 1R curves were recorded by electrognomegrams "Statgam-P23Db" (USA) and "Sinucens-746" (Germany), taking into account APD ... SBP, mean® pressure in the right atrium (RSH), systolic, mean® and coccy-diastolic pressure in the right ventricle (RRVC), pulmonary artery (JIA) and pulmonary artery donation (PZLA).
During catheterization of the left ventricle (LV), the end-diastolic pressure of the left ventricle (EDDD) and its contractility indices cp/dtm were determined - the maximum rate of increase in the gluteal pressure, which characterizes the maximum rate of ventricular relaxation.
Calculated SI = ---l/mn/m1
OSH1S -------* 80 din*s*cm""
SI (GARDEN - KDTsLA) IURLV “-------------” 13.6 g * m * m *
Total pulmonary resistance (OLS) according to the formula: SDIA-PP
-----* 80 dyne * s * cm"1
PD (perfusion daakgnie) according to the formula: CD = SBP - DCS^,
where ßKC^ is mean® pressure in the coronary sinus (we Hg).
Resgraphic examination was carried out according to methods® (M.Tishchenko, 1973) with registrations of integral rheography, rheoencephalography, rgopulmacography of the upper lobe in the lower lobe, rheohepatography, rheosography of the forearms and legs. Rheograms were recorded using a ChRG-1 rheograph and a "tvi integraf.-34" recorder (Sweden).
Echocardiographic study was carried out on the device "Echoview" company "Picket" (USA) with a computer calculation of the main indicators in one-dimensional. mode according to the generally accepted method.
The parameters of the acid-base state (ABS) were determined on the analyzer "Koriing-168" (England) and AVL-940, the hemoglobin content was recorded on the device "Hemolux" AM-101 according to the hemoglobin cyanide method.
The function of external respiration (RF) was studied using the Metatest-2 apparatus.
The study of the microvascular bed of the boulevard kongokgavi was carried out with the help of a fat neck lamp ftni "On:, p" (Germany) according to the method of B.C. Volkov (1975), modified by V.V. Smirny (1978).
Platelet adhesion and spreading were studied using the ELO method. Vasilyeva, fahgo? Willebrand was determined mihrelp-ratioshpag,: by the method according to I.Eespgluko. Aggregation of thrombosis was studied by the method of S. Zot and O'Brien on aggregometers from Siesco (USA) and EM-840 (Italy) with reagents from Serva.
Thromboxane and prostate were determined by the radiological method using commercial kits from Seragen (USA).
The indicators of the plasma link of hemostasis were studied using thromboelastography using the apparatus GKGM-4-02 (USSR). Fibrinogen was determined by the ML method. Rutberg.
Continuous electrocardiographic examination during the day is based on the use of the Medi "og MA-14 system (Oxford Medical Systems, England).
RESULTS OF THE STUDY
I. Khlktyam-exaerimeetalikg research.
n. "dry" Er;.-g.!0rsii ¡;i indicator of CHD in healthy lac.
Immersion in an immiscible medium causes noticeable changes in a number of parameters. Thus, 20 minutes after immersion in the IM, the CVP increases by 1.2 mi Hg. (44%) (p<0,05), среднее ДЛА на 4-6 мм рт.ст. (39%) (р<0,01), работа правого желудочка сердца на 67% (о<0,01), СИ повышается на 0,5 л/мкн/м1 (14%) главным образом за счет увеличения ударного индекса на б мл/и" (11%). Сбъем крови в правых отделах сердца повышался от /99±18 до 371±16 мин (р<0,05). Тенденция к увеличению параметров ЦГД сохранилась до 6 часов режима КМ. В дальнейшем стала отмечаться тенденция к снижению СИ на 2-3 сутхи воздействия, снижение ДЯА, к 3-м суткам - ЦВД, к 6-7 суткам - АДС.
Thus, the fluctuation of central hemodynamics indicators indicates the development of hyperoedema of the pulmonary circulation, especially during the first 3 days of the MI regimen, while compensatory reactions are formed, defense mechanisms are quickly activated (Herip-Gausra reflex), without leading to overload, especially of the right parts of the heart , due to the appearance of massive diuresis and a decrease in O CC.
On the same troupe of patients with cgm "two methods for determining the MOS were studied: thermodilutsky and integral rgography, so it was very clear that under the conditions of" dry "immersion in a person, the prostate gland" increases, which entails
is a decrease in the constant ohmic component of the rheogram, on average by 20%. Thus, the absolute values of the MOC measured by the immersion method, the integral X-ray diffraction method, are known.
"Multiple synchronous measurement of cardiac output, both before MI and during MI, showed that under normal conditions, in a horizontal position, the average MOS values differ significantly: 7.60±0.4 l/mmn (integrated rheography) and 7.53±0.28 l/min (thermal modulation).In IM, the MOS values measured by the method of integral rheography are lower by an average of 1.73 l/min (Table 1).
Table 1.
Usradpenaaya davamsha MOS-TD and MOS-IR.
Immersion mode MOS-TD MOS-IR R
background 7.53±0.29 n=14 7.60±0.35 11=11 . 0.39
Day II b.01±0.25 n=9 4.03±0.21 n=11<0,01
III day 6.64±0.26 5.72±0.27<0,05
IV day 5.57±0.27 a=9" 4.28±0.23 n=9<0,01
V day 6.80±0.20. "n \u003d 18 5 "24 ± C, 16 p-16<0,01
VI day 6.47±0.21 a=8 4.97±0.23 n=8<0,01
Thus, in further studies, this difference was taken into account when analyzing the average CHD values determined under immersion conditions.
2. Influence of "dry" shmeresh vd induce hemodynamics in persons with PAH.
The study of the effect of MI on the cardiovascular system in patients with PAH showed that, as in healthy individuals, there are pronounced individual reactions of various indicators of central and peripheral hemodynamics.
The main tendencies of changes in MO, VR and VV (power of the left ventricle) were manifested in a decrease in their values, starting from the messenger of the 1st day of immersion. Most of the studied patients showed a persistent decrease in blood pressure during immersion (Table 2).
Table 2.
Dynamics of MOS (l/May), SBP (mm Hg), A (kgm/bnp) ■ Ammersin conditions in persons with PAT.
Readaptation
Immersion (day) (day)
Parameters Background I III V VII I III
M 6.79 4.92 5.67. 5.39 15.51 6.73
MOS ±t 0.50 0.70 0.65 0.39 0.30 0.55
p 34 42 55 39 41 32
R<0,05 >0,05. <0,05 <0,05 >0,05 >0,05
M 94.94 88.13 90.74 88.66 88.26 93.38 92.08
SBP ±t 0.86 0.78 0.25 0.93 0.75 0.80 0.91
p 48 47 43 45 45 42 43
R<0,01 <0,01 <0,01 <0,01 >0,05 >0,05
M 8.43 5.61 6.83 6.31 6.38 8.33 7.88
A ±t 0.71 0.88 0.81 0.43 0.41 0.82 0.61
p 16 16 16 15 15 15 15
R<0,05 >0,05 <0,05 <0,05 >0,05 >0,05
The average values of heart rate in the group as a whole were quite stable and the fluctuations were unreliable.
An analysis of the pulsatile blood filling of the head, lungs, forearms, legs and liver showed that under conditions of MI there is a pronounced process of redistribution of blood, known as the "effect of centralization of blood circulation" (E.B. Shul'khenko, 1975, S.M. Belyaev, 1982, O. Saieg, 1973). At the same time, there is an increase in the vascular zones of the head, lungs and shoulder girdle with a simultaneous decrease in this parameter in the lower extremities.
So the pulse blood filling of the head by 3 days of MI increases .. I by 17% 1r<0,01), среднеиммерсионный уровень этого же параметра в легких составил 132- 166% (р<0,05), в сосудистой зоне голени - 61% (р<0,01) от исходного уровня, кровоток в печени уменьшатся на 36-43% (р<0,05) (табл.3).
Table 3
Investigation of changes in the rate of anacrotic growth (V), diastolic index (CI) of pulse blood pressure (PC) in the lungs and limbs (in %%) (foa - 100%) in persons with PAH.
Immersion Readaptation
Parameters Day 1 Day 3 Day 5 Day 7 Day 1 Day 3
Upper PC 104.1 156.6 158.8 157.9 163.3 161.1
share V 122.1 124.5 110.8 115.2 152.1 155.3
mild CI 67.0 52.9 54.3 57.1 62.8 72.4
Lower PC 186.8 152.2 135.8 123.9 125.4 109.8
share V 144.5 132.5 135.8 122.1 130.7 121.6
mild CI 75.0 75.1 70.4 78.2 b9$ 68.7
Pre-PC 141.2 132.4 114.7 102.9 85.3 91.2
shoulders V 117.2" 98.5 82.2 84.6 78.8 70.1
CI 80.5 74.5 78.2 93.1 111.7 90.3
Lower legs PC 66.0 67.0 62.3 58.5 74.5 88.7
V 96.2 99.8 89.4 94.5 78.2 89.4
di- 75.1 81.4 78.3 81.5 91.8 95.7
The data obtained indicate that in the case of MI, hypervolemia of the pulmonary circulation is clearly formed, most pronounced in the first 3 days of dry-air diving both in healthy individuals and in patients with borderline arterial hypertension.
According to echocardiographic studies, as the stay in immersion conditions increases (after 24-48 hours), most individuals experience an increase in EDV, ESV, SV, MO (p> 0.05), however, these changes are statistically insignificant according to the average data. It should be noted the pronounced individual nature of echocardiographic parameters. As for the ejection fraction, it practically does not change during the entire study.
3. The state of hemostasis, microcirculation, acid-base balance, respiratory function under immersion conditions.
The most characteristic changes in the modeling of hypervodemia of the pulmonary circulation were noted in hemostasis. Both in healthy people and in people with PAH, in the MI strata, by day 3, the hemocrit maximum increased by 15% (in healthy people) and
25% (streets about GTLG). The adhesive ability of platelets is regulated by the content of von Willebrand factor (VW) in plasma. It turned out that, both in healthy and in patients with PAT, there is a pronounced correlation between these indicators. Isln slowly its level approached upper bound the norm or was above it (the age norm at 45-55 years is 147.9±9.1%), then in the process of conducting the study, by the 3rd day, MI DV increased to 245-360%.
In addition, there was an increase in the number of platelets by 8-12%, an increase in the degree and time of platelet aggregation and disaggregation, there was an inhibition of fibrillation, an almost two-fold decrease in the level of 6-keto Pg Fn with an almost unchanged level of TGWH
During the readaptation period in healthy individuals, all hemostasis indicators return to their original values after two days, in contrast to individuals with PAH, in whom recovery occurs by 5 days after the end of the MI regimen.
Thus, in the MI mode, there is a pronounced gilercoagulation syndrome with the threat of thrombosis.
Under conditions of MI, microcirculation worsens. According to the conjunctival biomncroschopin, intravascular aggregation of red blood cells (Knieseli phenomenon) increases with a slowdown in vascular blood flow, a violation of the permeability of the vascular wall in the form of the appearance of perivascular hemorrhages.
From the side of KShchS, development is noted respiratory acidosis, an increase in Rso, and a decrease in R
According to the study of respiratory function, it was found that in MI there are functional disorders of lung ventilation, which are restrictive in nature and manifest a decrease in DO, VC by 20-25% (in healthy people) and by 30-33% (in LNCs with PAH), respiratory rate increased (from 14±1.1 to 18±1.2). The changes were significant (p<0,01).
Thus, as a result of the studies, it was found that MI causes pervolemia of the pulmonary circulation with a number of adverse syndromes, the severity of which depends on the presence of pathology in the cardiovascular system, in particular, PAH. These disorders are noted in changes in hemodynamics, worsening of plasma, vascular and platelet >e "ostasis, microcirculation, respiratory function, acid-base balance and are most pronounced in the first three cyi. immersion.
4. The use of breath * nmya garden with excess dogleii shimmerensh.
As a means of correcting the identified pulmonary mechanisms, we proposed the method of breathing under excessive breathing (DID / in the first
three days IM. Previously (according to the IBMP program) it was established that the optimal pressure regimen for compensating hypervolemia of the pulmonary circulation is +10 cm of water column.
Analysis of the results of the studies showed that DID sessions under MI conditions lead to a moderate decrease in MI, SV, an increase in blood pressure, with virtually no effect on the power of the left ventricle of the heart (p> 0.05), there was an increase in VR by 20%.
The state of the central nervous system, l hemodynamics, according to echocardiography, did not significantly change under the influence of DID, i.e. breathing sessions under excessive pressure, as it were, "soften" the effect of MI, stabilizing functional state of cardio-vascular system.
The most pronounced changes were in peripheral hemodynamics: during the DID session, there was a decrease in blood supply to the vascular zones of the head, lungs, and upper limbs; along with this, the blood filling of the vessels of the abdominal organs, in particular the liver, increased significantly, and the blood flow of the legs increased (Table 4).
This nature of redistribution of roofs indicates that DID promotes decentralization of blood flow, compensating for hypervolemia of the pulmonary circulation, creating a natural depot in the liver.
It has been noted that DID-sessions lead to the restoration of the partial pressure of oxygen in the blood, reduced during immersion (compensation of respiratory acidosis), and contribute to an increase in oxygen saturation of body tissues.
In addition, it was found that DID sessions have a hypocoagulable effect on both platelet and plasma and vascular hemostasis. This reduces the aggregation activity of platelets. On the 3rd day of MI with the use of DID sessions, platelet aggregation remains unchanged (before immersion - 44.4 ± 4.45 rel%, on the 3rd day of MI - 44.9 ± 4.78 rel% with induction of AOF -5M), 1, also does not change. Platelet aggregation induced by Adr and ristomycin behaves in a similar way, the indicators of 6-keto Pg I, and T, SH are normalized.
DID sessions did not have a significant effect on platelet spreading, there is a tendency to reduce the adhesion of platelets and EF.
DID sessions had a positive effect on the plasma link of hemostasis, lowering the blood coagulation activity (according to thromboelastography, the index "I" did not change, the indices "I", "c", "T" lengthened, the "FAK" index increased).
Table 4
Dflamikha PC (ml) of the head, lspxx, liver, limbs under the influence of DID sessions.
Indicators Initial FIT Immersion After FIT
state
immediately after 60 minutes
PC M 0.112 +0.057 -0.048 +0.027 +0.017
head ±t 0.001 0.020 0.011 0.011 0.013
p 27 36 72 33 68
R<0,01 <0,01 <0,05 >0,05
PC M 2.7 +0.6 -1.3 + 1.9 -0.7.
upper ±t 0.3 0.3 0.6 0.7 0.6
gave n 30 36 70 32 69
lung R<0,05 <0,05 <0,05 >0,05
PC M 4.5 +3.1 -s,s +2.7 +1.2
lower ±t 0.4 0.7 0.9 0.9 0.5
shares p 31 36 71 35 48
lung R<0,01 <0,05 <0,01 <0,05
PC M 1.9 -0.9 +1.9 -1.0 -o.s
liver ±m 0.1 0.3 0.4 0.4 0.2
p 25 33 58 23 38
R<0,01 <0,01 <0,05 >0,05
PC M 0.3 +0.15 -0.13 +0.14 ■+0.10
pre-±t 0.1 0.04 0.03 0.05 0.09
shoulder p 26 26 56 27 33
R<0,01 <0,01 <0,01 >0,05
PC M 0.6 -0.14 +0.07 -0.05 +0.02
shins ±t 0.1 0.05 ■ 0.03 0.04 0.02
p 23 32 51 19 68
R<0,01 <0,05 >0,05 >0,05
Note: the sign "+" - an increase in comparison with the initial state, the sign " - a decrease in the indicator.
The positive effect of DID sessions on hemostasis can be explained by an improvement in hemodynamic parameters: blood flow in the pulmonary circulation normalizes, hepatic blood flow improves, diuresis normalizes, therefore, cell damage (erythrocytes, platelets) decreases, the flow of anticoagulants from the liver into the blood increases and, in Finally, hemostasis parameters are normalized.
Thus, DID sessions in healthy individuals and in patients with PAT caused unidirectional changes, namely, they eliminated the signs of ptercoagulation: they increased the activity of the blood anticoagulation system and decreased the activity of the coagulation system, eliminating the risk of thrombosis.
According to conjunctival biomicroscopy, DID sessions prevent the deterioration of microcirculation.
■ The use of DID in the modeling of pterischemia of the pulmonary circulation leads to the leveling of changes in respiratory function that occur under the influence, bringing the indicators closer to the background data. It was noted that DID sessions lead to the restoration of the partial tension of blood oxygen, reduced during immersion (compensation of respiratory acidosis), and contribute to an increase in oxygen saturation of body tissues.
Thus, in clinical and experimental studies, a clear reaction of the human body, both healthy and with damage to the cardiovascular system in the form of PAH, is determined, which is expressed especially clearly in the first 3 days of adaptation to dry-air immersion by hypervolemia of the pulmonary circulation, spercoagulation syndrome, development compensated respiratory acidosis, has an adverse effect on microcirculation, respiratory function.
Apply DID contributes to the correction of pathophysiological changes that occur in MI, in particular, there is a clear unloading of the pulmonary circulation, signs of hypercoagulation are eliminated, the state of the microvascular bed and respiratory function does not worsen, changes in K.1CS are eliminated.
No adverse reactions from the use of DID in the mode of +10 cm of water column were noted in any case.
The action of the DID is physiological, since during the session the "excess" blood, "squeezed out" from the small circle of blood circulation, accumulates in the natural depot of the chroai - in the liver.
II. Research in clinical settings.
The above gave grounds to apply the DID method in clinical conditions in the complex therapy of pulmonary edema in ball patients with cardiovascular diseases.
In cardiological practice, the following nosological forms form dangerous situations in terms of the development of lung tissue: acute myocardial infarction, severe mitral and aortic stenosis, hypertensive crises. Therefore, patients with the named pathology were investigated.
In the treatment and control groups, from the moment the threat of pulmonary edema was detected in the ball, complex treatment was carried out, including neuroleptics, in some cases narcotic analgesics, peripheral vasodilators, fast-acting diuretics, oxygen therapy, according to indications - antiarrhythmic therapy, in some cases, cardiac glycosides, and positive and other drugs for low blood pressure.
The only difference was that the control group (no PID) used intravenous and inhaled defoamers, while the study group did not.
The DID method is implemented using the commercially available apparatus "NIMB-
1. Clinical effectiveness of the method of breathing under excessive pressure in the treatment of pulmonary edema in patients with acute myocardial infarction.
Of the 52 point AMI who used the DID method, there were 46 patients with HFRS and 6 patients with cardiogenic shock and pulmonary edema.
Dynamics of CHD indices in patients with AMI with the use of DID in the complex therapy of pulmonary edema is presented in Table 5.
The obtained results of the studies indicate that in group I, with the use of DID, there is a faster normalization of indicators: the average pressure in the right atrium decreases, SPPA and DDPA decrease, and CLCL decreases.
In patients of the control group, on the background of traditional therapy, the performance of the right ventricle normalizes by 60 minutes, and LVDD remains elevated even after 1 hour from the start of treatment.
Table 5
Dyamics of DHD parameters in patients with AMI in the treatment of pulmonary edema with traditional therapy (group II, a-10) and with DID (pear I, n-15).
Indicators Group Initially 5 shsh 30 min 60 min P,
BPs mm Hg III. R.M 134±2 128±7.5 132±4.1 128±b.9 115±3.2 105±3.1<0,05 113±4,7 106±6,2 <0,05 <0,05 <0,05 <0,05
SDLA mm Hg I II *» 41.1±1.8 38±3.3 40±2.1 38±3.4 20±2.9 31±4.1 18±3.1 24±29<0,05 <0,01 <0,05 <0,01
DDLA mm () t.st. I ■ II 29±3 31±2.2 28±2.1 31±2.7 16±3.7 24±3.17<0,001 14±3,1 18±2,9 <0,01 <0,001 <0,01 <0,001 <0,01
Heart rate beats / min. I II R.;, 102±3.2 103±2.78 98±3.18 107±3.9 88±2.7 101±2.1 84±2.1 95±4.1<0,05 <0,05 <0,05
SI l/min/m1 I II P«. 2.77±0.18 3.02±0.1 2.85±0.17 3.02±0.12 2.79±0.11 3.21±0.23 2.8±0.19 3 .12±0.11
fan srdip. mmHg. I II b.85±1.1 7.12±1.4 6.97±1.2 7.13±1.3 5.2±1.1 6.3±1.5 4.1±0, 28 4.9±1.02<0,05 <0,05 <0,05 <0,05
LVDD mm Hg I II 19.32±1.7 18.28±1.67 19.08±1.3 18.33±1.5 17.01±0.9 20.2±0.8 P.9±1. 2 16.4± 1.22<0,01 <0,01 <0,01 <0,01 <0,05
Duration of the period of exile from I II 0.2010.01 0.19±0.01 0.20±0.01 0.19*0.01 0.19±0.02 0.21±0.03 0.22± 0.03 0.20±0.01<0,01 <0,01 <0,05
dp/dt. LV mmHg I II p 1034±55 1097±64 1037±39 1097±64 1057±41 1071±52 1062±39 1079±44<0,05 <0,05 <0,05
dp/dtyP. sec"1 1 II Р i, 22.02±1.3 24.GI±1.7 22.02±1.3 24.01±1.7 23.011:0.9 23.09±0.7 23, 17±0.8 23.38±1.2<0,05
0I1CC days/s/cm"" I II 1968±143 1864±172 2001±129 1864±168 1774±131 1800±141 1628±123 1730±112<0,05 <0,05 <0,05 <0,05
The dynamics of the main psychological manifestations in patients with AMI and pulmonary edema was as follows. In the group of patients who underwent complex treatment of pulmonary edema with the use of DID, shortness of breath decreased faster, so in 40 (87%) patients, respiratory rate returned to normal after 10 minutes. At the same time, in the control group, shortness of breath decreased by 25 minutes only in 19.4%. The average time of shortness of breath relief in group I was 8±0.3 minutes, in group II - 34.3±0.5 minutes. The differences are significant (p<0,01).
The mean time from the start of treatment to a pronounced decrease in cyanosis was 13.3±0.8 m:sh, respectively. (I gr.) and 36.8±1.0 min. (II tr.) (p<0,01).
For the group using DID, the time during which cyanosis was stopped was from 5 to 30 minutes, and in the group without DID - from 20 to 60 minutes.
An important clinical sign of resolution of alveolar pulmonary edema is the disappearance of wet creeps.
When using the complex therapy of DID, moist rales in the upper sections of the lungs disappeared after an average of 11.9 ± 068 men., in the lower sections, on average, after 6.0 ± 0.8 hiccups in 75% of patients. In patients of the control group, the average time was respectively: 31.3±0.9 min. and 38.4±0.3 min., moreover, 4 patients still had wheezing after 60 minutes of observation, and they were not included in the calculation. The differences are highly significant.
The fact of the appearance of diuresis is an important indicator in the resolution of pulmonary edema. Thus, in the group of patients with the use of DID, the average time for the onset of diuresis was 24.5 ± 0.8 minutes, in the control group 37 ± 0.8 minutes. The differences are highly significant.
In 6 cases of acute myocardial infarction complicated by HK1U, the use of DID gave a temporary positive effect. Severe circulatory insufficiency continued to progress, and as a result, all ballrooms died.
Thus, the proposed method for the treatment of alveolar pulmonary edema in patients with AMI complicated by CABG, in all cases, leads to a rapid and effective relief of the alveolar stage of the pulmonary stack and an improvement in the clinical condition of patients within the first 5-10 minutes of its use.
2. Clinical "efficiency" of the method of breathing under low pressure in patients with<пгезозэм в отеком легких.
28 mitral stenosis with alveolar pulmonary edema were examined, 10 of which included DID sessions in complex therapy, 10 patients made up the control group.
Against the background of DID sessions in patients of the main group, there was a pronounced ". dynamics of the parameters of the right ventricle: decreased CVP, sour pressure in the pulmonary artery, so SPPA decreased from 6C ± 8.46 mm Hg to 4ß ± 4.S mm Hg .st., DCLA - from 32±5.3 mmHg to 18±3.1 mmHg, DLAav - from 45.3±7.47 mmHg to 29±3.7 mm Hg The nature of the changes is significant.
Significantly decreased pressure in the left atrium: from 27.8±2.93 mm Hg. up to 17.5±2.9 mm Hg Other iziekeshi; indicators of CHD nssklp unreliable.
When analyzing clinical manifestations, their rapid resolution was noted in patients who included DID in the complex therapy of pulmonary edema.
Tai:, the average spajm from the beginning of treatment to a pronounced decrease in cyanosis was 14.3 ± 0.6 mi:. (I group) to 39.2 ± 0.9 minutes (II group) "(p<0,01).
As a result of the use of DID, shortness of breath decreased by 20 minutes. In the control group, by 40 minutes shortness of breath decreased in 75% of patients.
The disappearance of hoarse rales in the main group was noted on average after 15±0.4 min. - in the upper sections, and after 18.0±0.4 min. - in the nukkikh departments, which was significantly less than in the group with conventional therapy (35±1.0 min and 43±4.3, min, respectively). The changes were significant. In 4 patients in the control group, moist rales persisted after 60 minutes.
When analyzing UD as a manifestation of acute respiratory sufficiency, it was found that DID contributes to a decrease in this indicator after 5 minutes (from 34±0.6 to 24.2±0.7) (p<0,001). К 10 мкнугс УД уменьшалась до уроаня 20±0,3 в ми-нугу. В контрольной группе еще через 40 минут сохранялось учащенное дыхание и составляло 23±2,2 в минуту.
The average time of occurrence of diuresis in the study group was 25.2±0.8 Mim. and 43±0.6 min. in the control group.
Thus, the use of DID in the complex therapy of pulmonary edema in patients with mitral stenosis contributes to a more rapid resolution of the pulmonary circulation hypervolemia and relieves clinical manifestations in 10-20 minutes.
Table 6
Dvpyainza pskazatghei CHD in 5 aortalgia with stelosis and pulmonary edema in direct conventional therapy and DID (n = 19).
Parameters Initial values After treatment Р
Heart rate, beats/shsh 100±2.8 82±4.3<0,05
MOS, l/min 3",4±0.28"2*4.2
BP cf, mm Hg 93.1±3.21 88±3.7<0,05
With. 115.2±3.4 108±4.2<0,05
D. 75.6±2.1 76±2.38
SDLV, mm Hg 250±12.2 180±9.21<ао!
KDDLV, mm Hg. 2b.1±2.1b 21±3.23<сц«и
029.3±39.1 1059±21.17
(1p/£Y/P0 13.29±0.76 20±2.1
I-UAC. 0.091±0.007 0.084±0.C&2
1,-OAC 0.0525±0.001 0.0513±0.Sh
DZMK-OAC (FIS) 0.5861±0.00-. 0.568010.601
OAK-ZAK (FI) 0.3314±0.02 0.3011±0.0117
OAK-I, 0.2911±0.07 0.2688±(H0I
FIR 0.0721±0.004 0.06624^0^0113*
SV 64.2±3.3 $),1±4.1
FI 49.72±3.89 55.19±3.1
Dlk er, mm Hg 24.27il.71" 17.1±2.12<0,01
DND s, mm Hg ■47.3±5.12 34±2.81<0,01
D. 28.12i2.98 18±4.12<0,01
cf. 31.3±3.08 26±2.13<0,01
Dprzhe, mm Hg. 47.4±5.2 38±1.62<0,01
s 10.01±1.21 8.71±0.98<0,05
DsrPP, mm Hg 7.33±0.95 65±0.49<0,05
3. Klanichgsklya efficiency of the method of breathing with excess pressure in patients with aortic stenosis in the edema of the lgshzh.
41 scores of aortic stenosis and pulmonary edema were examined, 19 of which included DID sessions in complex therapy; 22 patients with conventional therapy constituted the Control group.
In the study group, when stopping pulmonary edema with the use of DID, there were pronounced changes in the direction of a decrease in such indicators as DLV, KDZYAZH, KSOYAZH and KVDV, SPLA, DDDA and DNAAm, as well as Avg. pressure in the right atrium (CVP). These changes were significant (Table 6).
With regard to clinical manifestations, DID sessions contributed to a more rapid decrease in cyanosis (the average time in group I was 14.5 ± 0.8 minutes, in group II - 35; 2 ± 1.2), shortness of breath decreased faster (cf. time in group I was 10.3±0.2 minutes, in group II - 32.3±0.6 minutes). Disappearance of wheezing was noted more likely in the main group (12.2±0.7 min. - upper lobes, 17.2±1.2 microns. - lower lobes) than in the control group (respectively - 27±2.1 and 40± 0.8). An earlier appearance of diuresis was noted: 25.5±2.8 (11 group) and 35.5±2.2 (group II).
Thus, DID contributes to a more rapid resolution of pulmonary edema when included in complex therapy in patients with ball aortic stenosis.
4. Clinical efficacy of the DID method in patients with severe tonic crises complicated by edema in the tapholes and ear detonation.
Twenty-two scores were studied, in which acute hypoventricular failure was accompanied by a rise in blood pressure to individually high numbers. In 12 patients, on the background of conventional therapy with antihypertensive drugs, antipsychotics, vasodilators, diuretics, the DID method was used.
The study of hemodynamic parameters showed that HRSO ALN proceeds at any SI parameters (from 2 to 5.6 l/min/m1), but at high blood pressure (up to 260/N. . Hg) and OPSS (up to 4000 dynes/ s/cm""), while pulmonary edema in patients with low SI proceeded at lower BP numbers. LVID increased sharply (up to 9.1±0.41 kgm/min/s*, at the norm - 5.1 xxm/min/m1).
Comtex therapy with the use of DID contributed to faster normalization of hemodynamic parameters and effective resolution of the clinical manifestations of ARF.
There is a frequent fact that with a more rapid decrease in blood pressure at the initial stages in boron patients with traditional therapy, the reaction of resolution of EA in contact with patients (group I) with the use of DID is more delayed.
When analyzing? clinical benefits DID contributes to a significant reduction in breathlessness in the 5-30th minute in 50% of the scores, the breathlessness completely disappeared after 25 minutes. The disappearance of moist rales over the entire surface of the lungs was noted after 20-30 minutes (in the control group, moist rales in the posterior-lower sections persisted for up to 60 minutes). The beginning of diuresis in the main group was noted from 15 to 40 minutes, in the ¡«¡playing - k?.0-<£рминутам соответственно.
In group I, the average diuresis time was 25.5 ± 2.8 minutes, in group II - 35.5 ± 2.2 minutes. The differences in the scores are significant.
Thus, the results of the conducted research show that the inclusion of the method of breathing under excess pressure of +10 cm of water column into the complex therapy of cardiogenic pulmonary edema contributes to its faster resolution.
1. Dry-air immersion in an immersion medium can serve as a model of pulmonary circulatory disorders, especially in the first three days of its use.
2. Under conditions of "dry" immersion, redistribution of blood occurs with an increase in its volume in the vascular regions of the head and lungs. The most pronounced changes in hemejtamihi occur in the first three days of immersion.
3. Hypercoagulability syndrome develops in immersion: adhesion of tumors increases, the level of Willsbrand factor increases, platelet aggregation increases; deterioration of the trsmboelastogram index; increases fibrinogen, increases heg. "zts:<р1гг, понижается уровень простациклина, повышается концентрация трсмбоксана, что соответствует реальней клинической ситуации отека легких у бояышх с сердечно-сосудистой патологией.
4. Under conditions of hypervolsmin in the pulmonary circulation, microrecirculation worsens due to an increase in intravascular aggregation of erythrocytes with a slowdown in vascular blood flow, a violation of the permeability of the vascular wall in the form of the appearance of percussion hemorrhages.
5. Under conditions of "dry" immersion, the ventilation function of the lungs decreases, accompanied by arterial hypoxia, hypercapnia, and respiratory acidosis.
6. Breathing under excess zatash +10 cm of water column in patients with borderline arterial hypertension leads to a decrease in blood filling of the vascular zones of the head and lungs with a simultaneous increase in crosopapatnesha
vessels of the abdominal organs, in particular, the liver, with the restoration of a normal, small ratio of blood volumes of the upper and lower halves of the body.
7. The use of DID in model studies during the first three days contributes to the compensation of respiratory acidosis, correction of impaired function of external respiration, and prevents deterioration of microcirculation according to conjunctival biomicroscopy data. The signs of hypercoagulability in the plasma, platelet and vascular parts of hemostasis are eliminated.
S. Breathing under excess pressure of +10 cm of water column is a highly effective, fast-acting and accessible for general clinical practice method of stopping cardiogenic pulmonary edema: the main clinical manifestations of pulmonary edema begin to decrease from 5 minutes of DID use and are completely stopped by 20 minutes, which creates the necessary reserve time for complex therapy.
9. The DID method is implemented using the "NIMB-1" and "Exhalation" devices, created on the basis of experimental and clinical data obtained in the framework of this study.
1. The method of "dry" immersion makes it possible to simulate the state of hypervolemia of the pulmonary circulation in order to study pathogenetic mechanisms and develop effective methods for their correction.
2. Hypervolemia of the pulmonary circulation, modeled by the method of "dry" immersion, is accompanied by changes in acid-base balance, plasma, vascular and platelet hemostasis, microcirculation, external respiration function, characteristic of hypervolemia of the small circle, which develops in acute left ventricular failure in patients with AMI, hypertensive crises complicated by pulmonary edema, heart defects.
3. The value of the minute volume of the heart under conditions of "dry" immersion can be determined using integral rheography using a coefficient that matches the MOS indicators obtained by the methods of integral rheography and thrmooilulation.
4. For the correction of hemodynamic disorders developing under immersion conditions. and other central laumi blood flow, shifted acid-base balance, pseudocoagulative syndrome:! the threat of thrombosis, dysfunction of the external
breathing, deterioration of microcirculation, the method of breathing under excess pressure of +10 cm of water column can be used with high efficiency.
5. To stop cardiogenic pulmonary edema in patients in a state that threatens with increasing asphyxia of protein foam and fatal arterial hypoxemia, it is possible to use with high efficiency in complex conventional therapy breathing under excess pressure of +10 cm of water column, air or oxygen-air mixture, in a ratio of 1 :1 - DID method. This method does not require complex respiratory equipment, anesthesiology service, it can be used in practical cardiology, both in a hospital and in an ambulance with the help of a compact device "NIMB-1" produced by the domestic industry and an apparatus "Exhalation" developed on the basis of the results of the present study.
The use of DID allows to stop the alveolar stage of pulmonary edema in patients with AMI, heart defects, hypertension in 10-20 minutes without the use of defoamers. This creates an optimal time reserve for complex therapy of acute heart failure.
The DID method is highly effective in the prevention of threatening cardiogenic pulmonary edema.
The identified contraindication for the use of DID is a pronounced violation of the contractile function of the right ventricle.
1. The effect of nitroglycerin, molsidosh and sodium nitroglycerin on central hemodynamics and data of electrocardiographic and echocardiographic studies in patients with acute myocardial infarction, / co-authors: Evdokimov V.V., Dolotova V.V. et al.// Materials of the III All-Union Congress of Cardiologists, Moscow^
1979, pp. 400-402.
2. Some new aspects of drug rehabilitation of patients with acute myocardial infarction, /co-authors: Orlov V.N., Radzevich A.E. and others//Tr. scientific-practical conference "Rehabilitation in IVS and heart defects", Gorky, 1980, p.65-67.
3. Influence of water-immersion hypodynamia on some parameters of hemostasis in persons with PAH. /co-authors: Orlov V.G., Yunusov MA to others/Dr. scientific-practical conference "Actual problems of space biology and medicine", M.,
4. Application of ultiple precordial zeads to the evalnation of theeffectiveness of Drugs used to treat Acute miocardial infarction, /co-authors: Orlov B.H., Radzevich A.E., Libov NA. and others //Tr. International Symposium on Eleugrocardiology, Budapest,
1981, pp. 293-295.
5. Some issues of pathogenesis and optimization of therapy in myocardial infarction, /co-authors: Orlov V.N., Uranov V.N., Radzevich A.E. and others//Gr. XVIII Congress of Therapists, Leningrad, 1981, pp. 442-444.
6. Evdokimova A.G., Kirichenko LL., Smirnov V.V., Kozlova V.G. / Influence of thermo-neutral "dry" immersion on platelet hemostasis, microcirculation, excellent metabolism and blood viscosity // In the book: Influence of environmental factors on the human body: collection of scientific papers MMSI, 1984, pp. 56-60.
7. Studying the effect of reduced gravity regimes on the body of apparently healthy men aged 45-55 years with functional abnormalities of the cardiovascular system in the form of neurocirculatory dystopia of the hypertonic type and searching for a method for adequate correction of these conditions under immersion conditions. Study of the therapeutic effect of the "dry" immersion mode / co-authors: Orlov V.N., Radzevich A.E., Fomin I.O. et al.//Itogovyn report, M., 1983, deposit No. 0-1429 in librarynote. IBMP, p.316.
8. Yunusov M.A., Evdokimova A.G., Vnnohodova T.V., Ivanov S.G. /Influence of "dry" immersion on hemodynamic parameters and functional state of erythron in
ball with arterial hypertension.//Influence of environmental factors on the human body: a collection of scientific papers MMSI, M., 1984, p.113-116. The state of microcirculation and cellular hemostasis in men with PAT under conditions of thermoneutral "dry" immersion, /co-authors: Kirichenko LL, Smirnov VV//Space biology and aerospace medicine, 1985, No. 5 p.35-33.). The effect of sodium nitroprusside, propranolol and mannitol on the size of myocardial infarction, /co-authors: Orlov VN, Radzevich AE, Shilova NA et al.//Kardiology, 1985, No. 4 p. 17-20.
".. Indicators of hemostasis in persons with NCD, who are in the conditions of "dry" immersion, /co-authors: Kirichenko L.L., Masenko V.P., Raskurazhen A.B.//Space biology and aerospace medicine, 1988, No. 1 pp. 10-13 1. The state of central and peripheral hemodynamics in the 7-day mode of "dry" immersion in patients with hypertensive NCD, /co-author: Radzevich
A.E., Solovieva A.V., Vinokhodova T.V. and others//Space biology and aerospace medicine, 1989, No. 10 p.62-64.
Refinement of selection criteria and search for optimal means of physical prevention of hemodynamic, orthostatic and vestibular consequences of reduced gravity in relation to the special contingent of older age groups with hypertensive NCD, / co-authors: Orlov V.N., Radzevich A.E., Kirichenko LL., Nesvetov V.N. et al.//Final report N214-88060, inv. No. 336249/2984, deposit. in VNIITI, M., 1988, p.293.
A method for evaluating the adaptation of an organism in the simulation of weightlessness under immersion conditions. //A.c. No. 1352690, DSP (co-authored with Orlov V.N., Shulzhenko E.B., Uranovym V.N. et al.), 1988.
A method for preventing pathological reactions in reduced gravity. //A.c. No. 1531269 DSP (co-authored with Orlov V.N., Radzevich A.E., Shulzhenko E.B.), 1989. Evdokimova A.G., Yunusov M.A., Vinokhodova T.V., On the possibility of using "dry "Immersion in the treatment of arterial hypertension./Des. report of the scientific-practical conference "Hypertension and vascular diseases of the brain", Perm, 1990, p. 118-120.
A method for determining the volume-functional abilities of the left ventricle of the heart.//A.S. No. 1692553 (co-authored with Orlov V.N., Degtyarev VA, Nesvetov
B.N. and others), 1991.
A method for preventing circulatory disorders in reduced gravity.//A.S. No. 1724182 DSP (co-authored with Radzevich A.E., Fomichev V.N., Uranov V.N. et al.), 1991.
19. Comparative assessment of the effect of physical means of prevention on homeostasis in persons with NCD according to the pshertosh1 type, // (co-authored by Radzevich A.E., Kirichenko LL, Nesvetov V.N. et al.) / Final report x / d themes No. 89115, item No. 08/250, deposited at the IBMP, Moscow, 1989.
20. Clinical trials of the product "Exhalation" in persons with hypertensive-type NCD in the reduced gravity mode, //(co-authored with Radzevich A.E., Kirichenko LL., Nesvetov V.N., Olkhin VA et al.)/ The final report of the x / d topic No. 90133, in the bibl. IBMP, deposit no. 08/250, 1990.
21. Hypervolemia of the pulmonary circulation and the method of its compensation by the method of breathing under excessive pressure, /co-authors: Radzevich A.E., Kirichenko L.L., Olkhin V.A., Evdokimov V.V. and others // Sat. Proceedings of the scientific and practical conference of the Ministry of Foreign Affairs, M., 1993 p. 11-12.
22. Influence of "dry" immersion and respiration under excessive pressure on the state of the body in healthy individuals and patients with PAH. /co-authors: Radzevich A.E., Kirichenko L.L., Olkhin V.A., Evdokimov V.V. and others // Sat. scientific works, M., 1993.
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