Репозитарій

УДК 615.211:616.711-089-06

Резюме. Актуальність. Операції на хребті належать до травматичних, складних, тривалих втручань та можуть бути проведені за допомогою різних методів знеболювання. Кожен вид анестезії має свої побічні ефекти й ускладнення, як-от післяопераційна нудота, відрижка та блювання (ПНВБ). Часто це пов’язано з кількістю використаного наркотичного анальгетика. ПНВБ безпосередньо впливає на загальне задоволення пацієнта від анестезіологічного забезпечення. Операції на хребті потребують інтенсивної терапії болю наркотичними анальгетиками. Регіонарні методи знеболювання дозволяють зменшити кількість наркотичних анальгетиків та знизити больовий синдром. Мета роботи: порівняти erector spine plane block (ESP) як компонент поєднаної анестезії з загальною анестезією в контексті впливу на кількість наркотичних анальгетиків, ПНВБ та загальне задоволення від анестезії. Матеріали та методи. 83 пацієнтам була виконана операція на хребті. Залежно від методу знеболювання пацієнти були розділені на дві групи: група I — загальна анестезія, група II — загальна анестезія з ESP. Первинні кінцеві клінічні результати: кількість використаного фентанілу інтраопераційно та морфіну післяопераційно. Вторинні кінцеві клінічні результати дослідження: частота виникнення ПНВБ, загальне задоволення анестезією за 5-бальною шкалою Лайкерта. Результати. Загальна кількість фентанілу була нижчою у групі II (1,7 ± 0,7 мкг/кг/год) порівняно з групою I (4,7 ± 1,6 мкг/кг/год), p < 0,05. Морфін вводили 31 пацієнту в групі I та 6 пацієнтам у групі II. Частота виникнення епізодів ПНВБ була меншою у групі II (29 пацієнтів) порівняно з групою I (11 пацієнтів). Загальне задоволення від анестезії було вищим у групі II
(4,38 ± 0,80) на відміну від групи I (2,97 ± 0,90), p < 0,05. Висновки. ESP як компонент загальної анестезії зменшує кількість наркотичних анальгетиків інтра- й постопераційно та, як наслідок, знижує частоту розвитку ПНВБ і поліпшує загальне задоволення від анестезії.
Ключові слова: Erector spine plane block; операції на хребті; побічні ефекти; регіонарна анестезія

Background. Spine surgeries belong to traumatic, complex, long-term interventions and can be carried out using various methods of anaesthesia. Each type of anaesthesia has its own side effects and complications, such as postoperative nausea and vomi­ting (PONV). Often it is related to the amount of narcotic analgesic used. PONV directly affects the patient’s overall satisfaction with anaesthesia. Spine operations require intensive pain management with narcotic analgesics. Regional anaesthesia allows reducing the amount of narcotic analgesics and control the pain syndrome. The purpose was to compare erector spinae plane (ESP) block as a component of combination with general anaesthesia in the context of the impact on the number of narcotic analgesics, PONV and general satisfaction with anaesthesia. Materials and methods. Spine surgery was performed in 83 patients. Depen­ding on the method of analgesia, they were divided into 2 groups: group I — general anaes­thesia, group II — general anaesthesia with ESP block. Primary outcomes: amount of intraoperative fentanyl and postoperative morphine. Secondary final clinical outcomes of the study: incidence of PONV, overall satisfaction with anaesthesia on a 5-point Likert scale. Results. The total amount of fentanyl was lower in group II (1.7 ± 0.7 μg/kg/h) compared to group I (4.7 ± 1.6 μg/kg/h), p < 0.05. Morphine was administered to 31 patients in group I and 6 patients in group II. The frequency of PONV episodes was lower in group II (29 cases) than in group I (11 ca­ses). Overall satisfaction with anaesthesia was higher in group II (4.38 ± 0.80) in contrast to group I (2.97 ± 0.90), p < 0.05. Conclusions. ESP block as a component of general anaesthesia reduces the amount of narcotic analgesics intra- and postoperatively and, as a result, decreases the frequency of PONV and improves overall satisfaction with anaesthesia.

Background: Walking as a method of functional recovery is used to treat many diseases. It is an accessible, natural and widespread form of
physical activity. Terrenkur is defined as distance, time, and angle dosed hiking; a method of training and treating patients with cardiovascular
diseases. One alternative method of rehabilitation is Nordic Walking which leads to increasing both the number of muscles involved in
movement and physical and aerobic load.

Background. The global trends in the development of medical education are based on the wide and
open access to modern technologies, both at the undergraduate and postgraduate stages. There is a
clear tendency of shifting emphasis to the practical orientation of the acquired knowledge and the
control of acquired practical skills and abilities, and the widespread introduction of simulation
learning technologies.

Introduction. Functional capacity is important parameter of activity of a person. It can be assessed with different methods, including interviewing, walk tests, cardiopulmonary exercise testing. According to the recommendations of the European Society of Cardiology, the assessment of functional capacity is an important step in the perioperative management of a patient with concomitant cardiovascular pathology during non-cardiac surgery. Purpose of our study was to implement assessing of functional capacity in clinical practice, including perioperative management of patients. And also, to compare the practical value of self-reported methods of assessing functional capacity and exercise testing. Materials and methods. 15 healthy men aged 33±5.4 years and 172 patients with documented pathology of the cardiovascular system aged 65±2.8 years were included in the study, among them 51% were male. We compared the value of different methods and the expediency of assessing the functional capacity of a patient with concomitant pathology of the cardiovascular system before planned non-cardiac surgery. Results. All healthy individuals gave a positive answer to the question about ability to climb two flights of stairs. The average Duke Activity Status Index score was 52.47±5.96, which corresponded to the calculated value of METs 9.19±0.73. During cardiopulmonary exercise testing, the average value of VO2max in these individuals was 47.56±11.34 mL/(kg·min). A direct strong correlation between Duke Activity Status Index values and VO2max was established (r=0.91, р˂0.01). 36 patients (21%) reported inability to climb two flights of stairs added. The average DASI in these persons was 12.84±4.38 and the level of NTproBNP was 1116±75. On the contrary in the rest of the patients the DASI was 28.18±7.72 and NTproBNP 302±42 with statistically significant difference (p˂0.01). The dynamics of troponins in the examined subjects did not show any increase in the postoperative period. The values of the EF in patients reported inability to climb two flights were lower by 9.78% compared with others (56.57±12.34% and 62.71±6.35%, p˂0.01). The average number of days spent in the hospital was 22 in patients with inability to climb two flights and 12 in the rest. 32 patients (19%) died, 28 deceased belonged to the group with inability to climb two flights of stairs. The average time of death was 29.86 days. Correlation analysis revealed a direct relationship of average strength between the Duke Activity Status Index and EF (0.42, p 0.007), an inverse relationship of average strength between the Duke Activity Status Index and NTproBNP (-0.42, p=0.01) and the number of days spent in a hospital (-0.39, p=0.005). In conclusion we found that healthy men with an active lifestyle have higher average VO2max parameters and confirmed that the VO2max obtained during the cardiopulmonary exercise testing was comparable to questionnaire methods for assessing functional capacity. One fifth of patients with confirmed cardiovascular pathology self-reported inability to climb two flights of stairs. These individuals had a lower EF, a higher concentration of NTproBNP, a longer stay in the hospital, and significantly higher mortality. the Duke Activity Status Index correlates with left ventricular systolic function and NTproBNP level.

BACKGROUND: Since its start, the war in Ukraine has taken a devastating toll on the country's children. As of now, 508 children have been killed and 1,135 injured. Besides, 13 children suffered from sexual violence, and 19,546 went missing, were deported and/or forcibly relocated, with 386 eventually returning to Ukraine. The repercussions of these harrowing experiences have had profound effects on the overall well-being and mental health of children, along with their access to medical care and education. Simultaneously, Ukraine has witnessed rapid changes in its rehabilitation system due to the ongoing war.