Likuvalna hypothermia. methods of hypothermia

", Polyagaє in the implementation of complex cameras, adjusted to reduce the cost of living with the brain, improve the delivery, cerebral blood flow and the prevention of critical episodes of hypoxia and hypoxemia. Until the present hour, not so richly real instruments have been proponated to fight against ischemia. The main principle is to take the mind out of ischemia in the offensive.

Control of AT and CPP during the course of the brain... Hypotonia is one of the most significant causes of secondary ischemic attacks. In the last hour, there are recommendations for the registration of vasopressors and agents, which will be a positive effect, as a time-consuming approach to the correction of hypotensives. Obviously, vasopressor does not suppress entering due to the renewed volume of circulating blood, albeit, looking at the especially sensitive brain to hypotensive disorders, it’s time-consuming vasopressors to get involved. According to the authors' figures, the frequency of sympathomimetics stasis per hour of operations on internal cranial aneurysms reaches 25%.

Control of glucose for an hour to get the brain... At the same time, a decrease in the level of glucose in the blood can lead to a reduction in the level of neurons for a breakdown of energy balance, an increase in glutamate, aspartate, Ca ++ in the last space, and the launch of mechanisms for developing and developing the brain. However, instead of the level of glucose in the blood, it is necessary to develop an ear for neurons. Hyperglycemia pidsilu to the brain, as in the case of the brain, and in the middle ischemia.

During an hour of disagreeable ischemia, an increase in glucose concentration in the cells at the same time because of insufficient supply of acidic changes in metabolism to an anecdotal level, which is increased instead of lactate in the brain and as much as possible metabolic acidosis... Immediately, radicals are set in motion, so that the cell's membranes are destroyed and the cell's collapse is wiped out. It is necessary to prophylactic hypotension of hyperglycemia. Achievement of glucose levels in the blood of ailments in the areas of 5-9 mmol / l.

Hypotermia for the brain:
neuroprotective effect hypothermia It is widely seen and stagnated in neurosurgery since 1955. The classical theory of brain damage is based on the concept, which means that the neuron's vision before an hour of inadequate blood flow may become unhealthy for the brain's metabolic requirements. It took a trivial hour that the hypothermic brain was grounded on a significant change in cerebral metabolism and the consumption of neurons in acid.

So, when the temperature of the brain drops to a skin degree per Celsius, cerebral metabolism decreases by 5-7%, with a decrease in metabolism up to 50%, the phenomenon of "sleep-driving" on the electroencephalogram (EEG) is prevented. So it’s like a brain at 37 ° C, which is dry to the ground with a stretch of 5 quills, then at 27 ° C - even a stretch of 10 quills. In this hour, it is obvious that the hypothermic effect of hypothermia is not only a decrease in cerebral metabolism.

To transfer, when hypothermia wikid glutamate, aspartate is attributed, the production of nitric oxide decreases, as it takes a part in the established radicals and fatty acids.

hypothermia to get the penetration of Ca ++ into the cell, which is fundamentally important for the development of an ischemic cascade. Hypothermia of the stabilization of cell membranes and renewal of the functions of the hematoencephalic bar.
Without piece blood circulation The possibility of stagnating only a small amount of hypothermia (31-32 ° C) through serious cardiological problems, which occurs at a significant decrease in temperature of the floor.

Hypotermia is a plant for organism, as a result of a decrease in the central temperature of the body to below 35 ° C.

In normal humans, the temperature in the empty skull, the education of the great sudins, the organs of the black and chest empty, is taken to the endless ryvny - 36.7-38.2 ° С. rіvnі vіdpovіdaє hіpothalamus.

Temperature of the "shell" til ( skeletal cells, Pіdshkіrnoї klіtkovini, shkіri) start lower than the central one by ten degrees, and by the hour - by a few degrees.

stages of hypothermia

cause

The steel temperature is adjusted to the balance of heat production, so that the heat transfer and heat output are reduced. As soon as the heat output has begun, it will be overturned on heat production, and the hypothermia mill is developing.

The main reasons for hypothermia:

  • trivial regional anesthesia;
  • trivale perebuvannya in the cold, zanurennya in cold water;
  • the volume of infusion of cold breakdowns, whole blood or preparations.

Prior to the group for the development of hypothermia, the following should be included:

  • children;
  • lіtnі people;
  • individuals in the camp of alcoholic sp'yaninnya;
  • patients in an unrecognizable country or misbehavior (as a result of severe damage to cerebral blood circulation, hypoglycemia, great injuries, disruption, etc.).

Besides pathological hypothermia, as a result of hypothermia as a result of hypothermia, there is a very therapeutic hypothermia. Vaughn vikorystovuєtsya with the method of reducing the risk of non-vascular ischemic ear tissue through lack of blood circulation. Shown to therapeutic hypothermia є:

  • the importance of hypoxia in newborns;
  • ischemic stroke;
  • important traumatic ear central nervous system;
  • neurogenic fever, as a result of brain injuries;
  • zupinka heart.

see

Falling as a decrease in the central temperature, hypothermia extends to several types:

  • light (35.0-32.2 ° C);
  • middle (32.1-27 ° C);
  • important (less than 27 ° C).
The steel temperature is adjusted to the balance of heat production, so that the heat transfer and heat output are reduced. As soon as the heat output has begun, it will be overturned on heat production, and the hypothermia mill is developing.

In clinical practice, hypothermia has a little more importance. In case of a conciliatory hypothermia, the patient will be able to build up to an independent abnormally passive development. With an important form of deterioration in thermoregulation, the quality is lost.

signs

Signs of hypothermic hypothermia (temperature of thila - from 35.0 to 32.0 ° C):

  • drowsiness;
  • the destruction of the organization in the hour and the space;
  • apathy;
  • m'yazove tremtinnya;
  • hastened the dikhannya;
  • tachycardia.

A spasm of blood vessels (vasoconstriction) and an increase in the concentration of glucose in blood plasma are indicated.

Further, lowering the central temperature to reduce the function of the heart-vascular systems, Deterioration of nerve-muscle conductivity, reduction of pink activity and improvement of metabolic processes.

When the central temperature is lowered to 27 ° C and a comatose stump develops less, it is clinically likely to appear as the next signs:

  • visibility of tendon reflexes;
  • visibility of reaction to light;
  • Decrease in the amount of antidiuretic hormone (polyuria, cold duresis) for reducing the secretion of antidiuretic hormone, which causes hypovolemia;
  • pinching myazovoy tremtinnya;
  • fall arterial vise;
  • change in frequency dikhalnykh rukhiv up to 8-10 per quill;
  • bradycardia is rotated;
  • blinking arrhythmia.

diagnostics

The main method for diagnosing hypothermia is the value of the central temperature of the body. In this case, it is not possible to take into account the temperature indicators in the groin (axillary) area, as it is possible to change the temperature between the central and axillary temperature of the warehouse in 1-2 degrees. With hypothermia, it is even more.

In normal humans, the temperature in the empty skull, the enlightenment of the great Sudins, the organs of the black and chest empty, is on the constant level - 36.7-38.2 ° C.

Vimіryuvannya of the central temperature is visible in the ear canal, stravohode, nasopharyngeal region, sech mіhury or rectum for the help of special electronic thermometers.

For the assessment of the zagalny camp, the obvious damage to the metabolism and the functions of life of important organs, laboratory procedures are carried out:

  • zagalny blood analysis;
  • biochemistry analysis of blood for the values ​​of sevina, creatine, glucose, lactate;
  • coagulogram;
  • pre-shedding blood for acid-water level and level of electrolytes (chloride, magnesium, calium, sodium);
  • zagalny analysis of the sech.

Necessary monitoring of the patient's stance (EKG-control, pulse oximeter, arterial vise vimir, temperature of the patient, and later on vimiruvannya diuresis).

In case of adolescence on the ear of the internal organs or fractures of the cysts, a radiography is shown. computer tomography from a separate part of the body.

lykuvannya

When the patient's hypothermic condition (as it is known to be in svidosti), they keep warm in dry warmth and warm up, curl a warm carpet over the head, giving a hotter drink. Tsyogo can appear to finish.

With important hypothermia, it is also necessary to actively develop the patient for a number of points. The sufferer does not go to the bathtub. hot water Before the expansion of peripheral blood-bearing vessels and massive entry of cold blood into the main vessels and up to internal bodies... The result will be Rizke Padinnya arterial grip and lowering the frequency of the heart is very fast, as well as the mother of critical inheritance.

Besides pathological hypothermia, as a result of hypothermia as a result of hypothermia, there is a very therapeutic hypothermia. Vaughn vikorystovuєtsya with the method of reducing the risk of non-vascular ischemic ear tissue through lack of blood circulation.

One of the following methods:

  • іngalyаtsіya bled і pіdіgrіt up to 45 ° C souring through an intubation tube or a mask;
  • internal infusion of warm (40-42 ° C) crystalloid growth;
  • lavage (promivannya) slunk, intestines abo sectional mikhura warm rosters;
  • lavage breast cancer for the help of two thoracostomy tubes (best effective method Zigrivannya navit in the most severe hypothermia);
  • lavage black wastes warm dializatom (indications for patients with important hypothermia, electrolyte balance, Intoxication or gostim necrosis of skeletal muscle).

The active internal development is guilty, as only the central temperature is up to 34 ° С. When carrying out an active preparation, the necessary EKG-control, a large risk of a breakdown in the rhythm of the heart is very fast (shlunochkovaya tachycardia, blinking arrhythmias).

prophylaxis

Prevention of hypothermia includes entering, directing on the reduction of hypothermia to the body:

  • organizing the correct procedure for the work and recovery in winter time for people who work in the winter;
  • warm clothing and dry swelling suitable for the weather minds;
  • medical control over the camp of participants in winter sports zmagan, navchan, vyskovyh diy;
  • organization of community items to be collected before the hour of frost;
  • vidma vid vzhivannya alcoholic beverages before being in the cold;
  • start procedures to polish up the attachment to the smallest climatic minds.

Serves and acceleration

hypothermia - I will load my life camp, inherited from which you can be:

  • arrhythmia of the heart;
  • swelling of the brain;
  • pack of legends;
  • hypovolemic shock;
  • gostra nirkov and pechinkova lack;
  • pneumonia;
  • phlegmon;
  • polyonephritis;
  • otitis;
  • tonsilitis;
  • arthritis;
  • osteomyelitis;
  • sepsis.

Nastacha sisnyu (hypoxia) until і / or before an hour we can reduce the damage to the brain of the neonatal, which can lead to the death of any important disability.

According to the statistics, usually one million of the people of the population suffers from impaired neurological development in cases of hypoxic-ischemic encephalopathy (DIE), as well as winikla, altogether, as a result of postponed asphyxia. In 20% of children, married people in asphyxia, the diagnosis of infant cerebral palsy (cerebral palsy).

It is a pity that the specific way of doing such an exercise is not simple, but standard medical ones, come in to transfer the extra functions of life to important organs. Ale in the light, a new method of treatment - hypothermia - was developed.

So tse take?

Likuvalnaya hypothermia is a piecemeal control of the cooling of the body by reducing the intensity of metabolic processes in the brain and increasing the stiffness to hypoxia. Systemic (cooling of the whole body) and selective (cooling of the brain) of hypothermia; however, it is effective and recommended in terms of the standard of treatment of newborns in addition to the importance of hypoxic-ischemic encephalopathy.

Behind the cordon in the likuvalnoy hypothermie vikoristovuyutsya road ustatkuvannya, as for our country, unfortunately, it is not even more accessible, because in Ukraine it often turns out to be simple methods cooling: gel bags, mice with ice, grilki, dances or gum mittens, reminiscent cold water, Fan.

Shown to lykuvannya

If the child is in asphyxia, the doctors at the presentation of clinical and laboratory data, take a decision about the need for conducting a clinical hypothermia. Indicated for stasis of this kind of lіkuvannya є: less than 5 points for the Apgar scale; metabolic acidosis in the blood; in two important vipadkas - sudomi. Before the word, they are at least dumb, as they need to take advantage of hypothermia, to come to obstetric hospitals of the 1st-2nd stage of additional help, not to see the possibility of intensive therapy in their structure, but in the current state of affairs. At the same hour, one of the most necessary changes in efficiency є an ear of cold weather in the first six years of the birth of the child's people.

Systemic hypothermia with vikoristannyam simple efforts cold vikoristovuyutsya with newcomers with a gestation period of 35 days and masoyu tila for 1800 grams. In all cases, a letter is required for both fathers before carrying out a hypothermia.

How do you see it?

Immediately, the message of the people, the child, who needs a drug hypothermia, is transferred to the form of intensive therapy for newborns, dey to carry out piece ventilation lungs, as well as medication for hemodynamics.

On the reanimation table, up to the baby, temperature control sensors are attached - in the intestine and in the rectum. Head of medical staff - to reach the indicator of temperature of a newborn's body 33.0-34.0 With a stretch of 1 year. The initial triviality of the period involved is 84 years, which is stored in two phases: active cooling - 72 years from the moment of the cob; zіgrіvannya - 12 years of active step-by-step development of the phase of cooling.


For a quote: Shevelov O.A., Butrov A.V., Kalenova I.V., Sharinova I.A. Therapeutic hypothermia - a method of neuroprotection in ischemic stroke // RMZ. 2012. No. 18. P. 893

The method of hibernation therapy, which helps to overcome neurovegetative blockades and zahalnaya cooling of the body, firstly by A. Laboratories and P. Hugenar in the middle of the last century. Hybernotherapy allowed the effectiveness of the treatment of shock stuns and significantly increase the hour of saving werewolf changes in the central nervous system in case of total ischemia and neurotrauma. The ability to protect the brain in important Ukrainian countries has increased the rate of therapeutic hypothermia (TG) in reanimatology, cardio and neurosurgery, with traumatic brain injury (TBI). Out-of-the-box cooling of patients with ischemic stroke (II) was significantly slower, and the clinically significant inflow of backward TG on the result of therapy was not demonstrated.

In the capacity of the main mechanisms of cerebroprotective effects of TG in total cerebral hemorrhage, it was seen to develop in the world of lowering temperature, reducing metabolism, reducing the survival of neurons to sourness and deterioration of malnutrition. The revelation of the facts of metabolic depression and a decrease in the level of living by the brain by 5-7% with a decrease in temperature by 1 º allowed a demonstrable observation of TG yak effective way increased bending of neurons in case of thermal camps.
The period of hibernation therapy in Western medicine ended in the 1970s. in conjunction with a large number of important acceleration and side effects home TG. Lowering the temperature up to + 32 ° C and lowering it to an increase in cardiovascular depression, reducing the heart disease, reducing the arterial pressure (AT), the potential for automation, improving There is also a progressive build-up of electrolysis breakdown and breakdown of the acid-puddle plant, breakdown, adjustment of the functions of the scale and ovens. Podovzhutsya period of elimіnatsії drugs, The number of septic tanks is increasing.
TG was widely used for cardiac surgery and for TBI right up to the 1980s. ... This is actually a single center, which stagnates TG, which has become a blood circulation pathology. E.N. Meshalkin, in case of surgical correction of giant aortic aneurysms, the possibility of a safe total blood circulation increased by 60 min was demonstrated. without zasosuvannya piece blood circulation.
Unimportant for lowering the interest to the problem in the end of the XX century, the pre-treatment of the efficiency of the TG in the experiments and the clients did not adhere, but the first ten years of the XXI century. can justly be called the period of the TG renaissance. The reason for the turn of the TG in key practiceє knowing the fact that it’s not possible to reach the present hour efficiently and methods of cerebroprotection.
Significantly, if you are hungry in the Danish hour of TG, you can treat the time that the back of the cooling body is seen as a necessary component of treatment in the recommended protocol for the management of ailments with hypertensive internal malignant hematomas (5th 2009). According to the recommendations of the American Heart Association (2010), the TG's home is viewed as an important warehouse of heart-legacy reanimation (SRL).
V methodical recommendations after the reanimation visits of the European for the sake of reanimation (Reanimation-2010) it is expressly stated that we will alone bring a neuroprotective effect to the TG, which is not the case for this current day pharmacological drug So Volodya will bring neuroprotective actions to total blood circulation. In the same place, the initial TG is designated in the capacity of the necessary lankan vision for CPR, which is directly related to the change in neurological inheritance. classic deaths and preserving authenticity.
Recently, European and American recommendations may be based on the induction of my own TG, in order to lower the basal temperature of the patients at the least insecure boundaries at least + 32 ° C.
TG є by a general and routine methodology in the great majority of the great hospitals of the Russian Federation. American Society of Hypothermic Medicine (Intensive Cold Emergency Care) install, Provide your robot for specially split protocols. The discussion of the registration of the TG, the extent to which the specificity of the methodology is presented on the website of the association and in the materials at http: //www.med.upenn. edu / resuscitation / hypothermia / protocols.shtml. Velmi covered the statuvati practically outside the ignorance of the vitality medicine of the TG, especially with the presence of that magnificent admission, which is the accumulation of accumulations in the twentieth century.
most popular modern technologies home TG based on contact heat input from curves great area... We have developed an expanded method of blood cooling behind the help of internal heat exchange catheters, as well as other methods of lowering the temperature of the blood, including internal infusion of cold solutions. For more than 30 years, there was a breakdown and the equipment “Kholod-2F” and “Fluidkranioterm” were successfully stashed, allowing the local craniocerebral hypothermia (KCG) to be used to cool the surface of the head of the head. Dosvid zasosuvannya KTsG demonstrating the high efficiency of this technique, including in the case of a megalithic TG, to improve the acceleration of TBI and the accumulation of total damage to blood circulation. Velma was successful with the CCG to study and study in neonatology in case of asphyxia and birth injuries in newborns. In addition, a large number of faults are associated with the transfer of the foreign TG, and it is tied with an extended thought about those that lowering the temperature in the entire brain can only be done at a lower temperature of the main heat / coldness of the body - blood, to get rid of it.
At the same hour vidomo, when average temperature close to + 37 ° C, the brain is thermogeterogenous in the norm. Falling from the functional activity, the temperature gradients between measles can reach 1 º. It seems that local hyperthermia of the brain develops in TBI, and in the area of ​​trauma and asphyxia of the brain, the temperature of the neurons rises by 1.5 ° C in the food. Apparently, direct temperature control of the brain and non-invasive radiothermometry at CCG were performed. Bulo showed a decrease in the temperature of measles in transcranial cold in animals and in the presence of KCH in patients in non-slip mills... In addition, with the induction of the KCH, the temperature in the ear canal is determined, and the temperature of the ear canal is measured. Zastosuvannya KCG viglyadaє methodically more beautifully zagalny TG in cerebral catastrophes, which was known in the previous recommendations. However, the confirmation of the CCG registration in case of the second non-systematization, the details of the method are not explained, but it was spontaneous to carry out the reference information.
Meta robots: find the main effects of the KCH in ailments in the state period ІІ.
Material and methods of preliminaries. The pre-treatment was carried out on the basis of the revision of the cerebral blood circulation system No. 1 of the UDP. For the KCH, a revision device "ATG-01" was used, which allowed a trivial hour to reduce the temperature of the scalp area to + 3 ± 2 ° C for an additional sholomiv-cryoaplikator. Monitor the temperature in the area of ​​heat dissipation, the outer ear canal, basal temperature... The triviality of the KCH procedure ranged from 4 to 24 years.
CCG was induced in 25 patients during the period II. The criterion for the inclusion of the II, confirmation by the method of neuroimaging (CT or MRI of the brain), the term is not more than 72 hours.
Middle age of patients in schools 70.6 years old (20 patients from the second in the basin of the right and left middle cerebral arteries, 5 - in the vertebral-basilar system).
The criterion for viklyuchennya bula bradycardia (heart rate below 50 beats / hv). Neurological deficiency was assessed using the NIHSS scale (National Institutes of Health Stroke Scale. Brott T., Adams H.P., 1989). All patients were treated with standard therapy, but did not include additional sedation. Parameters of cerebral blood flow were assessed by the method of transcranial dopplerography (TCD) on the "Angiodin-PC" apparatus. Rozrakhovuvali intracranial vise (ICP) according to the formula (Klingelhofer J.).
The results of this discussion. All the patients were treated for a visit and they endured the CCG procedures well. NIHSS deficiency rate was 11.3 ± 0.26 points.
CCG with a triviality of the procedure for at least 4 years led to a severe regression of neurological deficiency. At the end of the procedure, the average NIHSS score decreased to 6.8 ± 0.1 (p<0,01), регресс неврологического дефицита составил 39%. Достигнутый результат был стабилен на протяжении всего времени пребывания пациентов в отделении (ОНМК); 7 пациентам потребовалось проведение повторных сеансов КЦГ в связи с повышением уровня неврологического дефицита. При 2-3-кратных воздействиях, проводимых ежедневно, уровень дефицита стабилизировали в диапазоне лучших достигнутых результатов.
Stagnation by the TKD method allowed for the development of significant changes in cerebral blood flow, for CCG to occur and manifest itself in increased peak systolic blood flow by 69% (23.88 ± 9.1 cm / s) and middle blood flow rate by 69% (23.88 ± 9.1 cm / s) and middle blood flow rate. 1 cm / s) in the transcript of the test in patients with a long history of insult up to 48 years. The average decrease in ICP was 31%, and statistically significant indications were only those in patients with a high level of ICP (in 5 patients - 50 mm Hg). Indicators of systemic AT in CCG practically did not change.
Before the control group, boules included 10 patients, who did not eliminate CCG, with areas of localization of ischemic heart disease and a large amount of neurological deficiency (11.4 ± 0.41 points for NIHSS) the same as in the main groups. Changes in the neurological status and cerebral blood flow were fixed until an hour or so after 24 years. There was no statistically significant change in the neurological status and cerebral blood flow in the control group; the regression of neurological deficit was 1.08 ± 0.66 points for the NIHSS.
In patients with cob normal basal temperature, the temperature in the ear canal decreased after 4 hours from the cob to + 35-33 ° С.Bilsh trivial procedures were brought to a decrease in the auricular temperature up to + 30 ° С. 'What is OTG (~ + 36 ° C) without myazovy tremtynnya and did not vimagal predatkovoi sedation. The average gradient of basal temperature and temperature in the ear canal becomes 2.6 ° C.
In 12 patients, the abnormalities of the supernatant were affected by changes in the basal temperature up to + 38-40 ° С, at a whole auricular temperature was increased by 0.5-1 ° С. Induction of the CCG for 4-6 hours allowed the reduction of the temporary temperature and reaching the vortex temperature gradation (the basal temperature of the auricular is 2-3 ° C).
Otrimany material is given for the development of visnovoks, so that the CCG in the version of the vicious methodology allows the achievement of positive clinical results in sick people from the II. There is a regression of neurological deficiency, abnormalities, a severe change in the brain, a decrease in ICP, which is more difficult for itself to increase blood flow in the magistral vessels of the circulating disease, bit by bit.
Predstavlenі results can argumentuvati vіdomimi danimi, otrimanimi in experiental doslіdzhennyah at vіdtvorennі zagalnoї gіpotermії models іshemії i neurotrauma, de shown scho gіpotermіya mozk spriyaє galmuvannya vikidu glutamate prignіchennya protsesuvannya i vzaєmodії signaling molecules faktorіv apoptosis znizhennya oxidative stresu scho lie in osnovі effective toxicity. The ICP is decreasing, the axonal transport is changing, the axonal transport is changing, the pial microcirculation. Hypothermia with a decrease in the amount of loss of brain tissue and bending of neurons in the case of an enlarged brain, accelerating the renewal of ATP during reperfusion. In addition, it seems that lowering the temperature of the brain will prevent the development of all the main pathogenetic mechanisms of the ear of neurons in case of ischemia, reperfusion and neurotrauma, demonstrating neuroprotective effects themselves.
The KCG methodology is guided by all types of methods for the development of hypothermic hypothermia, not a hypothermic hypothermia, not a hypothetical correction of thermoregulation; According to the specified parameters of the CCG, there are a whole range of updated and foreign recommendations on the validity of the TG. KCG appear to be effective in the correction of pararetic stanіv, as the sutta is covered with a broach II.
Our presenters did not see any acceleration or side effects of the KCG’s stagnation during the period of the state hospitalization of the patients, but to the department of "ATG-01"

literature
1. Arutyunov O.I., Semenov N.V. About the temperature of the brain and liquor of the empty in the class and experiment // Tr. Kiev SCIENCE-PREVIOUS. psycho-neuron. institute. K., 1949.T.12. S. 150-157.
2. Bukiv V.A. Cold and organism. Food for the out-of-the-box coolness of the creatures and the people. L., 1964.S. 216.
3. Vilenskiy B.S. Non-advanced studies in neurology. M., 2006.S. 231.
4. Genov P.G., Timerbaev V.Kh. Intraoperative damage to the brain during the period of development of cerebral aneurysms: Materials of the 6th Science and Practice. conf. "Safe for the sick in anesthesiology and reanimatology." M., 2008.S. 15-16.
5. Ivaschenko O.I. The change of AML to the brain in patients with hemorrhagic GPMK in case of local cranio-cerebral hypothermia in the first year of the insult: Materials of the laboratory of the physical physiology of the brain of the GU NDI brain of the Russian Academy of Medical Sciences. M., 1995.S. 23.
6. Kolesov S.N., Likhterman L.B. Functional neuroheploradiation (diagnostics, prognosis, control of treatment) in neurological and neurosurgical pathology // Heat treatment in medicine: Zb. tr. All-Union. conf. Leningrad: GOI, 1990. Part 1, pp. 91-95.
7. Kopsh S.N. Craniocerebral hypothermia in obstetrics. M .: Medicine, 1985.S. 184.
8. Labora A., Hugenar P. Hybernotherapy in medical practice. M., 1956.S. 281.
9. Litasova E.E., Vlasov Yu.A., Okuneva G.N. s sp_vavt. Clinical physiology of piece hypothermia / ed ed. E.N. Meshalkin. Novosibirsk, 1997.S. 564.
10. Litas E.E., Lomivorotov V.M., Postnov V.G. Perfusion-free killed hypothermic zakist / ed. E.N. Meshalkin. Novosibirsk, 1988.206 p.
11. Lomіvorotov V.M., Chernyavskiy A.M., Knyazkova T.A. s spivavt. Retrograde perfusion of the brain as a component of the anti-hemic to the brain during reconstructive operations on the aortic duos // Pathology of blood circulation and cardiac surgery. 2010. No. 1. S. 44-49.
12. Negovsky V.A. Treatment of organism and piece hypothermia. M .: Medgiz, 1960.S. 302.
13. Lovtsevich I.V., Gutnikov A.I., Davidova L.G. Hypothermia as a method of neuroprotection in patients with ear structures of the posterior cranial fossa: Materials of 6-ї Sciences.-Pract. conf. "Safe for the sick in anesthesiology and reanimatology." M., 2008.S. 43-44.
14. An important injury to the skull and brain / ed. V.M. Ugryumova. M .: Medicine, 1974.S. 318.
15. Usenko L.V., Tsarov A.V. Piece hypothermia in the field of reanimatology // Zagalna reanimatology. 2009. T. V. No. 1. S. 21-23.
16. Shevelov I.A., Kuznutsova G.D., Tsikalov E.N. Thermoencephaloscopy. Moscow: Nauka, 1989.224 p.
17. Shulman H.M., Yagudin R.I. Electrothermal method of localization of the brain rosters: Materials of the 4th All-Union. z'yzdu neurokhir. M., 1988.S. 103-105.
18. Bigelow W.G., Lindsay W.K. Hypothermia. Its possible role in cardiac surgery // Ann. Surg., 1950. Vol. 132, No. 5. P. 849-866.
19. Correa M., Silva M., Veloso M. Cooling therapy for acute stroke (Cochrane Review). In The Cochrane Library, Issue 4, 2002.
20. Kees H. Polderman et al. Induction of hypothermia in patients with various types of neurologic injury with use of large volumes of ice-cold intravenous fluide // Crit. Care Med. 2005 Vol .. 33. N 12. P. 2744-2751.
21. Mirto N., Prandini E. Mild hypothermia reduces polymorphonuclear leukocytes infiltration in induced brain inflammation // Arquivos de Neuro-Psiquiatria. 2005. Vol. 63. No. 3b. P. 18-24.
22. Laxorthes G., Campan L. Hypothermia in the Treatment of Craniocerebral Traumatist // J. Neurosurg. 1958. Vol. 15, P. 162.
23. Lyden P.D., Krieger D. et al. Therapeutic hypothermia for acute stroke // International Journal of Stroke. 2006. Vol. eleven). R. 9-19.
24. Thomas M. Hemmen Cooling therapy in stroke // J Neurotrauma. 2009. Vol. 26 (3). P. 387-391.
25. Hertog H., Worp B., Tseng M.-C., Dippel D. The Cochrane Collaboration // Cochrane Stroke Group. 2009. hub 2.
26. Povlishock J.T., Enoch P.W. Сlinical Monitoring // International Anestthesiology Clinics. 1996. Vol. 34. No. 3. P. 23-30.
27. The Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest // NEJM. 2002. Vol. 364 (8). P. 549-556.


Hypotermia (yak method) - a whole piece of lowering the temperature of the room (or part of the room) by the way of cooling. Stasis is self-reliant or in addition to being a drug addict. Develop local (misce) and out-of-the-box hypothermia.

Local hypothermia of the slunk is carried out behind the aid of a special device LGZH-1 with bleeding twists of the two-fingered intestine, before the slunk, erosively and a number of ignited ailments (for example,). To a sick person, through the introduction of a probe from thin balloons, in the form of a slunk. At the balloon, cool down the coolant (50% alcohol t ° 4-5 °), continuously circulate through the apparatus. The triviality of hypothermia 3-4 years. Overflow the roof overnight. Local hypothermia to the brain is carried out behind the auxiliary device "hypothermia", from which cold water and or cold water flow around the hair part of the head. Get stuck with important brain damage (injuries, damage to the blood supply to the brain). Triviality of hypothermia 2-4 years; at the same time, an intravenous infusion of hypertonic growth, plasmi is shown. The local hypothermia of the symptoms stagnates as a sickly zest during amputation in seriously ill people. Кінцівка, decorate with bears in ice, naklavshi in front (for, for 2-3 years; for, for 1-2 years).

I will get rid of hypothermia during operations, which will help to reduce blood circulation (surgery on an open - "dry" -, surgery for iin.). When the temperature is lowered to 25 °, the blood circulation can be increased by 10-15 minutes. and navi more. Hypotermia can be recognized by two methods.
1. Zovnishnє cooling (bath t ° 3-5 °, lined with bears in ice, aparati - hypothermia at the viglyad, which is stored in a system of tubes, which are cold in a circle). A sick person is given endotracheal anesthesia with meat and kerovans. In case of reached glibini (div. Narcosis), put the sick person in a cold bath. Control the temperature in the air flow with a special thermometer. For 30-60 minutes the temperature drops to 32-30 °. Wiiymayut a sick person from the bathtub, vitirate and put on. Stretching 30 min. the temperature will go down spontaneously by 2-5 °. M'yazovu tremtinnya on the cob, I know the supplementary relaxant.

After the end of the operation, putting a sticker on the wound, put the sick person in a bath at t ° 40-45 ° and warm up to t ° 33-35 °, then transfer it to the skin, cover it with a carpet. Dalі to move independently. Hypothermia changes the sensitivity of the fabric to a sour hunger, which allows the brain to tolerate a decrease in blood circulation without shkodi.

The general rules of hypothermia for an additional device, for example, are lined with toys with ice.

2. Extracorporeal (Extraorganic) cooling; Shelter through pipe systems to bring the sick person into the cooling apparatus, and then pour it into the great artery.

Hypotermia is lower than 20 ° inimage of piece blood circulation (div.). The main problem of hypothermia is heart fibrillation. The frequency of the whole accelerated growth at a temperature lower than 28 °. If the heart is determined, it is necessary to carry out a defibrillation (div.).

Hypotermia (in Greek. Hypo - lower and therme - warmth; synonymous with coldness) is a piece of lowering the temperature of the room, which can be reached under anesthesia, for an additional physical inflow (cold water, ice, cold that day). Hypotermia reduces the need for an organism in sourness, advances its stiffness to hypoxia (div.), Zmenshu or to help assimilate a certain amount of time to the brain. Hypotermia is indicated in case of operative engagement on a "dry" heart, in the process of yogo vimikayut for 10 min. For more (ischemia to the brain, the posture of hypothermia, can be transferred without any insecure herds for 3 minutes), during operations, it is possible to compress the aorta and turn on the blood flow through the leg artery. In neurosurgery, hypothermia stagnates during operations to drive aneurysms in the brain and in the brain. Hypotermia was effective in thyrotoxic crisis. In ailments with an important thyrotoxicosis and significant changes in the exchange of processes, I will additionally fix hypothermia in combination with neurovegetative blockade and endotracheal anesthesia. Hypothermia stagnation during great operations in severely ill patients, compensatory forces before surgery (I. S. Zhorov). In the period of surgery, hypothermia is indicated for hypoxic cerebral blockages, intoxication and CNS injuries (A.P. Kolesov).

Under anesthesia (div.) With hypothermia - even foldable, technically important, a kind of combined zenbolyuvannya. At the same time, there is a need for important slowing downs to go into the hypothermia of the lack of that, if it is not safe, amoused by the heavy camp of the sick person, or the folding involved, changing the rizik, of tying with the hypothermia itself.

Hypotermia can be both foreign and musical. In case of miscellaneous hypothermia, according to Allen, the kintsivka, overtightened with jgut, is wrapped with ice (in the world of tanennya, add a new one). After 60-150 minutes. the temperature of the cooling fabrics drops to 6-8 °, which will reduce the need for sourness and increase the arthritic effect. In lithium ailments, it is found in an important camp, the stagnation of muscular hypothermia during amputation due to the drive of atherosclerotic or diabetic gangrene has become effective.

In case of hyperthermia, obovascovy endotracheal anesthesia, which will prevent the power of kerovan dichotomy and stasis of muscle relaxants (div.). Zm_ni with zagalnogo cooling have a cyclic (phasic) character. The 1st phase of hypothermia - "adrenergic" - is characterized by a decrease in the temperature of the heart and blood flow up to 34 ° (pochatkova, or light, hypothermia). In the face of an infusion of adrenaline, an arterial and venous grip grows, the pulse and dichotomy are frequent, the arteriovenous growth in the wake of sourness grows. Hyperglycemia, hypercalysemia, the strength of the necessary in the roof and thyroxine are indicated.

The 2nd phase is infused at a temperature lower than 28 ° (hypothermic). In the beginning of the phase, the importance of attaching all functions to the body is promoted. The curse of the mucus, the drop in arterial and venous clutch, the pulse rate up to 40 beats, changes in the heart vikid and arteriovenous growth (arteriovenous blood pressure), decrease in the internal The endocrine function is suffocated. Sickness is in evidence. Doses of narcotic speech at the moment should be significantly reduced, recommend to navigate to a 100% acidic insufflation. At ts_y phase it is possible to wake up the heart with a term for 10 min.

The third phase, which begins when the temperature is below 28 ° C, is characterized by a higher degree of endocrine function of the hypophysis, thyroid gland and supranircus glands. The curse of mischief changes to weaknesses. Often, the heart fibrillation, which I am clogging up with death, if I do not take the surface of anesthesia, then at temperatures not lower than 21 °, no respiratory, no cardiovascular reflexes do not know, I want to do something. T.M.Darbinyan the phase of cooling the organism from 27 ° C to 20 ° is seen as the hypothermia.

Glybokoi hypotermієyu slіd in vzhatya colder lower than 20 °, as vimagає zasosuvannya apparatіv extracorporeal blood circulation. Drew, Kin and Benazon (C. Є. Drew, G. Keen, D. B. Benazon) brought that at t ° 13 ° ischemia to the brain is transferred by a stretch of 45 minutes. with more updates of all functions. S. A. Kolesnikov і spіvr. carried out cooling to 9-15.6 ° C from zupinka blood circulation for 7-45 min. However, the critical dosage of storage of high hypothermia is not great. The lethality at nіy shcha of the temporal arch through the often develops a syndrome of decortication.

The final stage of hypothermia є period of development. With a new maє buti, it is preferable to come to the senses, to the fabrics over their lives. It is recommended to take an active part in treatment (with warm water, warm to the children, for additional treatment and so on) In addition, with sufficient anesthesia.

In the cob phase of hypothermia, organism for a decrease in temperature appears to be threefold, moreover, the increase in temperature does not decrease, but, navpaki, grows in 2-7 times. To stifle the whole reaction with the success of stasis of curarization of non-depolarizing relaxants in conjunction with non-glib anesthesia. When there is a tremor, it is recommended to intravenously introduce 10-25 mg of aminazine and 20 mg of promedol.

Damage to the disorder, such as vinikє with hypothermia, lead to acidosis, and acidosis and hypoxia of the myocardium provoke heart fibrillation. Hyperventilation is recommended for combating dichal acidosis. When fibrillation has come, most of the time is defibrillation with a capacitor discharge (V.A.Negovskiy, N.L. Gurvich).

For the improvement of the coronary blood circulation, the reduction of the thoracic aorta (div.

For the improvement of hypothermia, it is necessary to use the methods of cold cooling, cooling empty to the body and extracorporeal blood circulation. Cooling control thermometer in the rectum or stravohody (special thermometer).

Zovnishnє cold water can be reached by covering a sick person with ice-cream, bored by a bathtub with water at t ° 3-5 °, wrapped in a carpet, cold water is passed through a yak through pipes. For the most recent cooling, there are most special refrigerators, for example, the device "Autogipotherm" (Swedish virobnitstva).

With any method of cooling, it is necessary to reduce it, if the temperature of the blood circulating through the cooling surface of the tissue, to decrease by 2/3 of the planned cooling: after the end of the cooling, the temperature continues to fall, if the temperature is too hot. ...

Hypothermia by the method of cooling emptying - washing of the open breast cells with cold water (1954), the introduction of a cylinder slunk into the empty ones with circulating water in new cryogenic water, etc. With extracorporeal cooling, venous blood from empty veins is consumed in the refrigeration system, and then it goes back into the body through the stegnova artery. A. A. Vishnevskiy and T. M. Darbinyan from sp_vr. We have developed the method of single regional perfusion to the brain and heart, which allows operating on an open heart in the minds of a general hypothermia for 9-29 minutes. The method of regional hypothermia of the head for the additional help of the new coldness, the staff of the quickness and the quickness of the test began to be stashed in the complex of calls for reanimation (div. Living organisms).

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