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Table 1. - Hemodynamics indices at general anesthesia with propofol in combination with EA (numerator) and total propofol anesthesia in combination with fentanyl (the denominator) in children (n = 40)
Stages of research FE HBV ADP HR SPVR HI
Results 70.89±1.2 70.49±0.85 23±1.67 24.59±1.61 76.97±1.58 82.65±2.21 99.73±2.2 97.8±2.21 29.62±1.5 30.29±1.54 2.76±0.1 2.87±0.09
Premedica-tion 68.18±1.63 68.28±1.03 21.43±0.98 22.9±1.31 86.2±1.23* 90.23±1.79* 113.83±2.68*** 107±2.11* 29.52±1.39 32.16±1.77 3.12±0.12 3.02±0.11
Intubation 67.3±0.92* 66.55±0.96* 24.13±1.45 26.88±1.63 93.13±2.89*** 91.33±1.78* 126.43±3.4* 105.18±1.91* 25.77±1.33 27.81±1.04** 3.76±0.11*** 3.4±0.1***
traumatic stage 68.14±1.04 68.4±0.96 24.29±1.47 25.56±1.62 75.49±1.21** 77.63±1.39** 107.13±1.21*** 100.73±2.13 23.37±0.75* 26.03±0.89* 3.33±0.1*** 3.07±0.07**
awakening period 70.64±0.91 70.9±0.7** 24.57±1.48 24.45±1.69 76.67±1.47 76.38±1.49* 111.41±2.6* 96.75±2.27 22.57±0.73* 28.14±0.72 3.49±0.1 2.75±0.05**
Note: * The reliability of differences were compared with results (P<0.05).
** the Reliability of differences were compared with the previous stage of study (P<0.05). *** The significance of differences were compared with results and previous stages of study (P<0.05).
In second group the patients were compared with the results indicating reduction in SPVR 14.06% in the period of anesthesia 2. In condition of CEA with propofol the main course stages maintenance. Other indices such as FE and ABP had tendency to at operational period were accompanied by minor, as well as com-decrease, respectively 2.96% and 6.07%, while indices HBV and HR pensate changes of basic indices of CH, that testified on effective had tendency to increase respectively, 3.94%, 3.0% and 6, 97%. protection of child's body with anesthesia at abdominal surgical inConclusions. 1. CEA was taken with bupivacaine and was terventions. combined with propofol, it was characterized smooth clinical 3. CEA on the base of propofol use was the method of choice course, prolonged analgesic effect (up to 3.5 hours), early awak- to protect children in abdominal surgery. ening of patient from anesthesia.
References:
1. Isenberg V. L., Ovchinnikov V. I., Diordiev A. V. The perspectives of development anesthesia in pediatrics//Regional Anesthesia and cure of acute pain. - 2006. - Volume 1, - No. 2. - P. 54-60.
2. Boyko V. V., Pavlov A. A., Bohun V. "The advantages and disadvantages of different anesthetic methods for supply for antinociceptive protection" International Medical Journal, - 2010. - No. 4.
3. Geodakyan O. S., Epidural analgesia with ropivacaine in adolescents text./O. S., Geodakyan, JI. E., Tsypin//Anesthesiology and reanimation - 2006. - No. 1. - S. 20-23.
4. Sabirov D. M., Batirov U. B., Saidov A. S., Intra abdominal hypertension is a real clinical problem//Bullet. intensive. ther. - 2006. - No. 1. - P. 21-23.
5. Marochkov A. V., Dudko V. A., Reznikov M. V., Experience of use anesthesia with isoflurane abdominal operations//Surgery News. -2008. - No. 2. - P. 116-124.
6. Mrochek D. A., Optimization of anesthetic management of laparoscopic cholecystectomy.//Medical panorama. - 2004. - No. 5. - P. 37-39.
7. Persson J., Flisberg P., Lundberg J., Thoracic epidural anesthesia and epidural hematoma//Acta Anesthesiologica. - 2007. - Vol. 3. - P. 58-62.
8. Ryu H. G., Bahk J. H., Lee C. J., Lim Y. J. The coiling length of thoracic epidural catheters: the influence of epidural approach an-gle//BJA. - 2007. - Vol. 3. - P. 401-404.
9. Inhyung L., Yamagishi N., Oboshi K., Haruo T./Eliminating the effect of epidural fat during dorsolumbar epidural analgesia in cat-tle/VVA. - 2006. - Vol. 7. - P. 86-89.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-165-167
Yusupova Umida Masharipovna, Assistant Andijon State Medical Institute, the Republic of Uzbekistan E-mail: evovision@bk.ru
Evaluate the effect of copper-bearing iud on women's reproductive health
Abstract: Contraception using modern copper-bearing Intrauterine device (IUD) in the last twenty years, and remains the most acceptable method of birth control population. The main factors influencing the choice of this method are: the fear of repeat abortions, psychological and non-acceptability of the negative attitude to hormonal contraception, affordable cost, ease of use. Keywords: The copper-containing, IUD, contraceptives.
Section 8. Medical science
Despite the widespread promotion and dissemination of oral contraceptive, in the minds of many women, the IUD is the most affordable, cheap, reliable and convenient method of protection from unwanted pregnancy. High efficiency, accessibility for all social groups, the lack of systemic effects on the body, the possibility of a long and continuous use, rapid recovery of fertility after removal tools, no need to explain the choice of the daily control of the majority of women in favor of this method of contraception [1-5].
Analysis of domestic and foreign literature has shown a high interest of researchers in various aspects of intrauterine contraception. However, so far in the literature there are conflicting opinions about the use of the IUD, which indicates unsettled sight medical community on contraception in general.
The objective assessment of the impact of copper-bearing IUD on women's reproductive health.
Material and methods. The study involved 72 women who were established copper-containing IUD, the main group and 30 women in healthy women without IUDs — a control group.
During the investigation of cases of pregnancy have been reported. This is consistent with numerous studies, we meet again-ment of high contraceptive effectiveness of copper-containing IUD today [3; 4].
All of the women surveyed were aged 22 to 47 years old. The average age of women was 36,2 ± 1,3 years.
The results and discussion. In the study of menstrual function revealed that 95 (93.7%) of patients in both groups menarche occurred in a timely manner. The average length of the menstrual cycle in all women was 27,1 ± 1,3 days. Elongated menstrual cycle (days 31-35) was noted in 2 (6.7%) control group of women and 6 (8.3%) — a second group truncated (23-27 days) — 3 (10.0%) and 7 (9.7%) women, respectively. The duration of menstrual bleeding vibrational-las 3 to 7 days, with a mean of 5.2 ± 1.1 days.
Between menstrualnys spotting occurred in 1 (3.3%) women in the control group. Abundant menstruation observed in 1 (3.3%) patients and 13 controls (15.7%) patients of the main group. However, it should be noted that a third of these women used IUDs are not more than a year. In this respect, we adhere to the view that such changes in menstrual function often are reversible and do not require additional treatment [5].
According to the results of the research that the majority of patients in both groups (93.9%) indicators hemoglobin levels were within the normal range, we can not agree with the opinion about the development ofiron-deficiency anemia due to increased volume and duration of menstruation on a background of copper-containing IUD [1].
In analyzing the medical history of all patients found in 39 (54.2%) women were extragenital diseases. Among all the diseases accounted for the largest share of diseases of the digestive organs. At the time of the study did not reveal a single case of acute exacerbations of chronic extragenital diseases. In 2 (6.7%) women in the control group and 12 (16.7%) — main group had a history of surgery.
For patients was characterized by a high incidence of gynecological diseases transferred. It is noteworthy that 5 (16.7%) in the control group and in 20 (40.3%) of the main groups have a history of chronic inflammation of the pelvic organs, and a core group of women with this pathology significantly more. Patients repeatedly treated for inflammation of the genitals in outpatient and inpatient settings.
In order to determine the position of the IUD in the uterus, gynecological pathology detection performed ultrasound new pelvis.
All women in the intrauterine cavity of the uterus located correctly. In 93.9% of the women, there were no pathological changes.
Uterus was defined as the formation echo dense pozadi bladder with a longitudinal size of 4.7 to 7.1 (average of 5.1 ± 0.2 cm), a transverse dimension between 4.0 and 5.7 (mean 4.3 ± 0,2 cm) and anterior-posterior size from 3.8 to 5.9 (on the average 4,8 ± 0,3 cm). Endometrial thickness averaged 0,54 ± 0,06 cm. Appendages field study in two women in the control group were found signs salpingoophoritis. Symptoms of adhesions occurred in 3 women of the main group.
Breast examination, which included ultrasound and mammography, showed the presence of fibrocystic breast in women in the control group 1 and five — the main, all these cases were previously confirmed diagnosis before the IUD is inserted.
Analysis of the generative function ofwomen showed that one patient had an average of 4.4 pregnancies (4,7 ± 0,5 in — the first, 4,2 ± 0,4 — in the second group). The average number of births fall into one patient (the ratio of the number of births to the number of women giving birth), it was about the same and amounted to 1.6 in the first group and the second — 1.7. Srav-tional analysis of the reproductive behavior of women indicated that abortion prevailed in the outcomes of pregnancies. The ratio of the number of abortions among genera was 2: 1 in the first group and 1.6: 1 — for the second.
The number of abortions, the woman comes from one of the first group was 1,3 ± 0,04, the second group — 2,8 ± 0,3. The share of the first group ofwomen who have had three or more induced abortions, almost half the preview decreases the figure in the second group. It was found that almost every third woman in the control group and one in four — the main group had a history of abortion up to birth.
To date, some researchers argue that the IUD is a leading factor in the etiology ofinflammatory diseases ofthe pelvic organs [3]. We hold a different view. There are factors that affect the likelihood of the development of inflammatory diseases of the pelvic organs (pelvic inflammatory disease), such as the woman's age, number of sexual partners, the number of abortions, the presence of a history of genital inflammatory diseases, etc. The occurrence of PID in IUD users, according to our data, often due to a lack of screening and treatment prior to use IUD or wrong selection of candidates for this type of contraception, or the lack of follow-up during the use of the IUD.
Recent large multicenter study showed that the risk of pelvic inflammatory disease on the background of the IUD does not differ from that show-telja in the population and is 1.6-2.2%. Compared with women not using contraception IC, in applying the IUD has several high probability ofPID in the first 20 days after IUD insertion.
Until now, no single point of view on the possibility of long-term use of copper-containing IUDs. Some experts believe that these contraceptives are already enough reasons to increase the previously approved five-year term of their service. For less than the IUD is changed to the new, the less the risk of pelvic inflammation, perforation and other complications observed, mainly, soon after the introduction of contraceptives. Furthermore, as a result patients contraception costs become much cheaper and more accessible [2].
Some interest in terms of the risk of inflammatory diseases is age of onset of sexual activity surveyed women-communities, which was significantly lower in the group of women with pelvic inflammatory disease and condition, pitchfork 18,5 ± 0,3 years vs. 19,4 ± 0,3 — healthy.
It is now established that the main risk of inflammatory diseases of the pelvic organs in the background ICH associated with infections, sexually transmitted infections. In our study, significant differences were found between groups in the average number
of sexual partners (1,3 ± 0,3 and 1,9 ± 0,1, respectively, in groups). Until the middle of women who had more than 4 sexual partners, the first group is 4 times greater than in the second. Having multiple sexual partners increases the likelihood of sexually transmitted infections, and hence the inflammatory diseases of the pelvic organs, including women with IUD.
The risk of inflammatory diseases of the pelvic organs in women using IUD and nd having ifektsii asymptomatic sexually transmit-
ted infections, similar to the risk in women who do not use this method of contraception. Intrauterine contraception while respecting its use of technology has no negative influence on fertility of women, allowing them to use the IUD after bear pregnancy. Among the women who wished to conceive after the timely extraction of the IUD, 55.6% — have become pregnant within six months, the rest in those year. does not exceed the average in performance The frequency of complications of pregnancy and childbirth.
References:
1. Becker F. V. Characteristics of reproductive health in women with prolonged intrauterine contraception: Author. cand. med. Sciences. -J., - 2004. - 24 p.
2. Revazova F. S. Clinico-morphological features, vnutrima-accurate. Contraception: Author. Dis ... cand. med. Sciences. - M., - 2003. -26 c.
3. Revazova F. S. Prevention of complications of intrauterine contra-drug concept "Marvelon"//Gynecology. - 2000. - No 6. - Vol. 2. - C. 1834-84.
4. Revazova F. S., Prilepskaya V. N., Kondrikov N. I. Results ofApplications, copper- and levotorgestrelsoderzhaschih IUDs in women of reproductive age//Materials of IV Russian Forum "Mother and Child", part 2. - M., - 2002. - P. 325-327.
5. Hatcher RA., Rinehart W. Blackburn R. Fundamentals of contraception. - University. Johns Hopkins University, - USA, - 2002. - 346 p.
