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Number of distinction had been detected in surveyed patients during evaluation of haemostasiogram indices first of all in platelet link. Indices were acquired values to be typical for physiological gestation. It should be noted that normalization of these values occurred faster in surveyed group II as compared with surveyed group I. Markers of thrombophilia became normal values faster in women from group II in relation to control group than in women from group I respectively.
Thus, conducted therapy with Essentiale forte N was conductive to haemostasis. Conducted researches confirm the safety of application. Elevation of D-Dimmer and FMSC levels is the reflection of haemostasis system since such factors in APS and thrombophilia are elevating long before estimated pregnancy and markers of such processes.
If to take into account that increase in coagulation potential is an adaptive response for haemostasis system during physiologically proceeding pregnancy then thrombophilic type disturbance of gestational adaptation to be observed in APS often points to advisability to study of co agulation system and devise of preconceptive therapy long before the estimated pregnancy.
Enabling the use of Essentiale forte N in the complex therapy of women with APS promotes bringing the pregnancy to term. The most effective application of the methodology in the pregravid period, it reduces the incidence of miscarriage, intrauterine growth retardation, perinatal morbidity and mortality.
References:
1. Balasch J., Carnwna F., Lopez-Soto A. et al. - 1993. Hum. Reprod. - Vol. - 8. - N12. P. 2234-2239.
2. Linnikov V. I. - 2013. Immunotherapy in complex treatment of antyphospholipid syndrome//Reprodact endocrin. - 10:2. - P. 23-26.
3. Linnikov V. I. 2005. Diagnostics, principles of treatment and prevention of thrombophilic conditions associated with primary an-tiphospholipid syndrome in pregnancy, childbirth and postpartum women dissertation for the degree of MD, - Moscow. - P. 33-35.
4. Makatsaria A. D. Bicadze V. O., Baymuratova S. M. Antiphospholipid syndrome - immune thrombophilia in obstetrics and gynecology. - 2007. Triada-X, - Moscow. - P. 1112.
5. Sidelnikova V. M. - 1986. Noncarrying of pregnancy, - Moscow. P. 75.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-105-108
Matlubov Mansur Muratovich, Samarkand State Medical Institute. Head of the Department of Anesthesiology and Rehanimatology. Associate professor.
E-mail: [email protected] Semenihin Arseniy Arsenevic, Republican Scientific-Practical Center of Obstetrics and Gynecology of the Ministry of Health of the Republic of Uzbekistan. Professor of the Department of Anesthesiology and Rehanimatology.
E-mail: [email protected] Najmutdinova Dilorom Kamaritdinovna, Director of Republican Scientific-Practical Center of Obstetrics and Gynecology of the Ministry of Health of the Republic of Uzbekistan, professor E-mail: [email protected] Goyibov Salim Saydullaevich, Samarkand State Medical Institute Assistant Professor of the Department of Anesthesiology and Rehanimatology E-mail: [email protected] Kim Olga Vitalevna, Samarkand State Medical Institute Assistant Professor of the Department of Anesthesiology and Rehanimatology E-mail: [email protected]
Assessment of functional status cardio-vascular system in pregnant women with obesity
Abstract: 124 pregnant women at the age from 23 to 28 years old in gestation periods of37-39 weeks have been examined with the aim of investigation of hemodynamic status of pregnant women with obesity. All examined patients have presented in 6 groups. In all observed patients pregnancy, according to the consultations of obstetric-gynecologists, was accepted as uncom-
plicated. Groups were identical due to age and gestation periods, differences consisted only in body mass and body mass index (BMI). The degree of obesity has assessed according to body mass index. The carried out investigation showed that overweigh as far as its progression has a very unfavorable influence for hemodynamic and functional status of cardio-vascular system in general. The most significant disorders of the functional status of cardio-vascular system have been taken place for the obesity of II and III degrees.
Keywords: pregnancy, obesity, hemodynamic.
Introduction. It is generally known that overweigh in pregnancy as far as its progression leads to the disorders of the basic system of life support, and in the first place cardio-vascular system [1-6]. Also it is needed to note that pregnant women with obesity have been presented the group of high risk for the development of preeclampsia, so far as disorders of macro- and microcirculation have a leading role in the development of such pathology [7-11]. In this connection the study of hemodynamic status in pregnant women with obesity is gained special importance for preparation to delivery, determination of orientation of drug treatment and selection of rational method of manual of anesthesia.
The aim of investigation was to study of the status of cardiovascular system in pregnant women with obesity of the different degrees of significance in the gestation periods of 37-39 weeks.
Material and methods of investigation. 124 pregnant women at the age from 23 to 28 years old in gestation periods of 37-39 weeks with obesity of different degrees of significance have been examined in order to study the status of cardio-vascular system. All examined patients have presented in 6 groups. 19 somatically healthy not pregnant women with body mass index (BMI) of 19-24,9 kg/m 2 have been consisted in the first group and relatively healthy pregnant women with normal weight (BMI — 19-24,9 kg/m 2) have been consisted in the second group. Patients with overweigh and obesity have been consisted in the third, fourth, fifth and sixth groups; their BMI were respectively 25-29,9 kg/m 2, 30-34,9 kg/m 2, 3539,9 kg/m 2 and > 40 kg/m 2. Groups were identical due to age and gestation periods; differences consisted only in body mass and BMI which allowed us to make its objective and comparable assessment.
In all observed patients pregnancy, according to the consultations of obstetric-gynecologists, was accepted as uncomplicated.
The degree of obesity has determined according to body mass index (BMI) [3, 11]. According to BMI in somatically healthy not pregnant women (n=19) it was from 19 to 24,9 kg/m 2 (normal body mass, the 1st group); in relatively healthy pregnant women (n=21) it was from 19 to 24,9 kg/m 2 (normal body mass, the 2d group); in the 3d group of patients BMI was from 25 to 29,9 kg/m 2 (n=21), (overweigh); in the 4th group of patients BMI was from 30 to 34,9 kg/m 2 (n=21), (I degree of obesity); in the 5th group of patients BMI was from 35 to 39,9 kg/m 2 (n=21), (II degree of obesity) and in the 6th group of patients BMI was > 40 m-/m 2 (n=21) (III degree of obesity).
Central hemodynamic was studied the method of echocardiography with the use of ACCUVIXQX, Medison (Japan) apparatus and TRITON (Russian Federation) monitor.
Impact (II) and cardiac indexes (CI), general peripheral vascular resistance (GPVR) and the index of left ventricular capacity (ILVC) have been calculated [15].
Central hemodynamic has differentiated due to the following types: hyperkinetic, eukinetic and hypokinetic. Blood pressure (BP), heart rate (HR), respiratory rate (RR) and blood saturation by oxygen (SpO2) were controlled with the use of Schiller-argus (Sweden) monitor. The mean dynamic pressure (MDP) was calculated, 6 minutes step test [10] and Shtange test [9] have been used in order to assess initial functional status of cardio-vascular system,
peripheral blood circulation was assessed by diuresis during hours or minutes and gradient of temperature (At), presenting the difference between temperature of index finger of the hand and temperature of the eardrum area of acoustic meatus with using electro thermometer (Temp — 4) for it.
All numeral indexes received during investigation have been processed by the method of variation statistic with the use of Student criterion (with the use ofMicrosoft Office Excel program) and presented as M±m, where M was mean arithmetic value, and m was standard error. Differences in P < 0,05 was considered as statistically reliable. The received results have been presented in the table.
Results and discussion. As you can see from the table in the gestation periods of 37-39 weeks hemodynamic indexes in pregnant women with normal body mass — 2d group (BMI — 1924,9 kg/m 2) corresponded to the standards which were characterized for healthy pregnant women of such gestation period [14]. All women of this group have eukinetic type of blood circulation, ILVC was 0,58±0,005 Wxm 2, CI was 3,32±0,14 l/m 2/min, RR was 19,2±1,2 per minute, SpO2 was 98,4±0,6%, diuresis during an hour was 0,82 ml/kg/h, gradient of temperature (At) was 1,29±0,08 °C which were indirectly testified about quite satisfactory functional status of cardio-vascular system and its reserve possibilities, about effective oxygenation. During comparing the received results with such ones in somatically healthy not pregnant women with normal body mass (1st group) we have registered certain differences testifying about moderate changes in the system of blood circulation in pregnant women which it should been considered as process of adaptation of the human organism to the new conditions.
The differences between 1st and 2nd groups of patients were consisted in tendency in pregnant women of 2nd group to the frequent HR, increasing MDP and GPVR, reduction of the once and minute productivity of the heart. Some worsening of the results of functional tests with exertion in patients of the 2nd group has been taken into consideration (see table 1). At the same time all these changes did not have reliable character, because they did not overrun their physiological variations.
Increasing BMI until 25-29,9 kg/m 2 (overweigh, 3rd group) at the same gestation periods concerning group of pregnant women with normal body mass has provoked moderately significant hemodynamic disorders — significant reduction of once and minute productivity of the heart and ILVC respectively in 16,5%, 13,9% and 6,9%. At the same time eukinetic type of blood circulation, adequate diuresis and blood saturation by the oxygen have been preserved. Indexes which are indirectly characterized functional status of peripheral blood circulation have been worsened — At was increased in 15,1%, diuresis per hour was decreased in 12,2%. Absolute mean arithmetic indexes of 6 minutes step test and tests with breath-holding were decreased in comparison with such indexes in healthy pregnant women (2nd group) respectively in 6,0% and 5,6%. However these changes did not have reliable character, normokinetic type of blood circulation was still preserved.
During comparing the received results with the appropriate indexes in patients with normal body mass we have made a conclusion that overweighs provokes a series of pathologic processes leading
to the moderately significant disorders of the functional status of cardio-vascular system and reduction of its productivity.
Increasing of BMI till 30-34,9 kg/m 2 (I degree of obesity, 4th group) was accompanied by reliably frequent HR in 8,0%, increasing MDP in 9,2% and also decreasing of CI, II, ILVC in 20,2%, 25,7% and 10,3% respectively concerning with group of pregnant women with normal body mass. It has been decreased the once and minute productivity of the heart, At has been decreased until 1,68±0,08 C° which testified about the worsening of the peripheral blood circulation. Diuresis during an hour is remained in the stable numbers and it is not reliably changed. Against this background RR is reliably more frequent until 23,9±0,4 per minute with simultaneously reduction of SpO2 until 96,3±0,5%. 2
During comparison of the received results of the 4th group (I degree of obesity) with the 3rd group of patients (overweigh) it has been also noted progressive and reliable reduction of II, CI with simultaneously increasing of GPVR and At, also reliable worsening the results of 6 minutes step test and test Shtange in pregnant women with obesity (see table). We should note that in spite ofhave worsen functional status of cardio-vascular system as far as augment-
ing BMI in patients of 4th group normokinetic regimen of blood circulation has been preserved.
Increasing of BMI until 35-39,9 kg/m2 (obesity of the II degree, 5 group) is accompanied by reliable reduction of II, CI, ILVC in 34,5%, 28,6% and 17,2% respectively concerning the pregnant women with normal body mass which testifies about forming ofheart failure. At the same time MDP and GPVR were increased, HR was more frequent in 15,0%, 38,5% and 9,2% respectively. RR was more frequent in 26%. SpO2 is corresponded to 95,6±0,4%. The above listed hemodynamic changes are accompanied by worsening signs ofperipheral blood circulation — reduction ofdiuresis during an hour until 0,63±0,07 ml/kg/h and increasing ofAt until 1,84±0,06 °C. Indexes ofthe functional stress tests were progressively worsened, so, mean arithmetic absolute index of 6 minutes step test was reduced concerning the group of pregnant women with normal body mass in 30,3% and the result of Shtange test was 32,4%. It was planned a clear tendency of transformation ofthe eu-kinetic regimen ofblood circulation in the hypokinetic type. It is needed to note that practically all our investigated parameters characterizing functional status of cardio-vascular system were reliably differed from 4th group of pregnant women with obesity of the I degree (BMI — 30,0-34,9 kg/m 2) with clear tendency for worsening (see table).
Table. 1. - Functional status of system of blood circulation in pregnant women with normal body mass, overweigh and obesity in the gestation periods of 37-39 weeks
The studied parameters Investigated groups of women
1 (n=19) 2 (n=21) 3 (n=21) 4 (n=21) 5 (n=21) 6 (n=21)
HR, per minutes 76,3±2,4 78,9±2,6 82,2±2,1 85,8±1,6A 86,9±1,8A 90,4±2,1A
MDP, mm. Hg 79,1±1,2 82,1±1,2 86,6±1,3A 90,4±2,6A 96,6±2,1*A 101,6±2,8A
II, ml/m 2 44,8±1,6 41,7±2,1 34,8±0,5A 31,0±0,4*A 27,3±0,3*A 23,4±0,4*A
CI, l/m 2/min 3,48±0,18 3,32±0,14 2,86±0,09A 2,65±0,06*A 2,37±0,04*A 2,18±0,04*A
ILVC, W x m 2 0,59±0,006 0,58±0,005 0,54±0,007A 0,52±0,005*A 0,48±0,007*A 0,47±0,008A
GPVR, dinxs/sm 5 1127,5±54,2 1095,6±40,3 1293,9±55,8A 1476,2±64,3*A 1781,9±70,4*A 2159,3±70,3*A
Diuresis during an hour, ml/kg/h 0,84±0,05 0,82±0,09 0,72±0,11 0,71±0,09 0,63±0,07A 0,61±0,08A
At, b C° 1,12±0,09 1,29±0,08 1,52±0,07A 1,68±0,08A 1,84±0,06A 2,04±0,07*A
Step test in m. 564,1±32,8 432,3±40,8 406,4±30,8 345,2±23,4A 301,4±12,4A 269,4±18,3A
Shtange test, per second 33,4±2,3 28,4±2,5 26,8±1,4 21,8±1,6*A 19,2±0,9A 18,8±0,6A
Note: A - reliability of differences (p<0,0S) concerning group of pregnant women with normal body mass. * - reliability of differences (p<0,0S) concerning previous group of pregnant women with low BMI.
Increasing of BMI until 40 and more kg/m 2 (morbid obesity of the III degree, 6th group) was promoted to the progression of the signs of heart failure which have presented in reliable concerning patients of the 2nd group reducing of II, CI, ILVC in 43,9%, 34,3% and 19,0% respectively. Against this background MDP was increased in 101,6±2,8 mm.Hg., GPVR was 2159,3±70,3 dinxs/sm 5, also significant tachycardia (HR — 90,4±2,1 per minutes) and tachypnea (RR — 24,9±0,2 per minutes) were observed. Reduction of blood saturation by oxygen (Sp02-94,3±0,6%) and decreasing of diuresis during an hour are testified about the worsening of peripheral blood circulation. Hypokinetic regimen of blood circulation has taken place. The results of the received during performing functional tests have testified about dramatic reduction of adaptive possibilities of cardio-vascular system (see table).
The above listed allow us to conclude that overweigh as far as its progression renders extremely unfavorable influence for the functional status of cardio-vascular system and hemodynamic in general.
The most significant disorders of the functional status of cardio-vascular system have been taken place in obesity of the II
and III degrees. In such contingent of women, even in uncomplicated pregnancy to the gestation periods of 37-39 weeks it has been formed heart failure, hypokinetic regimen of blood circulation requiring individual approach to the prenatal drug preparation, periods and methods of delivery and methods of anesthetic manual.
Conclusions.
1. Overweigh as far as its progression renders extremely unfavorable influence for the functional status of cardio-vascular system and hemodynamic in general.
2. Increasing body mass index in pregnant women until 39,9 kg/m 2 concerning to pregnant women with normal body mass is accompanied by reliably significant reduction of impact index, cardiac index and the index of left ventricular capacity which testifies about decreasing once and minute heart productivity, forming of prerequisites to the development of heart failure.
3. Increasing of body mass index until 40 and more kg/m 2 is prerequisite to the development of heart failure which requires individual approach to the prenatal drug preparation, periods and methods of delivery and methods of anesthetic manual.
References:
1. Akhmedov F. K., Tuksonova D. I., Negmatullaeva M. N., Dustova N. K. Cardiac and kidney hemodynamic in pregnant women with preeclampsia against the background of obesity.//International journal of applied and fundamental investigations. Moscow. - 2013. - № 11 - P. 18-20.
2. Bayranova M. A. Optimal tactic of the management of pregnant women with obesity. Dissertation of the candidate of medical science. - Moscow, - 2012.
3. Dedov I. I., Melnichenko G. A. Obesity: etiology, pathogenesis, clinical aspects: Manual for doctors. - Moscow. - 2006 - P. 114-178.
4. Abdullah A, Hoq S, Choudhary R, Laifer S, Zarich S. Cardiac performance is impaired in morbidly obese pregnant females//J Obstet Gynaecol Res. - 2012 - Vol. 38 (1) - P. 258-265.
5. Dennis A. T., Castro J. M., Ong M, Carr C. Haemodynamics in obese pregnant women//Int J Obstet Anesth. - 2012. - Vol. 21 (2) - P. 129-134.
6. Nickens M. A., Long R. C., Geraci S. A. Cardiovascular disease in pregnancy: (women's health series). South Med J. - 2013 - Nov; -106 (11):624-630.
7. Gevorkyan M. A. Obesity and reproductive health of the women.//Obesity and metabolism. - Moscow. - 2008. - № 3. - P. 14-16.
8. Davidovich V. V. Function of external breathing in patients with morbid obesity.//Military medicine. - Minsk. - 2013. - № 3. - P. 34-38.
9. Lebedinskiy K. M., Zakharov D. A., Shevkunenko D. A. Prognostic modeling reactions of the blood circulation to the operation and anesthesia.//In the collection: Modern clinical hospital: Actual problems of management, prevention, diagnostic and treatment. -Saint-Petersburg. - 2002. - P. 129-130.
10. Chazov I. I. Manual on cardiology - M., - 1982. - P. 437.
11. Salov I. A., Marshalov D. V., Shifman E. M., Petrenko A. P. Features of anesthesia of the delivery of women with morbid obesity.//An-esthesiology and Rehanimatology. - Moscow. - 2012 - № 6 - P. 67-71.
12. Ellinas E. H. Labor analgesia for the obese parturient//Anesth Analg. - 2012. - Vol. 115 (4). - P. 899-903.
13. Satpathy H. K., Fleming A, Frey D, Barsoom M, Satpathy C, Khandalavala J. Maternal obesity and pregnancy//Postgrad Med. - 2008. -Vol. 120 (3). - P. 01-9.
14. Petrosans E. A. Dynamic of the level of blood circulation during physiological pregnancy.//Bulletin of the general practitioner. Special edition. - Tashkent. - 2003. - № 2. - P. 79-80.
15. Guryanov V. A., Tolmachev G. N., Volodin A. V. et al. Preoperational preparation of pregnant women with arterial hypertension depending on the status of autonomic nerve system and system ofblood circulation.//Anesthesiology and Rehanimatology. - Moscow. -2010 - № 6. - P. 7-12.
16. Krasnopolskiy V. I., Logutova L. S., Petrukhin V. A. et al. Diagnostic and prevention of the development of the severe forms of gestosis in pregnant women.//Russian bulletin of obstetric-gynecologist. - Moscow. - 2006 - № 1 - P. 69-72.
DOI: http://dx.doi.org/10.20534/ESR-16-9.10-108-110
Makhmudova Zulfiya Primkulova, Senior Researcher Republican Specialized Scientific Practical Medical Center Phthisiology and Pulmonology
E-mail: [email protected]
Evaluation of the results of surgical treatment of tuberculous spondylitis
Abstract: Using titanium autografts has high strength and plastic properties, wear resistance, quickly assimilated through ingrowth into the pores of the bone at the radical reconstruction operations in patients with spinal tuberculosis significantly improve the results of surgical interventions.
Keywords: tuberculosis spondylitis, anterior spinal fusion, extra pulmonary tuberculosis.
Currently, spinal tuberculosis is detected in the fuzzy and complicated stages of the disease and at the same time, the use of hightech operations in the surgical treatment of complicated forms of tuberculosis spondylitis improve the results of therapy, will reduce the period of hospitalization [1; 3; 5].
The effectiveness of the treatment of tuberculosis of the spine is not high: healing observed in 36,5-69,5%; remission process — in 29,0-52,8%; disability — in 67-88,8% of cases [2]. In complicated forms of tuberculosis spondylitis celebrated the destruction of a large number ofvertebral bodies with the emergence of large defects of the spine, filled sequester, cheesy masses, and spinal disorders with severe disorders of the spine stability and development of kyphotic de formation [2; 6].
At present various options anterior fusion with autograft and non-biological implant in complicated forms of tuberculosis spon-
dylitis can not completely solve the problem of the effective stabilization of the affected spine, which began to attach the recent important [4].
Objective: To study the effectiveness of the stability of the affected spine in the surgical treatment of patients with complicated forms of tuberculosis of the spine.
Methods and scope of the study: Spend analysis of data from 162 patients were treated Republican Specialized Scientific Practical Medical Center Phthisiology and Pulmonology complicated forms of tuberculosis of the spine. The disease — from 1 month to 1.5 years. The specific process is localized in the cervical region in 23 (14.1%) patients, the thoracic region in 44 (27.1%), lumbar spine in 60 (37.0%), the lumbosacral region in 31 (19.1%) patients. The diagnosis of complex clinical laboratory, bacteriological, histological and rentgenotomo-raficmethods. Methods of radiation survey in-
