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#46
17.10.2005, 13:02
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Öèòàòà:
Ó ìåíÿ áûë ñëó÷àé è íå îäèí (õîòÿ äî îñòàíîâêè íå äîõîäèëî) ãëóáîêîé áðàäèêàðäèè íà ââäåíèå äèòèëèíà (óêðàèíñêîãî ïðîèçâîäñòâà). Ìîæåòå ðàññìîòðåòü òàêæå ýòîò âàðèàíò. 
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#47
17.10.2005, 17:01
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Öèòàòà:
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#48
17.10.2005, 23:00
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Âîïðîñ ÁÀÄàõ, "èììóíîïèòàíèè" ó õèðóðãè÷åñêèõ áîëüíûõ.
SEE Program Electronic Edition 35. Which statement about nutrition supplements with immune-enhancing nutrients (immunonutrition) is MOST likely true? A. Immunonutrition has been found to decrease the rate of infectious complications after elective surgical procedures. B. Immunonutrition decreases mortality in critically ill patients. C. Immunonutrition shortens hospital length of stay. D. Immunonutrition decreases the duration of mechanical ventilation in critically ill patients. Comments on the incorrect answers B. Some studies have found that immunonutrition may actually worsen outcomes in critically ill patients. C. Immunonutrition has not been shown to shorten hospital length of stay. D. Immunonutrition does not decrease the duration of mechanical ventilation in critically ill patients. Correct answer is A Infection in the critically ill patient has been associated with higher morbidity and mortality, prolonged intensive care unit (ICU) stay, and prolonged hospitalization. Using enteral feeding formulas that contain specific nutrients (arginine, glutamine, nucleotides, and omega-3 fatty acids) can influence the immune and inflammatory responses. Many studies have been conducted to evaluate the outcomes of patients who received immunonutrition, but the results have been inconsistent due to variation in the study methods, nutrition formulas, study end points, and the heterogeneity of any critically ill population. To gain more insight into the possible benefit of immunonutrition, a metaanalysis was performed on all published data in multiple languages over a 10-year period. The authors identified and analyzed 22 studies involving 2,419 patients and found that immunonutrition had no effect on mortality, infectious complications, length of ICU stay, or the duration of mechanical ventilation when compared to standard nutrition therapy. When only the studies with better experimental design were considered, the authors actually found an increased mortality rate in critically ill patients. This raises the concern that immunonutrition may actually worsen outcomes in these patients. It is speculated that enhancing a patient's ability to mount an immune response may augment the inflammatory response already present in critical illness and lead to further organ injury. The authors did find that patients undergoing elective surgery had fewer infectious complications and shorter lengths of hospital stay. Mild immunosuppression has been described after surgical stress. It may be that augmenting the immune system with nutritional supplements may allow these patients to mount a more appropriate immune response in the postoperative period. The authors concluded that they could not recommend immunonutrition for all critically ill patients and that further research is needed to identify any subgroups that may benefit from the treatment. REFERENCES Heyland DK, Novak F, Drover JW, et al. Should immunonutrition become routine in critically ill patients? A systematic review of the evidence. JAMA. 2001; 286:944-953. Townsend CM Jr, Beauchamp RD, Evers BM, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 17th ed. Philadelphia: Elsevier WB Saunders; 2004:290-291,1973-1978.
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#49
18.10.2005, 22:13
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Öèòàòà:
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#50
18.10.2005, 23:04
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Öèòàòà:
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#52
19.10.2005, 11:01
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Öèòàòà:
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#53
19.10.2005, 19:32
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Öèòàòà:
 fakt v biografii
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#54
19.10.2005, 20:24
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Öèòàòà:
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#55
19.10.2005, 23:25
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Öèòàòà:
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#56
24.10.2005, 11:21
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Öèòàòà:
Ñïàñèáî!!!
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#58
24.10.2005, 14:05
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Öèòàòà:
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#59
24.10.2005, 16:08
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Öèòàòà:
È ïîæàëóéñòà óòî÷íèòå, ÷òî èìåííî Âû èìåëè ââèäó! Ñïàñèáî! 
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#60
24.10.2005, 22:54
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Èìåííî! ß èìåë â âèäó âòîðóþ òðàêòîâêó.
Âû ïèøåòå, ÷òî òàõèêàðäèÿ ëó÷øå, ÷åì áðàäèêàðäèÿ, êîòîðàÿ äåéñòâèòåëüíî ïîñëå èíòóáàöèè ïðîøëà áû. Òàê âîò ïðî ìåõàíèçìû. Ìíå èçâåñòíû, ïî áîëüøîìó ñ÷¸òó, äâà "çàêîíà ñåðäöà" - çàêîí (ìåõàíèçì) Ôðàíêà-Ñòàðëèíãà è ìåõàíèçì Àíðåïà. Íå ñîìíåâàþñü â Âàøèõ çíàíèÿõ, ïðîñòî äëÿ ñèñòåìíîñòè èçëîæåíèÿ íàïèøó êîðîòåíüêî... Ìåõàíèçì Ô-Ñ ïîçâîëÿåò óâåëè÷èòü cardiac output çà ñ÷¸ò óâåëè÷åíèÿ äëèííèêà ñåðäå÷íîé ìûøöû â äèàñòîëó.  íîðìàëüíî-ôèçèîëîãè÷åñêèõ ïðåäåëàõ ( à ìû ñåé÷àñ íå ðàçáèðàåì ïàòîãåíåç ñåðäå÷íîé íåäîñòàòî÷íîñòè è ïîðî÷íóþ âíóòðèñåðäå÷íóþ ãåìîäèíàìèêó ïðè êëàïàííûõ ïîðîêàõ) ýòî äîñòèãàåòñÿ ÓÂÅËÈ×ÅÍÈÅÌ êîíå÷íî-äèàñòîëè÷åñêîãî îáú¸ìà ëåâîãî æåëóäî÷êà. Ñäåëàéòå, ïîæàëóéñòà, àêöåíò íà ñëîâå "äèàñòîëè÷åñêîãî". Ìåõàíèçì Àíðåïà ÿ èçëîæó ñâîèìè ñëîâàìè. Ìîæåò áûòü äëèííî, íî õî÷ó ðàçæåâàòü. ß âåäü òîæå ìîãó îøèáàòüñÿ è õî÷ó, ÷òîá ìåíÿ èñïðàâèëè â ýòîì ñëó÷àå. Ñóòü â òîì, ÷òî îïðåäåë¸ííîìó äèàïàçîíó ×ÑÑ ñîîòâåòñòâóåò îïðåäåë¸ííàÿ âåëè÷èíà cardiac output è â ïðåäåëàõ ôèçèîëîãè÷åñêèõ çíà÷åíèé ýòî ñîîòâåòñòâèå ïðÿìî ïðîïîðöèîíàëüíîå. Íó òî åñòü ïðè ×ÑÑ, äîïóñòèì óñëîâíî, 60-80/ìèí cardiac output îäèí, à ïðè 80-100 óæå áîëüøå, à 100-110 åù¸ áîëüøå. Êàê âèäèì óâåëè÷åíèå cardiac output äîñòèãàåòñÿ óâåëè÷åíèåì ×ÑÑ, òî åñòü ÓÊÎÐÎ×ÅÍÈÅÌ ÄÈÀÑÒÎËÛ. Ñåðäå÷íûé öèêë çàíèìàåò ïðèìåðíî 0,8 ñåêóíäû. 0,3 èç íèõ óõîäèò íà ñèñòîëó, 0,1 íà âñÿêóþ ôèãíþ è 0,4 - íà äèàñòîëó. Ñêàæó Âàì ïî áîëüøîìó ñåêðåòó: ñåðäöå - î÷åíü íåãëóïîå è áîëüøå îòäûõàåò, ÷åì ðàáîòàåò è ýòî ÿâëÿåòñÿ ïðîÿâëåíèåì ïðèíöèïà ñîõðàíåíèÿ ýíåðãèè (äåëàòü ïîìåíüøå, à ïîëó÷àòü ïîáîëüøå), êîòîðûé ðåàëèçîâàí äàæå â îðãàíèçàöèè ïåðèîäè÷åñêîé òàáëèöû Ìåíäåëååâà (åñëè èíòåðåñíî - ìîãó ïîÿñíèòü). À çà ñ÷¸ò ÷åãî äîñòèãàåòñÿ óâåëè÷åíèå ×ÑÑ? Òîëüêî çà ñ÷¸ò óìåíüøåíèÿ âðåìåíè äèàñòîëû! Óâåëè÷èâàÿ cardiac output òàêèì ïóò¸ì, Âû èä¸òå ïî ýíåðãåòè÷åñêè áîëåå çàòðàòíîìó ïóòè ïî ñðàâíåíèþ ñ ìåõàíèçìîì Ô-Ñ. Äëÿ êàêèõ-òî ïàöèåíòîâ óâåëè÷åíèå ýíåðãîçàòðàò ñåðäöà è, ñîîòâåòñòâåííî, ïîâûøåíèå ïîòðåáíîñòè ìèîêàðäà â êèñëîðîäå, ìîæåò îêàçàòüñÿ ðîêîâûì...
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Ëèíåéíûé âèä
