The purpose of the study was to determine the effectiveness of prescribing dobutamine and nitroglycerin in intensive therapy of cerebral and cardio-hemodynamic disorders in the syndrome of the inferior vena cava in cancer patients. Material and methods. We carried out a survey of 25 cancer patients diagnosed with lung cancer, which was complicated by the syndrome of the upper vena cava. These patients were treated at the department of anesthesiology with beds for intensive care of the SI "Grigoriev Institute of Medical Radiology of the National Academy of Medical Sciences of Ukraine ". Before the operation, the patients were examined by clinical and instrumental methods for the diagnosis of cerebral and cardio-hemodynamic disorders (cerebral blood damage, as well as complaints of shortness of breath, cramping, coughing). In order to evaluate the presence of cerebral and cardio-hemodynamic disorders in patients, an analysis of the level of enzymes of the neuron-specific enolase (NSA) and glycolysis (glycerol-3-phosphate dehydrogenase, glyceraldehyde-phosphate-hydrogenase) was performed 3 days before the operation. Results and discussion. The problem was solved in the following way: in the standard scheme of treatment of cerebral and cardioghemmodynamic disorders in upper vena cava syndrome, which includes preoperative medication with cardiovascular inotropic agents, in particular, dobutamine, diluted in 0.9% sodium chloride solution, for three days to conduct two parallel operations intravenous infusion of 250 mg dobutamine administration with speed of 15-18 mg / kg / min, while 1% solution of nitroglycerin with the speed of introduction of 30-34 mg / min, while the keel of its infusion depends on the specific enzyme neuron-enolazy and glycolysis, including glycerol-3-phosphate and glyceraldehyde phosphate dehydrogenase. Simultaneous use of two parallel intravenous infusions of dobutamine and nitroglycerin, can reduce the disadvantages of each individual drug and enhance their positive joint action, reduce and prevent the emergence of cerebral and cardio-hemodynamic disorders, thereby preparing the patient for surgery. The presented set of features is optimal for the treatment of cerebral and cardio-hemodynamic disorders. It allows to provide a new technical result, in particular, to reduce the severity of cerebral and cardio-hemodynamic disorders in patients in the preoperative period, which helps them to delay surgical intervention. Conclusions. The question of adequate timely correction of central hemodynamic disorders is one of the key factors in the treatment of patients in intensive care units. Preoperative preparation of patients with SVPV includes, first of all, measures to improve the safety of surgical intervention and the favorable flow of the process in the immediate postoperative period.
Keywords: upper ventricular vein syndrome, neuronspecific enolase, enzymes glycolysis, oncopathology, intensive therapy, dobutamine, nitroglycerin
Full text: PDF (Ukr) 205K