Critical Care Medicine

The anesthesiologist-resuscitator, unlike doctors of other specialties, proceeds from the priority of protecting not health, but the life of the patient. And the ICU is the "heart" of any health facility, where intensive care is carried out and the "struggle" for the life of a patient of any profile

Tez-tez kasallanuvchi bolalar o‘tkir respirator kasalliklar (O‘RK) bilan kasallanish darajasi, tengdoshlariga nisbatan yuqori bo‘lgan, bolalar guruxini anglatadi. “Tez-tez kasallanuvchi bolalar” muammosi hozirgacha pediatriya amaliyotida dolzarb muammolardan biri bo‘lib qolmoqda. Tez tez kasallanuvchi bolalarda yuqori nafas yo‘llari kasalliklari-rinit, nazofaringit, quyi nafas yo‘llari kasalliklari – traxeit, bronxit, pnevmoniya, quloq burun-tomoq kasalliklari – otit, yevstaxiit, adenoidit, sinusit ko‘p uchraydi va boshqa somatik patologiyalar ham kuzatiladi.

Актуальность. Проблемы послеоперационных осложнений аноректальных мальформаций (АРМ) у детей и адекватное повторные реконструктивные операции остаются далеко нерешенной в детской колопроктологии. Послеоперационные осложнения при хирургической коррекции АРМ зависят от показания, выбора оперативной тактики, эффективности метода первичной коррекции, наличия сопутствующих врожденных патологий соседних органов и профессионализма хирурга. Цель. Улучшение результатовхирургической коррекции АРМ путем изучения причин возникновенияосложнений, оптимизации тактики, интра- и послеоперационных мер профилактику детей.

The article highlights the actual problem of diagnostics and treatment of cardiogenic shock. A number of measures of a therapeutic and diagnostic nature are given

Реакция симпатико-адреналовой системы, возникающая в связи с хирургической агрессией представляет собой быстрый и в тоже время, чрезвычайно действенный компенсаторный механизм, направленный на поддержание гомеостаза. Изучение состояния данной системы в период операции, анестезии и в ближайшие дни после них является одним из основных условий для своевременного выявления различных, в первую очередь, гемодинамических и метаболических сдвигов, выявленных хирургической агрессией и целенаправленного коррегирования их.

342 patients operated on for severe traumatic brain injury in Republican Specialized Scientific and Practical Medical Center of Neurosurgery from 2008 to 2017 were examined and treated.Decompressive cra-nioectomy was performed by 222 patients out of 342 (64,9%), Craniotomy - 120 (35,1%). Decompressive cra-niectomy was the main method of surgical treatment of patients with acute traumatic intracranial hematomas, accompanied by edema and prolapse of the brain. Reducing the time elapsed from the moment of trauma to surgery, correction of hemodynamic disorders, increased surgical efficiency, reduced the risk of complications in the postoperative period, and improved treatment outcomes

Overweight and obesity in children is a global problem in the world. According to WHO data for the period from 1975 to 2016 the number of obese children from 5 to 19 years of age in the world has increased more than 4 times (WHO. 2021 URL: https://www.who.int/ru/news-room/fact-sheets/detail/obesity-and-overweight ). The enormous increase in the incidence of obesity among children has led to an exacerbation of the problem of sleep disorders. From the point of view of brain electrophysiology, sleep is defined as a normal biological process of consciousness in which there are criteria for brain waves. A child spends more than 30% of his life sleeping, and this condition is critical for growth and development. For this reason, sleep pathologies and their clinical consequences have become priority areas of scientific research in recent years [Sánchez-López AM, Noack-Segovia JP., et al. 2020, Aguilar M.C., Sánchez A.L., et al. 2013].

One of the achievements of the last decade in the field of health care of the Republic of Uzbekistan is the rapid introduction of many types of high-tech medical care. First of all, this significantly increases the demands on medical personnel in terms of their theoretical knowledge and practical skills. The development of market relations in all spheres of economic and social life, including healthcare, requires the training of specialists with the necessary competencies. Global problems based on medical errors and significant risks of negative scenarios require further development of educational technologies and improvement of their quality in all areas of training of medical professionals in the future. does.

В последнее время использование ультразвука в качестве инструмента для своевременной диагностики патологических состояний новорожденных приобретает широкую популярность в ОРИТ. На данный момент существуют различные протоколы прикроватной ультразвуковой (УЗ) диагностики, используемые у взрослых пациентов, в частности BLUE, FAST, RUSH и т.д. При этом выбор специализированных протоколов, разработанных именно для новорожденных, невелик (SAFE, SAFE-R). SAFE-протокол начинается с оценки сердечной деятельности, далее оценка функций легочной ткани и брюшной полости на наличие жидкости. Авторы при пересмотре нового протокола рекомендовали назвать его SAFE-R (Sonographic assessment of liFE-threarening Emergencies Revised), включив в диагностический поиск критический стеноз аорты, острые абдоминальные осложнения и массивное внутрижелудочковое кровоизлияние.

Effective and safe pharmacotherapy of recurrent bronchitis in children of different ages and prevention of its chronicization is important. More than 100 million cases of bronchopulmonary diseases among children are registered worldwide. Of all pathological conditions, today respiratory diseases account for more than 50% of the total morbidity in children of different ages. A high increase in bronchopulmonary diseases is observed especially among children of preschool and school age, and improper management and self-medication of such patients can subsequently lead to a protracted and recurrent course of the pathological process, which acquires medical and social significance. Recurrent bronchitis is characterized by repeated episodes of acute bronchitis 2-3 times or more during the year against the background of an acute respiratory infection. The criteria for diagnosing an acute episode correspond to the clinical and radiological signs of acute bronchitis – clinical data: increased body temperature, dry cough, sometimes wet, diffuse dry and variable moist rales in the lungs; X-ray picture: change in the pulmonary pattern without infiltrative and focal shadows in the lungs.

Своевременное представление о волемическом состояние больных детей с нефротическим синдромом (НС) дают возможность предотвращать грозные осложнение связанные сразвитием генерализованных отеков.

The article deals with the treatment of patients with acute widespread peritonitis, which is one of the most important problems of modern abdominal surgery. At the time of admission in a critical condition and requiring resuscitation. a significant increase in intra-abdominal pressure is found in more than 50% of cases, clinical signs of abdominal compartment syndrome are detected in about 4% of cases. The aim of the study: Evaluate and improve the results of treatment of patients with peritonitis by using surgical methods aimed at preventing ACS in complex treatment. Material and research methods. We analyzed the clinical data of 112 patients operated on for common peritoni-

Острое повреждения почек (ОНИ) является одним из грозных осложнение при нефротическом синдроме (НС) у детей. Своевременное определение факторов риска развития позволяет эффективно предотвратить ОНИ при НС у детей.

Around the world, the corona viral infection pandemic is one of the pressing problems; the treatment of pregnant women and its consequences, both of the pregnant women themselves and of newborn children born from those who have had COVID-19, is of great importance. All over the world, bronchopulmonary pathology, in comparison with other diseases of the bronchopulmonary system in children, occupies one of the first places. COVID-19 in pregnant women and the condition of infants is of great interest not only to obstetricians and gynecologists, but also to pediatricians. On February 11, 2020, the World Health Organization assigned the official name to the infection caused by the new corona virus – COVID-19 (“Coronavirus disease 2019”). To study the course and treatment of children under 2 years of age with pneumonia born to women who had COVID-19 during pregnancy in comparison.

"Anesthesiology and resuscitation is one of the most complex and difficult specialties, requiring broad erudition, deep knowledge and mastery of the hands at the same time from the doctor."

Improving the children's resuscitation service and improving the quality of care for children in critical condition is one of the main areas of healthcare in the Republic of Uzbekistan. The availability and quality of medical care at the resuscitation stage of treatment, regardless of the location of the patient, largely determines the outcome of the underlying disease. In children, due to anatomical and physiological features and rather significant differences in the nature of pathological processes, critical conditions occur much more often than in adults.

The Convention on the Rights of the Child, which has been committed by almost all countries of the world, provides for the implementation of a wide range of legislative and administrative measures to ensure the interests of children, and, first of all, in the field of protecting their health. The health of children and adolescents is of exceptional importance in preserving the gene pool of the nation, the labor and defense potential of the country. In this regard, the reduction of infant and child mortality in the Republic of Uzbekistan is a national task. In children, due to anatomical and physiological features and rather significant differences in the nature of pathological processes, critical conditions occur much more often than in adults. Accidents (drowning, injuries, overheating, poisoning, bites, etc.), critical conditions and decompensation of chronic diseases in children and adolescents require timely specialized resuscitation care. The availability and quality of medical care at the resuscitation stage of treatment, regardless of the location of the patient, largely determines the outcome of the underlying disease. Therefore, the decisive role in reducing child mortality belongs to the resuscitation service.

Обеспечение безопасного обезболивания при реконструктивной хирургии у детей является наиболее актуальным. Включение ингаляционного анестетика севофлурана в качестве основного компонента комбинированной анестезии несет в себе определенные преимущества с сохранением компенсаторных возможностей основных систем жизнеобеспечения. Целью исследования явилось изучение эффективности проведения общей анестезии с применением ингаляционного анестетика севофлурана при операциях по поводу врожденных расщелин верхней губы и твердого неба.

The purpose of the study was to improve the quality of anesthesia during orthopedic operations in children using the opioid-sparing anesthesia technique.
Materials and methods. The course of anesthesia was analyzed in 48 patients aged 3 to 14 years, during orthopedic operations in children. The distribution of patients into groups was carried out depending on the technique of anesthesia. Group 1 (main) consisted of 25 children who underwent general anesthesia using low doses of fentanyl, sevoflurane and propofol. group 2 (control) - 23 children who underwent general anesthesia with fentanyl and propofol. Echocardiography was used to determine hemodynamic parameters. The dynamics of changes in the level of cortisol in the blood and the concentration of catecholamines (adrenaline, norepinephrine, dopamine) in daily urine was studied. Results. In children of the first group, during the introductory period of anesthesia, there was a decrease in CI, an increase in heart rate and UPS. Stroke index (SI), mean arterial pressure (MAP), cardiac index (CI) changed insignificantly compared to the previous stage of the study. In the children of the second group in the most traumatic stages of the operation, there was an increase in SI, HR, and AI. In the most traumatic stages of the operation and after the operation in children of the first group, there was a tendency to increase cortisol, in the second group of patients, an increase in cortisol was noted.

The problem of choosing the option of optimal anesthesia in order to reduce the risk of adverse reactions and complications remains its relevance, especially in children, and is far from its final decision.

Since the last decades of the 20th century, the attention of researchers has been attracted to peculiar deviations in the psycho-emotional sphere among workers in a number of professions, which were subsequently combined into one syndrome, called professional burnout syndrome or burnout-syndrome. In the International Classification of Diseases of the X-revision, this disease appears under the heading Z.73.0 as a "state of complete exhaustion." Most often, service sector personnel, including medical ones, are subject to it, it proceeds in the form of 3 options - emotional exhaustion, depersonalization and reduction of personal achievements. Among the risk factors are frequent stress, hard work, high responsibility for the result of work, irregular working hours, etc. Therefore, among doctors of various specialties, its prevalence is not the same - for example, if among surgeons it occurs in 57%, then among anesthesiologists-resuscitators - up to 82 % (Lovchev A.Yu., Koryachkin V.A. 2009).

It is well known that assessment stimulates learning. A single exam does not fulfill all the functions of assessment, such as assessing knowledge, understanding, skills, motivation, and feedback. Written exams test cognitive knowledge, which is just one aspect of competence. The structuring of questions and assessment by emphasizing objectivity has been emphasized and has become important in practical assessment. The Objective Structured Practice Examination (OSPE) is now the accepted tool for assessing practical skills in both pre- and paraclinical subjects.

Neuroblastoma (NB) is an embryonal tumor of childhood arising from cells of the sympathetic nervous system. Clinically, the disease is characterized by high heterogeneity from spontaneous regression to aggressive progression, metastasis and patient death. It ranks fourth in frequency among solid tumors of childhood.

Кардиоплегия дель Нидо, которая традиционно использовалась для защиты миокарда в педиатрической хирургии врожденных пороков сердца, теперь широко используется во взрослой кардиохирургии. Целью данного исследования было сравнить безопасность и эффективность кровяной кардиоплегией (КП) с кристаллоидной капдиоплегией (КК).

Pnevmoniya o‘pka parenximasining o‘tkir yuqumli yallig‘lanishi bo‘lib, xarakterli klinik va rentgenologik belgilar asosida tashxislanadi. Pnevmoniya bolalarda eng tez-tez uchraydigan va jiddiy o‘pka kasalliklaridan biridir,eng yuqori kasallanish va o‘lim darajasi yangi tug‘ilgan chaqaloqlarda va hayotning birinchi yillaridagi bolalarda qayd etilgan. Pnevmoniyadan vafot etgan bolalarning yosh tarkibini tahlil qilish shuni ko‘rsatadiki, barcha o‘limlarning 96,1% erta yoshda sodir bo‘ladi va salbiy oqibatlarning maksimal soni chaqaloqlik davrida sodir bo‘ladi (100 ming bola aholiga 102ta). Jahon sog‘liqni saqlash tashkiloti (JSST) ma’lumotlariga ko‘ra, butun dunyo bo‘ylab bolalar o‘limining asosiy sababi- pnevmoniyadir. Bir yilda pnevmoniyadan 5 yoshgacha bo‘lgan 1 millionga yaqin bola hayotdan ko‘z yumadi. Bu OITS, bezgak va qizamiqdan ko‘proqdir. Pediatriya amaliyotida pnevmoniya va uning asoratlarini erta aniqlash va tashxislash muhim ahamiyatga ega.

COVID-19 bilan kasallangan bolalarning aksariyati tuzalib ketadi, biroq baʼzilarida uzoq muddatli, koʻp aʼzoli simptomlar va asoratlar mavjud boʻlib, ularning kasallanish darajasi ortib bormoqda [1]. Uzoq muddatli COVID yoki post-Covid sindromi (PCS) yoki post-o‘tkir COVID – bu tibbiyot hamjamiyati tomonidan tan olingan va xavotirga sabab bo‘lgan fanlararo ishtirokni talab qiladigan nisbatan yangi muammodir. COVID-19 bilan uzoq muddatli yurak oqibatlarini bashorat qilish qiyin. SARS-CoV-1 va SARS-CoV-2 ning genetik o‘xshashligi, shuningdek, 12 yillik kuzatuv davomida bemorlarning 40 foizida yurak-qon tomir kasalliklari aniqlangan oldingi virusli epidemiyalar tajribasi bu kasallikning uzoq muddatli oqibatlarini ko‘rsatadi. COVID-19 [2]. SARSCoV-2 virusi uchun ijobiy PCR testi (polimeraza zanjiri reaktsiyasi) bo‘lgan bemorlarning taxminan 10% 3 haftadan ko‘proq vaqt davomida tiklanmaydi, kichikroq qismi esa oylar davomida tuzalmaydi [3]. COVID-19 boshlanganidan 100 kun o‘tgach, bemorlarning 41 foizida hali ham doimiy alomatlar mavjud, nafas qisilishi eng keng tarqalgan simptom (36%). Chap qorincha funktsiyasining pasayishi va o‘pka gipertenziyasi belgilari kamroq tashxis qilinadi [4]. COVID-19 ning inson organizmiga uzoq muddatli oqibatlari hali ham noma’lum, ammo SARSCoV-2 virusi keltirib chiqaradigan pandemiyadan keyin tasvirlangan alomatlar xavotirga soladi va bemorlarni uzoq muddatli kuzatishni talab qiladi [5]. Prognoz nafaqat kasallikning o‘tkir davrida o‘pkaning shikastlanish darajasiga, balki ekstrapulmoner ko‘rinishlarga ham bog‘liq bo‘lishi mumkin. Shunday qilib, diagnostika, shoshilinch tibbiy yordam, kasallikning kechishini va uning asoratlarini o‘rganish va oldini olishga asosiy e’tibor uzoq muddatli oqibatlarga olib keladigan omon qolganlar tanasidagi o‘zgarishlarni o‘rganishga qaratildi [6].