JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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118
Muminov Abdusalim Abduvakil,
Samarkand State Medical Institute
Uzbekistan
Matlubov Mansur Muratovich,
2
Republican Perinatal Center, Tashkent,
Ilhamov Akmal Falkovich,
3
Republican Specialized Scientific and Practical Medical Center for Obstetrics and Gynecology, Tashkent,
Uzbekistan
Tarayan Sergey Kimovich,
Hamdamova Eleonora Gafarovna
.
THE EFFECT OF ANESTHESIOLOGICAL AID ON THE CONDITION OF THE NEWBORNS EXTRACTED
BY CESAREAN SECTION IN MOTHERS WITH MARKED MITRAL STENOSIS (MS)
A comparative assessment of the condition of newborns extracted by caesarean section from mothers with
severe MS against the background of traditional HMA and combined anesthesia based on BE due to low concentrations
of local anesthetics was carried out
.
Keywords:
condition,of newborns caesarean section severe mitral stenosis general anesthesia.
Муминов Абдусалим Абдувакил,
Республиканский перинатальный центр, Ташкент, Узбекистан
Матлубов Мансур Муратович,
д.м.н., доцент кафедры анестезиологии и реаниматологии Самаркандского Государственного
медицинского института, Узбекистан
Ильхамов Акмаль Фалькович,
Республиканский специализированный научно-практический медицинский центр акушерства и
гинекологии, Ташкент, Узбекистан
Тараян Сергей Кимович,
Хамдамова Элеонора Гафаровна
.
Кафедра анестезиологии и реаниматологии Самаркандский Государственный медицинский институт,
Узбекистан
ВЛИЯНИЕ АНЕСТЕЗИОЛОГИЧЕСКОЙ ПОМОЩИ НА СОСТОЯНИЕ НОВОРОЖДЕННЫХ,
ИЗВЛЕЧЕННЫХ ПУТЕМ КЕСАРЕВА СЕЧЕНИЯ У МАТЕРЕЙ С ВЫРАЖЕННЫМ МИТРАЛЬНЫМ
СТЕНОЗОМ
АННОТАЦИЯ
Проведена
с
равнительная оценка состояния новорожденных, извлеченных путем кесарева сечения, у
матерей с выраженным РС на фоне традиционной ГМА и комбинированной анестезии на основе БЭ за счет
пониженных концентраций местных анестетиков.
Ключевые слова
: состояние, кесарево сечение, новорожденные, тяжелый митральный стеноз, общая
анестезия
The aim of the research:
Comparative
assessment of the condition of newborns extracted by
cesarean section in mothers with marked MS on the
background of traditional GMA and combined anesthesia
on EB base by decreased concentrations of local
anesthetics.
Materials and methods of the research
. For
the comparative analysis of the early adaptation period,
38 histories of the development of the newborns extracted
by CS in mother with marked MS (1.9-1.1 cm
2
).have
been analyzed, Depending on the type of anesthesia, all
newborns were divided into 2 groups. 19 children
extracted under the conditions of combined anesthesia
(CA) on the background of epidural blockade by means
of decreased concentrations of local anesthetics were
included into the 1st group and the same number of
children extracted under GMA conditions with AVL were
included into the 2nd group. We have also analyzed 38
JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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anestheological maps and histories of deliveries by means
of CS in maternity complex of Samarkand Medical
Institute clinic №.1 (Samarkand), AC RSSPMCOY A and
G (Tashkent).
Both groups of mothers were identical according
to gestation terms (33-35 weeks),character of operative
intervention, degree of MS evidence (1.9-1.1 cm
2
),
physical status of parturient women, frequency and
evidence of extragenital diseases, starting level of uterine
fetoplacental blood flow. The condition of premature
newborns at birth was estimated by means of Apgar score
during the 1st and 5th minutes of life [12], NACS score
[3] and the V.А. Bushtyrev’s in score an hour and 24
hours after birth [3] The course of early postnatal
adaptation of newborns was estimated by mathematical
analysis
of
cardiac
rhythm
by
means
of
cardiointervalography, along with this the index of
tension (TI) was determined in 5 minutes and 24 hours
after birth [1,11], concentration of total cortisol (CS) was
determined in umbilical cord blood by means of
immunochemiluminescent analysis (IChLA) (analyzer
MAGLUMI600 ShibeCoL-TD China) in 5 minutes after
birth.
Efficiency of self-
breathing was evaluated
according to saturation of oxygen SpO2 (monitor Triton-
Russia), in 2 and 24 hours after birth. Statistic processing
of the obtained results was carried out by means of
variation statistics with definition of the criteria of
reliability distinction according to Student by means of
Microsoft Excel program.
Results and their discussion.
As it can be seen
from the table, all newborns had the weight of the div
less than 2000 gr, at birth that corresponded to gestational
terms in delivery and criteria of prematurity. Assessment
according to Apgar score made 5.9±0.4 during the 1
st
-
minute in the first group of the newborns and in the
second 5.4±0.1. In 5 minutes after birth arithmetical
mean data of Apgar scale reliably increased in both
studied groups and made 7.2 ± 0.2 score and 6.7±2 scores
accordingly. Reliably higher score in the group of
children extracted in conditions of GKA with AVL
(table). is of particular attention. In analysis of the results
of psychoneurological picture of newborns adaptation
according to NACS scale in 2 hours after birth the best
results were registrated in the first group of children born
under the conditions of CA on the basis of epidural block,
their average score made 30.2 ± 0.3, while in the second
group of the newborns it only made 28.6 ± 0.2 scores that
had statistically reliable difference. 24 hours later
absolute arithmetic mean values data relative to previous
stage of study in both groups reliably increased. Along
with this Reliable intergroup differences were not
registrated.
Some indices characterizing the newborns condition in early adaptive
period (M ± m)
Studied indicators
Anesthesia method
GCA
with IVL
GMA
with mechanical ventilation
Gestation period, weeks
33,2 ± 0,4
33,4 ± 0,6
Weight at birth, gramess
1905,6 ± 30,6
1894,8 ± 32,8
Scale according to Apgar assessment (scores)
1 minute
5 minutes later
5,9 ± 0,1 *
7,2 ± 0,2 *
5,4 ± 0,1 *
6,7 ± 0,2 * ∆
NACS scale (scores)
2 hours after birth
24 hours after birth
30,20 ± 0,3 *
35,7 ± 0,5 ∆
28,6 ± 0,2 *
35,4 ± 0,3∆
Stress index (conv.units)
2 hours after birth
24 hours after birth
1432,6 ± 50,4 *
730,8 ± 22,8 ∆
1935,6 ± 80,4 *
796,8 ± 20,2 ∆
Total cortisol, nmol / l
5 minutes after birth
591,8 ± 35,6 *
338,6 ± 22,4 *
Oxygen saturation,%
2 hours after birth
24 hours after birth
92,9 ± 0,1 *
96,3 ± 0,2 ∆
91,2 ± 0,1 *
96,4 ± 0,3 ∆
Note: ∆ - statistically significant differences (p <0.05) relative to the previous stage of the study; * -
intergroup statistically significant differences.
As can be seen from the table: ID at the 5th
minute after birth significantly exceeded the upper limits
of the "stress norm", while making up 1432.6 ± 50.4
conventional units in the 1st group of children, and 1935 ,
6 ± 80.4 units, in the second group reflecting the extreme
degree of tension of the sympathetic division of the ANS
and regulatory systems of the heart rhythm, which
significantly less marked in newborns extracted under SA
conditions on the basis of EB 24 hours after birth, IN in
both studied groups significantly decreased, amounting to
731.8 ± 22.8 conv units.in the 1st group of newborns,
respectively, and in the second 796.8 ± 20.2 conventional
units, which testifies to the persistence of quite marked
distubances of the regulatory systems of the heart rhythm
and sympathoadrenal mechanisms of its regulation. The
concentration of CC in the umbilical cord blood at the 5th
minute after birth in children of the 1st group was
significantly higher (591.8 ± 35.6 nmol / L) in
comparison with the 2nd group of newborns (338.6 ±
22.4 nmol / l), which indicates a more intact and more
active physiological response of the hypothalamic-
pituitary-adrenal system to the birth process in newborns
extracted under conditions with CA based on EB. A lower
concentration of SC in the group of children extracted
JOURNAL OF HEPATO-GASTROENTEROLOGY RESEARCH | ЖУРНАЛ ГЕПАТО-ГАСТРОЭНТЕРОЛОГИЧЕСКИХ ИССЛЕДОВАНИЙ
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under GMA with AVL (group 2) indicates inhibition of
the functional state of the hypothalamic-pituitary-adrenal
system, which is a consequence of the stress response of
the mother's div to general anesthesia and drug load. In
2 hours after birth, SpO2 in newborns of the 1st group
was 92.9 ± 0.05%, and in the 2nd group - 91.2 ± 0.1%,
which characterizes a marked depression of the
respiratory function, which had to be corrected by oxygen
therapy. In 24 hours after birth, in the process of carrying
out post-syndromic intensive therapeutic measures, SpO2
in both studied groups significantly increased to 96.3 ±
0.2% and 96.4 ± 0.3%, respectively.
Conclusions
The studies which carried out made
it possible to state a less marked negative effect of YCA
with mechanical ventilation on the basis of epidural
blockade with reduced concentrations of local anesthetics
on newborns. Under the conditions based on the use of
epidural blockade, the adaptive capabilities of the
organism of newborns are preserved to a greater extent
during the period of early adaptation to extrauterine
conditions, despite the extremely unfavorable initial
background prematurity, DBC and a marked decrease in
the coronary reserves of the mother, associated with
severe stenosis of the atrioventricular opening (1.9-1.0
cm
2
). The results obtained make it possible to recommend
CA based on epidural block with the use of reduced
concentrations of local anesthetics for delivery by
cesarean section in pregnant with severe mitral stenosis.
Список литературы/References
1.
Baevsky R.M., Kirilov S.Z., Kletsky S.Z. Mathematical analysis of changes in heart rate during stress. M
.: Science; 1984. p 22.
2.
Semenikhin A.A., Baratova L.Z. Evaluation of the effectiveness of regional blockades with reduced
concentrations of local anesthetics. // Regional anesthesia and acute pain management. 2009. T IV (4). P. 21-27.
3.
Baratova L.Z. Abstract of. Cand. of med. Sciences Anesthetic management of abdominal delivery in
pregnant women with circulatory failure. Tashkent.
4.
Semenikhin A.A., Yusupbaev R.B. Ways to reduce the operational and anesthetic risk in pregnant women
with circulatory failure: scientific publication // Journal of Theoretical and Clinical Medicine. - Tashkent, 2013 .-- P.
46-48.
5.
Lebedinsky K.M., Shevkulenko D.A. Hemodynamic complications and critical incidents in central
neuraxial blockages: epidemiology and developmental mechanisms // Anesthesiology and reanimatology. - 2006. - No.
4. - P. 76-78.
6.
Ovechkin A.M. Possibilities and features of neuraxial anesthesia in patients with severe concomitant
pathology // Regional anesthesia and treatment of acute pain. 2009. Volume III, No. 3. - P. 36-47.
7.
Okorokov A.N. Diagnostics of diseases of internal organs. V. 9 "Diagnostics of diseases of the heart and
blood vessels"; - Minsk: Med. lit. 2009 .-- P. 258-305
8.
Sultanov S.N., Umirov L.R. Obstetric tactics with moderate stenosis of the atrioventricular foramen. //
News of dermatovenerology and reproductive health. - Tashkent, 2010. - No. 4 - P. 22-25.
9.
Yusupbaev RB Umerov A. On the issue of delivery of pregnant women with heart disease: scientific
publication. // Journal of Theoretical and Clinical Medicine. - Tashkent, 2012. - No. 3. - P. 100-103.
10.
. Shifman E.M., Filippovich G.V. Selected chapters from the monograph "Spinal anesthesia in obstetrics"
post-puncture headache. // Regional anesthesia and acute pain management. 2014. V. 8.No. 1. P. 31-46.
11.
Chimarov V.N., Krylov V.I. Analysis of cardiointervalogram in children. Tyumen 1988.P. 15.
12.
Chimarov V.N., Krylov V.I. Analysis of cardiointervalogram in children. Tyumen 1988.S. 15. Chernukha
E.A., Komisarova L.M., Baybarina E.N. and others. The course of the postoperative period and the period of adaptation
of newborns, depending on the type of anesthesia during cesarean section. Obstetrics and Gynecology. 2003; 3: 12-15
13.
(Kravtsova A.G., Garbuz I.F., Starosotskaya S.I. adaptive capabilities of children born by caesarean
section // International Journal of Applied and Fundamental Research. - 2014. - No. 3-2. - P. 104 -106; URL:
https://applied-research.ru/ru/article/view?Id=4860
