The work suggests to assess the indices of the central and cerebral hemodynamics in ischemic and hemorrhagic insults, to ascertain some peculiarities of hemodynamic complex depending on the character of insult, to evaluate the dynamics of indices of the central and cerebral blood flow under the influence of neuroprotectors possessing a calcium- blockading effect (phenyhidin, diltiazem, nimodipin) in ischemic and hemorrhagic insults, to substantiate hemodynamic sensible use of the aforecited pharmpreparation, to appreciate indications to their application and their efficacy in combined treating insults. The thesis presents the results of observing 126 ischemic and hemorrhagic insult patients during a severe period, the control group including 20 helthy persons.Modern methods of diagnosis, such as computer tomography of the brain, ultrasonic extra- and transcranial Doppler sonography, tetrapolar thoracic rheography, were applied in the work. The investigations revealed ischemic insult to result in essent ial decrease of the heart blood output and an average dynamic arterial pressure increase, peripheral vascular resistance rise, these phenomena complicated with reliable ascending cerebral circulatory resistance and slowed- up cerebral arterial blood flow to unfavourably influence the blood supply in the brain. Hemorrhagic insult causes a raliable average dynamic arterial pressure increase and pumping myocardial function reduction simultaneously with enchancing cranial blood flow resistance and its velocity diminution, on the one hand these prevent intracranial pressure rise, on the other hand these promote developing hematoma accompanying cerebral tissue ischemia. In hemorrhagic insult, as contrasted to ischemic insult, circulatory resistance on the portion "general carotid artery- middle cerebral artery" is to a great extent higher, blood flow velocity is lower due to spasms and (or) angioneurotic edema in the region of hematoma, these having a protective function and simultaneously promoting cerebral ischem ia both in the perihematic area and in the distance.Phenyhidin causes no intrinsic changes in the indices of the central and cerebral hemodynamics in ischemic insult patients. In 67 per cent of intracerebral hematoma patients the preparation reduces an average dynamic pressure because of its marked negative inotropic efficacy. Under phenyhidin effect autoregulating cerebral mechanisms tend to limit the blood flow to the brain despite the character of insult.Diltiazem reliably descends an average arterial pressure regardless of character of insult. Its hypotensive effct is significantly more protracted in intracranial hematoma. The drug sufficiently ascends blood flow resistance in the precranial portion of the carotid arteries in ischemic insult patients, however, it having no marked influence on the blood flow in the cerebral vessels.Nimodipin considerably decreases an average dynamic arterial pressure in hemorrhagic insult and results in rice the carotid vessels resistance, but essentially only common carot id arteries resistance, to hematomic mass grouth, promotes preventing blood supply in an increased intracranial pressure. Nimodipin negatively influences the cerebral blood flow in ischemic insult patients. The preparation increases circulatory resistance and descends linear blood flow velocity in the cerebral arteries. Nimodipin causes no intrinsic changes in the indices of the central hemodynamics. Nimodipin in combined treatig intracerebral hematoma patients reliably promotes improving the results of treatment at the end of a severe stage as compared to the similary cured patients but without applying the aforcited preparation.Some practical recommendations were elaborated. It is safe to use diltiazem as a neuroprotective means in ischemic and hemorrhagic insults in arterial hypertension patients.Phenyhidin as a neuroprotective means needs no sufficient correction of the central and cerebral hemodynamics. However, in hemorrhagic insults it is not worth to administrer phenyhidin in cases of negative inotrop ic efficacy of the remedy.Nimodipin is worth to be prescribed to the intracerebral hematoma patients with (or without) blood discharge into the ventricls of the brain and subarachnoid space, it surving as a neuroprotective remedy and a preventive cerebral ischemia means without additional correction of the central and cerebral hemodynamics.It is not expediant for ischemic patients to take nimodipin as a neuroprotector or an anti- ischemic remedy. In cerbral infarction it is safe to use some other calcium antagonists, diltiazem or phenyhidin, namely.
