Korol'ov A. Intensive care and anaesthesia in patients with pulmonary embolism

The thesis is devoted to problem of the adequate diagnostic and treatment tactic for different forms of acute pulmonary embolism on the basis of angiopneumography and hemodynamic measuring beforе and during therapy, improved methods of the intensive and thrombolytic therapy and anaesthesiological management.There were studied the changes of central and pulmonary hemodynamics of 60 patients with different embolic volumes and terms. There were worked out clinical, angiopneu-mographic, hemodynamic readings for operative and conservative treatment dependent on the volume of decrease of pulmonary blood circulation. There were done the recommendations for anaesthesia during thrombembolectomy. Results of treatment of 27 patients with pulmonary embolism using various thrombolytic preparations are evaluated comparatively. Alteplase (actilyse) therapy proved to be the most safe and effective in management of patients, than streptokinaze and urokinaze therapy (the resumption of pulmonary blood circulation-90,9% a gainst 62,5%). The using of the alteplase decreases the mortality during thrombolytic treatment from 25 to 13,6%. Effectiveness of thrombolytic therapy depends up on early diagnosis and treatment. Thrombembolectomy with bypass was effective in 60%.