Mosentsev M. The variants of hemodynamic support for modulation of metabolic response in patients with severe sepsis and septic shock

The dissertation is a devoted to problems of a substantiation and introduction of the optimal variants of hemodynamic supportive therapies for a modulation of metabolic response in patients with severe sepsis and septic shock with use of Early Goal-directed therapy, coupled with intensive insulin therapy, and new drugs that contain the substrates with insulin-independent utilization – Glycosteril, Sorbilact and Reamberin. It has been found, that the metabolic disturbances, as a hypermetabolic syndrome and hypercatabolism were typical for septic patients and they were associated with hyperglycaemia and hemodynamic hyperfunction. When the results of the study were receive, there were find the criteria for estimation of the metabolic stress, mitochondrial dysfunction existence, and its dynamics under the influence of the therapeutic methods administration. The use of drugs with insulin-independent utilization led to hypermetabolism and hemodynamic hyperfunction limitation and hyperglycaemia removal. On the basis of pharmacokinetic analysis the mechanisms of metabolic modulation of fructose, sorbitol and succinate were established and optimal regimens for they administration were made.