Gryzhymalskiy Y. Optimization of anesthetic management of cesarean section (clinical and immunological research)

The dissertation work is devoted to the study of influence of different methods of the anaesthetic management of the cesarean section on the indices of immune status of the parturient woman and new-born and also determination of the optimum type of anaesthetizing from position of their influence on immunity. In the article the130 pregnant, puerperal and parturient women, who had been executed the planned cesarean section and also the 80new-borns were explored. A comparative estimation of the 4 different methods of the anaesthesia cesarean section is conducted and it is proved on the basis of the clinical-statistical analysis that the optimum of all methods of comparison is epidural anaesthesia. The satisfaction of the patients with the anaesthesia was the best in a group where EA had been used (92 %) (r<0,05). The application of the general anaesthesia at the cesarean section results in development in the postoperative period of the second transient combined immunodeficient. At application of SA there is the second transient immunodeficient state with the overwhelming damage of cellular immunity, and at the use of EA an immunodeficient is not observed. There was the reliable diminishing of content of amount of lymphocytes at the use of IAGA and TVVA, Cd3+ (T-cell) and phagociytic activity of neutrophils of the new-borns (p<0,05). At the use of EA and SA the probed indices of the imunogramme of the new-borns were in normative limits. The most of origin of postoperative festering-septic complications are observed during the leadthrough of the general methods of anaesthesia. At the use of IAGA these complications arose up 14,2 % parturient women, and at the application of TVVA 14,7 % (r<0,05). At the application of EA festering-septic complications were not in the postoperative period. On the basis of findings in relation to minimum negative influence on the immune system of the parturient women and new-borns, the high satisfaction of the patients with anaesthesia, for certain less of the undesirable phenomena and postoperative festering-inflammatory complications the optimum method of the anaesthetic management of elective (planned) cesarean section it follows to count EA.