The scientific work presents a new solution to the current problem of modern anesthesiology and intensive care (IC) - improvement of the results of treatment of patients with acute stroke (AS) with concomitant diabetes by optimizing tactics and methods of IC. The study was conducted in three stages. At the first stage, the state of study of the problem in the world was investigated, the literature publications of recent years concerning the IC of both AS in general and patients with concomitant DM in particular were analyzed. The result of this phase of the study was the isolation of problems that have been developed and analyzed insufficiently. According to the results of this study, the goal and objectives of further research were established. The next stage was a retrospective analysis of the history of the disease of patients ho suffered AS. Retrospectively, in the archives, 416 disease histories analyzed in the intensive care unit in 2011-2014 were analyzed. The first detected complications of carbohydrate metabolism were detected in 48 patients (11.5 % of all patients with AS). In 29 patients, the diagnosis of DM was not established (and appropriate therapeutic measures were not taken), despite the available clinical and laboratory features. At the next stage, a complex clinical and neurological and laboratory examination was performed on 346 patients (171 women and 175 men) who suffered an acute ischemic stroke (AIS) with and without such a DM (main groups). To determine the effectiveness of the developed treatment algorithm, a separate group (36 patients - 15 women and 21 men) was selected, in which treatment was carried out according to the traditional approach (control group 1). The next section of the study is devoted to the study of the importance of timely diagnosis of CMD and DM in patients with AS. In particular, it was found that the prevalence of CMD in patients with AS reaches 65.6 %. The purpose of the research, the results of which are set forth in the next section, was to reveal the frequency, peculiarities of the course and to develop a scheme for correction of sleep apnea syndrome (SAS) in diabetic patients with AS. It was established that the probability of occurrence of respiratory disturbances in diabetic patients with AS in them is high (in our study - 63.3 %). Risk factors are male sex, obesity, high score for NIHSS (>15) when admitted. The peculiarities of the development of SAS in patients with AIS and concomitant DM are a rapid improvement in 1-3 days of treatment (with respiratory support) and the need for long-term therapy at subsequent stages. In these patients, positional therapy and non- invasive respiratory support may be initiated early with good tolerability and relatively low risk of complications. Water-electrolyte disorders in diabetic patients with AS is devoted. In general, electrolyte disturbances were observed in 81.2 % of diabetic patients with AS. The most common anomalies in this category of patients are hypernatremia and hyponatremia. Disturbances in the exchange of magnesium and phosphates in diabetic patients with AS are significantly more frequent than in patients without DM. In this case, the phenomenon of increased loss of these electrolytes (hypophosphatemia and hypomagnesaemia) is prevalent. The next section presents the results of the study of the emergence and treatment of acute decompensation of carbohydrate metabolism in patients with AS. It has been established that the best way of administering insulin in such patients is by intravenous injection with a syringe dispenser. When using the hypodermic route, the total daily dose of insulin increases, which leads to more frequent episodes of hypoglycemia. Hypoglycemia has been recorded more frequently in the traditional treatment group. When hypodermic insulin was administered, hypoglycaemia was more profound and prolonged (on average - up to 1.4 days) than with the use of infusomats. Lactic acidosis is rare in AS, its course is accompanied by a shallow degree of lactic acidosis and is well documented (in our case, no patient died), in cases of severe acidosis (pH of blood < 7.0), a buffered sodium bicarbonate solution was used. Next section of the study presents the results of studying the effectiveness of neuroprotector's combination. The analysis of the presented materials showed that the combination of citicoline with magnesium sulfate was reliably effective in treatment in the diabetic patients (first group). In other groups of patients (patients with prediabetes, patients without DM, but with transient hyperglycemia; patients who received the traditional treatment) significant differences in the dynamics of clinical and laboratory parameters was not found.At the end of the study, the analysis and discussion of the results, conclusions, practical recommendations, list of used literary sources and applications are presented.
