Hnativ Y. Pathophysiological, biochemical and clinical features of blood osmolarity disorders in neurosurgical patients and their correction (clinical and experimental study)

The dissertation work provides a scientific justification and presents the results of solving an urgent task: diagnosing the features of destabilization of the water-salt balance in patients with neurosurgical pathology. In the experiment, functional changes in the nervous system, biochemical disorders and morphological features of disorders of the brain, liver and kidney tissues during the modeling of hypohydration and hyperosmolar syndrome of varying severity in rats have been studied. In patients with central diabetes insipidus, a study of central hemodynamics and oxygen balance has been carried out. An experimental model of hyperosmolar hypohydration syndrome (analogous to CDI) in animals was developed; functional changes in the nervous system, biochemical disorders and morphological features of brain, liver and kidney tissue disorders developing with an increase in the osmolarity of blood plasma of varying severity against the background of hypohydration were studied. A highly informative criterion for the preventive diagnosis of water-salt metabolism disorders in neurosurgical patients was developed based on monitoring the features of the excretory and concentration renal functions; a formula for calculating the osmotically volumetric urine index is proposed.It is established that the range of OVUI in the norm is in the range of 8.0-12.0; its shift in neurosurgical patients indicates the likelihood of clinically significant disorders of water-salt metabolism. A decrease in OVUI to ˂ 1.0 indicates the development of central diabetes insipidus. The OVUI value of 7.0 against the background of polyuria indicates the likelihood of developing cerebral salt-wasting syndrome, and the OVUI of 13.0 at a normal rate of diuresis indicates a syndrome of inappropriate antidiuretic hormone secretion. Pathogenetically substantiated ways and means of preventing and correcting water-salt metabolism disorders in neurosurgical patients are optimized.